Do Commercial Payers Rely on ICER Assessments During Specialty Drug Coverage Deliberations?
February 28, 2023
The Institute for Clinical and Economic Review (ICER) releases value assessment reports that determine cost-effectiveness ratios (CERs) for new and existing therapeutics. A newly published study in the Journal of Managed Care + Specialty Pharmacy, examines whether and how commercial insurance plans in the US incorporate these reports into their reimbursement decision-making process.
According to the authors, “We found that when controlling for other factors, health plans’ specialty drug coverage decisions were associated with ICER’s estimated CERs. Plans infrequently cited ICER value assessments. We did not observe a trend for plans more often narrowing coverage criteria for drugs with CERs $175,000 or more compared with drugs with CERs less than $175,000.”
To read more, click here.
(Source: Journal of Managed Care + Specialty Pharmacy¸ February 28th, 2023)
