Bonus Add-on for EP494: ICER and the Pharma Pricing Arms Race, With Sarah Emond

Pharma raises list prices to maximize rebates. Higher list prices blow up patient coinsurance. Pharma responds with copay cards. PBMs fight back with maximizers and accumulators. Prior auths ramp up. Premiums rise. Deductibles climb. And at no point in this cycle does anyone stop to ask: is this drug actually worth its price? That is the pharmaceutical pricing arms race Stacey Richter lays out in this bonus episode — and it is the entire reason ICER exists.

This short companion episode to EP494 features Sarah Emond, CEO of ICER (the Institute for Clinical and Economic Review), the only financially independent nonprofit in the US conducting rigorous, public, multistakeholder value assessment of prescription drugs. If you have not heard of ICER before, start here.

WHAT YOU'LL LEARN
✅ What ICER is and how it works: comparative clinical effectiveness analysis combined with cost-effectiveness modeling to determine a fair, evidence-based price for new therapies — conducted publicly, with all stakeholders invited, free from financial conflicts of interest

✅ How the pharmaceutical arms race was built: list prices inflated to generate rebates, coinsurance tied to list rather than net price, copay cards disrupting PBM formulary strategy, maximizers and accumulators responding, and the whole system spiraling without anyone anchoring price to value

✅ Why Sarah Emond believes the arms race can be deescalated — because higher prices, more access restrictions, and more cost sharing are the result of choices the system has made, and different choices are possible

✅ Who actually pays for all of it: only three ultimate purchasers exist in US healthcare — taxpayers, self-insured employers, and patients themselves — and every dollar extracted by any intermediary comes from one of those three

WHY THIS MATTERS
The pharmaceutical pricing debate generates a lot of heat and very little light because most of the actors in the system have a financial stake in the status quo. ICER's value — as Sarah Emond describes it — is not just the math but the process: a public, multistakeholder forum where the evidence gets scrutinized and a fair price gets defined, independent of who stands to gain. Without that anchor, plan sponsors and patients are left absorbing costs that have nothing to do with how good the drug actually is.

=== LINKS ===
🔗  Show Notes with all mentioned links:  
https://cc-lnk.com/EP494-BonusClip

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06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH.

02:38 What is ICER?

02:54 What does the Institute for Clinical and Economic Review do?

05:14 The importance of still showing up, even when others don't understand or disagree.

09:12 Why it's important to think about population health and how our choices impact affordability for everyone.