The Institute for Clinical and Economic Review (ICER) will begin considering barriers to drug access in an effort to promote both fair pricing and also fair access. ICER has published a whitepaper on the necessary components needed for fair access to drugs and more recently a protocol detailing how it will carry out its initial payer assessment regarding drug coverage policies. Its first report detailing its findings will be released on October 2021.
“In the first iteration of this annual assessment, ICER will evaluate the coverage policies of 15 of the largest commercial payers in the US. For each formulary, ICER will examine tiering, step therapy requirements, and elements of the prior authorization criteria for 28 specific drugs — all of which ICER previously found to be priced fairly at a cost-effective level — to determine if coverage policies are in concordance with criteria for fair patient access. For years, we’ve heard anecdotes that payers have broadened access to treatments that ICER determined to be cost-effective. Let’s put that to the test, and see how consistently payers truly are reciprocating fair pricing with fair access.” Read more here.
(Source: ICER, 5/25/21)