Impact of ICER Assessments on Payer Decision Making in the United States

Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023

Beyond Value Assessment: Payer Perceptions of ICER's Policy Initiatives

Objectives: To assess how the Institute for Clinical and Economic Review (ICER) has evolved its policy scope beyond value assessments in the last 7 years and explore payer perceptions of ICER's new policy initiatives. Method(s): Completed ICER assessments and policy papers published from 2016-2022 were counted to quantify ICER's activities and output. Double-blinded, web-based surveys of US healthcare payers were fielded through Xcenda's research panel, the Managed Care Network, in October 2020 (N=47) and June 2022 (N=51) to explore perceptions of ICER initiatives, including policy papers, Unsupported Price Increase (UPI) reports, and ICER Analytics. Result(s): ICER has published 65 value assessments and 17 policy papers since 2016. ICER's output of policy papers has increased in recent years (mean of 1.3 publications annually, 2016-2018 vs 3.7 annually, 2020-2022), whereas the number of value assessments has remained flat (mean of 9.3 assessments annually, 2016-2018 and 2020-2022). Payers perceive ICER's policy initiatives to be of varying degrees of usefulness. In 2020, the subset of payers reporting familiarity with ICER initiatives found the policy paper on valuing cures to be the most useful initiative (42% reporting extremely or very useful [n=38 reporting familiarity]), followed by the UPI report (40% [n=40]);the policy paper on COVID-19 pricing models was viewed as least useful (22% [n=37]). In 2022, the most useful initiatives among payers reporting familiarity were ICER Analytics (51% [n=49]) and the policy paper on orphan drugs (45% [n=47]);the policy paper on fair access was perceived as least useful (29% [n=44]). Conclusion(s): ICER's output of annual policy papers has increased over time, demonstrating ICER's growing investment in policy initiatives. Payer perceptions of the usefulness of ICER initiatives vary, with ICER Analytics being the most useful in 2022. Additional research is needed to better understand how payers use ICER's policy papers/initiatives to inform decision making.Copyright © 2023