Global P&MA trends in 2026: From cost control to structural reforms

Published on June 5, 2026

The P&MA landscape is rapidly increasing in complexity as payers respond to rising healthcare spend. While much recent discussion has focused on policy shifts such as MFN pricing, broader structural changes are reshaping global P&MA. Four trends define this shift: intensified cost containment paired with stricter value-based pricing; stronger linkage between reimbursement and local investment; structural reform of HTA and access pathways; and the rise of alternative payment and access models.

Trend 1: Global focus on cost containment and stricter value scrutiny

Cost containment is intensifying across all major markets. Governments are tightening pricing levers, increasing rebates and clawbacks, and reinforcing financial risk transfer to manufacturers. In Italy, for example, rising hospital drug overspend has led to increasing clawback obligations. In Germany, the Health Finance Commission is recommending that the…

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