When and How is Real-World Evidence Useful in Payer Decision-Making?
Research published in Value in Health from the National Pharmaceutical Council and the University of Arizona School of Pharmacy sheds more light on how real-world evidence is used in decision-making among managed care organizations, and how to increase its use going forward.
Today more health care stakeholders are using real-world evidence (RWE) to better understand how a treatment, service, or method of delivering care works in real-world, clinical practice environments. This evidence, derived from real-world data from sources such as electronic medical records, medical claims databases or patient-reported outcomes, can inform decisions on how best to use available and emerging health care treatments and technologies. However, little is known about how managed care organizations (MCOs) use RWE. Research published in Value in Health from the National Pharmaceutical Council and the University of Arizona School of Pharmacy sheds more light on how RWE is used in decision-making among these organizations, and how to increase its use going forward.
To better understand how RWE is being used in managed care environments, this study explored three questions:
- How was RWE perceived and used in managed care environments, including pharmacy and therapeutic (P&T) committee decisions?
- What features of RWE studies, such as the study design (e.g., prospective vs. retrospective cohorts), type of analytic methods, population, outcomes (e.g., safety vs. efficacy) and data sources (e.g., claims vs. electronic health records), make certain studies more useful to payers?
- What barriers are associated with the use of RWE studies at the research study, individual evaluator and payer organization level?
Researchers addressed these questions by surveying a sample of pharmacists and physicians from a variety of health care-related organizations about payer perception of RWE. Results showed that payers recognize the value of RWE, but use of such studies varies from organization to organization and is limited.
Participants also explained what would improve RWE quality and use to make the studies more useful and recognizable to payers, allowing them to use RWE in a wider variety of situations.
For more information, read the full study here or a summary of the findings on NPC's website.