Big promises, hard work: What 2026 will demand from pharma

It would be an understatement to describe the past year as tumultuous for the life sciences industry. Between shifting political winds, accelerating technological change, and markets that have felt permanently on edge since January, 2025 has been equal parts unsettling and invigorating to witness. Progress has rarely moved in straight – at points, even logical – lines, but it has moved quickly, often forcing companies to make decisions before the ground beneath them had fully settled.

That sense of momentum, tempered by uncertainty, makes predicting what comes next both irresistible and slightly foolhardy.

But, alas, a fool I am.

From AI drug discovery and cancer sniffing dogs, to patient support programmes and the breakout performance of GLP-1s, every conversation this year has seemed to surface three more fault lines waiting to open, painting a picture of an industry juggling long-term ambition with short-term constraint.

Distilling that complexity into a handful of trends has been no small task. What follows is not a definitive forecast, but more of a set of signals areas where pressure is building and 2026 looks set to demand more clarity, discipline, and follow-through than the year just gone.

Trend #1: GLP-1 promise meets reality

If 2025 was the year GLP-1 drugs cemented their place in the cultural zeitgeist, 2026 will be the year the industry grapples with what comes next. With semaglutide now the world's second-best-selling medicine at $26 billion in combined sales in 2024, and promising trials exploring applications in neurodegenerative, musculoskeletal, and cardiological conditions, it’s a safe bet to say that we're approaching a critical inflexion point where the promise of this so-called “miracle” drug class must meet practical reality.

Over the coming months, the conversation will shift dramatically from clinical efficacy to delivery infrastructure – because writing prescriptions is relatively straightforward; ensuring patients can access, afford, and maintain treatment long-term is anything but. Adherence is a core challenge here. All drugs come with a list of potential side effects, and common among GLP-1s are some unpleasant gastro challenges – an experience that may deter patients from continuing with their intended dose.

This is the area where I see huge opportunity for pharma companies to explore patient support programmes and real-world adherence strategies, particularly as healthcare systems struggle to meet skyrocketing demand. This challenge will only intensify as the GLP-1 arms race heats up. For example, Eli Lilly's planned 2025 submission of orforglipron, a daily oral option, signals a pivotal shift in convenience, but adds complexity to already strained delivery systems.

Uncertainty in the patent landscape adds an exciting layer of urgency, also. While US protection extends to 2032, Novo Nordisk’ primary semaglutide's patent expires in major markets next year, including China, India, Canada, Brazil, and Turkey, representing 40% of the global population. China's expiration is particularly significant, potentially transforming it into the largest market for generic semaglutide. While Novo's secondary patents on formulations and methods extend protection into 2033 in some regions, core patent expirations will inevitably accelerate generic competition.

But perhaps most challenging is the cultural conundrum. As in tandem with the truly revolutionary medical potential of GLP-1s, there is a danger. The online “wellness” space has already started to exploit the weight loss application of these medications, fuelling counterfeiting and unsafe self-directed care as patients stretch doses to manage costs. Education campaigns will be critical in 2026 – the industry can no longer ignore cultural demand. As the market fragments globally, real-world data becomes essential to understanding how patients actually use these drugs outside trials and whether the industry can deliver sustainable, equitable access beyond the prescription pad.

Trend #2: AI

Like most people, I looked at the rise of generative AI with a mixture of enthusiasm and caution. With so much potential, it was hard to ignore. But, after a year of enthusiastic experimentation, 2026 feels primed to be less of a breakthrough moment for generative AI in pharma, and more like a reckoning. The scramble to appear AI-literate in 2025 led to some curious behaviour – quotas, pilots, and point solutions deployed with little clarity on purpose. The result has been predictable. Even the most powerful tool can create chaos when forced into the wrong workflow – just ask McDonald's Netherlands or Coca-Cola about their AI-generated Christmas adverts and the backlash that followed.

The data tells a sobering story. A recent MIT report found that 95% of generative AI pilots at companies are failing. In life sciences, despite significant investments, only a handful of leaders report successfully scaling AI, and even fewer have achieved meaningful returns. More often than not, the problem isn't the technology – it's the application.

