Contributed Commentary by Jason Dong, Mural Health 

September 22, 2023 | The clinical trial landscape has a long-acknowledged problem – a lack of participant diversity. Most clinical trial participants are from higher-income households, white and male. The FDA has said ensuring people from diverse backgrounds join clinical trials is key to advancing health equity. Yet too often clinical tech lags consumer expectations and clinical trial participants are left out of pocket. 

The Challenge  

There are two main paths in clinical trial payment. The first is reimbursement for out-of-pocket costs, for example, travel to and away from the clinic. The second is stipends for their participation. Both these pathways mean patients have to sometimes bear a financial burden. 

10% of Americans do not have any savings at all and a further 13% have less than $100 in their savings account. Overall, half of all Americans have less than $5,000 in savings. It is almost impossible to recruit and retain these people for clinical trial participation when they are being asked to pay fees or facing long delays for reimbursement. 

This has always been a problem, and the industry has long talked about patient centricity, but the pandemic and increase in decentralized trials is finally forcing us to be more proactive in adopting new solutions. 

For example, prepaid debit cards are often used in clinical trials. However, we see these cards as a barrier because they come with fees for participants and place a logistical burden on site staff to manage and distribute physical cards. As a result, we are working to drive wider adoption of fee-free digital solutions. 

The Solutions 

The impracticalities of past payment solutions are now acting as a catalyst for fully digital, patient-friendly solutions. For example, travel can be paid directly by participant management platforms and digitization allows instantaneous stipend payments and faster study startup.  

Digital solutions also offer the opportunity to better serve underrepresented groups. For example, apps can offer translations and accessibility features. A lot of pharma companies now have explicit requirements to include measures which will drive patient diversity. 

However, there is still work to be done. Currently clinical participants are taxed if they get up to $600 in their stipend. This does not represent a big tax benefit for the government but is a huge barrier for patients and disproportionately affects low-income patients. 

Risk Averse or Just Slow? 

Traditionally, the life-science sector has been slow to adopt new tech. In some ways this makes sense, we are a risk-averse industry. But we need to consider why we are being risk averse and if it is preventing the adoption of solutions which will improve the life of patients.  

Clinical tech often lags what consumers are using. Right now, you and I are using payment solutions like Venmo or PayPal and communicating via faster messaging apps than sites use to communicate with patients. We have an impetus to bring patient experience up to the same level as people experience in their home lives and modernize clinical trials. 

This requires work on the part of sponsors and CROS. The industry needs to consider if it is moving slowly because it is best for the trial or because it is the easiest thing to do. We need to identify select places where more risk is acceptable for the adoption of new solutions which will improve patient experience. 

The Future 

Patients must be given much more freedom for how they want to be reimbursed, and the industry must adopt fee-free methods which are easy for both participants and sites to use.  

The old patient payment solutions are not good for business in the long run because they are a barrier to participation. Too much tech is still sitting in the 2000s, we need to innovate and bring participant payment into the 2020s to remove recruitment and retention barriers. 

Adopting these patient-centric approaches is good for sponsor reputation, good for trial success rates and ultimately good for the bottom line and everybody in the clinical trial system, including participants. 

While adoption is still on a trial-by-trial basis, pharmaceutical companies are increasingly recognizing the benefits of patient-centricity and moving away from outdated fees, prepaid cards, and checks to new innovative digital solutions. 

 
Jason co-founded Mural Health with the goal of using technology to elevate patient experience in clinical trials. When Jason was an investor in pharma technology businesses at Advent International, he had an off-the-cuff conversation with co-founder Sam Whitaker about what it would look like to modernize the patient experience. That conversation snowballed, and over the course of the next year, Mural Health was founded. Jason is excited to bring his experience and insights in building a world class organization at Mural Health. Jason grew up in New Zealand and came to the US to attend Harvard. Previously, he was a management consultant at McKinsey & Co. He can be reached at jason@muralhealth.com.