How Does a Medication Become Part Of The Preferred Drug List?

  • When a new medicine comes on the market, two questions are commonly asked: is it cost-effective and valuable for our members? And will it become part of the Premera 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 don’t work in the pharmacy industry, 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. Within ICER, there are relationships 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
    ICER provides data on drugs’ cost-effectiveness so that we can better safeguard our members. ICER’s reports are used 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 your clients

    With the skyrocketing cost of drugs, ICER’s data can help us determine what medicines are the best value for our members. For example, when Vascepa, a 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. Their report also helped us 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 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 our mission to make healthcare better and more affordable.

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