Thread by @PeterKolchinsky

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