ICER seeks comment on Value Framework Changes for Ultra-Rare Condition Treatments

The Institute for Clinical and Economic Review (ICER) has proposed adaptations to its value framework for very rare conditions. ICER is a leader in evidence-based analysis of the effectiveness of drugs and other medical treatments. ICER’s analyses, including benchmark value-based prices for new drugs, are used by a growing list of payers in developing fair prices. To address the different economics of value assessments for very rare conditions, ICER published a white paper on the research and ethics of the issue and convened an all-stakeholder meeting in May. ICER is now soliciting feedback from stakeholders on their proposal. Proposed adaptations include a broader range of cost-effectiveness thresholds, the context of difficulty in research on very rare conditions, a broader definition of other advantages such as improvements in school, family and community, and benefits to systems for screening and care of people with rare conditions. Send comments to by Monday, September 25th at 5pm ET for consideration.

New CMS tool maps health provider capacity by state, county

A new mapping and data tool from CMS allows web visitors to visualize the density of a range of health care providers relative to the number of consumers. The updated Market Saturation and Utilization Tool uses Medicare claims data and can be sorted by state or county. Policymakers can use the Tool for health services location planning and to asses how provider supply impacts utilization. Services in the Tool include ambulance, clinical lab, chiropractic, home health, hospice, long term care hospitals, skilled nursing facilities, and physical and occupational therapies. There is great variability between ERC states in all categories. For example, in ambulance services market saturation Vermont, Delaware and Rhode Island are in the bottom quartile while New York, Pennsylvania, New Jersey and Massachusetts are in the most concentrated quartile. New York is one of four states with extreme values of market saturation in most health service categories.

North American Free Trade Agreement (NAFTA) Renegotiation

On July 17, the Office of the United States Trade Representative released their report entitled ‘Summary of Objectives for the NAFTA Renegotiation’.  One of the promises made by Candidate Trump was a renegotiation of the North American Free Trade Agreement.  In a tweet from October 2016, Trump said, ‘I will renegotiate NAFTA. If I can’t make a great deal, we’re going to tear it up. We’re going to get this economy running again.’  However, in April 2017, President Trump stepped back from his plan to issue an Executive Order removing the US from NAFTA in favor of renegotiation of the trade deal.  This Summary of Objectives is a result of that decision.

Agriculture plays a large part in the Summary, with cross border agricultural trade being a large part of our import/export activity with Mexico and Canada.

To quote the Summary, ‘The new NAFTA must continue to break down barriers to American exports. This includes the elimination of unfair subsidies, market-distorting practices by state owned enterprises, and burdensome restrictions of intellectual property’.  Among these barriers mentioned were tariffs, price discrimination, regulatory incompatibility, lack of communication and technological capability, verification of country of origin of agricultural products.

Among other areas for renegotiation are: Environmental, Regulatory, Transparency, Labor, Anti-Corruption, and Trade Protection.

In response to the release of the Summary, Michael Dykes, D.V.M., president and CEO of the International Dairy Foods Association, issued the following statement in support of the report, saying “We are pleased to see efforts to address unjustified measures that unfairly limit access to markets for U.S. goods, such as price undercutting, included in the administration’s negotiating objectives. We believe these goals will allow the administration to address Canada’s new milk pricing policy, referred to as Class 7, which has allowed Canadian companies to sell their products below world market prices.

“In addition, we’re pleased to see an objective to expand competitive market opportunities for U.S. agricultural goods by reducing or eliminating tariffs. Canadian tariffs on some U.S. dairy products are nearly 300 percent.”

On the other hand, in testimony before a subcommittee of the Trade Subcommittee of the House Ways & Means Committee on the objectives of the NAFTA renegotiations, Stan Ryan, CEO of Darigold, a large farmer-owned cooperative in Washington State, urged caution.

‘NAFTA has been a driving force behind remarkable growth in dairy exports, and is the reason the United States’ share of Mexico’s dairy imports today is 73 percent.’  He noted that U.S. dairy sales to Mexico have risen to $1.2 billion last year from just $124 million in 1995.  He worried that the preferential tariffs enjoyed by the U.S. could be undermined if the benefits of NAFTA are watered down in renegotiating the dairy provisions of the agreement.

However, Ryan criticized the new Canadian dairy Class 7 system.  “It essentially matches the lowest price in the world for milk protein finished products, despite Canada having one of the world’s highest raw milk farm gate  prices, all operating under a state-controlled and state-protected system.  Common sense to economics would tell you that if it looks and feels like subsidized dumping, it probably is.”

