ICER Update 03.25.2019

Hello, everyone, and welcome to this edition of Excelsior Solutions’ ICER Update.

Here is this week’s ICER recap:

  1. This week, ICER released a Draft Evidence Report assessing the clinical effectiveness and value of the recently approved drug esketamine (Spravato™, Janssen) for treatment-resistant depression (TRD). This draft report will be open to public comment until 5pm ET on April 17, 2019. Based on stakeholder feedback, ICER may revise key assumptions and findings for its Evidence Report, which will be published on May 9, 2019. The Evidence Report will be subject to deliberation during a public meeting of the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), one of ICER’s three independent evidence appraisal committees, on May 23, 2019.

    EXCELSIOR ACTION POINT: Owing to its REMS program that will require the use of Spravato in REMS-certified facilities, and the fact that home-use of Spravato will, at least initially, be prohibited, the question of impact on Rx vs. Medical benefit remains an open one. Plans are encouraged to understand the underlying clinical issues related to TRD so that Spravato’s emergence does not come as a surprise.

  2. ICER posted its revised protocol for conducting a new annual analysis to determine whether or not significant prescription drug price increases have been accompanied by new clinical evidence that could potentially support those increases. ICER’s first “Unsupported Price Increase” report is scheduled to be released on October 8, 2019.

    EXCELSIOR ACTION POINT: Plans are encouraged to avail themselves of the opportunity to influence this process in its developmental stage, as it will likely achieve a prominent role in the lay press and public policy forums once the first report is released in October 2019.

If you would like to discuss these ICER activities, or any other aspects of your Pharmacy Benefit Plan, simply reach out to your Excelsior Solutions account team and we will be happy to quickly set up a call.

Until next week!

Bob has more than 30 years of diverse experience in the pharmacy industry. Over the course of his career, Bob has led clinical and PBM operations teams in successfully managing more than $4 billion in annual drug spend. This was also while limiting per-member-per-year spending growth to levels that have simultaneously drawn industry acclaim and consistently high levels of member and payer satisfaction.

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