OBJECTIVES: To identify future evidence pricing and access challenges, and solutions for overcoming these, highlighting the systemic, stakeholder, and organizational changes required.

METHODS: Using the ISPOR top 10 HEOR trends 2022/3 as catalyst, a 2-cycle delphi approach based on broad expert payer and physician opinion (n=41) was used to determine the key evidence pricing and access challenges expected over the period 2023-30.

Scope covered complete lifecycle pathway, evolution of digital health and genomic insight, and consideration of value attribution.

Cluster analysis was used to structure the output. For each cluster, solutions to overcoming the challenges were identified.

RESULTS: The research identified:

• 10 “challenge clusters”: Affordability, Evidence, Assessment, Pricing, Differentiation, Sequencing, Personalization, Value Attribution, Portfolio Optimization, Pace of change.
• Actions which would help overcome evidence availability, accessibility, and acceptability challenges.
• Innovative and collaborative approaches to evidence creation and pricing to overcome access challenges.
• 13 barriers that will need to be addressed to enable personalized (digital and genomic) healthcare to reach its full potential in providing improved economic, clinical and humanistic outcomes. These included: policy and priorities, funding and access, physician behavior, patient preference, delays in updating treatment guidelines, delays in Health Technology Assessments and their implementation, and time lag in adopting technology.

CONCLUSIONS: To overcome challenges, changes will be required in 5 areas:

1. Systemic changes (Information Technology (IT) Systems, Regulatory and Health Technology Assessment Systems, Coding Payment and Funding Systems, Ethical and Legal Systems}
2. Stakeholder changes (Physicians, Patients, Payers, Manufacturers)
3. Organizational changes (Commercial, Evidence Development (R&D and HEOR), Market Access, Market/Business insight)
4. Strategic collaboration between manufacturers and data providers to access data
5. Integration of data from multiple sources (Prescription data, Electronic medical records (EMRs), Health resource utilization (HRU), Claims data, Real-time / wearable data, Social media data)