ICER: Payer Perspectives on the Use and Usage of ICER Reports · Health Plan Perspective on...
Transcript of ICER: Payer Perspectives on the Use and Usage of ICER Reports · Health Plan Perspective on...
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ICER: Payer Perspectives on the Use and Usage of ICER Reports
February 28, 2019
Presented By
Moderator: Jackie GladmanVice President, Sales and Marketing, Dymaxium
Elizabeth Sampsel, PharmD, MBA, BCPS Vice President, Payer Strategy and Relations, Dymaxium
John Watkins, PharmD, MPH, BCPSFormulary Manager, Premera Blue Cross
James Kenney, RPh, MBAConsultant, JTKENNEY, LLC
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Webinar Objective
• To provide insights on the US payer and decision maker perspective regarding the use, usage and quality of ICER reports for use in the P&T review process• Based on current responses (2018-19) from syndicated survey responses from the
FormularyDecisions.com® community
• Provide payer perspective using ICER, citing overall strengths and challenges
• Discussion of the use of ICER reports and implications for payers and manufacturers
Syndicated Survey Review -FormularyDecisions.com®
Elizabeth Sampsel, PharmD, MBA, BCPSVice President, Payer Strategy and RelationsDymaxium
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Central platform connecting health care decision makers to the evidence, resources, and their peer community, so they can work more effectively and collaboratively.
Data collected on:• 1900+ US PAYERs/HCDMs• 900+ organizations• 86% of covered lives (MCO)• Includes all top PBMs• 150,000 + evidence links• 2300 + products
Active evidence review and assessment to make informed formulary and reimbursement
decisions.
A closed payer only environment.
Relationships
FormularyDecisions.com®
Overview
Purpose: To better understand the payer perspective on the use, usage and quality of ICER reports for use in the P&T review process.
Data Results:• 614 syndicated survey responses
reviewed• 6 month timeframe:
Aug 13, 2018 – Feb 14, 2019
76.22%
24.34%
7.12% 5.24% 1.69% 0.37%0%
20%
40%
60%
80%
100%
ICER NCCN ASCO AHA DrugAbacus Avalere
Use of Value Frameworks n = 534
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69%of evidence access came from MCOs and PBMs
15%of evidence access came from Hospitals and IDNs
Usefulness of Value Frameworks
5%7%
1%3%
63%
21%
% Payer Feedback For Value Frameworks (n=550)
AHA ASCO Avalere DrugAbacus ICER NCCN
3.50
3.60
3.70
3.80
3.90
4.00
4.10
4.20
AHA ASCO NCCN ICER DrugAbacus
4.11 4.08
4.03
3.83
3.76
Weigh
ted AVerage
Usefulness of Value Frameworks (n=550)
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61.9%
Use and Usefulness of ICER Reports
Used or will use ICER reports in their P&T review n = 614
4.2
4.3
4.4
4.4
4.5
4.5
4.6
4.7
4.8
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Payer Letters and Comments
Comparative Value – incremental budget impact
Comparative Value – value-based benchmark prices
Manufacturer Letters and Comments
Comparative Value – incremental per outcomes achieved
Reference Sections
Summary of Coverage Policies
Comparative Clinical Effectiveness
Executive Summary
Average Rating
Ratings on ICER Sections Based on Usefulness n = 22
Usage and Quality of ICER Reports
1.2%
9.0%
18.4%
27.4%
35.0%
35.9%
40.8%
60.0%
0% 20% 40% 60% 80%
Other
Support risk based contracting
Support pricing/listingnegotiations
Primary source of evidence
Inform/validate my own researchand analysis
Support development of tierplacement
Assists in determining productaffordability
Secondary source of evidence
Usage of ICER Reports n = 363
4.5 4.5 4.3 4.3
0
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ReportSatisfaction
Report Quality Model Quality ModelSatisfaction
Aver
age
Rat
ing
Quality and Level of Satisfaction on ICER Report / Model n = 117
13.7%
86.3%
Recommendation of ICER n = 117
Not Sure Yes
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Keywords Associated with ICER
Payer Reasons for Not Using ICER Report
Primary reason ICER reports are not used are availability in time for P&T review. Other reasons are not able to extrapolate to payer population and time constraints.
