How to structure a payer engagement deck: What NICE reviewers actually need to see

Most payer engagement decks fail before the first question is asked. Not because the clinical data is weak. Not because the evidence base is incomplete. But because the deck was built to impress — not to inform a decision.

In my work with pharma clients across the UK and UAE, I see the same pattern repeatedly: a team with strong clinical evidence, a genuinely differentiated therapy, and a payer submission deck that buries the signal in 60 slides of background. The data is all there. The story is not.

This matters because NICE and equivalent payer bodies — whether the Scottish Medicines Consortium (SMC), the All Wales Medicines Strategy Group (AWMSG), or GCC national formulary committees — are evaluating dozens of submissions at any given time. The deck that earns a decision is the one that makes the reviewer's job easier, not harder. That requires a very specific kind of discipline in how you structure, frame, and visualise your evidence.

KEY INSIGHT

"Payer reviewers are not reading your deck to understand your science. They are reading it to make a funding decision. Those are not the same thing — and the distinction should shape every slide you build."

— Vaidehi Shukla, Principal Life Sciences & Market Research, A1 Slides

1.0 Understanding what a NICE reviewer is actually evaluating

Before discussing deck structure, it is important to reframe how most pharma teams think about payer submissions. The clinical evidence review — efficacy, safety, comparative effectiveness — is the foundation. But NICE, like most HTA bodies, is ultimately making a value judgement: is the clinical benefit proportionate to the cost, and is it sufficient to justify a funding recommendation within the NHS context?

This means your deck has to speak two languages simultaneously. It needs to satisfy the clinical scientist reviewing your trial data. And it needs to give the health economist and the committee clear, unambiguous answers to the following:

• What is the unmet need — and how significant is it within the NHS patient population?
• What is the incremental clinical benefit — over the existing standard of care, in the specific patient group NICE is reviewing?
• What is the cost-effectiveness evidence — and does the ICER (Incremental Cost-Effectiveness Ratio) fall within NICE's accepted threshold range?
• What are the real-world implementation considerations — patient identification, prescribing pathway, monitoring requirements?
• What is the proposed patient access scheme or commercial offer, if applicable?

A submission deck that answers these five questions — clearly, in sequence, with supporting evidence — is a deck that works. One that leads with 20 slides of disease background before getting to the point does not.

COMMON STRUCTURAL MISTAKES IN PAYER DECKS

• Leading with Phase I/II safety data before establishing unmet need and treatment landscape
• Presenting primary trial endpoints without contextualising them against the comparator NICE has specified
• Using clinical terminology (hazard ratios, p-values) without translating them into decision-relevant language
• Burying the cost-effectiveness model summary deep in an appendix
• Including the same data slide in multiple formats (forest plot, bar chart, table) without adding new information — this creates visual noise, not evidence
• Failing to address the indirect comparison methodology when a head-to-head trial was not available

2.0 The structural framework that works

Based on experience working with pharma teams preparing NICE submissions, TA appeals, and early scientific advice meetings, the following structure consistently outperforms alternatives.

It is built on one core principle: every section should answer a question that the reviewer has — not showcase information the manufacturer wants to present.

Ten sections. A submission deck with strong design discipline can cover all ten in 25–35 slides, leaving room for questions and discussion. A deck that sprawls to 70 slides without this structure typically covers the same ground — but makes the reviewer do the work of organising it.

3.0 The visualisation decisions that matter most

Clinical data visualisation in a payer context is a different discipline from clinical publication design. The journal article is for scientific peers who will read every detail. The payer submission slide is for a committee that may spend six minutes on your clinical evidence section.

This shapes every visualisation decision.

3.1 Survival and time-to-event curves

Kaplan-Meier curves are standard in oncology submissions. The mistake most teams make is presenting the raw curve without contextualising the numbers that matter to the reviewer: median overall survival, hazard ratio with confidence interval, and crucially — what the separation between curves looks like at the time points that matter for the NHS.

A survival curve that shows a meaningful early separation, but whose curves converge at 24 months, tells a different value story from one where separation is maintained. Make that visible. Do not leave the reviewer to interpret it.

3.2 Forest plots in indirect comparisons

Forest plots are widely used in NMA outputs. They are also widely misread by non-statistician committee members. If your submission relies on an indirect comparison, include a plain-language interpretation slide alongside the forest plot — not instead of it, but alongside it.

State clearly which comparisons favour your therapy, which are neutral, and which show uncertainty. Reviewers are not looking for perfection — they are looking for transparency.

3.3 Cost-effectiveness planes and ICER visualisation

The cost-effectiveness plane is a standard HTA visualisation, but it is routinely under-labelled in submission decks. Mark the NICE threshold lines (£20,000 and £30,000 per QALY) explicitly. Show where your base case ICER falls. Show the probabilistic spread. If your model shows ICER sensitivity to a particular assumption, make that visible rather than relegating it to an appendix table.

