How ICER’s Flawed Budget Impact Threshold Can Harm Patient Access

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A recent analysis by Avalere finds that the Institute for Clinical and Economic Review (ICER) uses an unreliable benchmark for affordability when assessing the value of a new medicine – which can have serious, negative implications for patient access. According to the analysis, ICER estimates a range of patient access scenarios based on the calculation of a short-term budget impact threshold. One of the primary inputs that ICER uses to calculate the budget threshold is the number of new drug approvals per year – a metric that can fluctuate significantly year-over-year. As a result, there can be wide and unpredictable variability in the budget threshold calculation. Stakeholders considering tools to inform patient access should ensure that all aspects of the analysis are methodologically sound and shaped by information that properly reflects components of a medicine’s value.

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