Evidence Supply and Demand: A Framework for Closing Gaps between Researchers and Payers

With growing efforts and investments by stakeholders to tap into Big Data, the evidence available to inform payer decision-making, including real-world evidence, may be more plentiful than ever before. But is the evidence that the research community generates what payers view as useful? How can we align the research payers need with the research developed?

With growing efforts and investments by stakeholders to tap into Big Data, the evidence available to inform payer decision-making, including real-world evidence, may be more plentiful than ever before. But is the evidence that the research community generates what payers view as useful? How can we align the research payers need with the research developed?

A paper published in the September issue of The American Journal of Managed Care introduces a framework developed by researchers at the National Pharmaceutical Council (NPC) and AcademyHealth that could help harmonize research with decision-maker priorities. Authors tested the framework with payers by asking them to apply it to three payer decisions, including whether to cover a new treatment, how to update treatment decisions for a class of medications with many new alternatives, and if limits should be put in place for a treatment with safety concerns. 

In an interview, Jennifer Graff, PharmD, NPC’s vice president for comparative effectiveness research, explains the framework and what authors found. 

Dr. Graff highlights four key findings:

  • Distinctive Evidence: Payers don’t often want more evidence for specific outcomes, they want evidence that clearly defines the differences between treatments.
  • Timely Evidence: Payers want evidence in a timely manner. Because it is difficult to make changes when a care pathway is firmly established and clinical practice guidelines are in use, new evidence is most valuable when the basis for a treatment is still uncertain.
  • Broader Outcomes Evidence: Information from registrational trials, such as those used by the Food and Drug Administration, often don’t account for outcomes that matter to payers. Payers often look for data that reflects factors like total cost of care, long-term safety and data among subpopulations. 
  • Quality Real-World Evidence: High-quality real-world evidence fits several payer needs to guide their decisions. Real-world evidence can provide the right information at the right points in time.

As efforts continue in the U.S. to improve the volume and quality of evidence, applying a framework may help payers more readily apply evidence to coverage or formulary decisions and, ultimately, support wise clinical use of treatments. Read more.