OBJECTIVES: Given the rapid evolution of ICER’s VAF since 2015, this study aimed to assess trends in the uptake and impact of ICER on coverage decisions from 2016 to 2018.

METHODS: Double-blinded, web-based surveys were fielded in November 2016 and November 2018 to individuals within managed care organizations and health systems. The surveys assessed payers’ perceptions of the ICER VAF and utilization of the ICER VAF in coverage decisions.

RESULTS: 55 payers completed the survey in 2016, and 54 payers completed the survey in 2018. Over the 2-year period, payers increasingly reported that the ICER VAF had at least occasionally influenced coverage decisions (49% in 2016 vs 78% in 2018). The “most influential” components of ICER’s reports were the comparative clinical effectiveness (100% in 2016; 89% in 2018) and cost-effectiveness (56% in 2016; 63% in 2018) sections in both survey years. Payers reporting utilization of ICER’s value-based benchmark prices grew substantially from 22% in 2016 to 61% in 2018. In 2016, payers identified ICER’s cost-effectiveness (33%) and budgetary impact (31%) analyses as the most unclear components of the reports. Other benefits and contextual considerations (37%) and ICER’s voting questions (33%) were most unclear in 2018. Perceived strengths remained constant over the 2-year period, with payers reporting use of real-world evidence, transparency of methodology, and choice of clinical outcomes as top ICER VAF strengths. Perceived limitations of the ICER VAF evolved over time, with fewer payers citing timeliness of report(s) (45% in 2016; 28% in 2018) and stakeholder engagement (38% in 2016; 26% in 2018) as key limitations of the ICER VAF over the 2-year period.

CONCLUSIONS: These results suggest that the impact of ICER in informing payer coverage decisions has increased. Additionally, it appears that updates to ICER’s VAF methodology over the past 2 years have addressed some concerns previously noted by payers.