Affordability Under Pressure: How PAP Leaders Are Reinventing Patient Assistance Models in 2026

Patient Assistance Programs (PAPs) once a steady pillar of support for affordability are entering a period of redesign at unprecedented speed. Enter 2026, the marker of a decisive inflection point for PAP strategy. A year defined by the real world implementation of the Inflation Reduction Act (IRA), the rollout of cost smoothing mechanisms, rising demand and growing resource strain. Leaders are faced with tough decisions about how programs are designed funded and delivered.

At this turning point Access USA 2026 emerges as the definitive venue for understanding these challenges and crafting sustainable patient centric responses. What comes next and who is prepared for it?

Why 2026 Is a Critical Year

· Under the IRA the first set of negotiated drug prices take effect in 2026 and are expected to reduce out of pocket costs for many beneficiaries.

· Simultaneously the Medicare Prescription Payment Plan (MPPP) the companion cost smoothing program is rolling out in full force under 2026 guidance. This will allow beneficiaries to spread their prescription costs over time rather than paying lump sums at the pharmacy.

These reforms are reshaping the economics of drug access creating new affordability opportunities for patients but also imposing fresh pressures on PAPs manufacturers and payors as they rethink funding eligibility and program design.

As reforms reshape affordability levers PAP models are fragmenting. Some are adapting quickly while others are bracing for impact. PAPs must evolve not simply patch new policies onto old models but reimagine their structure mission and sustainability.

In this dynamic environment five themes are emerging across the market…

5 Ways PAP Leaders Are Responding to the IRA and Copay Reform

1. Re Architecting PAP Design Around Cost Smoothing and Out of Pocket Caps

PAP leaders are reevaluating eligibility thresholds enrollment timing and copay subsidies considering the new MPPP and out of pocket caps under Medicare Part D. By aligning PAP support with the smoother predictable payments that MPPP encourages programs can better support beneficiaries while potentially reducing fiscal volatility for manufacturers. This is directly addressed in the PAP session “Smoothing the Path Mastering IRA Implementation.”

2. Anticipating Policy Shifts From IRA to Broader Healthcare Reform

With 2026 bringing not just IRA implementation but broader turbulence from possible new legislation to shifting PBM behaviors and gross to net pressure PAPs are under pressure to stay ahead. The pre conference workshop “Policy to Patient Decoding Reforms for Patient Access” gives leaders a forum to scan the horizon for changes and plan adaptive strategies.

3. Embracing Technology to Enhance Efficiency and Preserve Patient Experience

As resource constraints tighten and demand grows many PAPs are turning to AI driven tools to streamline enrollment eligibility verification adherence support and communication. The session “AI Revolution in Patient Assistance” on Day 1 explores how generative AI and analytics can reduce administrative burden while improving patient support outcomes.

4. Addressing Broader Coverage Gaps and Emerging Uninsured Populations

Given projections that legislative shifts such as budget reconciliation efforts and Medicaid reforms may lead to increased rates of uninsured or underinsured individuals PAPs are broadening their scope to fill gaps beyond traditional safety nets. The PAP session “Navigating the New Healthcare Landscape A State by State Impact of the 2025 Budget Reconciliation Law” dives deep into this challenge.

5. Reinventing Funding Models From One Off Donations to Sustainable Scalable Support Systems

With gross to net pressures PBM behaviors such as accumulator and maximizer phenomena and rising demand traditional PAP funding models are under strain. The session “PAPs Under Pressure Navigating PAP Stresses from IRA Upheaval PBM Tactics Gross to Net Strain and AI Innovation” addresses how to rethink financial models balancing affordability for patients with long term sustainability for sponsors.

Pain Points: Economic Pressure Efficiency Imperatives and the Experience Paradox

· Rising demand vs finite resources: As more patients become eligible or in need amid coverage shifts PAPs risk being overwhelmed.

· Administrative burden and complexity: Regulatory changes including copay smoothing new eligibility criteria and evolving payer behavior require complex program redesign while manual processes may not scale.

· Balancing affordability with quality of experience: While cost smoothing and subsidies help reduce financial burden PAPs must ensure patient journeys remain smooth humane and supportive not bureaucratic.

· Uncertainty around funding sustainability: As pressures mount such as gross to net strain PBM tactics and regulatory enforcement sponsors may face tough decisions balancing cost control and program reach.

Why Access USA 2026 Is the Place to Be

Access USA 2026 is more than a conference. It is the crossroads of policy patient need industry strategy and innovation.

· Attendees will hear “The Patient Experience Affordability Access and the State of Healthcare Today,” a session that grounds the discussion in real world patient stories and data reminding stakeholders why PAPs exist.

· The “Leaders Council Roundtable” convenes top decision makers from major manufacturers and patient support organizations to debate and plan the future of patient access and affordability.

· The PAP tracks provide a comprehensive agenda from policy scanning to AI innovation from funding strategy to state by state access planning giving attendees a full toolkit for rethinking PAP design in 2026 and beyond.

In short if you want to understand how the IRA cost smoothing and shifting payer dynamics are really playing out and how PAPs can adapt to maintain affordability and dignity for patients Access USA 2026 is the destination for those answers.

The stakes have never been higher. Can PAP leaders truly afford to sit this one out?