ICER protocol for assessing drug coverage policies and barriers to fair access

The USA’s Institute for Clinical and Economic Review (ICER) yesterday posted a Protocol outlining how it will conduct its first annual assessment into how well major insurers’ prescription drug coverage policies align with a set of fair access standards developed by the ICER with expert input from patient advocates, clinician specialty societies, US payers, and life science companies.

In September 2020, the 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 policies are delivering “fair” patient access to prescription drugs.

Building on the criteria discussed within that paper, the health technology assessor convened a multi-stakeholder working group – comprising more patient community leaders than all other stakeholders combined — to advise the ICER as it undertakes this new annual initiative to assess Barriers to Fair Access within the prescription drug coverage policies of major US payers.