The 2017 assessment was the ICER’s first foray into rheumatology. The ACR provided written comments during public comment periods and attended and commented during a ICER panel meeting.
Since then, however, the ACR has slowly increased its participation with ICER. In 2019, during the ICR assessment of JAK inhibitors, the ACR established a relationship with ICER early in the process and was able to provide input throughout the drafting of the assessment. The ACR also was allowed a seat at the table when ICER presented its draft assessment at its policy roundtable meeting, where a panel of health economists and physicians voted on various cost-effectiveness questions. ACR representatives (Dr. Phillips and Doug White, MD, ACR treasurer) provided further input at subsequent ICER policy roundtables, along with representatives from some patient groups and pharmaceutical companies.
Saying these discussions focus on fair drug coverage, Dr. White commented on how remarkable the discussions are for their deep dives into the issue at hand. “Participants who have a highly specialized understanding of the workings of the U.S. drug market and who represent organizations with conflicting interests share insights and hear each other in a way that I’ve not witnessed before,” he says. “I don’t know if it will be enough to break the log jam, but I do think these types of conversations are an essential component to any rational policy changes in the future.”
Evolving Relationship
Amanda Grimm Wiegrefe, the ACR’s director of regulatory affairs, emphasizes the ACR has slowly increased participation with ICER over the past few years and aims for further involvement. “We know that healthcare costs will continue to be a focus of policymakers and public and private payers,” she says. “The ACR must increase our level of participation in ICER’s analysis, [and] I hope we will have the opportunity to expand our presence with the staff and begin communications at the inception of a project before the scoping document is drafted.”
Early participation in the process is essential to ensure the perspectives of rheumatologists and rheumatology health professionals are adequately represented throughout the entire process, explains Rachel Myslinski, the ACR’s vice president of practice, advocacy & quality.
Ms. Myslinski notes the ACR doesn’t always agree with everything in the final ICER assessments and the methodology used is not able to fully account for all the issues clinicians face in real-world medical practice. However, she emphasizes that ICER is fulfilling its mission and focus to develop cost effectiveness assessments. The ACR’s role, she says, is to actively participate by providing input on the implications of these assessments on practices and practitioners.