45.2%
36.5%
10.3%
4.0% 4.0%
0%
10%
20%
30%
40%
50%
The ICER report was notavailable in time to prepare
for P&T decision
I do not use ICER reports aspart of my formulary
evaluation
Other ICER organization bias The ICER report methodologywas not easy to understand
Reasons for Not Using ICER Reports n = 252
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Summary
• Payers and other health care decision makers (HCDMs) are using ICER reports and finding them useful for formulary decision making.
• Payers/HCDMs are rating ICER reports as high quality.
• Payers/HCDMs are accessing ICER reports through the FormularyDecisions.com platform®.
• Payers/HCDMs are using ICER primarily as a secondary source of evidence, but there is now a shift in using them for determining product affordability and to support tier placement development.
• A continued deterrent to ICER report use is availability of reports in time for P&T review.
John Watkins, PharmD, MPH, BCPSFormulary Manager Premera Blue Cross
Premera Uses ICER Reports
Special thanks to:Emily Tsiao, PharmD, PGY1 Managed Care Pharmacy Resident, Premera Blue Cross
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Premera Blue Cross
2 million members
1 million pharmacy lives
Home States: Washington, Alaska
Commercial, insurance exchange, and Medicare
Evidence‐based P&T process established in 2001
Formulary review includes pharmacoeconomic analysis
Member‐centric approach
Challenges at Premera
Fewer staff
Reduced administrative budget
Increased workload Asked to incorporate patient voice into
formulary process
Maintain value‐based formulary
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Alignment of Mission and Value Framework
Premera
•Mission: Improve our members lives by making healthcare work better
•Value framework: Considers clinical benefit, cost‐effectiveness, contextual factors, and budget impact
ICER
•Mission: Conduct evidence‐based reviews that help the health care system know what works
•Value framework: Considers comparative clinical effectiveness, incremental cost‐effectiveness, contextual considerations, other benefits or disadvantages, and budget impact
ICER Report Sections of Value to Premera
Executive Summary
Introduction
Summary of Coverage Policies
and Clinical Guidelines
Comparative Clinical
Effectiveness
Long‐Term Cost‐Effectiveness
Other Benefits and Contextual
Considerations
Potential Budget Impact
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Using ICER Reports: Challenges
Timing
P&T Committee Member and Internal Stakeholder
Education: How to effectively analyze and interpret ICER reports
P&T Committee Feedback
“Information from ICER on complex disease states has been helpful” ‐Premera P&T Committee Member
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Summary: Why Premera Uses ICER Reports
Provides information Premera is unable to obtain using internal resources
Provides information that helps Premera debate the value of a therapeutic agent with internal and external stakeholders
Estimated savings to Premera per quarterly P&T committee meeting: $10,000 ‐ $35,000
Premera Uses ICER Reports
John Watkins, PharmD, MPH, BCPSFormulary ManagerPremera Blue Cross
Emily Tsiao, PharmDPGY1 Managed Care Pharmacy Resident
Premera Blue Cross
© 2018 Premera. Proprietary and Confidential.
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James Kenney, RPh, MBAPresidentJTKENNEY, LLC
Health Plan Perspective on Value-Based Contracts and ICER
Value-Based Contracts
A value-based contract is a written contractual agreement in which the payment terms for
medication(s) or other health care technologies is tied to agreed-upon clinical circumstances, patient
outcomes, or measures.*
*AMCP Value Based Partnership Forum June 2017
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Design Model
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Key Drivers for Health Plans
Proof of Efficacy with Outcomes Performance
Limit Products to a Specific Population
Reduce Financial Risk
Insurance for Poor Real World Experience
Increase Rebates/Savings
Reduce Overall Costs
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Key Drivers for Manufacturers
Improved Product Access
Market Share Growth
Reduce Resistance to New to Market Agents Develop Concepts Pre-launch
Include Outcomes in Clinical Trial Design
Restrictive Plan Designs/Formularies
Gain a Competitive Advantage
ICER Role
Formulary review Determine Fair Value of Product Includes Contracted Rates Compares Competing Products
ICER Informs Assessment of Initial Launch Price of a Product
Potential Plan Benefit with Impact on Manufacturer List Price Examples Tymlos®
Entresto®
Aimovig™
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Short/Long Term Goals
Get Value in Return for Pharmaceutical Dollar Spend
Use Results to Make Formulary Decisions/Changes
Assess True Benefit of Treatments
Multiple Outcomes Contracts for Competing Therapies
Include ICER or Other Value Framework
Discussion & Questions
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Thank you for participating!For further information on the AMCP eDossier System contact [email protected]
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