Straining from ever-rising drug spending, U.S. payers are increasingly turning to and leveraging the cost-effectiveness analysis generated by the Institute for Clinical and Economic Review (ICER).
ICER has emerged as America’s informal health technology assessment (HTA) agency, determining whether specific drugs provide clinical value and are cost effective based on a defined threshold. Their analysis has created a challenge to industry because many therapies are ruled to be outside of ICER’s acceptable cost-effectiveness thresholds (up to $100,000 or $150,000 per quality-adjusted life year added (QALY)). Beyond giving a critical eye toward new branded therapies, these published reports are starting to influence the net price of drugs. In the past year, year we have seen pharma companies voluntarily lowering prices to be within ICER thresholds. More recently, CVS/caremark announced a new program whereby its employer and health plan clients can exclude certain “me too” drugs that are above the threshold.
In this executive briefing we explore the rise of ICER and what the increasing clout of this organization means for the pharmaceutical industry.
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