On January 17, 2023, the Institute for Clinical and Economic Review (ICER) published its second annual “Barriers to Fair Access” assessment of prescription drug coverage policies. The report evaluated coverage policies for 19 drug-indication pairs across 18 formularies, finding that major coverage policies demonstrated a high level of concordance with ICER’s fair access criteria.
ICER reported overall concordance ratings of 70 percent for cost-sharing drugs that were reasonably priced; 96 percent for clinical eligibility criteria; 98 percent for step therapy criteria; and 100 percent for prescriber restrictions. Because overall concordance with the fair access criteria was high, ICER did not find enough variation to explore correlation with features of the drug, drug class, or drug pricing. However, one drug stood out as an outlier in the analysis. The most expensive specialty drug in the analysis, Hemlibra®, had notably lower concordance rates for cost sharing and clinical eligibility criteria. In other words, it was less accessible than less expensive drugs reviewed. ICER suggested that the restrictive utilization management could be because the hemophilia A drug has alternative, yet expensive, treatments and is used chronically. The report also found that after receiving the draft results of the assessment, five payers changed their coverage policies for 11 drugs to better align with the fair access criteria. The report suggests an opportunity to use fair access criteria to encourage formularies to adopt more consistent approaches to providing fair access for drugs.
Read the full report here.
Last Updated on January 25, 2023 by Aimed Alliance
