Share Your Story

We want to hear your story.

Your lived experience helps inform ICER’s report on the overall benefit that a new drug brings to its patients. It’s important to us that we know what matters to you—the patient—to make sure our reports can support policies and guidelines that help make sure patients can access, and afford, the most effective treatments.

Please keep the following in mind:

  • ICER does not publicly post responses to this form but will describe the input we receive anonymously in our reports.
  • This form should take about 10 minutes to complete and is intended for individual patients, individuals with a lived experience, and caregivers. Patient advocacy organizations should contact ICER’s Patient Engagement Team to learn how they can participate in this assessment.
  • Feel free to answer any question that applies to you and to skip the ones that don’t.

ICER uses your feedback to guide sections of our report about the patient experience and aspects of the treatment or disease that may not be described in available clinical evidence.

You acknowledge that you are not required to provide information to ICER and that you are doing so voluntarily.  Please see our Terms of Use and Conditions and our Privacy Policy to review how we use and disclose information submitted to us.  While we do not plan to publish information that identifies a particular individual, we intend to use the information submitted as part of our drug reviews.  We recognize that submissions sometimes contain specific medical information that might raise concerns about appropriateness of treatment, physical or mental health, and safety.  The use of this site, and information submitted to ICER, should not take the place of professional medical care.  ICER does not diagnose health problems or provide treatment advice.  The completion of this form does not trigger any patient-provider relationship.  Any information found on this site, or inferred from this form, should in no way be considered medical advice or a plan for health management.  Anyone seeking or needing immediate medical treatment is advised to contact their health care provider or visit an emergency room.