The bottlenecks patients actually experience are administrative: weeks-long coverage confirmations, surprise bills, prescription authorisation delays, endless payer hotline loops. This is where AI has the potential to really earn its keep in 2026, by prioritising quiet competence over novelty.

We are already seeing early signs of this shift. Agentic AI initiatives are moving beyond simple task execution towards functioning as digital co-workers, handling regulatory documentation, synchronising data pipelines, and supporting compliance. But, as always, progress brings exposure. 

Shadow AI surged in 2025 as burned-out staff sought ways to independently improve their efficiency and with it came cybersecurity concerns around issues such as data breaches and vulnerabilities in AI-controlled devices. And so, in 2026, as the conversation matures, pharma companies cannot afford to overlook the importance of governance.

Formal frameworks, organisation-wide guardrails, and meaningful training will be essential. As generative AI use increases, trust will become the currency that matters most – trust in data provenance, in authenticity, and in the limits of automation. Ultimately, the companies that succeed will not be those that deploy AI fastest, but those that deploy it strategically, with human oversight that strengthens, rather than erodes, confidence.

Trend #3: Scotland's clinical trials ambition

As pharmaphorum’s resident Scot, it is unsurprising that Scottish health plans have caught my attention this year. Most notably, two events this year have teased plans to establish the nation as a global hub for clinical trials. The first, in Glasgow, offered a rather frank audit of the current failures and opportunities for scaling clinical research across Scotland. The second, at the launch of a white paper developed in part by AstraZeneca, cemented a crucial barrier to realising that ambitious goal: it's no longer enough to have world-class research capabilities, innovative universities, and an integrated NHS.

The stakes are high. Clinical trials are cash-generative for health systems and accelerate patient access to cutting-edge treatments. Yet, Scotland faces a fundamental challenge: translating potential into performance. As one industry leader recently noted, companies now need compelling reasons to place trials in any given country, whether Scotland, Germany, or Belgium. Cost matters (the UK ranks second only to the US for trial expenses), and so does speed.

The £36.9 million NHS Research Scotland Collaborative Accelerator for Commercial Clinical Trial Delivery in Scotland (CATALYST) programme, represents Scotland's strategic response. Four clinical research delivery centres in Edinburgh, Glasgow, Aberdeen, and Dundee now operate as a coordinated network, leveraging what Scotland does uniquely well: what Dame Anna Dominiczak calls the "triple helix" of NHS, universities, and industry, working in tight geographic and institutional proximity. This isn't easily replicated elsewhere as collaboration cannot be purchased, it must be cultivated.

Early results are promising. The 150-day target for first patient recruitment is being met. Partnerships with AstraZeneca on renal trials in Dundee and Glasgow have tripled recruitment by adding dedicated clinical fellows. Plans for decentralised trials in obesity and diabetes in 2026 will bring research directly to communities, rather than requiring patients to travel to centres. But maintaining the momentum of this hub and spoke model requires confronting uncomfortable realities in the coming months.

Infrastructure must extend beyond academic hospitals into primary care and underserved communities. AI-enabled patient identification systems that can screen trial-eligible patients overnight do exist, but aren't yet deployed at scale. A searchable national database spanning CHI Share, SKY Diabetes, and primary care records could also revolutionise recruitment – if data governance challenges can be solved and an opt-out system implemented safely.

Cultural change within the NHS remains the harder challenge. Clinical trials must shift from peripheral academic activity to routine care delivery, with protected time for clinicians and sustainable funding for research nurses, pharmacists, and data teams. The opportunity is genuine, but fragile. Scotland's patent-driven pharmaceutical success story, including the world's second-best-selling medicine developed on home soil, proves the ecosystem works.

Next year, we will see whether political commitment, healthcare culture, and digital infrastructure can be aligned to with the necessary execution to realise Scotland’s ambition of become the "platinum triangle" it aspires to be. Or else, watch opportunities migrate elsewhere.