Takeaways From AMCP 2026: Redefining Value, Evidence, and Access in a Rapidly Evolving Market

From static value to dynamic decision-making

A recurring theme at AMCP 2026 was the shift away from static value communication toward more dynamic, decision-ready insights. Stakeholders emphasized:

• The need for continuously updated evidence, given how quickly data becomes outdated
• Growing interest in forward-looking insights, including pipeline visibility and scenario planning
• The importance of balanced, credible data frameworks that support alignment between payers and manufacturers

Together, these discussions reflect a broader movement toward more transparent, timely, and actionable approaches to value communication.

Drug pricing reform is reshaping the access landscape

Federal pricing policy continues to play a central role in shaping payer strategy and manufacturer decision-making.

• The Maximum Fair Price (MFP) framework introduces government-negotiated pricing ceilings for select Medicare drugs, with expanding scope over time
• Potential Most Favored Nation (MFN) policies aim to align US prices with international benchmarks, creating broader global implications
• Changes to list prices and rebate structures are expected to cascade across the healthcare system, influencing formulary design, employer expectations, and patient access

These developments reinforce that pricing is increasingly a policy-driven system with wide-reaching downstream impact.

Specialty pipeline pressure is accelerating

The continued growth of specialty pharmaceuticals remains a defining challenge for managed care.

• Key trends include biosimilar competition, oncology innovation, orphan drug development, and evolving regulatory dynamics
• More than $43B in brand drugs are expected to lose exclusivity in 2026, creating both cost opportunities and access complexity
• A robust pipeline of high-cost therapies is expected to intensify affordability pressures and management demands further

This underscores the need for proactive, lifecycle-based access strategies rather than reactive approaches at launch.

AI is becoming foundational to managed care operations

AI is rapidly transitioning from a future concept to a core operational capability. Managed care organizations are navigating:

• Rising specialty spend and member cost burden
• Increasing prior authorization volume and compressed review timelines
• Fragmented data environments and workforce strain

At the same time, AI-enabled capabilities are being explored to:

• Improve operational efficiency and decision-making speed
• Enhance clinical and formulary review processes
• Support more data-driven population health strategies

The direction is clear: AI is becoming an embedded capability within managed care infrastructure.

Integrated benefit design is key to managing specialty spend

Sessions also emphasized the importance of aligning medical and pharmacy benefits to optimize specialty drug management.

• Pharmacy and medical benefits operate under distinct reimbursement and management structures, often creating fragmentation
• This disconnect can impact cost control, site-of-care optimization, and patient experience
• Integrated approaches enable more coordinated utilization management and improved overall efficiency

As specialty therapies continue to grow, benefit integration is emerging as a critical lever for managing total cost of care.

Evidence expectations are expanding beyond traditional endpoints

There is increasing recognition that traditional clinical endpoints alone are no longer sufficient to support payer decision-making.

• Patient experience is gaining importance
• Growing interest in incorporating these insights into formulary and value assessments, despite ongoing integration challenges

Real-world evidence remains essential, but complex.

• Mortality data continues to serve as a key endpoint for evaluating outcomes, though data limitations persist
• Data quality, completeness, and linkage remain ongoing challenges in real-world evidence generation

Accelerated approval highlights evidence trade-offs.

• Enables earlier access based on surrogate endpoints, with confirmatory evidence required post-approval
• Reflects the ongoing balance between speed to access and evidentiary certainty

Overall, value is expanding, requiring a more comprehensive and multidimensional evidence framework.

Oncology continues to drive innovation and complexity

Oncology remains at the forefront of clinical and access innovation.

• Advances in precision medicine, biomarkers, and genomics are reshaping treatment pathways
• Expansion of advanced therapies into earlier lines and new care settings is challenging traditional management models
• Increasing complexity is influencing formulary design, prior authorization, and value-based care approaches

For stakeholders, oncology represents both a major opportunity and a significant operational challenge.

What's next?

In addition to recapping where managed care stands today, AMCP 2026 signaled how quickly the landscape is evolving, as policy change, specialty innovation, and increasing evidence complexity continue to reshape how value and access are defined. This shift reinforces the need to move beyond static evidence toward more dynamic, forward-looking insights that can be used in real time to inform pricing and access decisions. If you’re thinking about how to stay ahead, we welcome the conversation.

Reported by The HWP Group’s Phoenix Riley, PharmD, MSc