Key Market Access Strategies for 2026

The past year has seen a significant shift from a focus on general coverage to a more granular, criteria-based approach. Payer perspectives indicate a heightened scrutiny of high-cost therapeutic areas like oncology, cell and gene therapies (CGTs), and specialty drugs, including the emerging class of GLP-1s for weight loss. Moving forward, market access strategy will concentrate on navigating the complex prior authorization and step therapy requirements.

Three Big Challenges to Tackle

• The shift to criteria-based access and state-driven Pharmacy Benefit Manager (PBM) reforms have made it harder to secure predictable access. Market access teams are investing in robust evidence generation, including real-world evidence (RWE), to support value propositions and negotiate innovative contracts that link payment to outcomes. They must also investigate using advanced analytics for payer segmentation, moving beyond simple tiers to understand policy nuances.
• With rising costs, clinical data alone isn’t enough. Payers are looking for value beyond clinical efficacy. Value stories must include how a product can reduce costs on a broader scale; for example, by preventing hospitalizations. Teams are also leveraging data on social determinants of health (SDOH) to show how a product can address non-clinical barriers to care.
• More intricate payer policies mean field teams must develop a deeper understanding of market access. Companies are investing in platforms that provide real-time, actionable access data to field teams, including the use of pull-through materials, pre-call planning products, and more. This allows reps to give more accurate information to healthcare providers (HCPs) and their staff.

Rise of Medical Benefit Management and Patient Services

In 2025, medical benefit management has been on the rise. Payers are using pharmacy benefit management tactics for drugs covered under the medical benefit. To support the shift, routes for product administration and HCP education are essential.

The topic of cost and reducing the cost of therapies has also been an area of focus, the goal being to deliver therapies to more patients in need. However, if the necessary patient support and cost reduction services are not in place, then the number of patients getting the care they need will decrease.

Creating Personalized Value Statements With AI

AI will not only be able to integrate disparate data sources into a holistic picture of a product’s value, it will also enable the creation of highly tailored, data-driven value stories for specific payers and providers. Currently, an equivalent level of customization is difficult to achieve at scale.

We are already seeing this come into effect with the recent partnership between Google Cloud and Inovalon. The partnership is focused on developing an AI-enabled solution to streamline prior authorizations. This “agentic AI” system will intelligently surface payer-specific rules and documentation requirements, free up clinicians and staff from a significant administrative burden, and speed up patient access to care.

Key Considerations for Market Access Success in 2026

1. Embrace a Data-First Mindset: Invest in the people, processes, and technology to synthesize data and generate actionable insights. Look beyond traditional coverage data to understand the full landscape of PA requirements and medical benefit policies.
2. Redefine Your Value Story: Your value proposition must include a robust health economic story to demonstrate how your product addresses payer pain points.
3. Investigate AI and Predictive Analytics: Begin exploring how AI can support your team, whether it’s through dynamic pricing algorithms or tools to streamline data analysis.
4. Strengthen Cross-Functional Collaboration: Market access is not a silo. Build strong partnerships with Research and Development (R&D), commercial, medical affairs, and patient services to ensure the entire organization is aligned.
5. Build Agility into Your Strategy: The market is changing at an unprecedented pace. Your 2026 plan should not be a static document; it must be built on a foundation of continuous monitoring and a willingness to adapt.

Want to learn more?

Contact us to learn how we can help your team achieve your market access goals.