Outlook Overview
- We continue to be in an "Age of Volatility" where adaptability is the minimum requirement for survival.
- 2026 will be defined by "Storms" across four sectors: Politics, Technology, Supply Chain, and Regulation.
- To thrive, leaders must prioritize Up-skilling Talent, mastering Direct-to-Patient Models, navigating Complex Reimbursement, and staying ahead of AI.
2026 Outlook: A Continued Age of Volatility
As with every year, I pause to reflect on the both the year past and the year to come. There is, of course, one thing we can be certain of with every turn in the calendar: change. We no longer have a long-term normal. I have borrowed the phrase that we live in an “Age of Volatility”, where accelerated change is normal and the ability to change and adapt quickly will be the minimum requirement for survival.
My prediction for 2026? Stormy with a chance of crazy.
- Political Storms: Midterm elections in addition to ongoing fraud and abuse investigations.
- Technology Storms: The acceleration of AI in all areas of business and life.
- Supply Chain Storms: What will be the long-term impact of tariffs? What is the potential time frame for bringing more production activities to the US?
- Regulatory Storms: A new regulatory “cure” for fraud and major changes to The Affordable Care Act.
In my world of pharmaceuticals and healthcare, there are too many issues for us to address, so I will focus on a few that I believe will have significant impact in 2026 and beyond.
The Ongoing Talent War & Labor Shortages
Challenges in attracting and retaining talent continue to impact all areas of healthcare. While wages have grown in recent years, so has the competition for skilled labor from other high-tech industries. However, the larger issue is driven simply by a lack of available potential employees. Here are some key numbers to consider:
- Physician Shortage: 37800 to 124,000 by 2034 (AMA)
- Shortage of hourly workers: Up to 9.7 Million by 2030 (Mercer)
Success in 2026 won't be found by hiring more people, it will be found in up-skilling the people we have.
The Solution
Success here will depend on our ability to up-skill existing employees with new technologies and processes. As with the industrial revolution of the early 1900s, employees will need to leverage new skills and technologies to navigate an evolving work environment.
Emerging Direct-to-Patient & Consumer Models
We have certainly all heard about LillyDirect® and TrumpRx with the goal of facilitating access to lower priced pharmaceuticals. This will not only to create more affordability in large disease states (e.g. diabetes) but also drive a shift toward personalized medicine and targeted therapies. The challenges in identifying, reaching, and engaging niche patient populations for rare and orphan diseases are undeniable. As such, embracing models whereby you both reach a patient and, once on therapy, keep them on therapy, is the key. Combining creative solutions that leverage technology will be the key driver in improving patient outcomes and adherence.
At D2, we have had the privilege of building on programs where, levering technology appropriately, we’ve seen:
- Over a 60% reduction in manual outreaches (significant call center savings)
- Over an 80% average increase in patient response rates
We can anticipate these direct-to-consumer programs will expand rapidly.
The Solution
Manufacturers must pivot to high-touch, low-friction digital platforms. By leveraging technology to automate patient outreach, organizations can simultaneously lower costs and dramatically improve adherence rates.
Pricing and Reimbursement
Securing reasonable reimbursement is not negotiable for a pharmaceutical manufacturer. Without it, you don’t have a product. As we see fewer payers in the market, the need to access key decision makers will become more and more critical.
Without reasonable reimbursement, you don't have a product.
As value-based pricing and direct contracting models become more common, the burden of proof is on the manufacturer to demonstrate clear clinical and economic value. Consequently, manufacturers need to be very thoughtful about the different levers impacting price and profitability. Too many times, D2 has seen manufacturers negatively impacting their overall Gross-to-Net by not having a cohesive model to evaluate pricing decisions. This includes more than the actual price, but all the elements that impact net price including rebates, chargebacks, discounts, copay cards, 340b, alternative funding, returns, etc.
Finally, the industry must prepare for continued expansion of the Most Favored Nation (MFN) pricing model. While as of this writing the MFN pricing includes nine manufacturers, we can expect this to expand significantly over the next 12 to 24 months.
The Solution
Winning the reimbursement battle requires more than just a model; it requires a seat at the table. Commercialization success in 2026 relies on a partner with the deep-seated connections to reach payers and to ensure clinical value is translated into sustainable, profitable access.
AI & Digital Technologies
Here I will simply say AI everything. The Trump administration is investing billions in research and infrastructure, referred to as The New Manhattan Project. This is being considered the next cold war or the space race of the 1950s and 1960s. The focus from the administration is in 4 areas: advanced manufacturing, robotics, biotechnology and nuclear fission.
The landscape is shifting rapidly… digital patient engagement, advanced AI for diagnostics and treatment, telehealth, virtual hospitals & physician access for remote care, generative AI in drug discovery etc. The challenge however is in navigating the integration of AI, machine learning, and data analytics in drug discovery, development, and commercialization.
While technology will move quickly, for many there will be significant challenges in implementing digital transformation across traditionally siloed organizations. In addition, with more information being shared across more systems, cybersecurity threats targeting sensitive research and patient data will be of major concern.
The Solution
Success in 2026 requires more than just adopting new tools; it requires organizations to eliminate silos and introduce a flexible, secure and seamless integration of AI from operations to patient.
Conclusion
Well, there you have it. It’s by no means an exhaustive list, but a few highlights of the storms we can expect to weather in 2026 and beyond.
At D2 we have the privilege to work with hundreds of clients spanning manufacturers, hospitals, specialty pharmacies, HUB’s and others. This provides us with a unique perspective on their issues and a challenge to ourselves on how to solve for real world issues. By continuing to accelerate technology-driven tools (yes, AI too) we help organizations capture, keep and care for their patients. Our mission is simple: to help our partners help more patients.
Here is wishing you all the best in 2026, we look forward to delivering better, together.
Let's get your team ready for 2026!
