Pharmacists Leading the Charge in Real-World Evidence–Driven Contracting: Clayton Irvine, PharmD, MBA, MS

At a recent Institute for Value-Based Medicine® event, Clayton Irvine, PharmD, MBA, MS, emphasized that pharmacists can play a pivotal role in fostering payer–provider collaboration for value-based contracts and indication-specific reimbursement models. Irvine, senior manager of oncology cancer care at the Mayo Clinic in Rochester, Minnesota, highlighted pharmacists’ influence in formulary development, protocol design, and clinical pathway creation, as well as in translating cost-effectiveness models into actionable decisions that reduce downstream impacts.

Irvine underscored the need for standardized drug utilization reviews and encouraged direct pharmacist involvement with payers and contracting teams, particularly through pilot programs targeting specific disease states or indications. Leveraging real-world evidence to guide payer discussions, he noted, can help overcome initial resistance to innovative care models. As value-based care gains prominence, Irvine stressed that pharmacists must expand their leadership in these initiatives to ensure optimal patient outcomes and sustainable care delivery.

This is the fourth video in a series with Irvine.

This transcript was lightly edited; captions were auto-generated.

Transcript

In your experience, what role can pharmacists play in shaping payer-provider collaboration around value-based contracts or indication-specific reimbursement models?

I think pharmacists can play a really big role. It's a huge broad bucket, but I think we're already seeing pharmacists do that each and every day. Pharmacists play a critical role in helping to shape formulary decisions, drive protocols, treatment plans, and build out those clinical pathways. But also looking at cost-effectiveness models, I can't highlight [enough] the importance of making sure that cost-effectiveness models are translated into making some of those decisions that drive those downstream impacts.

I think that ensuring that we have a standard for doing drug utilization reviews, and what do those look like at your institution? We need to make sure that we're conducting those. We need to make sure that we're being good stewards from that regard.

I think it's also important to consider having pharmacists, or a group of pharmacists, work with payers or work with your contracting teams as a pharmacy representative, to really partner with pilot programs, especially when we're talking about a specific disease state, even down to a specific indication. Can we look at real-world evidence? Can we use real-world evidence and data to help further support decisions that are ultimately the best option for the patient?

I also think that when we are able to partner with payers and conduct pilot programs or pilot projects, that then we can go back to the payers and we can show something that maybe initially we were getting push back for or wasn't as universally accepted—that's one way that we can start to change that narrative. There are pharmacists that are doing that today. There are pharmacists in those roles. I think it's an evolving landscape. I think that we as pharmacists are already doing a lot of this work, but I think that there's a lot more that we can do, and as we start to see this shift toward value-based care, I think it's going to be something that we as pharmacists have to prioritize even more so than how it’s being prioritized today.