OBJECTIVES: The influence of the Institute of Clinical and Economic Review (ICER) has increased over the last several years. This study sought to evaluate the current impact of ICER assessments on payer decision making and how payers are using ICER assessments in making coverage or formulary decisions.

METHODS: Double-blinded, web-based surveys were fielded through Xcenda’s research panel, the Managed Care Network, from September to October 2021.

RESULTS: A total of 50 advisors participated in the survey including representatives from health plans (n=29 [58%]), integrated delivery networks (IDNs; n=13 [26%]), and pharmacy benefit managers (PBMs; n=8 [16%]). Most respondents (74%) indicated that ICER’s findings are at least somewhat impactful in the decision-making process in their organization, and 62% indicated that ICER assessments influenced at least 20% of coverage decisions in the past year in their organization. Payers reported using ICER assessments most frequently as a supporting source for economic (62%) and clinical data (56%) when making a coverage or formulary decision. The comparative clinical evidence ratings, clinical effectiveness review, health-benefit price benchmarks and incremental cost-effectiveness ratios were rated the most impactful sections of ICER assessments during the decision-making process. About half of the respondents surveyed indicated using findings from an ICER assessment to inform pricing negotiations (52%) and to implement prior authorizations (46%) in the past year. When asked about ICER’s unsupported price increase (UPI) assessments, 40% of respondents noted they were at least somewhat influential in reinforcing or changing a decision and 36% of respondents indicated using UPI results in pricing negotiations.

CONCLUSIONS: Payers view ICER assessments as impactful in the decision-making process and are most often using them as a supporting source for economic and clinical data when making a coverage or formulary decision. ICER findings are most commonly being used for pricing negotiations and to implement prior authorizations.