PCMA Statement on New White Paper “Assessment of Barriers to Fair Access” Issued by ICER

(Washington, D.C.) — Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on a new white paper issued by the Institute for Clinical and Economic Review (ICER), “Assessment of Barriers to Fair Access:” 

“We appreciate ICER’s thoughtful approach to assessing appropriate formulary inclusion of fairly priced drugs. The results from the report indicate that pharmacy benefit managers’, PBMs’, formulary designs on behalf of health plan sponsors provide patients with fair access to prescription drugs.

PBMs develop prescription drug formularies with Pharmacy and Therapeutic (P&T) Committees that are composed of specialist and primary care physicians, pharmacists, and other clinical experts. P&T Committees evaluate available clinical evidence to select the most appropriate drugs for various conditions.

The criteria for ICER’s white paper focused on patient cost sharing, clinical eligibility, step therapy, and prescriber restrictions. The paper’s findings that the vast majority of payers’ policies are in line with ICER’s fair access criteria – ranging from 77% in cost sharing, 96% in clinical eligibility, 99% in step therapy, and 100% in prescriber restrictions – underscore the work that PBMs and their P&T Committees do to give patients affordable access to needed prescription medications.”


PCMA is the national association representing America’s pharmacy benefit managers (PBMs).  PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including:  commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.