Perspectives from US payers

Insights on ICER initiatives and evolving payer practices

With the rising costs of prescription drugs in the US, there is growing scrutiny and focus on the value of new treatments.

In the absence of a national Health Technology Assessment (HTA) body in the United States, the Institute for Clinical and Economic Review (ICER) has emerged as a leading voice in evaluating healthcare technologies on their clinical and economic value. However, given that there is no mandate to base pricing and coverage decisions on ICER assessments, there are many questions about the organisation’s impact.

Since 2018, ICON has surveyed US payers for their perspectives on the role of ICER and how ICER reports are influencing payer practices. We have also looked closely at patient outcomes and how that data can influence US payers.

The affordability hurdle for gene therapies

Until now US payers have absorbed and managed the cost of ultra-expensive therapies, but how long can they continue to do so? Read our whitepaper to understand the payer perspective on advanced therapy medicinal products.

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ICER's impact on payer decision making

Since 2018, ICON has conducted annual research with payers to track the role and reach of ICER in payer decision making. Read our third annual payer survey for insights.

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ICER's value-based pricing initiative

In 2019, ICER launched an international collaboration to develop new methods to guide value-based pricing. This initiative led us to conduct original research on payer reliance on ICER assessments and their perceptions on value-based pricing over the past year, as an update to our original 2018 research.  


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Who has the job of leading the evaluation of pharmaceutical value and pricing?

In 2018, we conducted primary research to evaluate the influence of ICER over payers and manufacturers. Over 60% of manufacturers surveyed agreed that the US needs an independent HTA body.

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Payers' perspectives on digital therapeutics

We interviewed health plan and pharmacy benefit managers for insights and recommendations on how digital health manufacturers can be successful in this rapidly expanding market.

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Will US payers give more consideration to PRO data in coverage decisions?

In the US, payers have historically focused on efficacy and safety endpoints as well as cost, with very little attention given to patient reported outcomes (PROs). With the increase in patient centricity, we surveyed US payers from MCOs, IDNs and PBMs to get their take on the value and use of PRO data.

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On-demand webinar: Industry perceptions and expectations: The role of ICER as an independent HTA