Clinical Trial Payments: Optimizing the Path Forward for Site Payments

Jim DiCesare, Sr. Director, Study Operations, IQVIA Clinical Trial Payments

Escalating competition for clinical trial sites, in tandem with other industry-wide challenges such as changing regulations; a lack of bandwidth and resources; identifying ideal sites and recruiting and retaining patients, are posing significant obstacles for sponsors and site teams within a global study portfolio, particularly in relation to clinical trial payments. Factors such as decentralized clinical trials, inflation and site attrition contribute to inconsistencies and financial confusion, especially with outdated payment solutions.

To address these persistent challenges, sponsors can leverage modern clinical trial payment solutions. The development of innovative approaches supports a comprehensive global strategy, the goal being to reduce the administrative burden associated with site payment processes. By adopting proven solutions, sponsors can be confident in ensuring timely and consistent payments for each trial, thereby minimizing queries and disputes from sites. 

This transformation is made possible through fully integrated systems that provide on-demand access to payment information, ultimately contributing to elevated levels of site satisfaction.

Navigating the Global Complexities and Dilemmas of Clinical Trial Payments

Clinical trial payment processes currently face several challenges that can adversely impact trial efficiency, precision and site satisfaction. Significant obstacles across their trial portfolios include:

  • The Impact of Increased Competition and Geographic Diversity: Fierce competition for trial sites has created serious obstacles. According to research from Bain, 53% of the sites lack adequate bandwidth to actually run clinical trials. This is in stark contrast to just 14% before the Covid-19 pandemic and 47% at the pandemic’s peak. This heightened competition forces sites into difficult decisions, often leading to the rejection of trial opportunities. The complexity is further compounded by conducting trials across diverse geographic locations, evidenced by a 39% increase in the mean number of countries per Phase III clinical trial. Additionally, Phase II and Phase III trials see increases of 41% and 25%, respectively, in the number of investigative sites.
  • The Current Clinical Trial Environment and its Influence on Payments: The influence of payment periods becomes evident with more than 80% of sites wanting a 30-day payment schedule. The reality is that evolving trial environments also introduce new intricacies to site payments, with factors such as decentralized clinical trial elements, high inflation rates and site attrition making trial protocols more complex. Splitting payments between sites and vendors can result in inaccuracies, hampering internal and site reporting capabilities. Further, legacy payment solutions prove inadequate, lacking the transparency and efficiency required to effectively address the diverse challenges associated with site payments.
  • Dynamic Economic and Political Environments: Economic conditions prompt sites to request additional budget items, impacting payment schedules and cash flow for CROs and sponsors. Varying levels of economic development and legal systems lead to potential fraud and currency control complications as well. Changes in domestic affairs, including political and social unrest and governmental structural shifts, directly impact site relationships and payment capabilities, necessitating careful navigation to ensure seamless global payments.

Legacy payment solutions are starting to reach the end of their life cycle and, as they stand, are not equipped to address this extensive array of challenges. So, to handle payments across sites and clinical trials, sponsors must opt for strategic solutions to enhance the effectiveness of the full trial payment process.

A Contemporary Approach to Streamlining Clinical Trial Payments

Sponsors must embrace comprehensive solutions that simplify payment processes, enhance transparency and ensure precise and prompt compensation for clinical trial sites. 

Transitioning to advanced trial payment solutions enables sponsors to achieve:

  • Enhanced Payment Efficiency: Modern clinical trial payment solutions significantly boost payment efficiency through diverse features and capabilities. Systematic alignment of protocol structures and triggers for payable visits ensures accurate and timely compensation. Features such as Electronic Data Capture (EDC) import, data reconciliation and automated payment calculation streamline processes. The Extract-Transform-Load (ETL) approach automates payments, providing sponsors with on-demand access to payment information and detailed reports by country, payee and currency, thereby enhancing transparency for strong financial management.
  • Comprehensive Oversight: Modern clinical trial payment solutions ensure transparency and traceability at every stage of the clinical trial. User-friendly payment portals grant sites 24/7 access to complete payment information, fostering increased visibility and accountability. The integration of key clinical data from EDC systems, study budgets, agreements and schedules of events enables automated invoicing for streamlined efficiency and prevent payment errors. Systematic alignment of protocol structures and payable visit triggers, along with EDC import, data reconciliation and payment calculation, ensures smooth operations.
  • Consistency across the payments’ lifecycles to increase total ROI: Through the new approach sponsors can help improve tax planning and management as well as cash flow. They can reduce the burden on clinical and financial staff for payments, disputes, reporting and reconciliations, all while minimizing site and study overall costs and overpayments. 

By adopting a modern approach and leveraging advanced trial payment solutions, sponsors benefit from a combination of expertise and cutting-edge technologies that drive cost and performance efficiencies. This shift also contributes to higher rates of site satisfaction, alleviating the burden on clinical operations and allowing personnel to concentrate entirely on clinical trial management.

Optimizing the Path Forward for Site Payments

The growing intricacy of clinical trials, heightened competition for sites and geographical diversity have rendered conventional payment methods unwieldy and ineffective. Through consolidation, the streamlining of payment processes becomes possible, guaranteeing investigators receive precise and timely compensation. This, in turn, fosters improved trial conduct and overall success.


About Jim DiCesare

Jim DiCesare is passionate about delivering innovative site activation and site payment services to clinical trials. With over 25 years of industry experience leading clinical operations teams at Merck, DrugDev, and now IQVIA Technologies, Jim has expertise across the contracting, budgeting, and investigator grant payment management continuum. He is a frequent speaker at industry conferences and has written for a variety of publications. Jim earned a B.S. in Accounting from Kutztown University.