RWD Is Transforming Mental Health, Neurology Managed Care: Mitzi Wasik, PharmD

At last year’s Academy of Managed Care Pharmacy (AMCP) Nexus conference, the poster presentations underscored a pivotal transition in how the industry views mental health and neurology—moving beyond simple symptom management to a holistic evaluation of functional outcomes and economic burden. To delve into these findings, The American Journal of Managed Care® (AJMC®) spoke with Mitzi Wasik, PharmD, executive director at the AMCP Foundation, via email for insights on the recurring themes of the meeting.

Mitzi Wasik, PharmD, MBA, BCPS, FAMCP, FCCP, executive director of the AMCP Foundation and senior vice president of Practice Strategy and Innovation at AMCP | Image credit: AMCP

A primary takeaway was the crucial role of real-world data (RWD). Wasik highlighted how RWD is bridging the gap between clinical trials and real-world application, offering payers a clearer picture of the impact of long-acting injectables and the high costs of untreated comorbidities. However, the data also highlighted challenges, including systemic biases that continue to drive disparities in diagnosis and treatment for women and marginalized populations.

AJMC: What themes or trends in mental health and neurology stood out across the posters presented this year?

Wasik: There was a strong emphasis on real-world data/evidence to quantify the economic and clinical burden of mental health and neurological conditions, including schizophrenia, depression, Alzheimer’s, rare neurogenetic disorders, and migraine. Studies highlighted the high costs associated with comorbidities, hospitalizations, and suboptimal adherence. Real-world evidence is a crucial area in healthcare coverage, and further work is needed to effectively integrate its use into coverage decision-making.

Multiple posters showed that long-acting injectable antipsychotics and newer combination therapies improve adherence and reduce acute care utilization compared to oral agents. Long-acting agents offer many benefits to patients with mental health issues and continue to find coverage within benefit plans.

AJMC: Were there any findings that challenged current prior authorization, step therapy, or utilization management approaches?

Wasik: There was a focus on disparities in diagnosis, treatment, and outcomes—especially among women, low-SES populations, and Medicaid beneficiaries. Underdiagnosis and mismanagement due to systemic biases were highlighted, particularly in women’s neurological health.

Several studies demonstrated that restrictive utilization management (e.g., insurance denials for new therapies like cladribine in MS) led to higher relapse rates, increased costs, and worse outcomes. Although the posters highlighted this with certain medications, overall utilization management is a critical tool in managed care for managing costs and selecting appropriate therapy.
Evidence suggested that step therapy protocols requiring failure on older or less effective agents before accessing newer therapies may delay optimal care and increase downstream costs, especially in populations with complex or refractory disease. More research and criteria are needed in this area to determine how to effectively manage complex populations with diverse needs.


AJMC: What did this year’s posters add to what we know about the importance of timely diagnosis and treatment across disease states, including neurological and mental health conditions?

Wasik: Timely diagnosis of conditions like mild cognitive impairment (MCI) and Alzheimer’s disease was associated with lower initial and long-term costs, delayed institutionalization, and improved survival.

Underdiagnosis and mismanagement—especially in women and marginalized groups—were linked to worse outcomes and higher costs. Early intervention in mental health was shown to reduce preventable healthcare utilization.
Many posters reinforced the importance of following up-to-date clinical guidelines and integrating new evidence into practice to ensure patients receive the most effective therapies as early as possible.

AJMC: Can you speak to the importance of real-world data for both health care providers and payers?

Wasik: Real-world data (RWD) are increasingly critical for both providers and payers to assess the true impact of therapies outside of clinical trials. RWD informs formulary decisions, value-based contracting, and policy development. Clinical trial data have long been recognized as a limitation following the launch of a drug. As we learn how to integrate real-world data in a meaningful way, a better understanding of how drugs work in the real-world population will continue to evolve.

RWD helps identify gaps in care, disparities, and the real-world effectiveness and safety of interventions, supporting more patient-centered and equitable care.

Some payers are using RWD to evaluate outcomes-based agreements, monitor adherence, and assess long-term value across the product lifecycle, but this is limited currently. Most payers struggle with the application of RWD in day-to-day decisions. There is a need for better infrastructure and education to support the use of RWD in clinical and payer decision-making.

Wasik: AJMC: Do you anticipate shifts in how payers are thinking about value in behavioral health, beyond symptom control?

Wasik: There was a theme in the posters toward evaluating value beyond symptom reduction, including functional outcomes, quality of life, economic impact, and social determinants of health. Payers recognize the interconnectedness of behavioral and physical health and are interested in models that address both domains to improve the total cost of care and patient well-being.

Examples of value frameworks are expanding to include considerations of health equity, access, and the impact of social and environmental factors on behavioral health outcomes. This is a larger issue in how to utilize data overall to apply to value-based frameworks.

AJMC: What unmet needs remain in these areas based on findings presented at this year’s meeting?

Wasik: Gaps exist for women, low-income, and minority populations in both mental health and neurology, driven by underdiagnosis, mismanagement, and systemic barriers. Utilization management should be incorporated into decision-making processes; however, we need to continue to understand its optimal application to prevent delaying access to new, effective treatments for patients with complex or refractory conditions. The abstracts/posters that were presented all were very specific to individual drugs or disease states and often had smaller numbers of participants. We will continually need larger numbers and the assistance of new digital tools to help curate better decision-making tools for the health care industry.


AJMC: Which emerging evidence areas in behavioral health or neurology do you expect to shape payer decision-making most over the next few years?

Wasik: As payers demand more evidence of value, studies comparing real-world effectiveness, adherence, and cost outcomes across therapies will be increasingly influential.

Evidence quantifying the impact of social determinants and disparities on outcomes and costs will drive policy and benefit design changes. The adoption of digital tools for mental health and neurology (e.g., prescription digital therapeutics, remote monitoring) will generate new RWD and may shift payer perspectives on coverage and reimbursement.

Advances in biomarker-driven and individualized approaches in neurology and psychiatry will require new frameworks for value assessment and utilization management. Precision medicine, along with RWD, will allow payers to create deeper insights into coverage for certain medications, avoiding failure of other therapies first.