DESIGN PRINCIPLE: The reviewer's interpretation should not require effort

For every chart in your payer deck, ask: if a reviewer spent 30 seconds on this slide, would they know the right answer to the question this slide is supposed to answer? If not, the slide needs redesign — not more data, but better structure and labelling.

4.0 Geographic considerations: UK NICE versus GCC formulary submissions

For pharma teams operating across multiple markets, it is worth noting the structural differences between a NICE submission deck and a GCC formulary dossier — as the decision frameworks are meaningfully different.

The practical implication: a deck built for a NICE submission cannot simply be reformatted for a GCC submission. The decision lens is different, the comparator landscape is different, and the real-world evidence base is different. Teams operating across both markets need two distinct narrative structures — even if the underlying clinical data is the same.

5.0 Five things payer decks consistently get wrong

Across submissions I have reviewed and supported, five failure patterns appear with enough regularity to be worth naming directly.

• 1. The patient population is defined too broadly. Manufacturers want maximum patient scope. NICE committees want precision. A broad label claim with weak evidence at the margins creates more scrutiny, not less. Define the population where your evidence is strongest — and be explicit about it.
• 2. The comparator is not the one NICE will use. If NICE has specified a comparator in the scoping document, your deck needs to be built around it. Using a different comparator — even one where your data looks more favourable — signals either a misunderstanding of the process or a deliberate attempt to avoid an unflattering comparison. Both outcomes are problematic.
• 3. Health economic uncertainty is understated. NICE reviewers are experienced with economic models. They will identify where assumptions are optimistic. A deck that presents a single base-case ICER without clearly communicating sensitivity — and without honestly addressing the scenarios where the model is less favourable — loses credibility at the committee stage.
• 4. Quality of life outcomes are underdeveloped. QALYs are the currency of NICE decisions. Yet many submission decks present HRQoL data as an afterthought — a single slide with EQ-5D scores and no narrative. If your therapy has a meaningful impact on patient quality of life, that story needs to be built deliberately, with the right instruments, in the right patient population.
• 5. The implementation section is missing entirely. What happens after NICE recommends? How do clinicians identify eligible patients? What is the prescribing setting? What monitoring is required? Committees increasingly want to see that a manufacturer has thought about implementation — not just approval. Its absence is noticed.

6.0 Strategic imperatives for teams preparing payer submissions

Drawing together the patterns above, teams preparing for NICE submissions — or parallel GCC formulary reviews — should consider the following:

• Start with the decision, not the data. Build your deck narrative backwards from the recommendation you are seeking. Every slide should be traceable to one of the five questions in Section 1.0.
• Separate your evidence pack from your submission deck. The full clinical study reports, economic model outputs, and supporting analyses belong in the technical appendices. The submission deck is the curated narrative that guides the committee through the evidence — not a repository of all of it.
• Brief your design team on context, not just content. A presentation designer working on a payer deck needs to understand what ICER thresholds mean, why the comparator choice matters, and what a forest plot is communicating. Without that context, they will make layout decisions that undermine the clinical message.
• Test your deck against the appraisal matrix. Before finalising, map each section of your deck against NICE’s published decision criteria. If any criterion is not clearly addressed within the first 25 slides, restructure before submission.
• Localise for each market. As outlined in Section 4.0, a UK NICE deck and a GCC formulary submission require different narrative structures. Build market-specific versions rather than adapting a single global deck.

BOTTOM LINE

• A payer engagement deck is not a clinical dossier in presentation format. It is a structured argument for a funding decision, built on clinical and health economic evidence. The teams that succeed at NICE are the ones whose decks make that argument clearly — without requiring the committee to do the interpretive work themselves.

Conclusion

Payer decision-making is a lifecycle — from early scientific advice through submission, appraisal, and post-launch evidence collection. The submission deck is one moment in that lifecycle, but it is a high-stakes one. A well-structured, clearly visualised payer deck does not guarantee a positive NICE recommendation. But a poorly structured one, regardless of the quality of the underlying evidence, can undermine a genuinely strong clinical case.

The investment required to get the structure, framing, and visualisation right is small relative to the commercial consequence of a negative or restricted recommendation. It is worth treating the deck as a strategic asset — not a formatting task.

RELATED TOPICS:

Payer engagement presentations | NICE submissions | Market access deck design | Health economic modelling slides | KOL engagement | Pharma presentation design UK | Life sciences consulting | A1 Slides

ABOUT THE AUTHOR

Vaidehi Shukla

Principal, Life Sciences & Market Research | A1 Slides (UAE)

Vaidehi works with pharma companies, biotech firms, CROs, and market research agencies across the UK, UAE, and GCC to translate complex clinical and commercial data into executive-ready presentations. Her work spans market access submissions, pipeline reviews, KOL engagement materials, competitive intelligence decks, and payer-facing documentation.

WORKING ON A PAYER SUBMISSION OR MARKET ACCESS DECK?

A1 Slides works with pharma and life sciences teams across the UK and GCC to design payer submission decks, NICE dossiers, and market access materials that communicate evidence with the clarity and structure that HTA committees require.

Contact us at www.a1slides.com or reach out directly via our life sciences practice.