Peter Kolchinsky Profile picture
Sep 29, 2020 9 tweets 5 min read Read on X
It seems @icer_review’s heart is showing a little in today’s report on essential compassion & fairness of proper insurance w/ low OOP costs for medicines. But they still have a lingering attachment to math that’s been rightly criticized as racist... icer-review.org/wp-content/upl… 1/
...by patient advocate @SuePeschin in this short, incisive piece. morningconsult.com/opinions/cost-… I wonder if it’s a bit uncomfortable for policymakers ICER claims to have influenced w/ its math. After all, #badmathkills 2/
.@icer_review says if medicines for kids w/ sickle cell disease don’t make the cut according to their math (which @SuePeschin has pointed out is deeply flawed), insurance should make those meds unaffordable to them (w/ high OOP costs) as leverage over drug companies. Harsh.
3/
So why? B/c @icer_review thinks cutting novel but high-priced drugs is best way to lower premiums for everyone, blaming such drugs (<10% of HC costs) for why many patients can’t afford insurance. How about first eliminating $800b of waste (10 administrators for every doctor). 4/
.@icer_review doesn’t care that today’s high-priced drugs are tomorrow’s inexpensive generics and that, for all those high costs, the drug industry’s overall profit margins are ~10%, leaving little room for price cuts. ICER pushes into bone, into R&D itself. 5/
Can we hope that as @icer_review’s heart thaws, scope of its thinking might broaden? Will it open its math up to include variables it’s been leaving out (eg drugs go generic, hospitals don’t!)? If it did, that would flip many previously “overpriced” drugs to be worth it. 6/
Until then, politicians might want to pay close attention. Some may be implicated in #badmathkills as patients continue to beseech @icer_review to stop rounding down the value of their lives (making it harder to continue funding R&D into better treatments for those disease). 7/
Better still, let’s echo @SuePeschin’s call: “Congress should pass a universal ban on using QALYs for coverage and reimbursement decision-making.” @SpeakerPelosi @ChuckGrassley 8/
.@LauraArnoldFdn please pass along to John. You guys are virtuous on democracy & mass incarceration but have remained rather... lean... on healthcare reform debate. Engage please. Don’t “block” out the feedback. 9/9

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More from @PeterKolchinsky

Mar 14, 2023
So let's get this right... @statnews elevates someone who would talk the US (as they have other countries) out of paying for a life-saving drug like Trikafta instead of recognizing the courage and intellect of someone like Gunnar Esiason @G17Esiason...
...who has #CF, considers himself fortunate to be able to get Trikafta in US thanks to insurance that hasn't yet totally succumbed to bad math, & advocates for the value of the lives of patients elsewhere, urging other countries not to fall for bad math.
realclearhealth.com/articles/2022/…
Should the staff at STAT recognize that they, like all of us, are or will someday be patients, they might not honor math that undervalues their lives and lives of their readers.
Read 4 tweets
Mar 12, 2023
Some say "urging calm" makes people panic more; stay quiet. I disagree.

The source of panic is uncertainty. People are afraid to talk about risks of a run on their bank in case they give everyone ideas. But everyone already is wondering about their bank. So let's talk.
SVB's failure is not some punishment for tech elite who can handle losing their money... because it's not about the elite and b/c depositors almost certainly won't be losing their money.
Though banks fail all the time affecting individuals and small businesses every year, they tend to be small regional banks. SVB is the largest since WaMu in 2008, and some of the most innovative companies in the US are simultaneously affected b/c that was SVB's specialty.
Read 24 tweets
Feb 24, 2023
One year since Russia attacked Ukraine, don’t take a moment of silence. Give real thought to year 2.

See how aid works in detail by reading @directrelief‘s report. See where money & medicines come from & where they go and how. Let that guide what you do directrelief.org/2023/02/ukrain…twitter.com/i/web/status/1…
Direct Relief is THE MAIN non-profit in the world capable of taking in, storing, and distributing donated medicines & other medical supplies to regions in need during peacetime, war, & catastrophe.
A year ago, some of us in biotech gave to DR to buy generators for hospitals. Several months ago, we donated to enable purchase of ambulances. All the while, @tevapharmeurope, @PerrigoCompany, @novartis, @pfizer, & many others have been donating literally tons of medicines.
Read 9 tweets
Feb 18, 2023
How much do you think ICER math (which Democratic Party often cites) would say US should spend on drugs/vaccines against smallpox in case of outbreak/pandemic?

(I estimate it spends ~$100m/year)

@statnews @SenateHELP @icer_review @IAmBiotech @PhRMA @SchaefferCenter @NPLB_org
Hint: ICER takes a very simplified approach to valuing a medicine that requires that someone be sick so they can be treated and get a measurable benefit in the present to score any value. If no one is sick, there is no benefit (no effectiveness).
So what happens when you divide even $1 by zero? That’s right. The equation breaks. Most people would say “but we are paying for those smallpox medicines/vaccines in case of an outbreak or pandemic”. That’s called risk reduction. It reflects that we value peace of mind.
Read 26 tweets
Feb 17, 2023
M&A is a necessary process of resorting products, cash, & people to where they are most highly valued. Whether the moment feels like sex or autophagy, it's disruptive to people who may wonder what their next job will be. We can help with that.
racap.com/the-right-job#…
There are tons of great jobs across our ecosystem. Many are at companies in the RA portfolio. When a company is going through M&A, at invitation of CEO & HR team, we presented to their team a Talent Briefing of many of the relevant jobs in the RA ecosystem.
And even Talent Briefings aside, if you are interested in learning more about those positions across our portfolio at anytime, here's the spot: open-positions.racap.com/?company=portf…
Read 4 tweets
Jan 13, 2023
Tension among insurance, innovator, & patients w/CF over access to life saving medicine is gutting. B/c Vertex was providing copay assistance, insurance plans stopped covering its drug. So Vertex cut back. Other innovators & their investors watching: what will patients do?
Here's how insurance and innovation are supposed to work together. Can't have most biomedical innovation w/ insurance, and insurance wouldn't be as valuable w/o treatments/cures to pay for. They are intertwined.
Insurance can ignore that value of medicine like Trikafta is much greater than seemingly high price society pays now. In the long run, this medicine will be generic and still saving lives. Vertex has transformed how humanity will think of CF forever. nopatientleftbehind.org/about/value-of…
Read 11 tweets

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