Trend 1: Purchaser demand for more rigorous evidence makes earlier evidence generation essential for access

Rising spending on drugs and recent policy changes mean purchasers are taking on more financial risk, and they’re responding by raising the bar for evidence to guide access. Access decisions increasingly hinge on outcomes-based contracts, broader step therapy requirements, and specific evidence frameworks. For example, CMS is working to modernize coverage with evidence development (CED), making greater use of real-world evidence (RWE) to support Medicare decisions. In parallel, the FDA is updating their RWE guidance and purchasers and independent assessors are refining health technology assessment (HTA) frameworks to become more comprehensive and dynamic. Both sets of guidance continue to influence access for high-cost and complex therapies, raising the evidentiary bar for pharma manufacturers. This is reshaping how pharma approaches evidence generation.

The definition of value is changing. Access increasingly depends on the relevance and specificity of evidence pharma can bring forward. To remain competitive, companies must:

• Anticipate expectations from purchasers before launch. Align strategies with real-world outcomes and payer-relevant needs.
• Break down siloes across functions for evidence planning. Integrate clinical, commercial, health economics and outcomes research (HEOR), and access teams to generate high-quality customizable evidence.
• Bring evidence to purchasers early. Demonstrate value in initial conversations with evidence tailored to payer-relevant outcomes.

Trend 2: Patient targeting is no longer just a launch tactic, but an essential strategic focus across the entire product lifecycle

Shorter commercial windows, higher development costs, and expedited approvals are forcing pharma to identify and engage patients earlier, with greater precision, and to sustain that focus across the product lifecycle. Pharma companies must know in advance who will benefit from a product and sustain engagement post-launch to support label expansion and long-term return on investment (ROI).

Evidence that demonstrates benefits for specific patient subgroups is now critical for both approval and access. Even in high-prevalence categories, payers and regulators expect early data on subgroup outcomes. For example, GLP-1s show how both high-impact evidence for subgroups and RWE can accelerate approvals, expand indications, and secure long-term advantage.

Leading pharma sciences companies must:

• Target patients across the entire product lifecycle. Segment rare, complex, and high-cost groups prelaunch, and sustain engagement postlaunch to generate RWE and reinforce value.
• Bring payer-ready evidence earlier. Demonstrate real-world outcomes up front by matching patients with the right treatments, collaborating with other organizations to identify high-value patients early, segmenting strategically to support value-based contracts, and aligning evidence with purchaser expectations.

Trend 3: Tailoring value narratives to each health system is critical as health system decisions become more complex

Health systems are weighing more variables than ever when deciding where to direct resources. With operating margins projected to drop by up to 13% by 2028 — and 34% of systems already planning long-term cuts to the drug budget — cost is no longer the stand-alone metric for ROI. Systems are also evaluating how well products fit into their broader clinical and operational priorities, including impacts on margins, workflow, and outcomes. This complexity is changing how health system leaders assess value.

There’s no one-size-fits-all approach. Health systems differ in their purchasing priorities: Some prioritize patient experience and outcomes, while others focus on margin or innovation. These variations influence how committees evaluate products, meaning pharma must adapt its value narrative to align with each system’s decision-making lens. No two health systems will evaluate value in the exact same way. Still, the following six archetypes provide a useful way to understand the most common orientations committees bring to purchasing decisions.

To align with health system priorities, pharma must create a feedback loop that tests and refines evidence against what matters to decision-makers:

• Segment customers by value priorities. Tailor narratives to what resonates and train commercial teams on how to position new metrics.
• Test evidence against decision drivers. Keep lines of communication open among commercial, HEOR, and access teams to ensure that the evidence generated matches a client’s needs.
• Proactively build partnerships to generate information on metrics. Providers and payers can provide RWE, long-term cost, and revenue impact data.

Ongoing feedback keeps value messages resonant with what matters most to health systems and ensures pharma can adapt to each system’s strategic and clinical priorities.

Trend 4: An agile distribution strategy sets you apart in a fragmented ecosystem

As care moves closer to the consumer — through home, digital, and ambulatory settings — distribution becomes more complex. Distribution decisions must now factor in a shrinking brick-and-mortar footprint, direct-to-consumer (DTC) channels, and home-based care. To ensure access, pharma must design distribution models that balance reach, control, and experience.

Patients now expect convenience and speed, so wait time and proximity drive care choices — 81% of patients use digital tools to interact with pharmacies. In response, some manufacturers are launching DTC channels to meet patients where they are.

At the same time, retail pharmacy disruptors — like Amazon and Mark Cuban Cost Plus — are bypassing the traditional payer-pharmacy benefit manager (PBM) model with transparent, direct-to-provider and -consumer channels. White and clear bagging are also increasing, creating friction over sourcing, reimbursement, and care coordination.

What life sciences should do:

• Keep channel strategies flexible and use-case specific. For retail drugs, success depends on patient activation, such as partnering with digital pharmacies and offering convenience. For provider-administered therapies, pharma needs to streamline logistics and balance payer demands with provider workflows.
• Design distribution for multichannel agility. Avoid overreliance on a single channel, and use real-time data to coordinate distribution across stakeholders and minimize friction.

Trend 5: Successfully unlocking GenAI opportunities hinges on a cultural shift

GenAI’s promise depends on practical integration into everyday workflows, from content development and insight generation to supply chain forecasting and field team enablement. While early adoption in pharma was narrowly focused on drug development, AI is now driving value across commercial, regulatory, and medical affairs functions.

But while the potential is huge, successful AI adoption depends on avoiding pitfalls — such as treating adoption as a plug-and-play solution instead of a strategic transformation, underinvesting in change management, or failing to implement workflows and data foundations to support AI at scale. These can lead to underused tools, compliance risks, and a lack of trust among users.

Successful adopters encourage experimentation with AI tools and cross-functional alignment. To unlock AI’s full potential:

• Invest in data systems and staff education. Prepare IT systems for AI adoption, and educate staff about AI technologies and principles at your organization, updating skills through ongoing experimentation.
• Build an AI process for governance. Develop evaluation criteria and processes for investment in AI tools and build a governance structure for ongoing monitoring and review.
• Prioritize use cases that are “low hanging fruit.” Identify a few use cases that fit into existing strategic goals based on potential risks and benefits, and then scale what works.