Unbiased Analysis of Today's Healthcare Issues
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…
On September 25, ICER released its 2023 value assessment framework. What is new? What stays the same? Here are a few key points you need to know. Special cases for ultra-rare and single or short-term therapies (SST): These did not change from previous. Adaptations for ultra-rare disease (from Jan 2020) Single or short-term therapies (from…
This week ICER released a number of potential changes to their value framework. A summary of these are listed in the table below.
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…
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…
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…
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…
This is the question I–along with co-authors Syvart Dennen, Priti Pednekar , Kelly Birch, Menaka Bhor, Julie Kanter , and Peter Neumann–aim to answer in our new paper in JMCP. The full title is: “For which diseases do broader value elements matter most? An evaluation across 20 ICER evidence reports“. The abstract is below. BACKGROUND: U.S.…
Check out my interview on the Redeeming Value podcast with Brian Reid. PRECISIONheor Vice President Jason Shafrin pops in to talk about the Institute of Clinical and Economic Review and the broader question of where the group’s influence is centered and the elements of ICER reports that stakeholders are paying attention to. Do listen to…
The Academy of Managed Care Pharmacy (AMCP) held an interesting webinar titled “5 Years of ICER – Insights and Impact on Payers“. Some highlights form the presentation. Most relevant information Jeremy Lee from MedImpact–a pharmacy benefits manager (PBM)–noted that their Pharmacy and Therapeutics (P&T) committee used four key pieces of evidence when making coverage and…