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Dr. Steve Pearson explains why he founded an organization to advance the use of evidence to improve health care affordability and access for all patients and their families.
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New York Medicaid pursued discounts, many of which were in line with ICER reports, which have saved the state over $500 million
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ICER’s third annual “Barriers to Fair Access” assessment of prescription drug coverage policies within US commercial insurance, and the Veterans Health Administration. The analysis found that major payer coverage policies for 18 drugs often met fair access criteria for cost sharing, clinical eligibility, step therapy, and provider restrictions.
However, the report’s findings suggest that major improvements are needed in the transparency of coverage policy information for consumers, and in detailing out-of-pocket costs for patients.
Of 10 high-expenditure drugs that had substantial 2022 net price increases, eight were not supported by new clinical evidence; these increases accounted for $1.27 billion in additional costs over one year.
Additionally, one of three Medicare Part B drugs with high list price increases in 2021 lacked adequate supporting new evidence, directly raising annual out-of-pocket expenses for Medicare patients by up to $680 per year
ICER received a new grant from The Commonwealth Fund to evaluate procedural and methodological changes that could further support health equity goals in health technology assessment (HTA). The findings from this effort will guide ICER’s update to its value assessment framework and inform the work of other HTA groups worldwide.