In a year filled with ups and downs, there’s a noticeable difference in how pharmaceutical leaders in the U.S. and those overseas feel about the future of their industry. A recent survey by Deloitte shows that American leaders are more pessimistic compared to their European and Asian counterparts. Pete Lyons, vice chair and leader of the U.S. Life Sciences practice at Deloitte, noted that ‘The differences between how European and Asian biopharma leaders felt about where the industry was headed was a really stark difference to the United States.’ About 90% of European and Asian leaders were positive or cautiously positive, while less than 60% of U.S. leaders felt the same. This is a significant drop from last year’s survey, according to Lyons. The lower optimism in the U.S. may be due to uncertainties in the market, such as tariff threats, government deals on drug pricing, and recent changes at the FDA. Lyons said, ‘I don’t think it’s surprising given the volatility, uncertainty and all that’s going on in the U.S., but I do think it’s a pretty stark difference to see how, especially for a global industry, that you see such differences in how the executives view the world.’ Despite these regional differences, the overall outlook for 2026 is mostly positive. Lyons pointed out that there’s been a rebound in merger and acquisition activity. Many experts predict that 2026 will be a strong year for M&A, following a multi-year dip. Deloitte’s survey found that 45% of C-suite executives identify dealmaking as a top priority in the near future. The report stated, ‘In biopharma, appetite is returning for pipeline expansion and early-stage assets, with aggregate deal value in the first three quarters of 2025 exceeding the entire 2024.’ Mergers and acquisitions aren’t the only way company leaders are planning to address rising costs. Nearly 50% of biopharma execs are looking to new drug launches to boost profits. Leaders also expect AI to drive growth and cut costs while they strive to improve R&D productivity and build their customer base. As the new year approaches, direct-to-consumer options are likely to become a growing part of pharma’s commercialization strategies. Pfizer and Eli Lilly have led the way with their platforms that sell blockbuster GLP-1s. Pharma companies across the industry are now exploring these and other innovative ways to directly reach patients, which could represent a fundamental change to the current U.S. healthcare system. As DTCs expand beyond GLP-1s to other products, the market could shift to cut out the middlemen, including pharmacy benefit managers, according to Lyons. Eli Lilly recently announced that it will also roll out a direct-to-employer approach in 2026 to improve access to its weight loss drugs — which could also disrupt traditional insurance and payment models. Details of the plan need to be hammered out, but the approach would offer companies flexible benefit design options, access to a dedicated pharmacy network, and holistic third-party-run obesity management programs. Beyond new commercial models, leaders are also hoping technology can help buffer downward pricing pressures. ‘Leaders tend to recognize that future competitiveness is likely to depend on how effectively they harness AI to fundamentally reimagine how their organization works, makes decisions and delivers value — a view shared by nearly 80% of surveyed executives,’ stated the report. While many respondents said they’re investing in AI to improve efficiency, only 9% said they’ve seen a payoff. Nearly 30% of leaders surveyed, however, are confident that agentic AI systems, which are capable of carrying out limited tasks independently, will have a substantial impact on their organization in 2026. But for AI to pay off, companies need to change their practices. ‘What it requires is moving beyond that experimentation and thinking: How do I build an agent to do one simple part of a process? And [then] trying to rethink the way that work gets done,’ Lyons said. ‘When you put that lens on it, there’s tremendous potential for using these kinds of technologies.’ While the regulatory and geopolitical landscape will likely remain unsettled in 2026, companies can learn to stay ahead of the curve. ‘You can look at that in two ways. You can say that uncertainty is a risk premium, meaning that it’s going to be a greater cost to my business, and I need to think about how I manage that,’ Lyons said, pointing out that uncertainty can also spur innovation. ‘I’d like to believe that as organizations face this, they can figure out how to innovate around it … and come out the other side even stronger.’