Health systems have become more consolidated. Some are acting as both providers and payers, and therefore have more influence as gatekeepers of market access. That said, safety and effectiveness are no longer the only considerations for drug adoption. New treatments must provide value not just for the patient but for the entire healthcare network, for instance, by lowering the total cost of care.  

This shift is driving pharmaceutical and biotech companies to take on a more integrated approach instead of refining their sales pitches. Similarly, other industry actors are exploring better partnerships and technologies to provide better outcomes.   

Driving More Strategic Partnerships

The healthcare system comprises multiple actors, including medical practitioners and hospital staff. Drug developers also play a key role. Beyond transactional interactions, these sectors have been increasingly working together to eliminate the numerous barriers to adoption in the medical world.

Let’s take access to medications as an example. In general, prescription drug utilization remains high in the United States. However, a recent study found considerable disparities in drug spending and use across different demographics. For instance, over 61% of ‘White’ Americans had insurance coverage and prescription fills and pharmaceutical spending, while the rest—American natives, Asians and Pacific Islanders, Blacks and Hispanics—cumulatively captured the remaining share. (1)   

There are many solutions to consider, but the paper suggests more policy reforms to ensure pharmacoequity, a state where everyone gets the medication they need, regardless of their race and health condition. (1)  

Meaningful industry gatherings, such as the Pharmacy Growth Collaborative, offer an opportunity for executives in the pharmaceutical sector and opinion leaders from academic institutions and relevant industries to understand the pain points and develop solutions together. These personal interactions help build trust and lasting relationships that support providers in delivering the best care possible.     

The Shift to Value-Based Care (VBC)

Health systems used to adopt a fee-for-service business model. More patients mean more profit, but this can lead to brief and impersonal interactions. Worse, individuals who lack insurance coverage or can’t afford to pay tend to avoid visiting the clinic or treatment centers. This common scenario makes early intervention almost impossible, and patients end up paying more for complex therapies.

Accountable Care Organizations (ACOs), which primarily serve Medicare beneficiaries, represent a significant shift toward value-based care (VBC). ACOs comprise providers, including physician networks and hospitals, as well as pharmacy executives, who collaborate to provide better patient experiences while maintaining cost-efficient services. Every successful implementation could earn savings for patients and incentives for the providers. (2)

Apart from personalized treatment strategies, the group also stresses preventive care. While ACOs are the brainchild of the federal government, private insurers are encouraged to form similar groups adopting the same principles.  

It can be a worthwhile move, as government records show that chronic diseases and mental health capture about 90% of the USD$ 4.9 trillion annual health care spending in the US. Extending the principles of VBC can lower expenditure because clinicians are addressing the root causes of the disease instead of merely easing its symptoms. (3)  

Data- and Technology-Sharing for Personalized Treatments

Patient-sharing networks require the use of electronic health records (EHRs) to study a patient’s medical history and medication use risks. This paves the way for individualized care, which tailors treatments, dosages, and drug selections based on a patient’s unique conditions.  

Moreover, the healthcare sector has been using artificial intelligence (AI) to improve administrative and clinical operations, both internally and externally. Many use the platform for clinical documentation and imaging, and diagnostics, although financial and regulatory concerns hinder wider adoption. (4)

Many clinical and healthcare research organizations team up to share costs and improve outcomes, particularly in drug development. Doing so requires removing research data silos and facilitating interoperability.

In recent years, companies have been co-developing medical technologies that benefit wider demographics. These partnerships are responsible for numerous digital health platforms that ensure the safety and effectiveness of newly-approved treatments. A biotech firm, for example, can tap a software development agency to create an AI-driven tool that improves adherence or identifies patients who are most likely to benefit from a new drug.

Additional Factors That Affect Market Accessibility

The recent structural and operational changes also impact market access. Many health systems operate on a provider-sponsored health plan (PSHP) model. This means the facility controls the delivery and payment of medical services. As such, they’re accountable for the care costs and are less receptive to novel drugs and treatments.

Pharmaceutical company marketing teams must work harder to get onto the PSHP’s formulary (approved drugs list). They must rethink their market access strategy and interactions. Rather than just selling, they must show how their products can solve the health system’s clinical and financial challenges.       

Practical Results Matter More Than Ever

Evidence-based treatment practices are the gold standard for drug manufacturing. That’s why the majority spend up to billions and go through several stages to prove the safety and effectiveness of a novel treatment. However, health systems are demanding real-world evidence on top of scientific proof. This means science is no longer enough to gain a competitive edge.

New treatments will enjoy wider adoption if medical data can demonstrate that they help reduce overall system costs. Drug manufacturers must consider the broader implications of their products and assess how they impact the entire health system. Do they reduce the length of hospital stay or readmission rates, for example? Without hard facts, your product won’t earn the nod of executives who take responsibility for the total cost of care.

Outcomes-Based Agreements  

There’s a silver lining for new treatments, though. Some pharmaceutical manufacturers and payers resort to outcomes-based agreements. It’s a form of a risk-sharing arrangement that links drug payments directly to a patient’s results. This forces pharma companies to guarantee their products’ performance.  

The system pays the full price upfront, but the manufacturer provides a rebate if the drug fails to meet pre-set lab markers or clinical outcomes. This partnership model benefits payers by eliminating the risks of spending on ineffective treatments. On the other hand, it allows drug makers to demonstrate the value of innovative drugs that need more real-world results. Patients also get access to potentially life-saving therapies.   

Adapt and Partner, or Perish

The health system is evolving and taking responsibility for a patient’s entire diagnostic and treatment journey. Oral medications have become essential components in the overall cost structure and service quality metric. This changes how medical practitioners view drug use and affects their prescribing practices.

If your therapy can’t lower their operational expense or improve their VBC scorecards, it probably won’t see the light of day. That said, expanding market access means mastering the art of collaborative problem-solving. Vendors must explore their medical group affiliations to develop shared solutions that enhance direct patient outcomes and the healthcare system’s efficiency. Organizations that actively adapt to these new realities are likely to succeed in 2026 and beyond.

References:

1. ‘Prescription Drug Utilization and Spending by Race, Ethnicity, Payer, Health Condition, and US State’. Source: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2837041#:~:text=In%202019%2C%20an,their%20population%20size
2. ‘Accountable Care and Accountable Care Organizations’. Source: https://www.cms.gov/priorities/innovation/key-concepts/accountable-care-and-accountable-care-organizations
3. ‘Fast Facts: Health and Economic Costs of Chronic Conditions’. Source: https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html#:~:text=Ninety%20percent%20of%20the%20nation%27s%20%244.9%20trillion%20in%20annual%20health%20care%20expenditures%20are%20for%20people%20with%20chronic%20and%20mental%20health%20conditions.12%20Interventions%20to%20prevent%20and%20manage%20these%20diseases%20can%20have%20significant%20health%20and%20economic%20benefits
4. ‘Adoption of artificial intelligence in healthcare: survey of health system priorities, successes, and challenges’. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC12202002/#:~:text=Across%20the%2043,regulatory%20uncertainty%20(40%25)