Roundtable: The State of Hub Services in 2026

Pharma's investment in hub and patient access support services has grown sharply alongside the specialty pipeline. The global market for these services, valued at approximately $3.55 billion in 2025, is projected to nearly triple to $10 billion by 2035 as stakeholders navigate an increasingly complex landscape of high-cost therapies, payer friction, and more.¹

The hub model is under pressure to evolve and hub transitions are accelerating. According to one survey, 45% of biopharma executives say they're considering consolidating hub vendors between 2026 and 2028, while 39% say they've felt leadership pressure to move at least some hub functions in-house, up from 28% in 2024.² What's driving that momentum, and what it means for patients already mid-journey, is a key question the industry faces right now.

Morbidity and mortality from medication non-adherence costs the US health system upward of $528 billion annually, and the stakes are especially high in specialty.³Across 99 novel medicines that launched between 2020 and 2024, an average of just 35% of first-year prescriptions were filled — 49% were rejected by payers and 17% were abandoned after payer approval, often due to high out-of-pocket costs.⁴ Even a brief gap in support can mean lost therapy and lost revenue.

At the same time, digital transformation and AI are reshaping how support is delivered, raising new questions about what hub functions manufacturers should own versus outsource and what the right operating model looks like in 2026.

To take stock of where the industry stands, Pharmaceutical Commerce spoke to four patient services experts to unpack the trends shaping hub services in 2026: what's driving transitions and how to protect patients mid-journey, what digital transformation actually looks like in practice, how to modernize without abandoning traditional channels, and how to choose the right operating model for this moment.

Those interviewed include:

• Aimee Bugosh, vice president, patient support services Two Labs Pharma
• Josh Marsh, vice president and general manager, Cardinal Health Sonexus
• Kristine McGaughey, vice president, implementation, ConnectiveRx
• Marci Peach, executive director of patient and access services, global pharmaceutical manufacturer

PC: Hub transitions are happening across the industry. What's driving that momentum and what does it mean for continuity of care?

Bugosh: Hub transitions are accelerating as manufacturers reassess their partners amid market disruption, rising cost pressures, and increasing expectations around patient experience and speed. Many are looking for more integrated, scalable models that can support complex therapies.

The challenge is that transitions often happen while patients are mid-therapy. Without a deliberate strategy, even minor disruptions can delay access or impact adherence. The most effective transitions are designed around continuity of care, with strong data migration, proactive communication, and overlap models that ensure patients experience a seamless journey—even when operations are changing behind the scenes.

Marsh: Hub transitions today are largely driven by compliance requirements, poor patient and provider experiences, and the need for more scalable, insight-driven models. Many manufacturers are reassessing whether their current partners can keep up with increasing complexity.

Continuity of care is the critical factor. A well-executed transition should be invisible to patients and providers, with no disruption to therapy or support. That requires rigorous upfront planning, parallel operations, and deep training so teams understand each patient’s journey before go-live.

When done right, a patient calling on day one is met by someone who already knows their case and can continue support seamlessly, often delivering a better experience from the start.

McGaughey: Hub transitions are not just vendor changes; they are operating-model corrections. The bigger risk is not the transition itself, but preserving a model that already creates delay, rework, and abandonment. If the patient feels the switch, the model was not designed well enough to begin with.

ConnectiveRx has a distinctive perspective because more than 65% of our current hub programs transitioned to us from another vendor, and 95% have stayed with us for more than five years. That suggests the market is not simply looking for a different partner; it is looking for a model that works better. The lesson is clear: manufacturers are not changing hubs for the sake of change. They are doing it because access friction has become too costly to ignore, and continuity has to be designed into the transition from day one.

Peach: I agree with Kristine’s point that this is less about vendor changes and more about operating-model correction. As manufacturers listen more closely to patients and providers, we’re realizing that some of our previous assumptions about what mattered most were misaligned and, in some cases, introduced unintended friction or gaps in continuity that impact both experience and product performance.

That’s driving more organizations to take a step back and reassess their hub model with a focus on reducing barriers, improving access, and ultimately strengthening adherence and persistency.

From a continuity perspective, the expectation should be clear: a well-designed transition should be invisible to the patient. If it’s thoughtfully planned and executed, there should be no disruption in their journey – only an improvement in how seamlessly they’re able to move through it.

What's happening with the digital transformations in patient support we’re seeing across the industry?

Bugosh: Digital transformation in patient support is evolving from isolated tools to more connected ecosystems. The focus is shifting toward real-time visibility across the patient journey, enabling earlier identification of access barriers and more proactive intervention.

