Why Cardiovascular-Kidney-Metabolic Health Is a Priority for Payers & What It Means for Manufacturers

Cynthia Miller, MD, MPH, FACP | VP, Medical Director, Access Experience Team
Christopher Terrone | VP, Healthcare Insights, Market Access

Cardiovascular-kidney-metabolic (CKM) health is rapidly emerging as a critical focus in health care—and for good reason. These interconnected conditions are among the leading causes of morbidity and mortality in the U.S., and they disproportionately affect individuals facing adverse social determinants of health (SDOH).

Why CKM Health Is Unique & Demands a Different Approach

• Cross-Specialty Complexity: CKM therapies span multiple specialties—cardiology, nephrology, endocrinology, and more—making care coordination and commercialization more complex than in single-disease areas.
• High Prevalence, High Spend: CKM conditions like type 2 diabetes, chronic kidney disease, and heart failure affect tens of millions of Americans and account for a significant portion of US drug spend.
• Rapid Indication Expansion: Many CKM therapies are approved for multiple indications, creating both opportunity and complexity as products evolve and compete across therapeutic categories.
• Guideline Overlap and Fragmented Care: Clinical guidelines for CKM conditions often overlap, but patients are treated across different specialties, leading to fragmented care and challenges in delivering guideline-directed therapy.
• Whole-Patient Focus: Effective CKM treatment involves more than medication alone. The American Heart Association Presidential Advisory calls for lifestyle change support and addressing SDOH. Payers are increasingly requiring or considering lifestyle counseling as part of access criteria.
• Payer Scrutiny and Access Challenges: Due to large patient populations and high costs, CKM therapies are under intense payer scrutiny, with growing interest in utilization management and Centers for Medicare & Medicaid Services price negotiations.

Survey Insights: What Payers Are Saying

Recognizing the growing complexity and impact of CKM health, Precision AQ is sharing a white paper based on findings from a survey of 25 payer decision-makers—including pharmacy and medical directors from national and regional health plans and pharmacy benefits managers.

The findings were striking:

• More than 75% of payers are following the CKM health pipeline more closely than other therapeutic categories, including 40% who are following it “much more closely.”
• CKM health is already a higher management priority than other therapeutic areas for most payers (84%), and a “much higher priority” for 40%.

The white paper also describes how payers are viewing non-pharmaceutical interventions such as addressing SDOH and incorporating lifestyle vendors into their management approach.

What It Means for Manufacturers

Manufacturers operating in the CKM space must adapt to a rapidly evolving landscape where payers are scrutinizing an already competitive landscape of therapies. Success will depend on early engagement, strategic alignment with payer goals, and a commitment to demonstrating real-world value across diverse patient populations.

These findings only scratch the surface, and our full white paper unpacks additional insights around payer expectations, access barriers, and emerging opportunities. 

For more on how Precision AQ supports pharma manufacturers in navigating complex access landscapes, including CKM and beyond, explore our Market Access capabilities.