Advancing the integration of patient-centered evidence into payer decision-making
May 2026 | Written by Sarah Daughtery, PhD, MPH
A recent Centers for Medicare & Medicaid Services (CMS) policy requiring patient representation on Pharmacy and Therapeutics (P&T) Committees is accelerating a meaningful shift in how payer decisions are informed. For life sciences organizations, this evolution reinforces a growing expectation: evidence must reflect outcomes that matter to patients and be relevant to real-world decision-making. Carelon Research is navigating this shift by building stakeholder consensus on how to advance the integration of patient-centered comparative effectiveness research (CER) into payer processes and helping clients develop evidence that is both scientifically rigorous and aligned to the needs of patients and payers alike.
With funding from the Patient-Centered Outcomes Research Institute (PCORI*), Carelon Research convened a 2025 workshop series and invited public and private payers, researchers, patient advocates, and other healthcare leaders to explore how patient-centered CER can be more consistently and effectively incorporated into payer decision-making. The discussions focused on opportunities to strengthen the use of patient-centered evidence, enhance stakeholder alignment, and support more transparent and collaborative approaches across the healthcare ecosystem. This work reflects Carelon Research’s broader commitment to advancing patient-centered research by fostering practical, cross-sector dialogue that informs both evidence generation and application.
Insights from the workshop series have been synthesized into a set of resources designed to support continued progress, including a high-level summary of key workshop themes, and a comprehensive project report outlining a roadmap for collective action. Together, these materials provide life sciences organizations and other stakeholders with a clear view of what unmet needs, if addressed, could advance the integration of patient-centered evidence into payer decision-making and help align research strategies to meet emerging expectations.
Workshop summaries
*PCORI is an independent, nonprofit organization authorized by Congress with a mission to fund patient-centered comparative clinical effectiveness research that provides patients, their caregivers and clinicians with the evidence-based information they need to make better informed health and health care decisions