1. From Experimentation to Strategic Partnership
2026 marks the end of trial-and-error vendor models. Sponsors are consolidating relationships and choosing partners who can plan, scale, and deliver consistently across pipelines.
“Pharma will stop experimenting and start choosing who to build with. Sponsors are facing rising costs, crowded pipelines, and an overload of point-solution technology, which is forcing a shift toward fewer, more strategic partners.”
— Patricio Casillas, CEO Rovia Clinical Research
“Sponsors are planning to consolidate their PI lists and prioritize relationships with site networks that can deliver across all therapeutic areas, all geographies, and guarantee consistent results.”
— Casey Orwin, CCO Alcanza Clinical Research
2. AI Moves from Pilot to Core Clinical Infrastructure
AI transitions from experimentation to embedded, operational infrastructure—particularly in feasibility, pre-screening, and monitoring.
“2026 will be defined by AI-native clinical operations: feasibility, pre-screening, and risk-based monitoring driven by AI models embedded in EHR and site workflows, rather than add-on tools.”
— Mona Alqam, US Country Head Pratia
“Voice and chat AI for patient pre-screening will become routine… this will become second nature in 2026 as organizations and the general public are increasingly accustomed to communicating through AI.”
— Nick Spittal, COO Velocity Clinical Research
“Solid, sensible and practical use cases for AI will begin to take foothold and deliver tangible, measurable value.”
— Kurt Mussina, CEO Paradigm Research
3. Consolidation Across Sites, Pharma, CROs, and Technology
Scale, governance, and integration become survival requirements as consolidation accelerates across the ecosystem.
“Site consolidation will continue as it becomes harder to compete as an independent. Pharma consolidation will continue as major pharma competes for assets in big markets.”
— Patricio Casillas, CEO, Rovia
“Expect continued and possibly accelerated consolidation across sites, MCRCs, and CROs, with more roll-ups of high-performing sites into regional or global networks.”
— Mona Alqam, US Country Head Pratia
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“Clintech vendors will consolidate or evaporate. It’s a wickedly crowded market with new entrants pitching the next shiny thing powered by AI.”
— Kurt Mussina, CEO Paradigm Clinical Research
4. Therapeutic Area Rebalancing Toward Chronic and High-Growth Diseases
Oncology, cardiometabolic/obesity, CNS, and cell & gene dominate growth, while vaccines and some infectious disease work plateau.
“Oncology will remain the largest driver of new trial starts, with strong growth in neurology, metabolic/endocrinology, and immunology.”
— Mona Alqam, US Country Head Pratia
“Cardiometabolic and obesity trials driven by GLP-1s and next-gen incretin drugs will accelerate.”
— Kurt Mussina, CEO Paradigm
“We’re seeing movement away from vaccine work. It has been too volatile and too detrimental to site organizations.”
— Jeff Kingsley, Chief Development Officer Centricity
5. Cost Pressure Rises — But Quality Remains Non-Negotiable
Sponsors push hardest on speed and cost containment, but quality and regulatory compliance remain immovable constraints.
“In practice, sponsors will push hardest on speed to decision and cost containment, but they will not be able to de-prioritize quality or diversity.”
— Mona Alqam, US Country Head Pratia
“In practice speed and cost-containment will dominate while quality remains a given.”
— Kurt Mussina, CEO Paradigm
“Cost containment is already driving downward pressure on fees, which means site-level productivity and operational efficiency will be increasingly stressed.”
— Casey Orwin, CCO Alcanza
6. Workforce Strain and Skills Bifurcation
The industry faces a dual challenge: retaining experienced clinical talent while rapidly upskilling teams for AI-enabled operations.
“The biggest challenge will be attracting and retaining experienced investigators and coordinators, while also upskilling teams on data science and AI tools.”
— Mona Alqam, US Country Head Pratia
“A split dichotomy is forming between digital and AI-native workers and more tenured professionals who may struggle with the pace of change.”
— Nick Spittal, COO Velocity
7. MCRCs Emerge as Preferred Strategic Infrastructure
MCRCs gain influence as sponsors seek fewer, deeper relationships capable of delivering scale, consistency, and governance.
“MCRCs will gain share as preferred network partners for sponsors looking for fewer, deeper strategic relationships that can deliver scale, diversity, and consistent quality.”
— Mona Alqam, US Country Head Pratia
“MCRCs will see their negotiating positions improve as the group proves out its value propositions in quality, speed, efficiency, and scale.”
— Kurt Mussina, CEO Paradigm Research
