Payer Preferences Around Manufacturer Provided Evidence and Engagements in the US

OBJECTIVES: The objective of this primary research study was to evaluate diverse payer organization stakeholder perspectives around manufacturer-provided evidence and engagements.

METHODS: Experienced stakeholders from US payer organizations were recruited to participate in an online quantitative and qualitative primary research survey in May 2024, consisting of 12 key themes consisting of 53 questions. To analyze the results, we conducted descriptive statistics and contextual analyses.

RESULTS: The survey included 20 participants, including 4 medical directors, 11 pharmacy directors, 4 industry/trade relations, and 1 actuary representing national and regional MCOs, PBMs, and IDNs.

Before product launch, the most valuable manufacturer-provided evidence for payers was efficacy (weighted average, 4.4/5), safety (4.1/5), and initial pricing estimates (4.1/5). Preferred method(s) for manufacturer pre-approval information exchange (PIE) were virtual meetings (68%) or in-person meetings (47%), with preferred timing of 0-6 (47%) or 6-12 months (42%) before launch. Post-FDA approval, the most valuable manufacturer-provided evidence was efficacy (weighted average, 4.4/5), pricing information (4.3/5), safety (4.2/5), and RWE (3.5/5).

Most participants (63%) had no/low trust in manufacturer-developed health economic models, with lack of transparency being the most significant driver. Only 10% of participants frequently/always use manufacturer models. The most common reasons for using manufacturer models are to support inputs/assumptions in their institution's model (37%) or to validate their model (32%).

Payers shared mixed perspectives regarding level of interest in pursuing innovative contracting with manufacturers (30% high, 45% moderate, 25% low). The most significant limitations to innovative contracting were availability of evidence to track outcomes (80%), availability of resources to analyze outcomes (70%), uncertainty around perceived value (65%), and concern with level of potential risk (50%).

CONCLUSIONS: While payer trust in engagements and materials from biopharmaceutical manufacturers varies, there is a demonstrated need for high-quality evidence. Transparency and quality of information are critical in these engagements to facilitate product access.