Original Report: Impact Analysis of ICER Formulary Implementation in Medicaid

By Xcenda |

What are the implications to product access if Medicare utilized an Institute for Clinical and Economic Review (ICER)-based formulary? Xcenda experts examined several product classes to understand the beneficiary impact if patients were switched from a current treatment to a medicine ICER deemed high value. 

ORIGINAL REPORT

Impact Analysis of ICER Formulary Implementation in Medicaid

The utilization of cost-effectiveness as the single barometer for the definition of value has severe implications for beneficiary access to medications. A significant number of patients with multiple sclerosis (MS), rheumatoid arthritis (RA), non-small cell lung cancer (NSCLC), multiple myeloma (MM), and psoriasis would lose access to the treatments their doctors determined was best for them if Medicaid began utilizing an Institute for Clinical and Economic Review (ICER)-based formulary. 

For example, Xcenda research suggests that over 99 percent of prescriptions to treat MS would be switched from their current treatment to a medicine ICER deemed high value and that ¾ or more of prescriptions for medicines to treat RA, NSCLC, and psoriasis would have to be shifted to an ICER-recommended drug. 

To learn more, download the report below.