Presentation (CTI)

OBJECTIVES: To evaluate payer perspectives on the usefulness and extent to which Institute for Clinical and Economic Review (ICER) Evidence Reports inform coverage and formulary decisions.
METHODS: A double-blinded, web-based survey of United States healthcare payers was conducted through Cencora’s Managed Care Network research panel in June and July 2024.
RESULTS: A total of 51 payers representing national and regional health plans (n=26), pharmacy benefit managers (n=13), and integrated delivery networks (n=12) participated in the survey. Approximately 75% of payers (n=38) reported utilizing ICER Evidence Reports to inform coverage and formulary decisions. Of these payers, the top-ranked uses were for background and context to support decision-making (74%) and as supporting sources for economic (68%) and clinical data (48%). The most common areas these payers utilized ICER Evidence Reports were for high-cost drug or disease states (84%), rare/orphan disease states (82%), and cell and gene therapies (63%). Payers (n=51) had mixed perceptions on the influence of ICER Evidence Reports where 37% reported they support broad access to an assessed product, 35% reported they restrict coverage or formulary decisions, and 41% reported they were not a driving factor in coverage or formulary decisions. In the past 24 months, the reports on sickle cell disease (31%) and multiple sclerosis (27%) were the most influential in supporting broad access to an assessed product, while the reports on Alzheimer’s disease (37%) and paroxysmal nocturnal hemoglobinuria (29%) were the most influential in restricting coverage of an assessed product.
CONCLUSIONS: The majority of payers utilize ICER Evidence Reports primarily for background and context or as a supportive source to inform coverage and formulary decisions. The reports were a driving factor in payer decision-making, associated with both expansion and restriction in coverage policies.