LTEN 2025: Market Access Trends

The LTEN 2025 conference had informative and engaging sessions on everything from brain science to negotiation tactics.

Yet, one of the hottest topics in hallway conversations was the seismic impact of the Inflation Reduction Act (IRA): “Wait, so Medicare can just say no now?” “Pricing just got a lot more complicated.” “Anyone figured out the Part D thing yet?”

Market access leaders in life sciences from 142 companies all came to Aurora, CO, for four days in late July, trying to learn what they could to figure this all out.

Nobody’s pretending it’s easy, and clearly the old way of doing things might not work the same way anymore. But it’s opening up new opportunities and forcing market access leaders to think creatively, adapt, and find new ways to succeed.

Key Changes from the IRA Affecting Payers & Market Access

The consequences of the IRA, for better or for worse, mostly revolve around three major changes. Each one plays a part in reshaping the way the pharma world works and builds on the last to create a buffet of new challenges. Almost like dominoes falling.

Drug Price Negotiation (Starting 2026)

Medicare just got teeth. For the first time ever, the government can sit across the table from pharmaceutical companies and negotiate prices for select high-spend drugs.

And yes, manufacturers are looking at reduced revenue potential, especially for blockbuster drugs. But here’s the kicker: payers are paying attention. They’re taking those negotiated Medicare prices and using them as leverage when they develop formularies or push for discounts in commercial plans.

Market access teams can no longer solely plan for launch anymore—they need to think about what happens when Uncle Sam starts haggling over their drug prices three years down the road. 

Product lifecycle planning just got a whole lot more complicated.

Medicare Part D Redesign (2025)

Patient out-of-pocket costs hit a hard stop at $2,000 annually. The coverage gap (that infamous “donut hole”) disappears completely. 

Sounds great for patients, right? It is (but still may not be affordable for some patients). Plus someone has to pay for all this, and it’s the payers fronting the bill.

Plans now shoulder more of the drug costs in the catastrophic phase, while manufacturers chip in with a 10% discount in the initial phase and a 20% discount in the catastrophic phase for negotiated drugs.

What does this mean in plain English? Simply put, payers are financially exposed like never before and have no choice but to scrutinize every formulary inclusion, step edit, and rebate with the intensity of a tax auditor. 

Moreover, manufacturers can’t coast on “me too” value propositions anymore. Instead, they need rock-solid outcomes data and cost-effectiveness arguments to maintain access.

Inflation Rebates

Price your drug above inflation? You owe Medicare a rebate. It’s that simple, and that limiting.

Manufacturers lose pricing flexibility over time, which changes the entire economic equation for drug development. Payers are starting to factor price stability into their access decisions, weighing formulary positioning and contracting against the likelihood that a drug’s price will stay reasonable.

Clearly, the days of aggressive price increases are over, and everyone in the market access chain must adjust accordingly.

Pressures From This New Reality

Attendees at LTEN were also able to get even more context and knowledge about the pressures of this new pharma world at the “Market Access Trends and Training Innovations: Insights from Industry Experts” session: 

• Payers Under the Microscope: Payers face unprecedented financial exposure and scrutiny from all angles. They’re questioning every decision with the intensity of someone who knows their job depends on getting it right.
• Value Stories Need Serious Upgrade: Pharma teams can’t wait until launch to figure out their value proposition anymore. They need compelling, evidence-backed stories earlier in the product lifecycle, and those stories better be bulletproof.
• Probing Skills Become Make-or-Break: Stakeholder alignment matters more than ever, which means teams need to get good at asking the right questions and listening to the answers. Surface-level conversations won’t reveal what payers really care about or what’s driving their pushback.

The Implications: What Smart Teams Must Do Differently

Spotting these pressures is easy—adapting to them isn’t. Tweaking around the edges won’t work. You need a complete strategic rebuild. Based on what we learned at the conference, here’s what that could look like:

• Value Demonstration Becomes Strategic Priority: Clinical outcomes, real-world evidence, and cost offsets become the currency of payer negotiations. Teams are learning to speak the language of financial impact—discussing dosing, side effects, and economic considerations—rather than focusing solely on clinical benefit, because payers need to see a drug’s value both holistically and through a financial lens.
• Earlier Conversations, Better Relationships: Proactive engagement with payers starts way earlier in the drug lifecycle now. Waiting until launch to have these conversations means missing the critical window when payers are forming their coverage strategies.
• Contracts Built for the New Math: Contracting strategies are evolving fast to account for the new liability model and government pricing rules. Companies are now engaging payers earlier to negotiate network contracts that unbundle facility and drug fees. Doing so enables clearer cost structures and more targeted reimbursement strategies.
• Breaking Down Department Silos: Cross-functional alignment between Market Access, HEOR, Pricing, and Medical Affairs becomes essential for survival. Teams that operate in isolation are getting eaten alive by the complexity of this new environment.

What People Most Wanted to Learn

Walking the expo floor and sitting in on conversations at LTEN, one thing became crystal clear: market access teams know they need help, and they’re not interested in generic solutions.

The biggest draw was negotiation training tailor-made for the messy, complicated scenarios these teams face every day. People weren’t looking for theoretical frameworks—they wanted training that could help them handle an intense payer meeting on Tuesday morning or figure out why their value story keeps falling flat.

However, what caught our attention most was how tired teams are of pitching. They want to learn how to sit back, listen to what clinicians and payers are really saying, and then tailor their responses to show genuine benefits rather than rattling off product features. Active listening at its finest, if you will. 

What Resonated Most About SNI

What resonated most about our approach at Shapiro Negotiations Institute (SNI) was the focus on real-world application. Teams loved our customized negotiation training because it’s grounded in their specific scenarios, not some made-up case study from a textbook.

The biggest interest area was far and away probing skills. People want to get to the real “why” behind stakeholder pushback instead of accepting surface-level objections. Because when a payer says “we’re concerned about cost,” they might actually mean “we don’t fully understand your drug’s merit” or “we’re worried about utilization patterns.”

The cross-functional piece hit home, too. Teams are finally realizing they need to understand the perspectives of payers, clinicians, and institutions—not just their own departmental goals. The siloed approach doesn’t work when everyone’s dealing with the same IRA constraints and pressure points.

Final Thoughts: What We Learned in Colorado

The best part about LTEN? People were energized to figure out ways to solve problems.

Sure, the IRA threw everyone a curveball. But the teams we met were looking for ways to work with the new rules instead of against them. They want to have better conversations with payers, ask smarter questions, and build the skills to help them win better deals.

Bottom line: the market access world just got a lot more complicated, and the teams that learn to listen, probe, and negotiate strategically are the ones that’ll come out ahead.