Chris revisits his November 2024 forecasts to assess how they’ve held up through mid-2025, giving them an overall grade of A-. He examines which trends played out as expected, where the landscape shifted more dramatically, and how these developments are reshaping patient access strategies.
To learn more, register for ConnectiveRx’s free webinar on September 24: Building Resilient Patient Support When Industry Change Never Stops.
Read on for Chris’s insights.
Patient Support’s Perfect Storm in 2025: Hits, Misses, and Surprises
By Chris Dowd, Senior VP of Market Development, ConnectiveRx
With eight months of hindsight, we’ve assessed how well those November predictions played out. They were largely accurate, with some real surprises thrown in. Let’s start with predictions that were right on target.
Issues Where Predictions Hit the Mark
Independent Pharmacies Refuse to Stock Negotiated Drugs
One alarming November prediction was that >90% of independent pharmacists would refuse to stock Medicare-negotiated drugs due to reimbursement concerns. That analysis proved prescient: A 2025 report from Aimed Alliance showed that 93% of independent pharmacists are refusing or considering not stocking one or more of the 10 drugs in the first round of price negotiations.
Copay Accumulator/Maximizer Programs Continue Their March
In November, data showed that 42% of "jumbo" employers would be using accumulators/maximizers, with another 8% joining by 2026. That forecast proved essentially accurate: Recent MMIT data shows that by Q3 2025, payers anticipate that 46% of plan sponsors will opt into an accumulator program, and 53% will opt into a maximizer. Payers anticipate that member enrollment for plans with an accumulator or maximizer program will increase by 10% by fall, ending at 48% enrollment for accumulators and 57% for maximizers.
State-Level Legislatures Continue Action Against Accumulators
In November, we noted the "mosaic of legislation" at the state level: 23 states, Puerto Rico, and D.C. had passed anti-accumulator legislation, 17 states had introduced bills, and 12 had taken no action. The July 9 map from the All Copays Count Coalition shows additional progress: 29 states, Puerto Rico, and D.C. have now passed legislation or taken regulatory action.
CMS Price Negotiations Foster Formulary Restrictions and Increased Cost Sharing
Our original analysis suggested that Medicare price negotiations would be "unlikely to lead to consistent reductions in patient cost sharing"–a forecast now validated by the latest data. A new report from the American Journal of Managed Care shows that after the first round of negotiations, selected Part D drugs “could lose rebate flexibility, prompting plans to place them on less favorable tiers or apply utilization management strategies.”
Meanwhile, therapeutic alternatives with better rebate terms may drive non-medical switching away from negotiated brands. Indeed, early data suggests that "most patients may pay more" under the new law, despite negotiated price reductions. Lesson: In a complex reimbursement environment like the USA’s, price negotiations don’t necessarily increase access.
For some of our November predictions, reality turned out to be significantly worse than forecast.
Issues Where Storms Proved More Severe Than Expected
Part D Plan Consolidation Accelerates
The November analysis predicted a 26% decrease in standalone Part D plans in 2025. Reality delivered a more dramatic contraction: An updated report from the Kaiser Family Foundation shows that just 7 firms will offer a total of 464 Part D Stand-Alone Plans in 2025—a 35% YOY reduction, and the lowest number ever.
Uncertainties Abound Following the 2024 National Election
- Domestic Manufacturing Push: President Trump signed an executive order in May to eliminate regulatory barriers to domestic pharmaceutical manufacturing. This represents a fundamental shift in manufacturing policy that hit without warning.
- Most Favored Nation Pricing Mandate: The President’s May executive order directed drugmakers to lower prices to align with what other countries pay. The Trump Administration is seeking price cuts from 59%-90%, threatening a complete restructuring of pharmaceutical pricing.
- 200% Pharmaceutical Tariffs: The President warned in July that long-awaited industry-wide tariffs would be announced "very soon," with rates up to 200%.
- HHS/FDA Transformation: Under RFK Jr., US health policy is seeing unprecedented changes to regulatory oversight and approval processes:
- Threat of reduced funding for research/staffing
- Increased scrutiny of vaccines
- “Make America Healthy Again” agenda
Add in Secretary Kennedy’s possible policy change to make it significantly more difficult and expensive for drug companies to advertise on TV and his July steps to terminate up to 10,000 HHS employees, and it’s easy to see why Pharma is more than a bit jumpy.Taken together, these developments go far beyond the "policy uncertainty" we warned about. Instead of gradual changes and traditional political maneuvering, the industry is facing immediate, dramatic policy earthquakes.
Bottom Line: Solid Analysis with Unprecedented Surprises
Overall, the November predictions rate a grade of A-. But the point of this look-back reaches far beyond a letter grade. The fresh data above underscores a critical reality for access teams: the perfect storm isn't theoretical anymore, it's operational. Manufacturers should immediately assess their patient services portfolio for vulnerability to these converging pressures, strengthen relationships with strategic partners, and build agility into their patient support programs.
When industry analysis proves this prescient, smart manufacturers don't just take notice—they take action.
To learn more, register for a free webinar, Building Resilient Patient Support When Industry Change Never Stops, on September 24 at 2:00 pm ET.
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