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ICER to review the role of health insurers in determining patient access to prescription drugs

Non-profit research institute will evaluate how health insurance policies may harm patient access to treatment

The Institute for Clinical and Economic Review (ICER) is set to review how health insurers’ prescription drug policies affect patient access in the US, the independent non-profit research institute announced yesterday.

The first annual assessment into how health insurance policies may harm patient access to treatment will seek input from patient advocates, clinician speciality societies, US payers and life sciences companies.

According to the assessment protocol: 'The overall objective of the assessment is to test whether the fair access criteria can help bring greater transparency to the public debates about fair insurance coverage for drugs and, in addition, promote the positive linkage of fair pricing with fair access that will advance the best interests of patients and the health system.'

ICER will aim to determine how well the insurance policies align with its set of fair access standards. As part of the first iteration of the annual assessment, ICER will use MMIT’s market access analytics solution to evaluate the coverage policies of 15 of the largest commercial payers in the US.

To determine if the coverage policies match its criteria for fair patient access, ICER will examine tiering, step therapy requirements and elements of the prior authorisation criteria for 28 drugs.

These 28 specific drugs will have been previously found by ICER to be priced fairly and at a cost-effective level.

The review follows previous research undertaken by ICER that analysed the ethical and practical elements of insurance coverage policy in the US.

The white paper, published in September 2020, presented a set of criteria that will support a ‘more transparent’ discussion among healthcare stakeholders to  identify if specific policies are delivering fair patient access to prescription medications.

Following this, ICER convened a multi-stakeholder working group to advise on the new annual assessment initiative, to aid in its efforts to evaluate ‘barriers to access’ in prescription drug coverage policies of US payers.

In a statement, ICER said that it expects to publish its first annual assessment of these access barriers on 20 October 2021.

Article by
Lucy Parsons

26th May 2021

From: Research, Regulatory

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