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ICER(Institute for Clinical and Economic Review)の台頭:支払者の視点

The Rise of ICER - The Payer Perspective

発行 FirstWord 商品コード 950470
出版日 ページ情報 英文
納期: 即日から翌営業日
価格
本日の銀行送金レート: 1USD=107.57円で換算しております。
ICER(Institute for Clinical and Economic Review)の台頭:支払者の視点 The Rise of ICER - The Payer Perspective
出版日: 2020年07月20日 ページ情報: 英文
概要

ICER(Institute for Clinical and Economic Review)の証言と価格ベンチマークデータは支払者に評価されているものの、今の時点では、支払者の意思決定の中心ではないと考えられています。一部の支払者にICERの方法論は、薬剤の価格設定と商業的な複雑さを考慮に入れていない劣った手段であるとみなされていいます。それにもかかわらず、支払者は自分たちの目的に合った場合には、ICERの評価を利用することを躊躇していません。ICERは製薬会社と支払者との関係において力となりつつあり、メーカーはその影響力に対応するための明確な方針と手順を必要としています。

当レポートは、ICER(Institute for Clinical and Economic Review)について調査しており、ICERの取組みや位置付け、ICER評価や支払者による使用などの情報を提供しています。

目次

主題の要約

調査手法と目的

主要な洞察の要約

問題と洞察

  • 臨床経済研究所(ICER)のイントロダクション
  • ICERの幅広い取り組み
  • ICERに関する論争
  • 支払者と製造業者の間のサードパーティであるICER
  • ICERの評価にますます精通する支払者
  • 支払者のICER評価による医薬品への理解を検証
  • 支払者のICER評価による優先製品の選択
  • 支払者のICER評価による治療患者の選択
  • カバレッジの決定のための支払者のICERレポート使用
  • ICERレポート使用による支払者の価格交渉
  • 支払者が感じるICERレポートの有用性
  • 支払者が必要なすべての分析カバーしていないICER評価
  • 支払者のICERレポート使用による売上に基づく契約
目次
Product Code: 596201550

Payers reveal where ICER is really impacting pharma/payer relations

How is the Institute for Clinical and Economic Review (ICER) influencing payer behavior? ICER's evidence and price benchmarking data are valued by payers but, for now, are not central to their decision making. For some, ICER's methodology is seen as a blunt instrument which fails to take into account the real-world commercial complexities of drug pricing and reimbursement. Nevertheless, payers are not slow to bring into play ICER's assessments if it suits their purpose. So how can pharma respond when ICER's assessments are referenced by payers?

ICER is becoming a force in pharma/payer relations and manufacturers need clear policies and procedures for responding to their influence. To help shape your strategy we interviewed experienced US payers with direct ICER experience. In The Rise of ICER - The Payer Perspective they outline the key issues and attitudes that shape payer thinking and thereby reveal the proactive steps pharma can undertake to mitigate risk from a negative ICER assessment, or make the most of a positive one.

Payers explore key questions such as:

  • How valuable are ICER assessments in helping payers make coverage decisions and identifying product formulary placement?
  • How influential is ICER's wider work, such as on unsupported price increases and real-world evidence?
  • To what degree are payers influenced by ICER and how might this change in the future?
  • How useful are ICER assessments for helping payers find data and information for their own drug information/review processes?
  • Are ICER's choice of thresholds to inform value-based price benchmarks important to payers?
  • What data and information would payers like to see included in ICER assessments?

What payers say:

"We hear more about ICER's reports from the manufacturers than we do from anybody else. I've had manufacturers come to me and say 'Hey, ICER just put out a report for this drug, but we did our own cost-effectiveness, our own version of ICER's evaluation, and we come up with a much different number.' Well, of course they did. ICER's reports seem to be more for manufacturers, because what I think they are trying to do is to come up with their own evaluation to dispute the numbers that ICER is putting out. I've had that happen a couple of times. Where they would say, 'Oh well, ICER looked at this but they should have looked at that. We looked at this, but they didn't." Pharmacy Director.

