OBJECTIVES: The Institute for Clinical and Economic Review (ICER) has emerged as a visible force in US health care. However, despite its rise in prominence, ICER’s influence on health plan decision-making is unclear. Our objective was to determine the frequency that US commercial health plans cite ICER value assessments in their specialty drug coverage policies, and whether citation frequency has increased over time.

METHODS: We used the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) Database, which includes specialty drug coverage policies issued by 17 large US commercial health plans. We identified coverage policies for drugs for which ICER had previously published a value assessment. We determined how often plans cited ICER’s value assessments in pertinent coverage policies that were in force in the month of August in four consecutive years (2017-2020).

RESULTS: Health plans cited an ICER value assessment in 0.48% (3/622) of 2017 coverage policies for drugs for which ICER had previously published a value assessment, 0.36% (3/833) of 2018 policies, 1.32% (15/1139) of 2019 policies, and 1.70% (26/1529) of 2020 policies. The number of plans that cited an ICER value assessment in at least one of their coverage policies increased from three in 2017 to 11 in 2020. In 2020, eight ICER value assessments were cited by multiple plans, three assessments by a single plan, and 25 assessments by no plans. ICER’s assessment of Duchenne muscular dystrophy therapies was the value assessment cited most frequently by health plans (cited by five plans).

CONCLUSION: Health plans infrequently cite ICER value assessments in their coverage policies, although citation frequency has increased over time. The included health plans cited ICER value assessments with different frequencies. Some ICER value assessments were cited by more health plans than others.