During AMCP 2025 in Houston, March 31–April 3, 2025, leaders from across the healthcare ecosystem—spanning managed care organizations, life sciences, PBMs, government agencies, employers, and health systems came together to confront the most urgent challenge in healthcare: delivering innovation in a system under pressure teaming with uncertainty.
And the shift is just as undeniable. From GLP-1s transforming chronic disease management to the Inflation Reduction Act rewriting Medicare policy, the future of managed care is here—and it’s anything but business as usual.
Here are 5 key takeaways from the conference:
Reform is real—and it’s accelerating.
From PBM reform to site-of-service legislation and IRA price negotiation, policy shifts are no longer theoretical—they’re active, layered, generating uncertainty, and moving fast. Whether it's delinking, spread pricing bans, or 340B clawbacks, the message is clear: Transparency, access, and value are no longer optional. But the biggest challenge? Adapting without losing control of clinical outcomes or financial sustainability.
GLP-1s are breaking the benefit model.
Obesity care has exploded into the mainstream, driven by GLP-1 demand—and payers are scrambling to balance clinical promise with affordability reality. As new indications roll in—from sleep apnea to substance use—benefit designs will need to evolve quickly to keep pace without breaking the bank.
The pipeline is shifting from incremental to transformational.
The traditional launch curve has been replaced by a wave of high-impact, high-cost therapies targeting rare, genetic, and chronic conditions. Cell and gene therapies continue their push into heart failure, neurology, hematology, and metabolic disease, while the traditional pipeline is also heating up—with complex generics, new MOAs, and niche delivery systems challenging old value frameworks. The takeaway? Payers are being asked to assess clinical value faster, earlier, and with less long-term data than ever before.
Patient experience is more than a buzzword.
Whether it’s through real-world evidence, shared decision-making mandates, or CMS advisory committees, the voice of the patient is moving upstream. RWE isn’t just for validation anymore—it’s part of the value equation. But it only works when paired with structure, transparency, and payer-aligned endpoints.
The new frontier? Payers as innovators.
While PBMs face scrutiny, they’re also quietly reinventing themselves—building biosimilar pathways, bundling GLP-1 services, and leaning into value-based models. Employers are pushing harder too, demanding ROI on high-cost therapies and taking a more active role in benefit governance. Innovation isn’t just clinical anymore—it’s financial, operational, and happening in real time.
What’s next?
2025 is a tipping point. With legislation in motion, pipelines heating up, and cost pressure mounting, managed care must lead, not just react. That means rethinking access, redesigning coverage, and building models that are flexible enough to weather what’s coming next.
At Inizio Evoke Acess, we’re here to help pharmaceutical and biotech companies translate complexity into action—so patients, providers, and payers all move forward together. Connect with us to learn more.