Payers for Most Part Wary of Real World Evidence

But some are coming around. That was one of the messages delivered yesterday in Philadelphia at a conference hosted by EyeforPharma, a worldwide company that seeks to keep the pharmaceutical industry relevant by tracking shifting trends. The title of the conference “Real World Evidence & Market Access Summit 2016” bows to today’s hot topic. Put simply, real world evidence (RWE) and post-market surveillance looks at how well new medications do after they’ve hit the market.

Not so good, according to Shalilja Dixit, one of the presenters at the conference. Dixit, who tracks health outcomes for Intercept, said that 49% of drugs do not have the same impact on outcomes that they had in the clinical trial stage. “The time is right for real world evidence to make that 60% to 70%,” Dixit said. “Rising health care costs are not acceptable, especially when outcomes don’t impress.”

Maybe that will impress health plans. Maybe not. David Thompson and Keith Kelly, of InVentiv Health, said that the days of getting effective data from a database are over. The trick is to engage stakeholders through every stage of gathering RWE, from research to design to implementation. “Stakeholder engagement can’t be done in a one-and-done fashion,” said Kelly. “You can’t just say, ‘The answer is E.’”

 Thompson said that, “Treatment patterns and adherence, that’s where real world evidence really shines.” In some clinical areas, such as diabetes, REW has been a “game-changer.”

But not so much of a game-changer that health plans are ready to jump in with both feet. “Payers have a pessimistic view that real world evidence can help them,” Kelly said. “Payers have indicated that the most important benefit of real world evidence for them is better understanding of the cost implications.”

Often payers will question whether RWE is reflective of their particular population. They also question whether RWE captures everything that’s happening with a patient. There are reasons other than therapeutic effectiveness that some medications don’t work (ie. lack of adherence).

That said, some health plans are indeed starting to use RWE. Kelly mentioned Geisinger Health Plan in particular as having a keen interest, as has the Veterans Affairs health care system. Integrated model insurance plans, such as Geisinger and Kaiser Permanente, should be fertile breeding grounds for RWE in the future.

Frank Diamond

Managing Editor

Managed Care magazine