Presentation (CTI)

OBJECTIVES: Payers are currently piloting AI for their operations and expect increased integration as capabilities mature and use cases are validated. This research aims to identify payer expectations and policies for drug manufacturer use of AI and to capture implications for manufacturers on how to optimize their engagements with payers in an AI-driven environment.
METHODS: A qualitative, web-based survey was fielded via the Rapid Payer Response^TM online portal (RPR^®) to 14 current US payers, including pharmacy directors (PDs) and medical directors (MDs) from commercial managed care organizations, PDs and MDs from Medicaid managed care and Medicare Advantage plans, pharmacy benefit managers (PBMs), and integrated delivery network payers (IDNs).
RESULTS: Payers have observed AI being increasingly leveraged by drug manufacturers for value dossiers, economic models, real-world evidence (RWE), literature reviews, patient support, and adherence insights. Only 2/14 payers (14%) already have formal written policies guiding how manufacturers may use AI in their submissions. 5/14 payers (36%) are developing policies, and the remainder (7/14; 50%) do not have policies and don’t anticipate creating any. Manufacturer use of AI is deemed not acceptable for data extrapolation, making clinical conclusions, or other sensitive areas requiring human oversight. Overall, payers rate manufacturers as only slightly to moderately prepared to support future payer needs in an AI-driven environment. Manufacturers are perceived to face similar challenges as payers themselves, including a steep learning curve, time-consuming development, and lack of transparency and validation.
CONCLUSIONS: Payers report expanding AI use by payers and manufacturers, but with few formal policies in place to govern AI development and deployment. Given the rise of AI-driven payer processes, recommendations for manufacturers include leveraging AI insights and tools where appropriate, self-testing payer strategies with AI before submitting, being transparent about how AI is used, and forming partnerships with payers on potential AI-driven collaborations such as patient management/adherence programs.