RESEARCH 1096
JMCP.org | August 2021 | Vol. 27, No. 8
Payer perceptions of the use of real-world
evidence in oncology-based decision making
Diana Brixner, PhD, RPh; Joseph Biskupiak, PhD, MBA; Gary Oderda, PharmD, MPH;
Douglas Burgoyne, PharmD, FAMCP; Daniel C Malone, RPh, PhD, FAMCP;
Bhakti Arondekar, PhD, MBA; and Alexander Niyazov, PharmD, RPh, MPH
ABSTRACT
BACKGROUND: Randomized controlled trials
(RCTs), the gold standard of safety and effica-
cy evidence, are conducted in select patients
that may not mirror real-world populations.
As a result, healthcare decision makers
may have limited information when making
formulary decisions, especially in oncology,
given accelerated regulatory approvals and
niche patient populations. Real-world evi-
dence (RWE) studies may help address these
knowledge gaps and help inform oncology
formulary decision making.
OBJECTIVE: To assess US payer perceptions
regarding the use and relevance of RWE
in informing oncology formulary decision-
making.
METHODS: A national survey containing
single-answer, multiple-answer, and free-
response questions evaluated 4 key areas:
(1) the value of RWE, (2) barriers to RWE,
(3) sources of RWE, and (4) use of RWE in
outcomes-based contracting. The survey was
distributed to 221 US payers through the
Academy of Managed Care Pharmacy (AMCP)
Market Insights program in February 2020.
Ten additional respondents were invited to
discuss the survey results. The survey results
were presented primarily as frequencies
of responses and were evaluated by the
respondent’s plan size, type, and geography
(regional vs national). Differences in respons-
es for categorical data were compared using
a Pearson Chi-Square or a Fisher’s Exact test.
What is already known
about this subject
• Payers use real-world data in decision
making.
• How real-world evidence (RWE) is
used depends on the available data
and therapeutic area.
What this study adds
• Payers acknowledge RWE on innovative
oncology products pre launch is limited,
highlighting a need for more early
communication with manufacturers
under preapproval information
exchange (PIE) rules.
• The types of RWE valued by payers both
before and after launch included total
cost of care, burden of illness, treatment
patterns, subpopulations, adverse event
profiles, off-label usage, and economic
data for possible use in contracting.
• Payers appeared to be more engaged
in conducting their own evaluations
of RWE for oncology products than
previously.
• The primary source of RWE data
continues to be administrative claims,
but many organizations are turning to
electronic health records.
• Payers’ interest in outcome-based
contracting was high, despite the
challenges to conducting these
arrangements.
Author affiliations
Diana Brixner, PhD, RPh; Joseph Biskupiak,
PhD, MBA; Gary Oderda, PharmD, MPH;
Douglas Burgoyne, PharmD, FAMCP;
and Daniel C Malone, RPh, PhD, FAMCP,
University of Utah, College of Pharmacy,
Salt Lake City. Bhakti Arondekar, PhD, MBA,
and Alexander Niyazov, PharmD, RPh, MPH,
Pfizer, Inc.
AUTHOR CORRESPONDENCE:
Diana Brixner, 801.581.3182;
Diana.Brixner@utah.edu
J Manag Care Spec Pharm.
2021;27(8):1096-105
Copyright © 2021, Academy of Managed
Care Pharmacy. All rights reserved.