Barriers to Fair Access Report prompts insurers to improve access to 11 drugs

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There’s a lot of very appropriate focus on the unfairness of unwarranted drug prices. But an equally important key to patients accessing those drugs is the fairness of insurance policies. To keep premiums affordable, insurers must balance, even encourage, appropriate to access care, while deterring overtreatment and excessive prices. ICER, the nation’s leading value assessment group, applies their considerable smarts and clout to both questions. In response to a report on the fairness of payer policies released today, five payers reversed their unfair policies to improve patient access to 11 drugs. This is a very powerful report.

ICER’s second annual report on the fairness of payers’ policies for access to drugs. For the policies they were able to access, they found most were very fair. All had fair provider qualification policies, 98% for step therapy, 96% for clinical eligibility criteria, and 70% for cost sharing of fairly-priced drugs. But prior authorization process burdens for treatment of two conditions ranged from 22 to 71 provider questions.

A big limitation on the results is that ICER was only able to assess some of the relevant policies. ICER selected for review formularies from the 15 largest US commercial, the Veteran’s Administration, and the two largest state ACA exchange health plans. But ICER was only able to access the policies for 64% of selected insurers and only one of the five PBMs selected for review. Transparency is key to accountability.

ICER is holding a webinar tomorrow, Wednesday January 18th at noon to describe the report and answer questions. Register here