What Sales Leaders Need to Champion in 2026 (a six-part series)

Part 2: Navigate Economic Uncertainty by Deepening Partnership Value

By Sergio Armani, Founder & CEO, ACG-Clinical

The clinical research market is growing. U.S. clinical trial spend is projected to reach nearly $50 billion in 2026, with steady 5-6% annual growth expected through 2035. The global market is approaching $130 billion with a trajectory toward $190-200 billion by the early 2030s.[1][2]

So why does it feel harder to sell?

Because growth and easy money are not the same thing. The economics of clinical research are tightening in ways that will reshape which companies capture disproportionate growth and which struggle for margin. If you think relationship selling will carry you through 2026, we need to talk about what is actually happening in your customers' boardrooms.

I minored in economics in school. I do not consider myself an economist, but I love reading about micro and macro economics and have always tried to use economic analysis for planning purposes. What we are seeing right now is textbook—macro conditions creating micro pressures that change buyer behavior at a fundamental level. Most sales organizations are not adjusting fast enough.

The Economic Reality Your Customers Are Navigating

The macro picture looks healthy. Global GDP growth around 3% through 2027. Pharmaceutical revenue expanding. Biopharma pipelines historically full with over 10,000 active drug candidates.[3]

But the economics of drug development are deteriorating rapidly.

IQVIA shows that internal rates of return on R&D investment have fallen to approximately 4%—below the cost of capital.[4] Translation: pharmaceutical companies are spending money on R&D but not generating enough return to justify it. Like borrowing at 6% to fund a project that only returns 4%. You are losing money on every dollar spent.

Biotech venture capital is down 30-50% from peak levels. U.S. policy shifts—pricing agreements with 14+ pharma firms, approximately 40% cuts to NIH funding—are creating additional pressure. Industry-wide, expect 5-10% R&D efficiency mandates.

Here is what this means: demand for clinical research services is growing, but buyers have become far more sensitive to price relative to value. They used to pay premium prices if they liked working with a company. Now every dollar requires clear ROI justification.

This does not mean massive cuts. What it means is trials in lower-priority therapeutic areas will be deferred. Smaller trials that do not generate sufficient return will be canceled. Sponsors will concentrate spending toward fewer companies who can prove measurable impact in high-value therapeutic areas.

The opportunity is significant for companies who position strategically.

How Economics Reshape Therapeutic Area Priorities

Here is where most companies supporting clinical trials miss it. They assume all therapeutic areas will benefit equally.

Wrong.

Macroeconomic pressures are amplifying growth in high-value therapeutic areas—oncology, immunology, rare diseases—while constraining less differentiated areas. Let me give you one example of what this looks like:

Oncology captures 35-40% of global clinical trial activity and biopharma R&D investment in 2026. Despite financing constraints, late-stage oncology trials remain resilient because they represent validated, high-value assets.

For technology companies: Oncology protocols are surging in volume and complexity. Biomarker-driven designs, NGS/MRD endpoints, decentralized elements. If you can demonstrate measurable improvements in data quality, protocol complexity management, or time-to-database-lock, you command premium pricing.

For patient recruitment and engagement companies: Sponsors need partners who can identify and engage biomarker-positive patients in rare subtypes. If you can prove you reduce screen failure rates or improve retention in biomarker-driven trials, you have pricing power.

The same dynamics play out in immunology (15-20% of pipelines), rare diseases (20%+ of late-stage assets), and other high-growth areas. But the implication is clear: companies positioning as generalists who can serve any therapeutic area will work harder for thinner margins. Sponsors are consolidating toward fewer, more specialized partners.

If you are still positioning as a generalist, you are leaving money on the table. Championship requires pushing toward strategic focus in 1-2 high-priority areas with differentiated, measurable capabilities.

I am not saying close offices or abandon therapeutic areas outside your focus. I am saying expend maximum effort on winning studies in therapeutic areas where the research is actually being done—oncology, immunology, rare diseases. Put your best resources, your most experienced teams, your product development dollars into building differentiated proof in those areas. That is where the growth is. That is where premium pricing lives.

Why Shallow Relationships Lose to Proven Partnerships

When budgets tighten and ROI scrutiny intensifies, buyers make ruthless calculations about where to spend. This is where relationship selling falls short.

The company that shows up quarterly, asks how things are going, positions as a trusted advisor—you are operating under the assumption that personal rapport creates preference. It does not. Not when your customer is being asked to defend every line item in front of executives who only care about measurable outcomes.

Let me be clear about what happens in those budget meetings. Your customer—the person you have lunch with—is being asked to justify your contract. What measurable impact have you had on time-to-first-patient? Screen failure rates? Enrollment reliability? If they cannot answer with data, your relationship does not give them cover.

Industry analyses are consistent: companies that demonstrably reduce time-to-first-patient, improve enrollment reliability, de-risk portfolio decisions will see budget allocations. Nice-to-have capabilities face slower awards and pricing pressure.[5]

But here is the opportunity: companies who invest in proving partnership VALUE will capture budget that never goes out to bid. Your customer will defend your contract because losing you creates measurable risk. That is the difference between fighting for every renewal and being considered non-negotiable.

What Partnership Value Actually Means

Partnership value is not being responsive. It is not having good relationships. It is not consultative support or regular business reviews.

Partnership value in 2026 means you are making your customer's organization measurably more productive in ways their executives recognize and depend on.

