2026 is taking shape and payers are telling us exactly how they plan to evaluate price, value, evidence, and contracting in the months ahead.
Across MAVA®’s ongoing payer panels, sentiment cycles, and rapid-turn advisory sprints, several themes have emerged. And they’re not subtle.
Payers are sharpening their expectations, tightening their thresholds, and raising the bar on what manufacturers must bring to the table.
Here’s what they’re signaling, and what it means for launch planning in 2026.
1. Price Justification Must Be Explicit, Not Implied
Payers say the era of “broad value narratives” is over.
Heading into 2026, they expect:
- Clear articulation of why a price is set where it is
- Evidence-backed rationale tied to real-world use
- Transparent drivers behind list price and net price strategy
- Early clarity on how future IRA adjustments may reshape pricing corridors
What this means for manufacturers:
Launch teams must align HEOR, policy, and pricing much earlier—and build a proactive price rationale before payers ask for it.
2. Real-World Outcomes Will Carry More Weight Than Trial Data Alone
Payers consistently emphasize a shift toward real-world performance indicators, especially for chronic and specialty therapies.
Themes we’re hearing:
- Linked EMR + claims data carries more credibility
- Evidence expectations are moving toward predictive RWE
- Outcomes tied to adherence, durability, and reduction in high-acuity events are top-of-mind
- Comparative RWE is increasingly expected—not optional
Implication:
Manufacturers need evidence packages that function like living systems, continuously updated and ready for payer interrogation.
3. Contracting Will Get More Sophisticated—and More Selective
Payers are preparing to push contracting beyond traditional rebates.
In MAVA® discussions, they’ve highlighted:
- Interest in outcomes-based triggers that reflect real-world events
- Growing comfort with subscription or budget-cap models
- Shrinking tolerance for “rebate-first” negotiations
- Preference for contracts they can explain internally and externally
Implication:
Manufacturers must model multiple contracting scenarios before entering negotiations—forecasting payer reactions, ROI, and competitive implications.
4. IRA Will Alter Payer Expectations Beyond Negotiated Products
Payers expect negotiation ripple effects across entire therapeutic classes, especially where:
- Products are adjacent to IRA-selected competitors
- Clinical differentiation is narrow
- Budget impact is sensitive
- Total cost of care is under scrutiny
They also anticipate greater pressure to justify coverage for therapies with unclear or inconsistent RWE.
Implication:
Teams need both portfolio-level IRA modeling and payer sentiment monitoring to understand where thresholds may shift.
5. Continuous Engagement Will Outperform Episodic Advisory
Perhaps the strongest signal from MAVA® panels:
Payers want ongoing collaboration, not one-off meetings.
They expect manufacturers to:
- Validate assumptions continuously
- Pressure-test access strategy in real time
- Share evidence updates as they emerge
- Ask targeted, scenario-based questions—not broad “what do you think?” prompts
Implication:
Insight must become a continuous operating function, not an annual process.
The Takeaway: Payers Are Already Preparing for 2026. Manufacturers Should Too.
Payer expectations for 2026 boil down to three things:
Clarity. Credibility. Continuous insight.
Teams that align pricing, evidence, and contracting with these expectations now will enter negotiations with a strategic advantage. Teams that don’t will find payer thresholds harder than ever to meet.
MAVA® is helping manufacturers stay ahead by capturing payer sentiment the moment it shifts—so strategy can shift with it.
To learn how manufacturers are using MAVA® to understand payer expectations and shape 2026 strategies, contact info@emaxhealth.net or visit emaxhealth.net.