HTA Quarterly | Fall 2021

In 2017, the Institute for Clinical and Economic Review (ICER) received funding from Arnold Ventures to develop annual Unsupported Price Increase (UPI) assessments to identify whether drugs with recent substantial price increases are supported by clinical evidence. To date, 2 UPI reports have been published to account for price increases that occurred in 2017–2018 and in 2019, respectively; the next report evaluating price increases in 2020 will be available in November 2021. Recent payer research conducted by Xcenda in 2020 found that payers are using ICER’s UPI reports with two-thirds of payers (66%) reporting them to be somewhat to extremely useful and 61% reporting them as somewhat to extremely influential on coverage decisions. Therefore, it is important for manufacturers to be familiar with the methodological approach of these assessments to prepare for future negotiations with payers. This article discusses ICER’s approach to the UPI assessment, considerations for manufacturers, and reactions from stakeholders.

Approaches taken by health technology assessment bodies may not be inclusive of all patient populations. Health disparities play a pivotal role in health outcomes of marginalized patient populations. While many health technology assessment organizations understand the importance of addressing health disparities, they rarely incorporate health disparities into the value assessment process.

Traditional approaches for cancer treatment have included surgery, radiotherapy, and chemotherapy. In recent decades, however, an intensifying body of knowledge surrounding the role of genomics and the immune system in cancer has led to the development of therapies targeted to specific molecular alterations and/or other biologic characteristics (eg, immune suppression). This evolution in cancer therapeutics offers vast opportunities to learn from key opinion leaders in oncology. This article examines how provider and payer insights aid In overcoming oncology market access hurdles.