Delivering Real World Evidence That Matters to Payers: Insights from a Survey of Access Decision Makers

Christopher Terrone | VP, Healthcare Insights  
Cynthia Miller, MD, MPH, FACP | VP, Medical Director, Access Experience Team 
Mitch DeKoven, MHSA | Vice President, Evidence Generation

Payer scrutiny of new therapies has intensified as the industry faces a surge in accelerated approvals, reliance on surrogate endpoints, and the introduction of products with limited, if any, long-term data. Payers often make coverage decisions in the midst of such uncertainty, leading to restrictive policies and access barriers. In this context, RWE has become indispensable for determining and demonstrating value, informing policy, and supporting market access strategies. 

To better understand how payers are using RWE, Precision AQ conducted its second annual survey, Real-World Evidence in Payer Decision-Making. This initiative engaged 25 market access decision-makers, including pharmacy and medical directors from both national and regional health plans as well as pharmacy benefit managers. The survey was designed to capture a cross-section of viewpoints from those responsible for shaping coverage and formulary policy across the United States. 

Key findings from this year’s research include: 

• The first year after FDA approval is a critical period when payers expect real-world evidence (RWE), reflecting their growing demand for timely data to support decision making 

• A key challenge to using RWE is that payers often do not find it actionable 

• Payers report that manufacturers deliver RWE with mixed success, with some communications falling short of payer needs