For technology companies: you have demonstrably reduced protocol complexity, shortened database lock timelines, enabled hybrid trials at lower cost while maintaining data quality.

For patient recruitment companies: you have consistently delivered enrollment targets 20% faster than historical timelines.

For patient engagement companies: you have improved retention rates by 15 percentage points in chronic disease trials.

The key word: measurable. If your customer cannot point to specific metrics that improved because of your partnership, you do not have partnership value. You have a pleasant vendor relationship that competes on price.

Deloitte is clear: executives are demanding measurable ROI from technology investments.[6] AI is table stakes, but buyers only pay premium for validated performance improvements. For patient engagement and recruitment companies, 2026 buyers expect transparent funnel metrics, linkage from outreach to randomization, proven last-mile conversion capability.

The principle is simple: in constrained environments, buyers pay for partners who reduce total cost of ownership and lower operational risk.

How Sales Leaders Champion This Transition

Transitioning from vendor relationships to genuine partnerships cannot happen inside sales alone. It requires cross-functional changes. But you have the ability to champion these changes.

You need to champion four things:

1. Product builds for measurable outcomes, not feature parity. Stop feature chasing. Bring real customer intelligence to product roadmap discussions: "Our oncology customers are being told to reduce time-to-first-patient by 20% while handling more biomarker-driven protocols. Here is the bottleneck. Here is what we could build that moves that metric. Here is proof from three customers."

2. Marketing messages outcomes, not capabilities. Not "Our platform has these capabilities." Instead: "Patient engagement platforms using our solution achieve 87% retention in rare disease trials versus industry average of 68%. Here is the data across 47 trials."

3. Business development targets buyers who value partnership. Push back when BD wants to chase every RFP. Ask: "Is this sponsor known for building partnerships or churning through service providers? Are they in a therapeutic area where we have differentiated proof? Do they have capability to realize value?"

4. Customer success owns outcome measurement. Move from adoption metrics to proactive outcome measurement. Work with customers to establish baselines, track improvements, document business impact they can present to their executives.

One of my clients implemented this and moved renewal rate from 78% to 94% in eighteen months. Not because they built better features. Because they made it easy for customers to prove ROI.

The Framework: From Vendor to Partner

Here is where to start:

Step 1: Audit your positioning. Can customers articulate—with data—what outcomes improved because they work with you?

Step 2: Identify metrics your customers are held accountable for. Not what you wish they cared about. What their executives actually measure.

Step 3: Map your capabilities to those metrics. Where do you genuinely move the needle? Be brutally honest about therapeutic areas where you are commoditized versus differentiated.

Step 4: Champion the organizational shifts. Product builds for those metrics. Marketing messages those outcomes. BD targets buyers in therapeutic areas where you deliver value. Customer success measures and documents impact.

Step 5: Focus resources on therapeutic areas where you can deliver measurable partnership value. Put your best people, your product development dollars, your go-to-market effort into 1-2 high-priority areas where you can build differentiated proof.

What This Means for 2026

The clinical research market is growing. Growth creates enormous opportunity for companies who position strategically.

Sponsors will consolidate spending toward fewer strategic partners who prove impact in oncology, immunology, rare diseases, other high-value areas. Technology companies will see budget growth in data analytics, real-world evidence, AI-enabled operations—but premium pricing reserved for validated performance improvements in specific therapeutic areas. Patient engagement and recruitment companies will be funded, but market share concentrates toward those who demonstrate therapeutic area expertise with proven retention capabilities.

Companies supporting clinical trials who position as genuine productivity partners in strategically chosen therapeutic areas will capture disproportionate growth and pricing power. Those who continue playing the generalist, relationship-selling game will work harder for thinner margins.

This is not about survival. This is about strategic positioning to capture premium opportunities.

Here is what I need from you:

If this framework resonates and you recognize your organization is leaving money on the table by trying to be everything to everyone, do not wait six more weeks to take action. The sales leaders capturing premium pricing in 2026 are making strategic choices now, not waiting until their renewal rates start dropping.

I work with sales leaders in the clinical research space to build the cross-functional capabilities required to deliver and communicate measurable partnership value. If you are ready to make hard choices about therapeutic area focus and drive championship across your organization, let's talk. Email me directly at sergio@acg-clinical.com.

And if you are not ready for that conversation yet, make sure you are following this series. Subscribe to my LinkedIn newsletter or check back at www.acg-clinical.com each week. Part 3 next week will challenge how you think about trust, policy, and the shifting landscape your customers are navigating. That discomfort is the point.

2026 will separate sales leaders who champion strategic positioning from those who just work harder managing the same playbook. Which side do you want to be on?

Next Week: Understanding the Shifting Trust Landscape

In Part 3, we tackle the second priority: Understand the Shifting Trust Landscape. Federal and geopolitical policies are reshaping how the public views clinical research, which affects sponsor priorities and the entire ecosystem you sell into.

Until then: Can your customers defend your contract with data in their next budget meeting? If you are not sure, you are leaving opportunity on the table.

References:

[1] Towards Healthcare (2024); SNS Insider (2024). U.S. and Global Clinical Trials Market Analysis.
[2] Future Market Insights (2024). Clinical Trials Market Report.
[3] International Monetary Fund (2025). World Economic Outlook.
[4] IQVIA (2025). Global Trends in R&D 2025.
[5] Deloitte (2025). Trends Shaping Biopharma; 2026 Life Sciences Executive Outlook.
[6] Deloitte (2025). 2026 Life Sciences Executive Outlook.