Patient support hubs have quietly become one of the most strategically important — and most contested — functions in pharmaceutical commercialization. For years, the model was simple: manufacturers launched a specialty drug, handed enrollment, reimbursement, and adherence support to a third-party hub vendor, and moved on. That playbook is now being rewritten.

A wave of 2026 industry research — from Guidehouse, Cardinal Health's Sonexus division, and multiple market analysts — points to a hub landscape in the middle of real structural change. Here's what's driving it, and what it means for manufacturers, vendors, and patients.

A Market Growing Fast, But Under Pressure

According to Grand View Research, the global pharma hub and patient access support services market is growing at a compound annual growth rate of around 10%. North America continues to dominate, holding roughly half of global revenue share, driven largely by the complexity of the U.S. payer landscape.

That growth isn't happening because the current model is working smoothly — it's happening because the need for support keeps expanding faster than the systems built to deliver it. Specialty and rare-disease therapies keep multiplying, and each one arrives with its own tangle of prior authorizations, benefit designs, and financial assistance eligibility rules. Program enrollment remains the largest single service category, reflecting just how much friction still exists simply getting a patient started on therapy.

Key points:

• ~10% CAGR, per Grand View Research
• North America holds roughly half of global revenue share
• Growth driven by rising specialty/rare-disease therapy volume, not smoother operations
• Program enrollment is the largest service-type segment

The Insourcing Swing — and Why It's Not That Simple

The headline finding from Guidehouse's 2026 Patient Support Programs Trends report is striking: a 23-point drop in third-party hub usage, as manufacturers pull patient support operations back in-house to gain more control.

But talk to people actually running these programs, and the picture is more nuanced than "insourcing is winning." Industry leaders increasingly describe the outsource-versus-insource decision as no longer binary. The real question manufacturers are asking is which parts of the hub function need to sit inside the organization — usually the CRM, the data layer, and strategic oversight — and which parts can still be executed by an external partner with specialized scale and infrastructure. Cardinal Health's Sonexus team describes this as clients increasingly keeping the CRM in-house while continuing to outsource functions like clinical support.

The result is a proliferation of hybrid models, custom-built around a brand's therapy complexity, launch timeline, and how much control the manufacturer wants over the patient and provider experience. Vendor consolidation and selective insourcing are both accelerating, driven less by ideology and more by practical motivations: compliance requirements, cost containment, scalability needs, and, in some cases, dissatisfaction with how existing programs are performing.

Key points:

• Guidehouse: 23-point drop in third-party hub usage
• Outsource-vs-insource is no longer treated as a binary decision
• CRM, data, and strategic oversight are the functions most often pulled in-house
• Clinical support and execution-heavy functions are still commonly outsourced
• Hybrid models are becoming the norm, tailored brand by brand

AI Adoption Is Real, But Uneven

Every hub conversation in 2026 eventually turns to AI, and the data backs that up — but adoption is far from uniform. Pharma leaders surveyed for the Guidehouse report identified AI and automation applied to reimbursement support, particularly prior authorization and benefits verification, as the single most impactful lever for improving both patient and provider experience.

In practice, that's translating into things like AI-assisted call quality monitoring and predictive models that flag patients at risk of falling off therapy before they actually do. But not every manufacturer is ready to move at the same pace. Some are leaning in hard, building dedicated AI governance functions — Cardinal Health, for instance, has stood up an internal AI Center of Excellence to build policy and secure infrastructure alongside its business teams. Others remain cautious, whether for compliance, risk, or cultural reasons. Vendors that want to stay relevant are having to design hub infrastructure flexible enough to serve both postures at once, rather than betting entirely on one.

Key points:

• AI/automation for prior authorization and benefits verification ranked as the most impactful improvement lever
• Applications already in use: call-quality monitoring, non-adherence prediction
• Some manufacturers are building dedicated AI governance (e.g., Cardinal Health's AI Center of Excellence)
• Others remain cautious on compliance, risk, or cultural grounds
• Vendors need infrastructure flexible enough for both adoption speeds

Affordability Friction Hasn't Gone Away

For all the talk of digital transformation, the oldest problem in patient access remains one of the biggest: cost. Copay accumulator and maximizer programs continue to be a major operational headache, with roughly two-thirds of surveyed leaders reporting that these programs actively create bottlenecks in the patient journey.

The stakes of getting this wrong are enormous. Medication non-adherence is estimated to cost the U.S. healthcare system more than $528 billion a year. For high-cost specialty therapies in particular, even a short disruption — a delayed prior authorization, a lapsed benefits check, a hub transition that goes sideways — can determine whether a patient ever starts treatment at all, let alone stays on it.

Key points:

• ~65% of leaders say copay accumulator/maximizer programs create operational bottlenecks
• U.S. medication non-adherence costs exceed $528 billion annually
• Short disruptions in specialty therapy access can prevent treatment initiation or continuation

Transitions Are the New Risk Frontier

As more manufacturers consolidate vendors or shift functions in-house, the transition itself has become a critical point of failure. Industry commentary consistently emphasizes that switching hub models needs to be "invisible" to patients and prescribers — meaning rigorous planning around data migration, staff training, communications, and overlap periods where old and new systems run in parallel.

This is a meaningful shift in how the industry talks about hub strategy. It's no longer just "build vs. buy" — it's "how do we change models without anyone noticing," because the population most affected by a bumpy transition is exactly the population least able to absorb a gap in support: patients newly starting complex, high-cost therapy.

Key points:

• Transition execution is now viewed as a primary operational risk
• Requires careful data migration, staff training, communications, and system overlap periods
• Goal: make the switch "invisible" to patients and prescribers
• Newly starting patients are the most vulnerable to any gap in support

What This Means Going Forward

Put together, these trends point toward a hub ecosystem that's becoming more modular, more data-driven, and more deliberately architected — and less of a one-size-fits-all outsourcing decision. Manufacturers are increasingly building bespoke operating models therapy by therapy, brand by brand, balancing control and agility rather than optimizing purely for cost or a single structural template.

For vendors, that means competing less on scale alone and more on flexibility: the ability to plug into a manufacturer's existing CRM, support a hybrid insourced/outsourced model, and meet AI adoption wherever a given client happens to be on that curve. For manufacturers, it means patient access strategy is no longer a back-office logistics decision — it's a core part of how a specialty therapy succeeds or fails commercially.

The through-line across all of this is simple: as therapies get more complex and more expensive, the infrastructure supporting patients through access and affordability has to get smarter, faster, and much harder to notice when it's working well.