Broadening the Scope of Value: Evaluating Payer Perspectives and Insights on ICER's Latest Initiatives and Tools
Author(s)
Nicole Szydlowski, PharmD, Benjamin Penley, PharmD, MS, Tasmina Hydery, PharmD, MBA, BCGP, Jane Y. Ha, MS, PharmD;
Cencora, Inc., Conshohocken, PA, USA
Cencora, Inc., Conshohocken, PA, USA
OBJECTIVES: The Institute for Clinical and Economic Review (ICER) conducts value assessments and other initiatives such as Unsupported Price Increase (UPI) reports and Barriers to Fair Access reports. Our objective was to assess payers’ perspectives of these ancillary initiatives.
METHODS: A double-blinded, web-based survey of US healthcare payers was conducted through Cencora’s Managed Care Network research panel in June and July 2024.
RESULTS: A total of 51 advisors from health plans (n=26), pharmacy benefit managers (n=13), and integrated delivery networks (n=12) participated in the survey. The proportion of respondents who found ICER initiatives to be at least somewhat useful was 92% for ICER Analytics, 86% for a white paper entitled Managing the Challenges of Paying for Gene Therapies, 70% for UPI reports, 63% for Barriers to Fair Access reports, and 62% for a Special Assessment to Inform CMS Drug Price Negotiation: Eliquis and Xarelto. Of payers familiar with UPI reports (n=43), 74% found them to be at least somewhat influential on their organization’s coverage and formulary decisions. Of payers who found UPI reports applicable to decision making (n=39), 44% used UPI results in pricing negotiations, 41% implemented prior authorization criteria, and 38% moved drugs to a higher tier. Of payers familiar with Barriers to Fair Access reports (n=48), 57% found them to be at least somewhat influential on their organization’s coverage and formulary decisions. Of payers who found Barriers to Fair Access reports applicable to decision making (n=41), 41% used findings in utilization management criteria review but did not make changes and 32% did not perform any actions in response to these reports.
CONCLUSIONS: Payers are reviewing and utilizing ICER’s reports and tools outside of value frameworks to guide decision making. Given the potential implications on patient access, biopharma companies and stakeholders should stay abreast of ICER’s ancillary initiatives to understand their continued impact.
METHODS: A double-blinded, web-based survey of US healthcare payers was conducted through Cencora’s Managed Care Network research panel in June and July 2024.
RESULTS: A total of 51 advisors from health plans (n=26), pharmacy benefit managers (n=13), and integrated delivery networks (n=12) participated in the survey. The proportion of respondents who found ICER initiatives to be at least somewhat useful was 92% for ICER Analytics, 86% for a white paper entitled Managing the Challenges of Paying for Gene Therapies, 70% for UPI reports, 63% for Barriers to Fair Access reports, and 62% for a Special Assessment to Inform CMS Drug Price Negotiation: Eliquis and Xarelto. Of payers familiar with UPI reports (n=43), 74% found them to be at least somewhat influential on their organization’s coverage and formulary decisions. Of payers who found UPI reports applicable to decision making (n=39), 44% used UPI results in pricing negotiations, 41% implemented prior authorization criteria, and 38% moved drugs to a higher tier. Of payers familiar with Barriers to Fair Access reports (n=48), 57% found them to be at least somewhat influential on their organization’s coverage and formulary decisions. Of payers who found Barriers to Fair Access reports applicable to decision making (n=41), 41% used findings in utilization management criteria review but did not make changes and 32% did not perform any actions in response to these reports.
CONCLUSIONS: Payers are reviewing and utilizing ICER’s reports and tools outside of value frameworks to guide decision making. Given the potential implications on patient access, biopharma companies and stakeholders should stay abreast of ICER’s ancillary initiatives to understand their continued impact.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA51
Topic
Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas