ICER Receives Grant from The Commonwealth Fund for Annual Assessment of Coverage Policies that Present Barriers to Fair Access

– ICER’s third annual “Barriers to Fair Access” report will be published in November 2023 –

BOSTON, June 21, 2023 – The Institute for Clinical and Economic Review (ICER) has received a new grant from The Commonwealth Fund to support ICER’s annual “Barriers to Fair Access” assessment, which analyzes how well prescription drug coverage policies from payers and pharmacy benefit managers align with a set of fair access criteria.  This is the third grant ICER has received from The Commonwealth Fund since 2018.

“With a funding partner who shares our mission of addressing access and affordability challenges for patients, we can continue to lead a national discussion on how payer coverage policies can improve access and affordability in the U.S. health care system,” said ICER’s Executive Vice President and Chief Operating Officer, Sarah K. Emond, MPP. “Building on two previous Barriers to Fair Access reports, this funding from The Commonwealth Fund allows us to expand our analyses to explore geographic differences and the impact of formulary size on fair access for patients.  Payers, pharmacy benefit managers, and drug makers all have a role to play in ensuring fair pricing and fair access to prescription drugs. And, while much attention is paid to the access challenges related to the prices chosen by drug makers, this annual ‘Barriers to Fair Access’ project shows that the payer community has a critical role to play, as well.”

In September 2020, ICER published the white paper: “Cornerstones of ‘Fair’ Drug Coverage: Appropriate Cost-Sharing and Utilization Management Policies for Pharmaceuticals.” This paper analyzes the ethical and practical dimensions of insurance coverage policy, while presenting a corresponding set of criteria that support a more transparent discussion among all health care stakeholders about whether specific policies are delivering “fair” patient access to prescription drugs. The criteria to be evaluated in the next “Barriers to Fair Access” report include those related to patient cost sharing, clinical eligibility criteria, step therapy, and provider restrictions.  How easily prospective plan enrollees can access these policies will also be evaluated. 

The mission of the Commonwealth Fund is to promote a high-performing, equitable health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including people of color, people with low income, and those who are uninsured.  

ICER plans to publish the next “Barriers to Fair Access” report in November 2023. Click here for more information.

About ICER

The Institute for Clinical and Economic Review (ICER) is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.