Health economics and outcomes research (HEOR) is crucial to how new therapies are evaluated, priced and supported in real-world practice. HEOR brings together clinical, economic and real-world data (RWD) to help regulators, payers, health systems, industry and policymakers understand the value of medical products.
HEOR looks at how well a treatment works, what it costs and what that means for patients and health systems.
HEOR and market access teams are entering 2026 with a wider footprint across pricing, coverage and real-world performance evaluation than ever before.
Payers are demanding more transparency, manufacturers are investing earlier in evidence planning and high-budget areas such as gene therapies and GLP-1s continue to reshape how value is defined.
Below are four trends shaping the 2026 HEOR and market access landscape.
Real-World Evidence Becomes Core Evidence, Not Supplemental Insight
Real-world evidence (RWE) is now central to value demonstration because it shows how treatments perform in everyday medical practice, not just under the controlled conditions of clinical trials.
ISPOR’s 2024–2025 Top 10 Trends ranked RWE as the #1 global priority, reflecting how it supports regulatory submissions, health technology and assessment (HTA) reviews and ongoing access decisions.
A 2025 peer-reviewed study in the Journal of Health Economics and Outcomes Research examined Hinge Health’s digital chronic back pain program using commercial claims from more than 100 million covered lives. Participants in the digital program had about 60% fewer imaging visits at three months than matched individuals who underwent traditional physical therapy.
And in October 2025, HealthVerity and Claritas Rx announced a partnership linking de-identified claims, electronic medical record (EMR), lab and specialty-pharmacy data in a privacy-protected environment. According to the companies, the integrated dataset is designed to give commercial, RWE and HEOR teams a clearer view of access barriers, speed-to-therapy and adherence, which are critical factors that shape the real-world value story.
AI and Advanced Analytics Move into HEOR and Access Workflows
AI and advanced analytics are increasingly shaping how teams analyze RWD and evaluate cost-performance relationships. In many cases, AI is being used not to replace human judgment, but to sort through large datasets and highlight patterns that support payer discussions.
A 2025 Value in Health study from Lyra Health evaluated two versions of the company’s provider-matching algorithm and found that the newer, value-based machine learning model reduced the average course of therapy by about two sessions and lowered per-episode costs by nearly 20% — roughly $340 in savings per member — while maintaining similar clinical outcomes.
AI tools are also appearing in areas like pattern detection, benefit design support and evidence synthesis.
Pricing Pressure and Outcomes-Based Models Shape Access Conversations
Pricing scrutiny intensified in 2025, driven by the Inflation Reduction Act (IRA) in the US and evolving value-for-money expectations in Europe.
Drug-price negotiation cycles continued through new IRA guidance, and many agencies applied more structured approaches to clinical added benefit, cost-effectiveness and budget impact.
In 2025, GLP-1 therapies for obesity and cardiometabolic disease were inherent to affordability debates, with an analysis from ICER and Brown University outlining policy tools such as outcomes-based contracts, preferred-product strategies and stepwise coverage to manage rising spend.
One of the clearest 2025 examples came from CMS’s Cell and Gene Therapy (CGT) Access Model. More than 30 state Medicaid programs used the model to implement outcomes-based agreements for sickle cell gene therapies. Under these contracts, part of the payment is tied to clinically meaningful outcomes, meaning that insurers pay more when patients improve and less when they do not.
HEOR and Market Access Planning Move Earlier and Become More Integrated
As evidence expectations rise, many organizations have strengthened how HEOR, medical affairs, access and communications teams work together across the product lifecycle. Integration here simply means these teams plan evidence needs together, rather than handing them off in sequence.
Pharma and biotech remained the largest users of external HEOR support.
Recently, Minds + Assembly launched Assembled Intelligence, described as a unified platform combining strategy, medical communications, creative, data and AI capabilities. As part of the launch, the company added Stratevi, a HEOR and market access agency, to align value narratives, evidence planning and payer communication in one ecosystem.
The combined platform includes more than 550 people globally.
In the coming year, RWE, AI, payment innovation and integrated evidence planning will likely sit at the center of HEOR and market access.
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