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The Participant-Reported Implementation Update and Score (PRIUS): A Novel Method for Capturing Implementation-Related Data Over Time

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Patient experience data in formulary decision-making: Payer-reported perceptions and use.

Steven Kheloussi¹, Iyar Mazar², Magdalena Harrington²

¹Kheloussi Consulting, LLC, Wilkes-Barre, PA.

Journal of Managed Care & Specialty Pharmacy

|May 29, 2026

Summary

This summary is machine-generated.

Payer decision-makers have varying understanding and use of patient experience data (PED). Barriers like subjectivity and lack of scientific validity limit PED integration into formulary decisions, necessitating further education on its value and collection methods.

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Area of Science:

Health Economics and Outcomes Research
Health Policy and Management

Background:

Patient experience data (PED) provide insights into patient experiences with diseases.
Limited data exist on payer perspectives and PED use in formulary decision-making beyond patient-reported outcomes.

Purpose of the Study:

To assess payer decision-maker familiarity with PED.
To understand payer perspectives on using PED in formulary development and benefit design.

Main Methods:

Conducted informal interviews with payer decision-makers to inform survey development.
Administered an online survey to a broader population of payer decision-makers regarding PED familiarity, use, and barriers.

Main Results:

Payer understanding of PED varies, with some citing non-PED sources as PED.
Most organizations consider PED of low to medium importance.
PED is infrequently incorporated into formulary decision-making due to perceived subjectivity, lack of scientific validity, and absence of standardized measures.

Conclusions:

Payer understanding and valuation of PED are inconsistent, hindering its meaningful use in decision-making.
Perceived barriers significantly impact the uptake of PED.
Enhanced training on the scientific merit and rigorous collection methods of PED is required.