ICER sets out protocol for drug coverage policies that present barriers to fair access

US medicines cost watchdog the Institute for Clinical and Economic Review (ICER) has posted a Protocol outlining how it will conduct its third annual assessment of how well major insurers’ prescription drug coverage policies align with a set of fair access standards developed by the Institute with expert input from patient advocates, clinician specialty societies, payers, pharmacy benefit managers, 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 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. The criteria to be evaluated in this year’s assessment include those related to patient cost sharing, clinical eligibility criteria, step therapy, and provider restrictions. The availability of these policies to prospective health plan enrollees will also be evaluated.