ICER published its fourth 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 the 11 drugs in scope often met fair access criteria for several categories, while areas for improvements were identified in the transparency of coverage policy information for consumers and in detailing out-of-pocket costs for patients.
The assessment also found payer coverage policies have largely improved since ICER’s first report was published, aligning more closely with ICER’s criteria for fair cost sharing, clinical eligibility, step therapy and provider restrictions. New for this year, ICER partnered with IQVIA, a leading healthcare data and analytics provider, to gain insights into national level cost sharing and prior authorization metrics from real-world claims data.
Final Documents
For questions or additional information, please contact info@icer.org.
ICER’s President and CEO Sarah K. Emond, MPP:
“Over the years, our systematic approach to assessing the barriers faced by patients to fairly accessing prescription drugs has sought to highlight where the system is doing well, and where the system can improve. As in previous years, our findings have identified areas where the policy choices made by payers and employers can better align with the fair access goals. For the drugs and health plans we assessed, coverage policies were largely structured to provide fair access, but it is difficult to determine how well that translates into real-world access and affordability for patients, especially since consequential decisions about patient cost-sharing are often left to the discretion of purchasers, and those data are hard to find. Evaluating fair access to therapies is a critical part of ICER’s mission, and we will continue to work towards fair prices and fair access for patients.”
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