OBJECTIVES: To evaluate the usefulness and extent to which ICER evidence reports informed payer coverage and formulary decisions over the past 24 months.

METHODS: Double-blinded web-based survey of US healthcare payers was fielded through Cencora’s research panel, the Managed Care Network, in July 2023.

RESULTS: A total of 48 payers from health plans (n=27), integrated delivery networks (n=9), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER reports to inform coverage and formulary decisions, 50% of payers indicated these reports were very/extremely useful. However, when payers were asked how many of their organization’s coverage and formulary decisions had been informed by ICER reports, 59% of payers said some/few were, 11% said about half were, and 30% said most/many were. Most payers used ICER reports as a supporting source of economic (60%) and clinical (50%) information, with very few (10%) using them as the main source. Half of payers reported using ICER reports as background and context to support decision-making. When queried about specific ICER reports published in the past 24 months, payers generally said they were not a driving factor in coverage or formulary decisions. However, 46% of payers indicated that the Alzheimer’s report was a driving factor in restricting coverage of an assessed product, and 31% indicated the hemophilia report had a similar impact. When payers reported a specific ICER report was a driving factor, they more often reported restricting coverage (9 reports) rather than broadening access (6 reports).

CONCLUSIONS: ICER reports were deemed as a supportive rather than main source of information for informing payer coverage and formulary decisions over the past 24 months. Although ICER reports were not often a driving factor in coverage or formulary decisions, they were associated with both expansion and restriction of payer coverage policies.