AMCP’s guidance translates CMS’s expectations for patient centered, evidence informed formulary decisions into practical steps payers can act on today without adding unnecessary burden to P&T workflows.
AMCP Real-world Evidence Standards to Support Payer Decision-Making
Payers value real-world evidence (RWE) that shows how drugs and other treatments impact their members’ outcomes and costs in the real world. However, they do not regularly use RWE in their decision-making because of a lack of standards that help them understand how to use the information. As part of a multi-year RWE initiative, AMCP Research Institute partnered with IQVIA, payers, pharmaceutical companies, and others to design payer-focused RWE standards. These standards include (1) a framework that outlines what RWE study types and endpoints might be available to support their decisions and (2) a checklist of payer-focused criteria that will serve as a template for pharmaceutical companies to use in sharing RWE with payer decision-makers.
AMCP RWE standards were published in JMCP in September, 2025 and they support payer decision-making based on RWE by specifying the information most relevant to them for coverage, formulary, and reimbursement decisions. In addition, the standards provide pharmaceutical companies and other researchers with a tool to inform RWE study design and a guide for communicating their results to payers to include in their decision-making process.
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