Study- Real-World Evidence has Limited Use in Managed Care Formulary Decision Making

Published Apr 3, 2018

Value in Health Report Examines Payers’ Perceptions, Practices

Lawrenceville, NJ, USA—April 3, 2018—Value in Health, the official journal of ISPOR (the professional society for health economics and outcomes research), announced today the publication of new research suggesting that while payers recognize the value of real-world evidence (RWE), the use of such studies to inform pharmacy and therapeutic (P&T) committee decisions is limited. The report of these findings, Real-World Evidence: Useful in the Real World of US Payer Decision Making? How? When? And What Studies?, was published in the March 2018 issue of Value in Health. The authors from the University of Arizona and the National Pharmaceutical Council invited pharmacists and physicians employed by managed care organizations, pharmacy benefit managers, healthcare systems, and government agencies to participate in a two-phase investigation: 1) an online survey that evaluated the potential use of sample RWE studies published in top-tier journals in payer decision making, and 2) focus groups or telephone interviews on attitudes and use of RWE in general. When asked whether observational studies play a role in their organization’s medication use policies, participants responded 11% “almost never,” 79% “sometimes,” 5% “often,” and 5% “almost always.” Responses further showed that while nearly all participants indicated that RWE is useful for monitoring safety, conducting utilization management, and examining costs, it is less likely to be considered in P&T decision making. Key concerns with the use of RWE in payer decision making include relevance to payers, timeliness, and transparency of methods. Specifically, timeliness of study results was rated as one of the greatest personal and organizational barriers to using RWE. Most health plans have compressed evaluation periods because of the 90-day review mandated for Medicare Part D and Medicare Advantage programs, but RWE studies are typically generated after product launch and after decisions for coverage and reimbursement have already been made. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations. “Heretofore, little has been known about how managed care organizations use real-world evidence in their formulary, utilization management, drug monographs, and other decision-making processes,” said lead author Daniel Malone, PhD, University of Arizona, Tucson, AZ, USA. “This study provides new insight that can be used to improve both the quantity and quality of real-world evidence as it is applied to the healthcare decision making process.”


  ABOUT ISPOR ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE®-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field. Web: | LinkedIn: | Twitter: (@ISPORorg) | YouTube: | Facebook: | Instagram:   ABOUT VALUE IN HEALTH Value in Health (ISSN 1098-3015) is an international, indexed journal that publishes original research and health policy articles that advance the field of health economics and outcomes research to help healthcare leaders make evidence-based decisions. The journal’s 2016 impact factor score is 4.235. Value in Health is ranked 3rd out of 77 journals in health policy and services, 7th out of 347 journals in economics, and 9th out of 90 journals in healthcare sciences and services. Value in Health is a monthly publication that circulates to more than 10,000 readers around the world. Web: | Twitter: (@ISPORjournals)    

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