Pharmacy News
Published February 17, 2020
A new medicine comes on the market and two commonly asked
questions follow: is it cost-effective and valuable for our members? How does
Premera Blue Cross decide if a new medicine will become part of our preferred
drug list?
The Institute for Clinical and
Economic Review (ICER)—a growing not-for-profit organization that evaluates
drugs and their cost-effectiveness and value—helps us answer these questions.
If you’re not engrained in the pharmacy world, you may not know what ICER is.
At Premera, ICER is an important part of our business and helps us make
healthcare decisions that have a high impact on our members.
ICER membership
Premera, along with other leading health organizations,
insurers, and drug manufacturers, are members of ICER. “Premera was an early
adopter of ICER. In 2014, we had developed a value framework similar to theirs
in 2009, so it was a natural partnership. And in 2015, we become a member,”
John Watkins, senior clinical pharmacist said. “Now, we have a relationship
that’s built on trust, shared data and analytics, and the common goal of
slowing the increase in the cost of care.”
How we collaborate with ICER
“As a
watchdog on drug pricing, ICER provides data on drugs’ cost-effectiveness so
that we can better safeguard our members,” John said. We use ICER’s reports to:
- Assess the value of drugs during Pharmacy and Therapeutics reviews
- Debate the value of a drug with internal and external stakeholders
- Identify savings we can pass on to our employer groups
With the skyrocketing cost of drugs, ICER’s data can help us
determine what medicines are the best value for our members. Recently, Vascepa,
a new drug for people with high levels of triglycerides (a kind of lipid), came
on the market. The ICER review documented that it reduces heart attacks and
other cardiovascular events in high-risk patients. “ICER’s cost-effectiveness
analysis showed that Vascepa has high value, so Premera made it a formulary
preferred drug. We wouldn’t have reached this decision without the ICER
report,” John said. “The report also told us how to identify patients for whom
it would be high value, so we can tailor our prior authorization criteria to
cover the drug only for those members.
ICER is also helping us set standards for prior
authorization and other utilization management (UM) criteria. Manufacturers
lobby Congress and state legislators to restrict our ability to effectively
manage expensive drugs. These standards will state what types of restrictions
ICER considers ethically appropriate and how they should be implemented. This
will help Premera continue on our mission to make healthcare better and more
affordable.