In the US, consequential decisions around prescription drug pricing and patient access have historically been made based on limited evidence and without patients in the room. In confidential negotiations, drugmakers and insurers make financial tradeoffs that seriously affect the health and wealth of all Americans. Too often, drugmakers charge as much as they can, insurers react by restricting care and raising copays, and patients are none the wiser.
We use comparative clinical effectiveness, which weighs the benefits and harms / burdens of one treatment option versus another through a systematic review of all available clinical evidence. Feedback from patients and families in addition to input from clinicians, manufacturers, and payers is used to frame the questions that an ICER comparative effectiveness review attempts to answer.
ICER strives to bring these consequential decisions about pricing and access of health interventions out in the open, with patients at the table, where we all can all have an evidence-based discussion about the benefits a new health care intervention provides to patients and their families, and how we should try to align our spending to make sure we get the most health we can out of the dollars available.
ICER Through the Years
2006 – 2010: Developing our Methods
As a research program at Harvard Medical School, Steven D. Pearson founded ICER in 2006 as an organization within Massachusetts General Hospital (MGH).
Dr. Pearson’s goal was more ethical than economic: to identify all the difficult tradeoffs that the US health system was making due to limited resources, and to improve those decisions through transparency, real discussions about the outcomes that matter most to patients, and an independent analysis of the best available clinical evidence.
Throughout these early years, ICER studied how other countries managed the process of health technology assessment (HTA), and we developed analysis methods – for example, a robust evidence rating matrix — that were uniquely suited for the uniquely American health care system. Many of our early assessments focused on devices and hospital interventions, such as proton beam therapy for adult and pediatric cancers, and cardiovascular evaluations like coronary computed tomographic angiography.
2010 – 2013: Introducing Independent, Public Deliberations
In 2010, ICER transitioned from writing siloed academic analyses to engaging broadly with the US health care system when we established the New England Comparative Effectiveness Public Advisory Council (New England CEPAC), a group of independent experts who would review ICER’s analysis of the evidence, hear patient testimony, and deliberate over the clinical and economic value of health interventions. Shortly after the establishment of the New England CEPAC, we acquired the California Technology Assessment Forum (CTAF) as an additional regional appraisal committee. By bringing these important discussions out into the open, where patients and other US health care stakeholders could inspect the evidence and wrestle with aspects of value and the difficult tradeoffs inherent to any health system, ICER began to be noticed as an organization that could facilitate better health care decision-making across the country. In 2013, ICER spun out of MGH and became an independent, nonprofit, nonpartisan, research organization.
2014 – 2016: Gaining National Prominence
The launch of Sovaldi® – the highly effective hepatitis C therapy that cost $1,000 per day – raised national awareness around the life-changing benefits of certain pharmaceuticals, as well as the ever-escalating prices attached to those breakthroughs. A key touchpoint within this national debate was ICER’s 2014 hepatitis C assessment, which helped underscore to media, legislators, and the broader public that pharmaceuticals do not operate as a rational market in the US, and that independent analyses and more transparency can enable better health care decisions, as well as better health outcomes for American patients. As ICER gained national prominence during this period, the Laura and John Arnold Foundation (now known as Arnold Ventures) provided a transformational financial grant that enabled us to further expand the scale and impact of our work.
2017 – 2019: Informing US Policies that Lead to Fair Pricing and Fair Access
Major public and private payers—including state Medicaid agencies, the Department of Veteran’s Affairs, more than 75% of private insurers and PBMs, and multiple employer coalitions—now use ICER’s assessments to inform formulary decisions, coverage criteria and price negotiations.
ICER’s first annual Unsupported Price Increases report found that, in 2017 and 2018, seven of the costliest US drug price hikes had no new important evidence to support their increases; the net price increases on these seven drugs alone cost American payers and patients an additional $4.8 billion over those two years. The National Academy for State Health Policy has drafted a model bill through which state legislatures can increase transparency around this price increases and authorize the state’s tax assessor to recoup a major portion of the additional drug spend.
2020 and Beyond: Expanding Patient-Centered Methods & Standardizing Ways for Health Systems to Implement ICER’s Work
Reflecting on the importance of the patient voice, in 2020 we doubled-down on our commitment to give patients a seat at the table during key conversations around fair drug pricing and access. We launched a new patient engagement program where we have committed to 1) offering to help patient organizations prepare for ICER assessments; 2) using what matters most to patients as the North Star of ICER assessments; 3) translating patient input into our economic models; 4) getting patient feedback on the assessment as it progresses; 5) having patients at the head table throughout public deliberation; and 6) partnering with patient organizations after the completion of an ICER assessment to encourage the broader adoption of key policy recommendations by the FDA.
Shortly after the announcement of our 2020 Value Assessment Framework, which promised to expand use of real-world evidence (RWE) throughout our reports, ICER and Aetion announced a partnership and platform to generate decision-grade RWE. ICER hopes that this partnership will set new standards for how RWE can better inform the consequential decisions pharmaceutical companies and health insurers make around drug pricing and patient access.
In September 2020, ICER published a new white paper proposing cornerstones of “fair” patient access. The paper analyzes the ethical/practical dimensions of insurance coverage, and it presents criteria for assessing the fairness of specific cost sharing and utilization management policies. In conjunction, we launched a new annual assessment into how coverage policies of major US insurers and PBMs align with fair access criteria, with our first report to be published by mid-2021. Our external working group — comprising more patient advocates than all other stakeholders combined — will help us develop a review protocol for this annual initiative. We all want every American to have sustainable access to high-value care, and the entire US health system will need to blend fair pricing and fair access to get the job done.
In November 2020 ICER formally launched ICER Analytics™, a new cloud-based platform that will revolutionize the ability of payers, life science companies, patient groups, and others to develop formularies, negotiate drug prices, and explore new ways to apply evidence in a drive toward a health system that can achieve fair prices and fair access for all.
ICER Case Studies
Interested in joining our team?
Our team is full of smart, hard-working, and passionate people, and we are looking for more of them to join us. We offer a fast-paced and intellectual atmosphere that is fueled by our mission to make a positive impact on the future of healthcare.