AI doctors will be good at science but bad at business, and big talk with little action means even higher drugs prices: 10 healthcare predictions for 2026 from top investors

After conceding a poor 2025 record, a Fortune commentary lays out 2026 healthcare and macro forecasts with clear investable implications: Humana’s aggressive Medicare Advantage push could add north of 1M members but produce steep losses and invite activist pressure; large employers will accelerate exits from the big-three PBMs, creating runway for alternative vendors; and CMS is likely to create billing codes for AI, catalyzing new products (and attendant fraud) while leaving unclear effects on overall costs. The authors also predict meaningful structural moves—dramatic falls in cell- and gene-therapy COGS to $5k–$50k enabling broader access, continued commercial drug-spend growth driven by GLP‑1 uptake despite Trump rhetoric, hotter inflation keeping rates higher for longer, and AI clinical tools succeeding as complements within larger systems rather than durable standalone businesses—plus speculative M&A upside (Epic to Microsoft) and public-health risks (measles outbreaks) that could affect utilization and policy risk.

Analysis

The Fortune commentary concedes a poor 2025 forecasting record and lays out several 2026 health-care and macro scenarios with explicit investable implications: Humana’s stated plan to offer more generous Medicare Advantage (MA) benefits could drive membership gains “north of 1M new lives” but the authors expect steep losses and subsequent activist pressure; the piece cites HCSC’s cash-burning acquisition of Cigna’s MA book and notes Illumina was down ~40% in 2025 despite a Q3 bounce, while AbbVie paid $2.1B for Capstan as evidence of active M&A in cell therapy. The authors predict CMS will create billing codes for AI, which should catalyze a wave of AI-enabled products and integration into payor/provider workflows but also raise fraud risk and uncertain effects on total health-care costs if fee-for-service incentives persist. They forecast a structural shift away from the big three PBMs as large employers seek transparent alternatives, dramatic falls in cell and gene therapy COGS to $5k–$50k enabling broader access beginning in 2026, continued commercial drug-spend growth driven by GLP-1 uptake, and macro pressure from hotter inflation and higher-for-longer rates; the overall sentiment is moderately negative with modest market-impact (score 0.33).

Key Decisions for Investors

• Trim or hedge exposure to HUM ahead of the company’s aggressive MA push and attendant margin risk, consider put protection or reducing net long exposure while monitoring membership and loss-ratio trends
• Allocate selectively to PBM-alternative vendors and integrated service providers with proven cost-savings track records as employers accelerate exits from the big three, prioritizing cash-generative names with contract stickiness
• Favor health-care and enterprise software companies positioned to capture AI billing-code adoption and systems integration rather than pure-play AI clinical standalones, and monitor CMS rulemaking and fraud-enforcement signals closely
• Treat ILMN and other distressed names as event-driven opportunities—maintain a watchlist for M&A catalysts (given Illumina’s 40% fall) but avoid sizeably increasing exposure until near-term operational improvement or clear takeover signals emerge