A Changing of the Guard at ICER

We’re in that weird pre-holiday period, where the sensible people have already checked out for the long weekend, and the less-sensible people are furiously trying to clear the decks. As a result, there’s a bit of a lull.

I expect a flurry of activity from the procrastinators over the next little bit, but -- for now -- I’m going to take the opportunity to take a breath. This is a short one.

Along similar lines: the Curve is off Monday and Tuesday for Independence Day.

Steve Pearson is leaving ICER, the organization that he founded in 2006. That’s big news, because ICER has carved out a fascinating niche in the U.S. health care system. Steve basically created, from scratch, an unofficial U.S. HTA.

And regardless of whether you like ICER’s approach or methods, that’s one heck of a feat, made all the more impressive by the fact that no one else has been able to do anything of similar scale. Standing up an HTA, official or otherwise, is tough, and ICER’s success is a testament to Steve’s tenacity and vision.

The change in leadership -- Steve will be succeeded by Sarah Emond, who has been with ICER since 2009 -- raises two worthwhile questions.

1. What’s next for ICER? Emond’s answer, to Endpoints, emphasized business as usual. Emond is sharp, well-spoken, and she understands the organization deeply, so it’s hard not to take her at her word. It’s hard to imagine ICER re-inventing itself. I continue to think this STAT op-ed from last year remains the philsophical blueprint for where ICER wants to play, which is to say: the launch price watchdog.

2. What’s next for Steve? This might be the more interesting question. He’s 63, and he’s planning to hand over the CEO title at the end of the year and then spend 2024 as an advisor to the group. So this could be a gentle slide into retirement. But being a health policy wonk is kind of like being a Supreme Court justice: it’s a lifetime appointment. So I’ll be curious to see where Steve pops up over the next couple of years. As you may have heard, the government is thinking hard about how to value medicines …

• The fact that President Donald Trump is going on and on about international reference pricing is fascinating for a couple of reasons. The first -- highlighted by STAT -- is the absurdity of claiming to be the “only President in modern times who ever took on Big Pharma” at the same time that “Big Pharma” is suing President Biden for taking them on. The second is the fact that international reference pricing is still a thing. It just seems un-American to use another system’s values to price our drugs, but maybe that’s just me, being in a Fourth of July state of mind.

• As it turns out, threatening hospitals with big fines for not being transparent has made hospitals a lot more transparent. A JAMA Network Open study found that nearly 88% of all hospitals were in compliance with pricing-transparency rules in 2022, up from 70% in 2021. And while hospital transparency is a good thing, philosophically, it’s this kind of data that has been used as the basis for a lot of good research showing hospital markups and the like, so seeing broader compliance is a big win.

• ProPublica wrote a 3,000-word story about why claims denial data doesn’t actually exist. You don’t need to read the whole piece to get the 12-word upshot: “insurance companies don’t have to disclose denial data, so there isn’t any.” But if you’re curious about the why, ProPublica gives you another 2,988 words of exposition.