ICER fair access report finds improvements but problems with transparency

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ICER’s third annual Barriers to Fair Access report found that most prescription drug coverage policies met fair rules for patient access. This is an improvement over previous years suggesting that transparency and public sunlight works. But the report also found that policies needed more transparency and are too complex. Policies on which patients are eligible for which drugs and for continuation of coverage, how to get approval for drugs patients are currently taking, was not available to patients or was very difficult to understand.  

Across all payers, ICER found 62% of policies met fair access for patient cost sharing, 99% were fair for clinical eligibility, 99% were fair for step therapy, and all were fair for prescriber restrictions.

ICER tested policies for 18 drugs that are fairly priced to ensure that patients can get them. The policies, or formularies, are the rules that payers, pharmacy benefit managers, and drug companies develop to decide what they will cover. For this report, ICER analyzed coverage policies for plans with both large and small enrollments, in different regions of the US, and across state insurance exchanges. They found little difference in the fair patient access based on the size of plans, region, or between private commercial plans and state-run exchanges.

ICER is holding a public webinar featuring patient advocacy groups to discuss the report’s findings at noon on November 10th. Register here