Patient Access Programs Face Policy Uncertainty, Technology Gaps and Affordability Challenges

Patient access and affordability programs are facing increasing pressure from policy uncertainty, complex benefit designs, and growing specialty therapy pipelines, according to industry surveys and analysis. The systems supporting patients are being asked to move faster than ever before as coverage rules evolve, therapy pipelines expand, and pricing expectations intensify under legislation like the Inflation Reduction Act.

Nearly 60% of patient services programs now operate a hybrid model that combines internal teams with external partners, according to a survey of more than 100 patient access decision-makers across biopharma, consulting, and specialty care. This concentration suggests a selective ownership model where manufacturers retain direct control over core program elements while engaging external partners for specialized capabilities. However, technology enablement remains uneven, with most respondents describing their operating reality as only partially technology-enabled, with automation supporting some workflows while others continue to rely on manual execution.

Interoperability is emerging as a critical gating factor for meaningful progress in patient access. More than half of respondents indicate they are either not prepared or only somewhat prepared to meet interoperability and data-sharing expectations within patient access. While more than 85% of respondents report confidence in the accuracy and completeness of data from vendor partners, they consistently cite challenges related to non-standardized or inconsistent data formats, limited actionability, and delays that prevent data from being used to trigger workflows or inform timely decision-making.

Policy uncertainty has become a constant challenge, with prior authorization requirements continuing to evolve and pricing conversations intensifying. The impact of policies like the Inflation Reduction Act and Most-Favored Nation are still playing out across both commercial and government channels. For access and affordability leaders, the challenge isn't just compliance but building programs and infrastructure that can adjust as requirements change without slowing therapy starts or adding friction for providers and patients.

Specialty and oncology pipelines are expanding, but more therapies alone don't improve access. Provider pathways are increasingly complex, benefit designs vary widely, and coordination across stakeholders remains inconsistent. Supporting patients in this environment requires access operations that reduce handoffs, limit manual work, and provide visibility across the process.

GLP-1 therapies continue to test existing access and affordability models, with demand remaining high and coverage remaining complex. These dynamics are pushing organizations to evaluate how access strategies scale and where affordability support fits across multiple points of entry. Even when access pathways improve, out-of-pocket costs remain a deciding factor for patients, with abandonment and non-adherence continuing when affordability gaps aren't addressed early.

The value of artificial intelligence will depend on how well it integrates into everyday access workflows, supporting tasks like information routing and decision support while maintaining human oversight. The real question is how to use AI to improve transparency, consistency and speed without losing the trust and judgment that patients and providers rely on.