ICER conducted our third annual assessment of how well major insurers’ prescription drug coverage policies align with a set of fair access standards developed by ICER with expert input from patient advocates, clinician specialty societies, US payers, pharmacy benefit managers, and life science companies. For each of the drugs reviewed by ICER in 2021 we performed analyses of the proportion of selected fair access criteria that are met in these formularies, analyzed across drugs, conditions, and payers.
ICER’s President-Elect Sarah Emond, MPP stated:
“Every day, patients face barriers to access because of policy choices made by payers and employers. Our report highlights key areas where payers should consider changes to improve the fairness and transparency of their coverage policies, especially for policy choices, like copay accumulators, that impact patient cost-sharing.
For the drugs and health plans we assessed, coverage policies were largely structured to provide fair access on paper, but it is difficult to determine how well that translates into real-world access and affordability for patients. This annual report underscores the importance of transparency and analysis in helping the system move to what we all want – fair prices and fair access.”
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