OBJECTIVES: This study aimed to evaluate payer perceptions and utilization of the Institute for Clinical and Economic Review (ICER) Value Assessment Framework in coverage decisions. METHODS:  A double-blinded, web-based survey was disseminated to payers within managed care organizations, health systems, and academic institutions in November 2016. The survey assessed payers’ experience and involvement with the ICER Framework, their perceived strengths and limitations of the Framework, and the level of influence the Framework had in recent coverage decisions. RESULTS:  55 payers representing 47 organizations completed the survey. All respondents were active members of a pharmacy & therapeutics committee. The majority of payers (67%) were familiar with the ICER Framework methodology and 36% reported reviewing one or more ICER evaluations within the preceding 12 months. Few participants (11%) reported that their organization actively engaged in a prior ICER review (eg, providing public comments, meeting attendance). 51% of respondents said that ICER’s recommendations had not influenced decisions, 44% noted occasional influence on decisions, and 5% said the recommendations often influenced decisions within their organization. As a whole, respondents indicated that use of real-world evidence (60%), transparency of methodology (53%), and choice of clinical outcomes (44%) were strengths of the Framework. Limitations noted by payers included: timing of evidence reporting vis-a-vis decision making needs (45%), lack of stakeholder engagement (38%), and use of fixed thresholds for cost per quality-adjusted life year and budget impact (35%). Regardless of current application, the majority of respondents (96%) agreed the Framework has potential to be more influential in future decision-making. CONCLUSIONS:  While many payers are familiar with the ICER Framework and recognize its potential impact, its actual application in the decision-making process has been limited. Findings from this survey indicate that utilization for decision-making may be increasing, though additional studies will be needed to confirm anticipated trends.