donate now The Fatty Liver Foundation

The ICER man cometh, do you know how insurance denies you drugs?

New drugs are coming for liver disease, but will we be able to get them approved by insurance?

In a few weeks the FDA will have its public comment meeting for obetacholic acid for treatment of NASH. This is in response to an application by Intercept for approval.  If FDA gives it a go ahead, the issue of the cost of the drug will be the next big thing. 

Remember this, the insurance company is not actually in business for your health. They don't get bonuses because you were cured. Their job is to not spend all of the premium money so they carefully manage what they are willing to pay for.

You might ask what tools do insurers use to deny claims?  There are many strategies, but one of the tools that a majority admit using is called ICER. This is a group that has a very sophisticated modeling system and they try to determine the cost/benefit of a new drug. In simple terms, they are putting a value on a year of life that might be extended by using the drug and they calculate how much a month someone should be willing to pay for that drug.

As you might expect, drug companies often think their drug is worth more than that and they often pay no attention to the ICER report. That isn't true with insurance companies as the report gives them someone else to blame for telling you that they won't cover this new medicine.

The ICER public meeting to discuss pricing for the potential new drugs for NAFLD/NASH is coming up Friday the 28th.  If you would like to attend virtually here is a link to register.

They have allowed for a brief segment for a few patients to provide public comments. It is limited to 5 minutes each so not a lot.  I have registered to speak on behalf of our foundation. They only allow a few so I hope to be one of the speakers.  If you are interested in attending, sign up at the link above, it is free.

If you would like to read the ICER draft report here is a link to that

ICER Revised Reference Report (April 13)

Also, just as a reminder, if you haven't taken the 2023 State of NAFLD/NASH Care in America Survey yet, below is a link to that also.  It is available in English or Spanish.  With drugs coming soon, information about what the real patient community thinks is important. At the ICER and FDA meetings I'll be speaking on behalf of the patient community and our surveys represent enough patients that it matters. Do your part and take 20 minutes to help us along.

2023 Care Survey English

2023 Care Survey Spanish


Click for our online community