Why Most RWE Fails Payer Scrutiny (and What Actually Passes)
Why Most RWE Fails Payer Scrutiny (and What Actually Passes) Real-world evidence is no longer optional in market access discussions. Payers expect it. HTA bodies ask for it. Internal teams invest heavily in generating it. And yet, a quiet reality persists: most RWE never meaningfully influences payer decisions. It isn’t rejected outright. It’s acknowledged, parked, and ultimately sidelined. The issue isn’t skepticism toward real-world data. It’s relevant. Too much RWE is built to demonstrate analytical effort rather than to reduce payer uncertainty at the moment a decision is made. Where RWE Goes Wrong The most common failure is simple: RWE answers the wrong question. Many studies focus on describing disease burden, mapping treatment pathways, or validating findings from clinical trials. While useful context, these insights rarely help a payer decide whether to reimburse, restrict, reassess, or expand coverage. Payers are not asking whether a therapy works in theory. They...