Spherix Global Insights Identifies Emerging Trends in Market Access Across More Than Twenty Key Therapeutic Areas
New payer research highlights tightening formularies, shifting contracting models, and rising cost-containment pressures heading into 2026.
EXTON, Pa., Oct. 14, 2025 (GLOBE NEWSWIRE) -- Spherix Global Insights announces the release of Special Topix™: Payer Management Strategies, a comprehensive new analysis examining how U.S. health plans and pharmacy benefit managers (PBMs) are redefining access, contracting, and coverage decisions across more than twenty therapeutic areas. Designed to help pharmaceutical manufacturers anticipate the next wave of payer-driven change and incorporate access challenges into brand development, the publication delivers forward-looking intelligence to support 2026 market access strategy and planning.
Based on quantitative and qualitative research conducted in summer 2025, the analysis integrates insights from nearly thirty pharmacy and medical executives representing national commercial and managed Medicare plans and PBMs, Blues organizations, and regional independent payers. Findings span 24 disease areas, including agitation from Alzheimer’s disease, Alzheimer’s disease, anticoagulants, asthma, atopic dermatitis, bipolar disease, chronic kidney disease (CKD), depression, type 2 diabetes, end-stage kidney disease, HIV, inflammatory bowel disease (IBD), lupus (SLE), metabolic dysfunction-associated steatohepatitis (MASH), migraine, multiple sclerosis (MS), myasthenia gravis (gMG), obesity, office-administered oncologics, oral oncologics, psoriasis, rare glomerular diseases, rare hematological disorders, rheumatoid arthritis (RA), and psoriatic arthritis (PsA).
Payers report intensifying cost pressures that are prompting broader shifts in benefit management. Plans are recalibrating toward total cost of care across benefits, which is driving tighter utilization controls, more selective coverage, and closer alignment between medical and pharmacy policies. Formularies are expected to tighten as plans refine step edits, prior authorization criteria, and site-of-care management. Biosimilar strategies remain uneven across channels and indications, reflecting both operational differences and variability in provider adoption, yet they continue to feature prominently in near-term cost-containment playbooks.
Within this environment, contracting is becoming more targeted. Competitive dynamics are strongest in mature categories where plans can leverage multiple clinically acceptable options to influence share. In areas with lower prevalence, complex pathways, or fewer substitutable products, contracting remains less active and more bespoke. Interest in outcomes- and value-based approaches persists, but day-to-day negotiations still largely center on placement, access conditions, and administrative terms that translate reliably into measurable savings.
Regulatory uncertainty adds another layer of complexity. While the immediate effect of the Inflation Reduction Act has been limited, payers are modeling potential downstream scenarios and considering how policy shifts could influence pricing strategies, launch sequencing, and benefit design. Many are monitoring guidance and implementation details, preparing to adjust coverage approaches as the implications become clearer, and balancing affordability goals with the need to preserve access and innovation.
As payer strategies continue to evolve under mounting cost pressures, policy shifts, and rapid therapeutic innovation, manufacturers need actionable guidance they can put to work now. Special Topix™: Payer Management Strategies gives market access and brand teams a practical edge for the 2026 planning cycle—pressure-testing access assumptions, sharpening contracting playbooks, and aligning cross-functional stakeholders on where to focus by therapeutic area and channel. Grounded in independent evidence and expert interpretation, it accelerates decision making, strengthens payer engagement materials, and helps de-risk portfolio and launch choices in a shifting access environment.
Special Topix™: Payer Management Strategies delivers the strategic intelligence manufacturers need to anticipate payer behavior, refine contracting models, and inform scenario planning while considering the downstream implications of policy and pricing reform. By linking robust quantitative data with qualitative payer commentary, Spherix helps clients translate emerging market signals into actionable access strategies.
This release is part of Spherix’s ongoing Special Topix™ series—targeted, high-impact analyses designed to inform biopharma teams navigating today’s rapidly evolving payer and policy environment.
About Special Topix™
Special Topix™ is an independent service that includes access to a report or series of reports based on current events or topics of interest in specialty markets covered by Spherix.
About Spherix Global Insights
Spherix is a leading independent market intelligence and advisory firm that delivers commercial value to the global life sciences industry, across the brand lifecycle.
The seasoned team of Spherix experts provides an unbiased and holistic view of the landscape within rapidly evolving specialty markets, including dermatology, gastroenterology, rheumatology, nephrology, neurology, ophthalmology, and hematology. Spherix clients stay ahead of the curve with the perspective of the extensive Spherix Physician Community.
As a trusted advisor and industry thought leader, Spherix’s unparalleled market insights and advisory services empower clients to make better decisions and unlock opportunities for growth.
To learn more about Spherix Global Insights, visit spherixglobalinsights.com or connect through LinkedIn.
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NOTICE: All company, brand or product names in this press release are trademarks of their respective holders. The findings and analysis addressed within are based on Spherix Global Insight’s analysis and do not imply a relationship with or endorsement of the companies or brands mentioned in this press release.
Contact
Bob Shewbrooks,
Neurology and Ophthalmology Franchise Head
Bob.shewbrooks@spherixglobalinsights.com
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