The U.S. Trade Representative announced that seven rounds of NAFTA negotiations will begin August 16.  We will keep you informed of all developments in these talks as they progress.


ERC members attend CSG forum in DC on the future of Medicaid

A few weeks ago, seven legislative and staff members from the CSG-ERC region were in Washington DC attending a three-day CSG Medicaid 101 Policy Academy. ERC attendees represented Connecticut, Maryland, Puerto Rico and Vermont. Medicaid covers one in five residents of the ERC region and funds $140 billion in health care services. The forum included twelve expert speakers on topics from the basics of the Medicaid program to the latest news on the impact of efforts to repeal and replace the Affordable Care Act. The forum ended with updates from participants about Medicaid in their states. Slides from presenters are online.

Meet NH State Representative Steve Darrow

Let us introduce Representative Steve Darrow, Vice Chair of the New Hampshire House Committee on Environment and Agriculture, and a first time attendee to the ERC Annual Meeting. Steve is a member of the CSG-ERC Agriculture and Rural Affairs policy committee.

Rep. Darrow has been a resident of NH for forty-five years.  Rep. Darrow has a degree from Franconia College in Literature.  He has been involved in local government, being the current chair of the Pemi-Valley Republican Committee and former selectman from Grafton, NH for twelve years.   In addition, Steve was a member of the school board for his school district, and has been active with the area trail maintenance volunteer group.

Steve was treasurer as well as member of the Board of Directors of the Mascoma Valley Health Initiative. Steve explained that the area in which he lives is very rural, and, because of that, the access to healthcare is limited. The Mascoma Valley Health Initiative is a non-profit organization with the mission of making health care more accessible for local residents, and helps with everything from providing transportation to lobbying for a new local health center.

Representative Darrow is retired from UPS after 28 years, during which time he spent nine years in Sales, nine years in Operations, and finally nine years in Industrial Engineering where he helped UPS become more technologically advanced.

We asked Steve what piece of legislation made him most proud, and he mentioned three things. HR7, which was a resolution that resolved to limit campaign contributions from any entity that will not be ineligible to vote in the next election. Second, he was very proud to vote for relief for NH dairy farmers, which provided $2.1 million to help offset the devastating impacts of 2016’s drought.  And lastly, although not a bill, but Darrow is very proud to sometimes buck the system and vote against the wishes of his party. He prides himself in being able to decide for himself what is best for his constituents.

When asked what he likes most and least about being a representative, Steve responded that he really likes being a part of such an historical body and process. He likes being able to speak up for what he supports or opposes. Steve further commented that he loves the committee work. He further noted that the NH House and Senate has a lot of great people with whom he is proud to serve.  However, he went on to say that he what he disliked the most was the obstructionists in both parties, something he sees as becoming more and more prevalent over the years.

We asked what attracted Steve to the Agriculture Committee, and he said he has always had an interest in agriculture and gardening, and likes being able to promote local agriculture and to support small farms. Since the NH House Committee on Environment and Agriculture also handles solid waste, it further attracted him, since he is a licensed transfer station operator and worries about our disappearing landfill capacity.

We asked Steve what he expected from his first ERC meeting. He said he is looking forward to networking and being able to meet with other legislators, and learning from them what their states’ issues are and what they are doing about them.

Rep. Steve Darrow is just one of the members of the Agriculture and Rural Affairs Policy Committee for ERC coming to the Annual Meeting August 13 through 16 in Uncasville, Connecticut this summer.  Join them by registering at

Lowest wage workers least likely to be offered health benefits at work

Only 22% of Americas earning the lowest ten percent of wages are offered medical benefits by their employer, according to a new report by the Bureau of Labor Statistics. This compares with 93% of the top ten percent of earners who are offered medical benefits at work. Unfortunately, the lowest wage workers also pay more for their benefits and employers pay less. Workers with wages in the lowest ten percent pay almost $125 more per month for family coverage than workers with wages in the top ten percent. Not surprisingly, even the lower wage workers who are offered benefits are less likely to accept them. Only 11% of workers with wages in lowest ten percent of Americans participate in employer-sponsored coverage, compared to 72% of those in the highest ten percent of wages. Employer offers of dental and vision benefits are lower than medical benefits among all workers, but the disparity between high and low wage earners is also reflected there. Low wage workers are also less likely to be offered retirement, paid leave, paid vacation, and paid holiday benefits, according to the BLS.