"From what I understand with value-based contracts, they often sound better than they are in reality; they're often very hard to operationalize. It's possible that ICER could help that if they were able to include very objective endpoints that would be noncontroversial for either party, and agreed upon as acceptable endpoints for that drug to reasonably meet in order to be performing the way it should. So then it might make it easier to operationalize because one of the reasons that I think we see fewer value-based contracts is oftentimes it's very hard to come up with endpoints that both parties accept as a fair result as a consequence of the particular drug, and not other confounding factors that could improve that outcome." Medical Director, Health insurer.

"We put together everything that is available: all the clinical information, all the economic information, we put that together in-house for the P&T materials. We don't base our economic discussions based on the quality-adjusted life year. We just don't look at the economics that way; we look at what's the weighted average cost, the cost per month, the cost per year." Pharmacy Director.

What to expect

A detailed report exploring payer attitudes to ICER, the value they perceive in their work and how it is influencing their relationship with manufacturers:

  • An examination of 14 key issues that shape payer thinking about and attitude to ICER
  • 13 targeted questions put to payers with ICER experience
  • Their responses which provided 40 insights supported by 94 directly quoted comments

    Expert contributors

    Experts contributing to this report have been screened to ensure they:

  • Currently hold or recently left a role working in a payer organisation in the US, including health plans and pharmacy benefit managers (PBMs)
  • Have direct experience of informing, supporting and/or making coverage decisions on medicines

Experts interviewed included

  • A Manager of Pharmacy Contracts at a not-for-profit PBM serving over a million members.
  • A Vice President of Clinical Strategy and Programs with responsibility for formularies at a pharmacy benefit manager.
  • A recently retired Physician Director of Pharmacy and Therapeutics and Medication Safety, and Chair of the formulary committee for a multi-specialty medical group and regional health plan (an Integrated Care Consortium or ICC) caring for about 750,000 members.
  • A Medical Director working at a health insurance company with more than ten million members.
  • A Pharmacy Director for a regional payer that covers commercial and Medicare lives. He runs a Pharmacy and Therapeutics (P&T) committee and is directly involved in formulary and coverage decisions for oncology products.
  • A Medical Director at a not-for-profit PBM serving over a million members.
  • A Vice President with responsibility for pharmacy at a not-for-profit health plan serving around a million members.

Experts provided their own individual views, which do not necessarily reflect the views of the organizations they work for.

Why choose FirstWord ExpertViews?

FirstWord's ExpertViews reports reveal the real world insights of knowledgeable experts to analyze in detail key commercial and market trends that pharma management need to understand if they are to effectively respond to critical developments. These highly-focussed reports:

  • Are based on primary research with experts whose knowledge and current experience is proven
  • Present clear insights and actionable intelligence
  • Include only the latest primary research and findings-we don't recycle content or pad-out our reports with secondary source material

Table of Contents

Subject synopsis

Research methodology and objectives

Key insights summary

Issues and insights

  • An Introduction to The Institute for Clinical and Economic Review (ICER)
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Intelligence exhibits
    • Sources
  • ICER's wider work
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Controversy around ICER
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • ICER is a third party in between payers and manufacturers
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Intelligence exhibits
    • Sources
  • Payers increasingly familiar with ICER's assessments
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Intelligence exhibits
    • Sources
  • Payers use ICER's assessments to inform their understanding of a drug
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Payers use ICER's assessments to validate manufacturers' data
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Payers use ICER's assessments to inform their choice of preferred product
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Payers use ICER's assessments to inform selection of patients for treatment
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Payers have been using ICER reports to inform coverage decisions
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Payers have been using ICER reports to inform pricing negotiations
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • Smaller payers may find ICER reports more useful
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • ICER assessments may not provide all the analysis that payers require
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources
  • ICER reports could be used by payers to inform value-based contracts
    • Issue summary
    • Questions
    • Key insights
    • Supporting quotes
    • Sources