How Payers Are Using ICER Reports

Despite the late timing of reports and less-than-transparent evaluation process, the Institute for Clinical and Economic Review (ICER) has potential to provide unbiased clinical and economic evaluations, according to a recent survey of payers. 

ICER is a non-profit foundation that has published more than 20 reports in a range of disease areas, from class assessment to individual assessments of high-cost drugs. The foundation evaluates the value of medical tests, treatments, and delivery system innovations to encourage collaborative efforts to improve patient care and health care costs. ICER focuses on two main components for its value framework—long-term value for money and short-term affordability.

To understand the current and potential impact of ICER assessment on payer decisions, a research team led by Nathanael White, ICON Plc, and colleagues, invited 422 formulary decision makers from US payer segments to participate in a 23-question web-based survey in July 2018. The researchers conducted 30-minute telephone interviews with 4 respondents to better understand the aspects of the web survey results. 

Of the 422 identified decision makers, 22 respondents met the inclusion criteria for the web survey. According to the survey results, 87% of respondents believe ICER is only slight to somewhat influential on their organization. Further, 95% said ICER’s use of cost-effectiveness thresholds are somewhat useful.

The survey revealed that payers often use ICER reports during P&T review (68%). Additionally, 60% of decision makers said they most often use the reference section for a literature review as part of the drug information and review process, and 50% said they use the reviews as a negotiation point for rebate and pricing discussions and to also inform choice of preferred product in a therapeutic area. 

Further results of the survey revealed that 37% of payers are likely to request that a product list price meet an ICER evaluation. Researchers also found that 35% said they would be likely to request a rebate greater than 50% of the difference between the list price and cost-effectiveness threshold. Finally, roughly half of the survey respondents said their organization has directly referenced an ICER assessment during manufacturer discussions. 

“According to payers, ICER has potential to provide unbiased clinical and economic evaluations, although payers perceive the late timing of reports and less-than-transparent evaluation process as drawbacks,” Mr White and colleagues concluded. 

This research was presented during AMCP Nexus 2018.

—Julie Gould