ICER Reports Play Significant Role in Managed Care’s Decision-Making, Study Finds

Linnea Tennant

Anne Loos

New research shows that managed care organizations (MCOs) are making ample use of the reports by Institute for Clinical and Economic Review (ICER).

The analysis is based on data from the FormularyDecisions platform, which facilitates information exchanges between insurers and drug companies, as well as a syndicated survey.

ICER, which is based in Boston and has been funded mainly by private foundations, does cost-effectiveness studies of tests and treatments. Such analyses have become more complex in recent years as personalized medicines and biologics have led to major clinical advances - and to treatment prices that are, in some cases, in the millions. ICER’s assessments, which are which are anchored in judgments about a drug’s contribution to quality-adjusted life, have influenced pricing decisions and negotiations between payers and providers.

In an email, co-authors Linnea Tennant, Pharm.D., MBA, M.S., assistant director of global health economics and outcomes research at Xcenda, and Anne Loos, M.A., a global health economics and outcomes research analyst at Xcenda, said they wanted to see how exactly ICER reports are playing into the decision-making of MCOs.

“It is important to understand how MCOs are utilizing ICER reports so we can understand ICER’s evolving role in payer decision-making and how these assessments may ultimately affect patient access to innovative medications,” they said.

Xcenda and FormularyDecisions are both part of AmerisourceBergen. Tennant and Loos’s findings were scheduled  to be presented at the Academy of Managed Care Pharmacy’s 2020 annual meeting. The in-person event was canceled because of COVID-19 and replaced with online presentations and posting.

Tennant and Loos found that MCOs represented 39% of users who accessed ICER reports on the FormularyDecisions platform. Survey responses showed that three-quarters (74%) said ICER reports factor into their decision-making, and those users spend an average of 12.5 minutes per session reviewing ICER reports.

Most (61%) of the respondents said ICER reports are used for their formulary reviews. Tennant and Loos said the survey also indicated a high level of satisfaction with the reports.

“While we expected that ICER would be a resource for many healthcare decision makers, it was interesting to see that when MCOs were asked about limitations of using ICER reports, nearly one-third reported no limitations at the time of the survey, which suggests that updates to ICER’s methodology over the past few years may have addressed some concerns previously noted by payers,” they said.

Of those who noted limitations, length, complexity and model methodology were the most commonly reported limitations. Also, 58% of MCO respondents who said they did not use ICER reports said it was because the reports were not yet available at the time they needed to make pharmacy and therapeutics (P&T) decisions.

Among those who used the reports for clinical decision-making, most (52%) said the reports were a secondary source of evidence and about a third (35%) said it was a primary source.

Asked how they use the data, 45% said the reports are used to assist determining product affordability while 42% said they are used to validate internal research.

“This aligns with the thinking that while U.S. payers are increasingly using ICER reports for decision-making, these evaluations should not be used in isolation but rather in the context of other value-based decision-making tools to incorporate a diverse set of perspectives and analyses,” Tennant and Loos said.

More broadly, the investigators said the study suggests MCOs get the most out of ICER reports when they proactively prepare for them.

“From our extensive experience working with our clients on ICER, we have seen that companies that prepare for evaluations are able to align internally more quickly, act more nimbly and confidently, and have more meaningful engagements with ICER throughout the evaluation,” they said.

The study is titled, “ICER’s Influence on Health Care Delivery: How Managed Care Organizations Use ICER Reports in Decision Making” The abstract can be found here.