As the Institute for Clinical and Economic Review's (ICER) influence on payer behaviour and health policy grows, how should pharma respond?
The ICER's novel and inclusive work on the value of drugs, using its own value framework and assessing the affordability, and even going so far as setting the value-based price benchmark of new drugs, has given payers powerful negotiating tools. The impact on pricing is being felt while drug affordability and access in the US's overheated drug sector is touching a wider stakeholder community. But not everyone is convinced. Pharma questions the emphasis on drug costs as the main determinant of value in the health care system, use of list prices (which can differ from actual prices paid in the US system), and use of Quality Adjusted Life Year (QALY) as a measure of cost-effectiveness.
The fact is the ICER is well supported and here to stay. As all new drugs in the US will be subject to ICER scrutiny, companies would be wise to fully engage in order to respond to ICER's negative results on their drugs, and benefit from positive ICER findings. That is why in Review of Influence: The Institute for Clinical and Economic Review (ICER) we interviewed leading experts in market access and Health Technology Assessment to help you understand where—and how—ICER will impact pharma and the steps industry can take to engage with ICER, and benefit from or challenge findings.
Experts explore the role and impact of ICER
What our experts say…
"My understanding is that there isn't the possibility that, as the drug maker, you can ask for an ICER report, or an update. I would like to see ICER allowing drug makers to request an assessment, if there is new evidence. It would be a positive thing if this can be done, say on the basis of new evidence such as change in the long term or medium term data."
Rito Bergemann
"ICER can share their data around cost-effectiveness with payers and then it is easier for payers to take decisions to put expensive drugs down the formulary tiers. Basically tiering decisions are going to be driven by ICER's analysis. Examples like CVS allowing clients to exclude drugs that don't meet ICER benchmarks, we will see more of these happening."
Shruti Desai
"ICER invites industry to weigh in during the assessment process but the relationship remains like a bull in a china shop because historically, industry has driven discussions about value—not a third party. While ICER, manufacturers, and payers have a shared interest in ensuring that the right patient gets the right drug at the right time, there's inevitable tension in that process."
Prof Laura Pizzi
What to expect
Expert contributors
The report harnesses critical insights and opinions from front-line industry experts who completely understand the potential for ICER's reports to be used by payers and the key areas where pharma can benefit.
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