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Another Voice: Patients have a right to the treatments ordered by doctors

By Seth Ginsberg

For too long, insurance-backed groups have been given enormous power to overrule doctors’ orders and make health care decisions that are not in the best interest of patients.

One of the insurance industry’s most vocal surrogates has just provided another example of why lawmakers must use the debate over Obamacare to reduce the power of special interests that are overriding decisions in the doctor’s office.

The Institute for Clinical and Economic Review (ICER) is best known for promoting a drug valuation framework that insurance companies use to decide “price benchmark.”
Earlier this month ICER released a framework of how it will calculate the value of a new set of drugs to treat osteoporosis.

This new class of drugs is designed to build new bone, as opposed to other medications that only slow bone degeneration. Yet while these medications work differently, have different results and are taken for different periods of time, ICER is comparing them to each other to determine their valuation.
The end result will be that access to this new class of transformative drugs is likely to be highly restricted by insurers.

In truth, ICER’s evaluations are designed to provide insurance companies with political cover when they deny patients’ access to treatments they need.

When patients seek medications that insurers deem to be too costly, insurers are able to point to the evaluations.

ICER’s insurer advocacy has its origins in a $430,000 startup grant from a foundation belonging to mega-insurer Blue Shield of California. ICER’s board has historically been comprised of members with deep ties to the health insurance industry.

While ICER spins a great web of rhetoric centered on patient health, its true focus is to promote health care rationing.

ICER’s efforts contradict patients’ rights to receive the specific care recommended to them by their doctors.  Doctors are trained to prescribe and perform treatment, while drug manufacturers spend decades developing life-changing medications.

Patients pay for insurers’ services under the expectation that they will heed the order of doctors who have taken an oath to protect the lives of their patients.

Insurers take no such oath – including those that lead ICER. It follows naturally that ICER’s value framework is going to promote cheaper medications ahead of patients.

Medical decisions must be made based on the interests of the patient. Our legislators must follow suit to promote patient outcomes and eliminate insurers’ ability to prevent patients from receiving the care prescribed by their doctors.

Seth Ginsberg is a co-founder of Creaky Joints and the Global Health Living Foundation. He is based in New York.

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