Real world evidence (RWE) and market access in the US

17 June 2020

Randomized control trials demonstrate drug safety and efficacy and hence are fundamental for regulatory approval. However, real world data (RWD) becomes a progressively more important source of evidence as we move across the development continuum of a drug. RWD can be potentially useful for obtaining regulatory approval as well. Communicating the value of a health technology is critical for supporting the market access of a drug. Favourable comparative clinical profiles and cost effectiveness can influence the position of a drug in the formulary of a payer.

The 21st Century Cures Act (Section 3037) amended the US FDA Modernization Act 114, directing real world evidence (RWE) utilization to support recommendation of a new indication for an approved drug. This allowed manufacturers to communicate wider scope of a product’s value such as comparative patient reported outcome data. The change broadened the audience covered and helped to expedite market access. The FDA has also acknowledged the importance of RWE for closing evidence gaps while making healthcare decisions. Avelumab was granted accelerated approval due to supportive data from an observational study that described poor outcomes in Merkel Cell carcinoma patients treated by cytotoxic chemotherapies.


Real World Evidence obtained during pre and post phases of drug development provides an opportunity to accelerate market access and facilitate quicker approvals. RWE can be potentially utilized by regulatory authorities to close the evidence gap associated with real-world effectiveness.