It’s been an extraordinary two years for anyone working in pharma commercialization, with the macro environment shifting meaningfully under the feet of all those sitting on the commercial side of pharma or building in digital health with pharma partnership aspirations. Perhaps the “noisiest” shift was Trump’s MFN (Most Favored Nation) progress since 2025: 26 manufacturers, covering 90% of the domestic pharma market, signing on by 31 August this year. In parallel, the FDA launched a new wave of crackdowns on DTC advertising, with 100 enforcement letters sent, 65 of them on 9 September 2025 alone, and letters have continued at pace throughout 2026. Alongside all of this, 32% of US consumers were using an AI chatbot for health information by the end of last year, with the number only growing globally throughout 2026 (OpenAI’s own count of weekly health questions rose from 230 million in January to over 300 million by July), whilst HCP access continues to be a challenge for pharma.
All of these changes have led to a number of challenges that keep rearing their heads throughout 2026, and as we turn the corner out of the summer, it’s pertinent to reflect on what these are and contemplate potential direction of travel for 2027.
Trend One: Pharma Built the Front Door but Have They Given Away the Keys?
A combination of the macro pressures on pharma, and the changing of the winds in consumer behavior forced a real reckoning for pharma companies in the first three quarters of 2026. Many companies poured millions into their own direct-to-patient portals, following Lilly and Pfizer’s leads, but the analysis still shows patients spending their time with telehealth providers and companies like Amazon directly, rather than with pharma. Whether this is an issue for pharma is still to be determined, but it certainly seems that digital platforms have inserted themselves between pharma and the patient, leading to more fragmentation, and an increased number of variables in their patients’ treatment journeys.
A striking case study this year was Hims & Hers, an intermediary pharma couldn’t go around. Within 6 weeks of their March 2026 launch (post-compounding agreement), Hims and Hers had fulfilled 125,000 Wegovy shipments (described by Novo as one of their “most voluminous” partners). Ultimately, Novo gave up the customer relationship in exchange for volume. Another prescribing layer that adds to the fragmentation is the growth of Amazon’s same day prescription services – expanding to nearly 4,500 cities and towns by the end of 2026. We’ve already seen them become a dispensing partner for Eli Lilly, Noom and Weight Watchers in the weight health space, and it remains to be seen whether they’ll settle into the “friend” or “foe” category for pharma, especially with the Senate looking increasingly closely at the direct telehealth-pharma connection. Of course, there’s no doubt that PBMs are not being replaced any time soon, with the Big Three processing 80% of all prescription claims in 2025, so Market Access Teams very much still have their marching orders for 2027.
Trend Two: Physician Attention is Shifting, but To Where?
Whilst big pharma battles a changing patient landscape, the other side of the coin, handling HCP engagement, is equally disrupted. Traditional field force tactics are more challenged than ever, with HCP access an ongoing headache and efforts to automate much of the rep’s pre- and post-call activities accelerating. Outside of the field model, grabbing HCP attention has starkly shifted from legacy platforms, with the media market as disrupted as it has ever been due to unpredictable performance of legacy channels, and emerging digital destinations for information-hungry HCPs. Linear TV is a clear example: the pharma and the OTC brand market spent 16% more on linear TV and got just 7% more household impressions last year.
When we think about HCP engagement, it’s hard not to immediately think about OpenEvidence vs. Doximity – a tale of two cities. OpenEvidence went from a $1bn valuation to $12bn in eleven months on roughly $100m of pharma ad revenue. Over broadly the same amount of time, Doximity’s quarterly growth fell from 23% to 10% to 5%, its stock lost 65%, and management told analysts that HCP digital pharma ad demand was soft. Both companies sell HCP attention to pharma. Pharma’s HCP digital budgets tightened, but they didn’t fall evenly. One company was hit by the squeeze, the other bounced from the reallocation. Investors are beginning to bet against venues specifically, rather than the business model and audience.
The overall complexity & volatility across the media landscape is leading to caution from commercial leaders: shorter contracts, more experiments, and a tighter grip on spend. As we move towards 2027, I believe Pharma’s success with HCP attention will depend on innovative partnerships in the digital health space – improving applicability to, and innovation for, HCPs – whilst jointly working on media strategies that benefit all parties.
Trend Three: Pharma is investing in speed, but at what cost?
For the last 20 years, pharma has invested relentlessly in a commercial model that, as explored, is fundamentally shifting under their feet. As the shockwaves of AI progress ripple through the industry, pharma has spent millions on pilots to speed up existing processes. Recent research suggests that 95% of enterprise AI pilots don’t move business metrics, and Gartner expects 40%+ of agentic projects to be cancelled by 2027. Speed applied to an old model is sped up wastage.
The risk of optimizing the old model rather than building a new one is becoming visible, and the external innovation required may well have to come from partners outside pharma’s existing vendor base. The cost of lagging is already visible in valuations: when Novo Nordisk announced 9,000 layoffs in September 2025, with its stock down 37% year to date, BMO Capital Markets explicitly called out being slow to act in launching direct-to-consumer (that is, standing up an entirely new commercial channel) as a leading cause. Eli Lilly, on the other hand, certainly enjoys the tailwinds provided by its tirzepatide blockbuster franchise, but LillyDirect launched in January 2024, well before the policy environment demanded a direct-to-patient channel. Lilly built the channel while it still had the luxury of choosing to.
Commercial reinvention is no longer a buzzword; I believe it’s now a mandatory survival mechanism in an industry facing deep disruption going into 2027.
While it might be tempting to view these trends as an existential threat to pharma, I’m bullish that pharma is in the best possible position to build something new with digital health partners: an industry that works with regulators rather than around them, gets to patients and physicians faster, and treats AI as a reason to rebuild the model rather than accelerate the old one. The real question is, who will take up the gauntlet, and with whom? It’s time we stop treating digital health and pharma as separate industries and treat them as what they are: necessary partners in the future of pharma commercialization, and in the fight for a reimagined future for patients and HCPs.
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