ICER Fair Access Report Gives Payers High Marks

Dec 24
Dec 24, 2024

Most major commercial payers provided fair access to a sample of prescription medications, according to a recent review from the Institute for Clinical and Economic Review (ICER). Sarah Emond, ICER’s president and CEO, tells AIS Health that payers “should be given a lot of credit for being in line with a lot of the criteria that we’ve established.” However, she cautions it is difficult to assess how payers implement the written policies in a real-world setting.

ICER’s fourth annual “Barriers to Fair Access” report, published on Dec. 19, assessed coverage policies associated with 11 medications that the nonprofit organization evaluated for cost-effectiveness in 2022. The authors identified the 10 largest commercial payers in the U.S. and selected those insurers’ largest formularies based on the number of covered lives. They obtained the formulary data from MMIT, AIS Health’s parent company, which also provided information on coverage policies if the payer did not share them with ICER.
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Tim Casey

Tim has been a reporter and editor for newspapers, websites and magazines for more than 20 years, including 10 years covering health care business topics. He has a deep knowledge of the managed care industry and pharmacy benefit management. He also has experience covering medical conferences and clinical and legislative health care issues. In 2014, the Society for Advancing Business Editing and Writing selected Tim as one of 15 journalists to participate in a national symposium on the Affordable Care Act. Tim has a B.A. in Psychology from the University of Notre Dame and an M.B.A. from Georgetown University.