Table 1b.
Copayment tier assignment guidelines in the pre-Value-Based Formulary (VBF) and the post-VBF periods for the intervention group
| Tier | Pre-VBF | Post-VBF Typical Case ICER threshold | Post-VBF Special Casea ICER threshold |
|---|---|---|---|
| Preventive | — | Cost-saving and preventive | Cost-saving and preventive |
| Tier 1 | Generic | Cost-saving or < $10,000/QALY | Cost-saving or <$50,000/QALY |
| Tier 2 | Preferred Brand | $10,000-50,000 /QALY | $50,000-150,000 /QALY |
| Tier 3 | Non-Preferred Brand | $50,000-150,000 /QALY | >$150,000 /QALY |
| Tier 4 | — | >$150,000 /QALY, or insufficient evidence to determine ICER | Insufficient evidence to determine ICER |
a
Special case: drugs that had additional value not reflected by their ICER. These values include ethical issues, disease rarity, unmet clinical needs, regulatory requirements, and other societal considerations.