ICER’s First Scorecard Finds Lack of Transparency of Drug Coverage Policies

December 8, 2021

The Institute for Clinical and Economic Review (ICER) reviewed barriers to fair access to fairly priced drugs, but found difficulties because many payers did not provide policy information. Using the proprietary MMIT Network formulary database, ICER looked at the 15 largest US formularies and identified 28 medicines they deemed to be fairly priced. However, the lack of transparency from payers complicated the analysis.

According to Denise Myshko of Managed Healthcare Executive, “ICER reviewers were unable to assess the full set of information for all drugs for all insurers. The database used did not include all policies or coverage, tiering information or prior authorization and step policies could not be determined for all insurers. Additionally, tiering was used to assess out-of-pocket expenses for patients, but ICER indicted that may not take into account the variety of copayment/coinsurance programs.”