Importantly, organizations are moving toward more flexible, modular solutions that can adapt over time, rather than large, one-time transformations. The goal is not just digitization, but better coordination across hubs, specialty pharmacy, and affordability programs to reduce fragmentation and improve the overall experience.

Marsh: Hubs remain the central bridge across patients, providers, payers and manufacturers, and digital transformation is strengthening that role. The biggest shift is the ability to capture and activate data across the full patient journey, using AI, automation and analytics to identify access barriers, predict adherence risks and support more informed, real-time decisions.

At the same time, leading programs are modernizing without leaving anyone behind. They are integrating digital capabilities into existing workflows while preserving traditional channels, ensuring all patients and providers can access support in the way that works best for them.

The result is a more connected, data-driven ecosystem where technology enables scale and efficiency, but human support remains central to delivering better access, adherence and outcomes.

McGaughey: Patient support is moving past digital theater and into real modernization. The question is no longer who has the most tools, but who removes the most friction from access. Electronic benefits verification, which cuts wait times from days to minutes, is fast becoming table stakes.

Too much “innovation” in patient support still asks providers and patients to adapt to the system. The smarter use of AI and technology is not to replace human judgment, but to remove administrative drag so people can focus on what humans do best: nuanced decision-making and compassionate care. Healthcare will always be human. The winners will be the organizations that use technology intentionally to simplify access, surface better information, and support deeper human decisioning where it matters most.

Peach: I agree with the idea that we’re moving past “digital theater” and into a more meaningful phase of transformation but from a manufacturer standpoint, what’s most important is that digital is finally being held accountable to outcomes, not just capabilities.

For a while, the industry equated digital transformation with adding tools (portals, apps, automation layers) without always stepping back to ask whether those tools were actually improving access or the overall experience. What we’re seeing now is a shift toward intentional digital design, where the goal is not to digitize every step, but to simplify the journey end-to-end.

A few dynamics are driving that shift:

• Expectation parity with other industries: Patients and providers increasingly expect healthcare interactions to feel as seamless as what they experience in retail or banking – real-time information, minimal redundancy, and transparency into next steps.
• Pressure to reduce time to therapy: Manufacturers are recognizing that every day of delay, whether from benefits verification, prior authorization, or affordability workflows, has a measurable impact on adherence and outcomes.
• Need for better orchestration, not just automation: It’s less about replacing human touchpoints and more about ensuring the right intervention happens at the right moment with the right information.

From our perspective, the most meaningful digital transformations are the ones that:

• Reduce administrative burden for providers and patients rather than shifting it
• Surface actionable insights in real time so decisions can be made faster and with more confidence
• Integrate seamlessly into existing workflows instead of requiring behavior change to adopt new systems

I also strongly agree that healthcare will always be human. Where we see the greatest opportunity is using digital capabilities—whether that’s AI, automation, or real-time data exchange—to clear the path for more meaningful human interaction, not replace it.

Ultimately, success is not measured by how advanced the technology is, but by whether the patient experiences fewer delays, fewer handoffs, and greater clarity throughout their journey.

How are hub providers modernizing operations without leaving behind patients and providers that still rely on phone calls, fax, paper-based workflows and human conversations?

Bugosh: While digital innovation is advancing, patient support remains a high-touch, human-centered experience. Many providers and patients still rely on traditional channels like phone, fax, and paper—particularly in complex or underserved populations.

Leading organizations are taking a pragmatic approach, using digital tools to streamline processes and reduce administrative burden, while preserving live support where empathy and problem-solving are critical. The priority is ensuring patients and providers can engage through the channels that work best for them—without creating fragmentation behind the scenes.

Marsh: Hub providers are threading this needle by adopting a hybrid, omnichannel model that modernizes around existing behaviors rather than replacing them. Phone, fax, and human interaction remain central, with case managers and nurses continuing to engage patients in the ways they trust.

Behind the scenes, hubs are digitizing those interactions by converting analog inputs into structured data and applying AI and analytics to improve speed, visibility, and decision-making. At the same time, they introduce digital tools like portals and self-service options where appropriate, allowing simpler tasks to move faster.
The result is a model that improves efficiency and scalability without excluding patients or providers who still rely on traditional channels.

McGaughey: The industry needs to stop treating digital and human support as opposing choices. Many patients and providers still rely on phone, fax, paper, and live assistance. Any model that assumes those realities will disappear is not modern, it is unrealistic.

