Will ICER’s ‘shared savings’ approach decrease value-based prices most for the most severe diseases?

That is the title of a paper recently accepted for publication by Value in Health with co-authors Shanshan Wang, Khounish Sharma, Kathryn Spurrier, Robert J. Nordyke. The abstract is below. Objectives To identify the types of disease most likely to be impacted by the Institute for Clinical and Economic Review’s (ICER) shared savings assumptions. Methods…

Barriers to Fair Access

Last month, ICER released their 2023 “Assessment of Barriers to Fair Access” . The report concludes the following regarding 18 drugs evaluated. ICER defines “fair access” based on the following criteria: Cost sharing Cost sharing based on net price. Patient cost sharing should be based on the net price to the plan sponsor, not the…

What is HIDI?

ICER recently released a white paper titled “Advancing Health Technology Assessment Methods that Support Health Equity“. In addition to discussing a variety of methods–e.g., distributional cost-effectiveness analysis (DCEA), extended cost effectiveness analysis, multi-criteria decision analysis (MCDA)–for quantifying the value of new treatments in terms of their ability to reduce health disparities, ICER also introduces the…

Are health insurers providing fair access?

How well did payers provide “fair” access policies? Based on an recent ICER report titled “Assessment of Barriers to Fair Access“, the headline figures seem pretty good: Overall rates of concordance with ICER’s criteria were 70% for cost sharing of fairly-priced drugs, 96% for clinical eligibility criteria, 98% for step therapy, and 100% for provider…

ICER’s updated process for determining unsupported price increases (UPI)

Last month, ICER updated their protocol for identifying drugs that have unsupported price increases (UPI). Not only is ICER examining rising drug prices, but California and Vermont now have laws tracking substantial drug price increases, requiring drug manufacturers to submit information that might justify increases above a certain threshold. ICER says that the UPI reports…

How ICER will conduct it’s “Barriers to Fair Access” Assessment

Last fall, ICER published a white paper titled “Cornerstones of ‘Fair’ Drug Coverage: Appropriate Cost-Sharing and Utilization Management Policies for Pharmaceuticals.” To paraphrase, ICER’s goal is to limit access restrictions (e.g., cost sharing, coverage limitations, prescriber restrictions, step therapy) when a drug is deemed to be cost effective. How will they do this? Their Barriers…