BACKGROUND: The influence of the Institute for Clinical and Economic Review (ICER) value assessment framework (VAF) on payer decisions has been increasing in recent years. There is limited evidence assessing how ICER’s VAF updates have influenced payer perceptions of ICER reports over time.

OBJECTIVES: To assess trends in payer perceptions of ICER’s evaluations over the last 4 years.

METHODS: Double-blinded web-based surveys were fielded in November 2016, November 2018, and October 2020 to individuals from integrated health delivery systems, pharmacy benefits managers, managed care organizations, and specialty pharmacies.

RESULTS: There were 55, 54, and 47 payers who completed the surveys in 2016, 2018, and 2020, respectively. Respondents identified clinical outcomes relevant to decision making (62%), validity of the framework (57%), and clear and transparent methodology (53%) as the top strengths of ICER reports in 2020. In prior years, a transparent methodology (53% in 2016 and 56% in 2018) was considered a top strength. Limitations were somewhat consistent with prior years, including not having results at the time of decision making (30% in 2020 vs 28% in 2018 and 45% in 2016). Respondents identified comparative clinical effectiveness (79%) and health-benefit price benchmarks (57%) as the most influential components of ICER reports in 2020, which was consistent with prior years, especially for comparative clinical effectiveness (100% in 2016 and 89% in 2018). The most unclear component of ICER reports has steadily been the other benefits and contextual considerations section (30% in 2020 vs 37% in 2018 and 27% in 2016).

CONCLUSIONS: While payer perceptions of ICER’s evaluations have evolved, methodology transparency has consistently been reported as a top strength over time, and timeliness of ICER reports continues to be a primary limitation.