Workflow misalignment quickly becomes an access problem, and affordability is where that breakdown becomes most visible. When providers are unaware of available support, 93% of copay funds can go unused – not because the need is not there, but because the support never connects to the patient at the right moment. And when out-of-pocket costs rise above $75, more than 30% of patients abandon a new prescription. That is why modernization has to do more than digitize the process. It has to make support easier to find, easier to navigate, and easier to act on in the real world, where small barriers still have outsized consequences.

Peach: This isn’t digital or human—it’s both. The real challenge is designing an experience where all channels work together seamlessly based on patient and provider needs.

Many providers still rely on phone, fax, and familiar workflows, and patients vary widely in digital comfort. Over-indexing on digital can create new friction if it forces behavior change. So modernization has to start with a “meet them where they are” mindset.

A few principles are key:

• Channel flexibility with consistent execution: No matter how someone enters the system, the experience behind the scenes should be efficient and connected.
• End-to-end simplification: Digitizing one step doesn’t fix the journey. Breakdowns between steps are where access issues occur.
• Better visibility: When digital tools don’t provide clarity, they drive more calls not fewer.

On affordability, the issue isn’t just awareness, it’s connection. Support has to show up at the right moment in a way that’s easy to act on, or it goes unused.

Ultimately, the goal isn’t to eliminate traditional channels, it’s to reduce reliance on them over time by building more intuitive, trusted options, while fully supporting those who still depend on them today.

As pressures mount, manufacturers are rethinking whether to outsource, insource, or hybrid their hub functions. What critical factors should guide that decision in 2026?

Bugosh: The decision is no longer a binary choice between outsourcing and insourcing—it’s about aligning the model to the needs of the brand and patient population.

Key considerations include therapy complexity, speed to launch, scalability, and the level of integration required across the ecosystem. Many manufacturers are gravitating toward hybrid models, where they retain strategic oversight but leverage external partners for execution and flexibility.

Ultimately, the most effective models are those that balance control, agility, and patient experience—rather than optimizing for cost or structure alone.

Marsh: Manufacturers are moving away from one-size-fits-all hub models and instead designing solutions around their core strengths. The key decision factors are control over data and patient experience, the ability to scale with complexity, and access to innovation, particularly in analytics and digital capabilities.

In many cases, that leads to a hybrid model, where manufacturers retain strategic oversight while partnering for execution and specialized capabilities. What matters most is flexibility. The right partners today are those that can adapt as a manufacturer’s portfolio, operating model, and patient needs evolve, while maintaining consistent, high-quality patient support.

McGaughey: The outsource-versus-insource debate is often framed too narrowly. The real question is not what to own, but what creates competitive advantage. Manufacturers should keep control where it is strategic and partner where outside expertise improves speed, scale, and execution.

Peach: This isn’t a simple outsource vs. insource decision. It’s about where manufacturers create the most value and where partners can accelerate performance.

Most pharma companies aren’t built to be technology specialists at scale, so trying to own everything can dilute focus and slow progress. At the same time, key elements of the patient experience require strong manufacturer ownership.

In 2026, the decision comes down to:

• Impact on patient experience and outcomes
• Speed and scalability of execution
• Control over critical touchpoints and insights
• Cost and measurable ROI

What we’re seeing increasingly is a hybrid approach—manufacturers owning strategy and experience design, while leveraging partners for execution and specialized capabilities.

Ultimately, the right model is the one that delivers a seamless patient experience while allowing manufacturers to stay focused on their core mission.

References

1. Grand View Research. "Pharma Hub and Patient Access Support Service Market Size, Share & Trends Analysis Report, 2025-2033." Grand View Research, 2025, www.grandviewresearch.com/industry-analysis/pharma-hub-patient-access-support-service-market-report.
2. Cardinal Health. "2026 Patient Hub Outsourcing and Insourcing Trends." Cardinal Health, 2026, www.cardinalhealth.com/en/services/manufacturer/biopharmaceutical/patient-access-and-adherence/hub-evolution-reports/2026-patient-hub-outsourcing-and-insourcing-trends-infographic.html.
3. Klein, Dan. "Medication Non-Adherence: A Common and Costly Problem." PAN Foundation, 2 June 2020, www.panfoundation.org/medication-non-adherence/.
4. IQVIA Institute for Human Data Science. "U.S. Medicine Use Climbs Amid Continued Affordability and Access Challenges." IQVIA, June 2026, www.iqvia.com/blogs/2026/06/us-medicine-use-climbs-amid-continued-affordability-and-access-challenges.