Despite the lip service pharma companies have given to diversity, many studies are still failing to hit participation targets. Just 24% of clinical trial professionals said in a recent survey that their companies are currently benchmarking disease demographics against enrolled populations.

“Because [trial diversity] was important, [companies] were highlighting that they were going to do that. But did they have the data to show they were achieving it?” said Katrina Rice, the chief delivery officer at eClinical Solutions, a clinical data software and biometric services provider. “There was already a lot of room for growth.”

Now, a new challenge is ahead. Healthcare costs are slated to soar in 2026. Americans shopping for plans through the Affordable Care Act’s open marketplace face premiums up to 59% higher if key subsidies from the law expire at the end of the year. Those covered by employee-sponsored plans aren’t being spared, with prices rising about 6% on average for benefits — the largest spike since 2010.

When healthcare costs rise, people may be less willing to participate in clinical, according to Rice.

“The factor that is going to have the largest impact on all we do is healthcare costs,” she said.

Pharma companies often offer compensation for participating in clinical trials, but indirect costs related to travel and lodging remain a financial barrier. Despite industry efforts to increase compensation, 58% of respondents to a survey of clinical study participants across 17 therapeutic areas said they weren’t reimbursed for trial-related costs, which ranged from $100 to $1,000 per visit.

Over half of respondents to another survey said cost considerations weigh heavily into their decision to sign up for a trial, issues that are compounded in lower-income populations. But there are other ways pharmaceutical companies can achieve their diversity goals. 

How the industry can stay on track 

The hits to diversity-related initiatives came during a broad anti-DEI crackdown early in the year.

Amid sweeping cuts to National Institutes of Health-funded research, grants for drug studies that included diversity-related words were slashed. Draft guidance for improving clinical trial diversity was removed from the FDA’s website before later reappearing, raising questions over the agency’s stance on the issue. And large drugmaekrs such as Pfizer and GSK revised or reworded DEI initiatives to fall more in line with the U.S.’ shifting political tides.

Through it all, most companies committed to diversity strategies despite the word becoming “taboo,” Rice said. In fact, the situation created an opportunity for companies to embed diversity even deeper into operations.

“Looking across pharma and higher education … everyone is [trying] to stop siloing diversity and instead blend it into all aspects of business — from research to recruitment to internal hiring,” Rice said.

Now, with healthcare costs set to rise, pharma companies will need to work harder to communicate R&D goals and a narrative about the upsides of participating in trials.

“How can pharma say through its calls to participate in trials that they can be a benefit?” Rice said.

Broadening access to research sites should also be a priority, Rice said. While Walgreens’ foray into the clinical research arena is an example for how to boost access to trial sites, more needs to be done. 

“Not everyone wants to go to a large hospital or can get to a research center,” Rice said. “Clinical trials should happen in a more distributed manner … where the people are.” 

AI can be used to pinpoint the right areas for clinical sites, Rice said. Service companies can also generate data to help with study design and site selection for more diverse populations. 

But pharma’s opportunity to create diverse studies could hinge more on soft skills than data points, Rice said. For example, building trust remains a major issue between many communities and the pharma industry. Hiring a diverse staff is still key to closing this gap, Rice said, so that it reflects the populations it’s working with.

To know if the industry has made progress, Rice said she’ll be on the lookout to see how well pharma has reached diverse communities.

“I want to see pharma and biotech companies at health fairs and other events talking about research and being visible in the community,” she said. “Progress is not just producing numbers — but showing that you’re there in the community you want to serve.”