Evolving Payer Preferences for Health Economic Information and Communication in the US
Author(s)
Calum Jones, BA, MSc1, Nicole Lodowski, BS, MPH2, Sreeranjani Menon, PhD2, Anthony Bentley, MSc1, Manish Chauhan, MSc1, Sophie Streeton, PhD1.
1Petauri, Bicester, United Kingdom, 2Petauri, Nashville, TN, USA.
1Petauri, Bicester, United Kingdom, 2Petauri, Nashville, TN, USA.
OBJECTIVES: Our previous research has demonstrated that payers have a low level of trust in manufacturer-provided health economic models. However, payers have acknowledged the ongoing need and utility for this type of information exchange to support formulary decision-making in the US. The objective of this primary research study was to gain insights into US payer preferences and evolving needs for manufacturer-provided health economic models.
METHODS: Experienced stakeholders from US payer organisations were recruited to participate in an online quantitative and qualitative primary research survey in March 2025, consisting of 53 questions. Descriptive statistics and contextual analyses of the results were conducted.
RESULTS: The survey included 18 participants, including 4 medical directors, 11 pharmacy directors, and 3 industry/trade relations, representing national and regional managed care organisations (MCOs), pharmacy benefit managers (PBMs), and integrated delivery networks (IDNs). The majority of participants (61%) had low trust in manufacturer-developed health economic models, with lack of transparency being the most significant driver. Only 6% of participants frequently use manufacturer-provided models, with the two most common reasons being to validate their institution’s model (37%) and to support inputs/assumptions of their institution’s model (32%). Budget impact models were perceived as the most valuable type of economic model. Most respondents (89%) believed transparency around data inputs is very to extremely important for building trust towards economic models. 2-3 years was noted as the preferred time horizon for economic models by most respondents (72%). Peer reviewed (37%) or virtual presentation/webinar (26%) were preferred channels of receiving and reviewing economic models.
CONCLUSIONS: As the access and payer landscape continues to evolve in the US, with increased focus on the economics of healthcare, manufacturers must reframe their approach to engage with payer customers around healthcare economic information in both a transparent and commercially relevant way.
METHODS: Experienced stakeholders from US payer organisations were recruited to participate in an online quantitative and qualitative primary research survey in March 2025, consisting of 53 questions. Descriptive statistics and contextual analyses of the results were conducted.
RESULTS: The survey included 18 participants, including 4 medical directors, 11 pharmacy directors, and 3 industry/trade relations, representing national and regional managed care organisations (MCOs), pharmacy benefit managers (PBMs), and integrated delivery networks (IDNs). The majority of participants (61%) had low trust in manufacturer-developed health economic models, with lack of transparency being the most significant driver. Only 6% of participants frequently use manufacturer-provided models, with the two most common reasons being to validate their institution’s model (37%) and to support inputs/assumptions of their institution’s model (32%). Budget impact models were perceived as the most valuable type of economic model. Most respondents (89%) believed transparency around data inputs is very to extremely important for building trust towards economic models. 2-3 years was noted as the preferred time horizon for economic models by most respondents (72%). Peer reviewed (37%) or virtual presentation/webinar (26%) were preferred channels of receiving and reviewing economic models.
CONCLUSIONS: As the access and payer landscape continues to evolve in the US, with increased focus on the economics of healthcare, manufacturers must reframe their approach to engage with payer customers around healthcare economic information in both a transparent and commercially relevant way.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE450
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas