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 […]
While many key elements of fair access were not able to be assessed, the analysis found that major payer coverage policies for 19 drugs demonstrated high concordance with many fair access criteria related to cost sharing, clinical eligibility, step therapy, and provider restrictions. During ICER’s assessment, five payers revised policies for 11 drugs in ways […]
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 will support a more transparent discussion among all health care stakeholders about whether specific […]
The purpose of the white paper is to analyze the ethical and practical dimensions of insurance coverage policy, while presenting a corresponding set of criteria that will support a more transparent discussion among all health care stakeholders about whether specific cost sharing and utilization management policies are delivering “fair” patient access to prescription drugs. Date […]