Arthritis Foundation Proclaims a Patient Advocacy “Win” Through Its Work with the Institute for Clinical and Economic Review (ICER)

The Arthritis Foundation helped influence ICER by including rheumatoid arthritis patients and their experiences with disease-modifying drugs and managing their disease

ATLANTA, April 10, 2017 – The health care landscape is changing by the minute and the Institute for Clinical and Economic Review (ICER), an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services, has become a major part of that landscape. ICER most recently assessed the clinical effectiveness and value of targeted immune modulators for the treatment of moderately-to-severely active rheumatoid arthritis (RA). Understanding how the report could greatly impact patients with arthritis, such as changing the cost or accessibility to these drugs, the Arthritis Foundation worked with ICER to consider the unique and varying cases of people with RA by reviewing their work, engaging in meetings, submitting written comments, providing patient experience data and engaging patients.

On April 7, 2017, ICER released the final report finding drug prices high but citing inadequate evidence to distinguish clinical benefit between the RA treatments. The organization also provided recommendations to the health care industry to ensure continuity and increased access to care for patients with RA.

“Diseases like RA aren’t ‘one size fits all’ and it takes more than just data to understand individual patients, their caregivers and providers as well as the risks associated with altering treatments for these patients,” said Anna Hyde, senior director of advocacy and access, Arthritis Foundation. “The Arthritis Foundation strongly encouraged ICER to listen to and engage with RA patients to learn how cases are individual and vary from person to person – and we are so grateful that they were open to including patients as part of their review process and final report.”

Part of our work with ICER included being part of the public meeting with ICER on March 24 (two weeks before the final report) and asserting the patient voice by presenting data from three patient surveys, providing information on biologic therapies and utilization management statistics, giving the floor to three patients and participating in a round table.

“I’m lucky. I’m on a biologic that works for me – that allows me to run Spartan races and live my life. I’m leaving this meeting [ICER March 24 meeting] to go get my infusion,” said Anna Legassie, RA patient and Arthritis Foundation Advocate. “I found out that my insurer doesn’t actually cover my medication on the formulary, but I haven’t been denied treatment, yet. I live in fear each time I go to get my infusion that it will be the time when they tell me I’ve been denied. Access to my biologic allows me to work and contribute to society economically at the same level or above many healthy people.”

Based on the report, ICER recommended the following to support patients with RA:

  • Streamlining and reducing prior authorization and step therapy requirements, including allowing patients who are stable on an effective treatment to remain on therapy if their insurer changes;
  • Improving rebate negotiations and shared savings for patients, including increasing transparency in discounting and rebate practices; and
  • Improving the utilization management process and developing a quick and transparent exception process for specific situations.

Together with Arthritis Foundation Advocates, the Foundation will continue to engage with ICER, among other influencers, to ensure people with arthritis are represented in our system’s health care system. To learn more visit http://blog.arthritis.org/advocacy/arthritis-patient-engagement-institute-clinical-economic-review/.

About the Arthritis Foundation:
The Arthritis Foundation is the Champion of Yes. Leading the fight for the arthritis community, the Foundation helps conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. The Arthritis Foundation’s goal is to chart a winning course, guiding families in developing personalized plans for living a full life – and making each day another stride towards a cure. The Foundation also publishes Arthritis Today, the award-winning magazine that reaches 4 million readers per issue.

Media Contact:
Claire Villines

(404) 965-7558

cvillines@arthritis.org