Payer Perceptions of Health Inequalities in Reimbursement Decision-Making: Results of a Global Survey

OBJECTIVES: With so few payer and health technology assessment (HTA) organizations currently considering health inequalities in the reimbursement decision making process, it is unknown how HTA tools will evolve to overcome challenges and how pharmaceutical manufacturers should focus strategy to ultimately achieve health equity goals. This research aimed to understand and describe current payer perceptions of health inequalities and their implications for pharmaceutical manufacturers.

METHODS: A global survey conducted via the Rapid Payer Response (RPR^TM) platform by Genesis Research Group sourced data from a network of 3,500 stakeholders across more than 65 countries. Surveys were distributed in March 2024; responses received by April 2024. To comply with market standards, surveys were double-blinded. Respondents (N=31) were located in the United States, France, Italy, the United Kingdom, Brazil, and China. Respondents included former or current members and advisors of payer and HTA organizations.

RESULTS: Respondents identified socioeconomic status as the primary driver of health inequality over age, gender, and genetic disposition. Key barriers to greater consideration of health inequalities in decision-making identified were data availability, burden of data collection, difficulty in translating benefits into cost savings, required changes in HTA framework, limited experience/familiarity with advanced methods, cultural inertia and need to balance economic pressures.

CONCLUSIONS: To act on these perceptions and overcome these barriers, payers recommend that pharmaceutical manufactures and life sciences companies 1) advocate for formalizing health equity considerations in the HTA process, 2) contextualize inequality within the disease burden by subgrouping analyses by sex, race and socioeconomic status, with greater focus on marginalized populations, and 3) implement advanced methods such as distributional cost-effectiveness analysis.