Recap: Day 3 of Asembia AXS26

The Asembia AXS26 Summit sessions further emphasized the critical need for operational readiness across the specialty pharmacy ecosystem. As the industry grapples with the transition from theoretical innovation to large-scale implementation, these discussions focused on bridging the gaps in artificial intelligence (AI) production, community-based advanced therapy delivery, and the rigorous demands of federal drug price negotiations.

Session 1: From AI Potential to Health Care Production

This session¹ moved beyond the hype of AI to address the production reality where adoption is currently lagging. Although 69% of health care executives cite AI as a top priority for 2026, only 8.3% of health care enterprises have AI operating in production today compared with 90% in professional services. Experts from Infinitus Systems and Optum Rx identified pilot purgatory as a major hurdle, where initiatives remain in perpetual evaluation due to unclear success criteria and inadequate data infrastructure.

Optum Rx highlighted 3 areas where AI is delivering measurable value: prior authorization, pharmacy SIG coding, and consumer self-service. AI-driven self-service alone has reduced live operator call volume by nearly 20% in the last year. However, the panel urged caution regarding patient-facing agentic AI, noting that although a mistake in retail leads to a wrong cart item, a mistake in health care carries categorical life-and-death stakes.

To move forward, organizations must establish formal governance—currently missing in 82% of health systems—and transition from black box models to transparent audit trails. A practical test for reliability was proposed: ask an AI agent the same question 5 times. If the response is inconsistent, it is not ready for the rigors of healthcare operations. The ultimate goal is a shift toward hyperpersonalization, where AI accompanies a patient through their entire journey as a persistent assistant.

“It’s still very much the Wild West in terms of what’s getting deployed, who’s governing and how,” Ankit Jain, CEO and cofounder of Infinitus Systems, and Santiago Abraham, chief information officer for Optum Rx, said in the presentation. “We’ll see who ends up being the governor of AI over time—whether it’s commercial enterprises, state governments, or federal governments.”

Session 2: Bridging the Operational Gap in Community-Based Advanced Therapies

As the pipeline for cell and gene therapies (CGTs) expands toward 200+ approvals by 2030, the industry faces an operational gap rather than a scientific one. With treatments costing between $300,000 and $4 million per dose, academic medical centers cannot absorb the projected volume of 100,000 candidates alone. Panelists argued that the future of delivery must be community-based, allowing patients to receive curative treatments close to home rather than relocating for months.

The transition to community care faces significant hurdles. Most nononcology specialists have never managed the buy-and-bill process for million-dollar assets, and approximately 65% of community oncologists report patient deterioration due to payer approval delays. In one cited case, a patient faced a 14-month delay for CRISPR-based therapy due to administrative obstacles and specialty pharmacy supply issues, highlighting how system failures can deny access to cures.

To bridge this gap, the panel called for standardized authorization pathways and robust standard operating procedures from manufacturers. Specialty pharmacy partners were identified as essential for managing the financial risk of products that community practices simply cannot afford to hold on their books.

"The question is no longer whether community oncology can deliver advanced therapies," Philip Marjon, MD, a hematologist-oncologist at California Cancer Associates for Research and Excellence, said in the session. "The question is how we will the systems to do it reliably, safely, and at scale to serve all of our patients."

Session 3: Navigating the IRA

With 40 products already having navigated the Medicare Drug Price Negotiation Program, manufacturers are shifting from theoretical concern to genuine institutional experience. Experts³ from Deloitte, Takeda, and Pfizer framed the Inflation Reduction Act (IRA) not as a market access exercise but as a massive matrix organization challenge requiring executive sponsorship and cross-functional coordination. They proposed a "5D framework" for readiness: diagnose, deploy, develop, defend, and deliver.

Strategic preparation must begin years in advance, particularly in designing real-world evidence programs that align with the Centers for Medicare and Medicaid Services’ specific data needs for the Medicare population. A dedicated person in charge is required—a senior leader with clinical fluency and commercial acumen who can navigate the compressed negotiation timeline. Furthermore, manufacturers were advised to include finance departments early to establish the methodological rigor needed for R&D and cost-of-goods submissions.

The next major milestone is IPAY 2028, which marks the first time Medicare Part B (physician-administered) drugs will be included. This introduces complex buy-and-bill dynamics and potential risks of nonmedical switching if pricing mechanics disrupt existing provider economics. The panel’s final takeaway was the necessity of memorializing lessons into a playbook because 20 additional products will be selected annually starting in 2029. Preparation for selection is no longer a "what if” but an "inevitable when.”

“You should be planning for it now,” Shaili Shah, US Ibrance lead at Pfizer, said in the session. “If you're scoping talent from across the globe, that takes a really long time. Leadership alignment takes a very long time, making sure you have resources. This is not our day jobs, and so how to get yourself prepared is to start as early as humanly possible. And remember, it's a good problem to have to be selective.”

REFERENCES

1. Steinzor P. What Health Care Leaders Have Learned From Deploying AI. American Journal of Managed Care. April 29, 2026. Accessed April 30, 2026. https://www.ajmc.com/view/what-health-care-leaders-have-learned-from-deploying-ai

2. Hohmann E. How Community Providers and Specialty Pharmacies Are Closing the Access Gap. Pharmacy Times. April 30, 2026. Accessed April 30, 2026. https://www.pharmacytimes.com/view/how-community-providers-and-specialty-pharmacies-are-closing-the-access-gap

3. Steinzor P. What 3 Rounds of IRA Negotiations Have Taught Manufacturers About Readiness. American Journal of Managed Care, April 29, 2026. Accessed April 30, 2026. https://www.ajmc.com/view/what-3-rounds-of-ira-negotiations-have-taught-manufacturers-about-readiness