Published May 23, 2016
Washington, DC—May 23, 2016—The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st Annual International Meeting Issue Panel 5—Use of Real-Word Evidence in Payer Decision Making: Fact or Fiction?—was held this morning in Washington, DC, USA. The Issue Panel was moderated by Daniel C. Malone, PhD, RPh, ISPOR President and Professor of Pharmacy, College of Pharmacy and Associate Professor, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA. Panelists included:
  • Craig Mattson, MS, MBA, RPh, Senior Director, Formulary Development, Prime Therapeutics, Eagan, MN, USA
  • John W. McKnight, PharmD, BCPS, Director, HPS Clinical Strategies, Humana, Louisville, KY, USA
  • Steven G. Avey, RPh, MS,Vice President, Specialty Pharmacy, MedImpact, San Diego, CA, USA
This Issue Panel considered the significant growth in the number of real-world evidence studies intended to guide health care decision making and the growing volume of data (e.g., administrative date, electronic health records) that can provide valuable information to inform treatment decisions in the real world. Recognizing the importance of real-world evidence, many organizations have responded by building internal teams, forming research collaborations, or investing in real-world evidence technologies. Yet it is unclear when and how real-world evidence has actually been used in formulary decision making. Additionally, researchers often don’t understand what evidence payers value so that the research is increasingly used in the payer community. Daniel Malone presented results from a multi-phase project as a foundation for the discussion. The multi-phase project included interviews with 20 medical and pharmacy directors and an evaluation of evidence cited in 25 pharmacy and therapeutics committee monographs. The panelists, from the payer community, discussed the value of real-world evidence from their respective perspectives. Jay McKnight of Humana discussed the advantages, limitations, and operational considerations affecting the usefulness of real-world evidence for formulary and benefit design. Steve Avey of MedImpact discussed the benefits of using best available evidence, the role of real-world evidence to inform reimbursement policies for specialty medications, and the challenges with using real-world evidence generated from administrative data. Presentations and slide decks from the ISPOR 21st Annual International meeting can be found here. Interested parties can follow news and developments from the meeting on social media using the hashtag #ISPORDC.


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