Six Payer Trends Shaping Market Access in 2025
Based on the search results, here are six key payer trends shaping market access in 2025:
1. Ongoing Medicare Advantage (MA) market challenges:
MA enrollment is expected to continue growing, but at a slower rate of about 5% annually from 2023 to 2028. Payers are likely to optimize products to support sustainable economics, and there may be market consolidation with smaller payers exiting12.
2. Shift in commercial insurance landscape:
The commercial segment is expected to rebound, with EBITDA margins likely returning to historical averages by 2028. However, there's a continued shift from fully insured to self-insured businesses as employers seek to cut costs12.
3. Changes in Medicaid enrollment:
Medicaid enrollment declined by about 6.5 million in 2023 and could fall further by 2.5-3 million lives over 2024 and 2025 due to eligibility redeterminations12.
4. Increased focus on value-based pricing (VBP):
Payers are emphasizing value-based pricing models to resolve tensions between premium pricing for targeted medicines and financial pressures on healthcare systems7.
5. Growth of artificial intelligence (AI) in payer operations:
Payers are anticipated to use AI for automated data retrieval, research, and competitive analysis11. Over 80% of surveyed health system executives expect the proliferation of generative AI to have a significant or moderate impact on their organizations in 20255.
6. Expansion of digital health and telemedicine:
Nearly 90% of health system executives expect the expanding adoption of digital tools, connected care delivery, and virtual health to influence their strategies in 2025. This trend is likely to impact payer coverage and reimbursement policies5.
These trends indicate a shifting landscape for market access, with payers focusing on cost management, value-based models, technological integration, and adapting to changing enrollment patterns across different insurance segments.
Sources:
5. https://www2.deloitte.com/us/en/insights/industry/health-care/life-sciences-and-health-care-industry-outlooks/2025-global-health-care-executive-outlook.html
7. https://www.tribecaknowledge.com/blog/6-pharma-trends-for-2025-trumps-return-ai-breakthroughs-and-market-access-challenges
11. https://www.mmitnetwork.com/thought-leadership/whats-ahead-market-access-2025/
12. https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare-in-2025-and-beyond