Performance Impact, Inc.

Grasping New Opportunities for Pharma

The pharmaceutical industry’s fundamental problems by now are so well known that even many consultancies have detailed them in creative sales promotions and reports. Neither the industry’s executives nor these rhetorical contributors, however, have devised consensus or plausible solutions to pharma’s difficulties.

Pharma remains, in large measure, somewhat unable to deliver precisely what the world’s healthcare systems need from it, which, stated in the simplest terms, are therapies to materially advance the standards of care. At the same time, the public and private systems that pay pharma’s bill have grown increasingly unwilling to shell out for the molecular offerings that have long been an integral part of the drug makers’ business culture.

If pharma is to remain a worthwhile business partner in the delivery of worldwide healthcare, the necessary action step requires that the industry do something to generate a value proposition that is the by-product of innovation, optional solutions, and measurable outcomes.

One of the underlying challenges in creating this value proposition is the elusive search for the right business model. The industry’s business environment is changing rapidly with heavy structural shifts. The developed world markets―particularly the most lucrative, the U.S.―are increasingly challenging but not the growth areas they used to be. However, most of these companies’ business models are built for those markets. So, this leaves them with questions on how to structure their innovation, marketing and sales, manufacturing, and portfolios accordingly.

The industry consistently points to a future with new growth in the emerging markets. But that does not mean that its current business model is ideally suited to take most advantage of emerging market opportunities. Some of the most interesting model shifts, from product divisions and portfolios to R&D structure, are starting to appear for emerging markets. Some companies see different kinds of model needs for this vast array of new markets.

The dust has not completely cleared from the transition. So far, what we can see is that there are divergent views on the future business model while decisions continue to be in significant flux to find what might work best in a new future environment. For now, one of the most critical challenges is breaking down old ways of working that can act as barriers to success. These companies need to work faster with downfield vision. They need to be connected in different ways and empowered. This is where fresh approaches to the business model could be of value and instill a sense that the status quo is not the right answer anymore.

Even more important is that the pharmaceutical industry must find the right kind of leadership in some of these companies for the new environment. It will require a leader with management process and management people skills like few other industries. The intersection of disciplines and people types in this industry is an interdisciplinary puzzle: from scientists, to marketers, to chemical manufacturers, to political experts, to medical doctors, to the unique expectation of what healthcare is for each customer. It requires a leader with extraordinary process and emotional intelligence acumen. This takes a flexibility and profound curiosity to see the way that the business will be not what the business has been. They should be willing to look at everything, to say that the status quo isn’t comfortable anymore, but also be able to instill the vision and strategy and reputation of the company to everyone, inside and outside the organization.

This balance of skill sets has been hard to find. The industry has been enormously successful, but the culture of companies has become static. Leaders are comfortable in these existing cultures and are promoted within it. Thus, the cultures have not been particularly well suited to breed and nurture leaders that are poised to challenge the status quo for the future. With few leaders currently available to mentor and identify such a rare mix of leadership skills in this industry, the road map has not always been clear to select that right person in the new generation of leaders.

To be sure, pharmaceutical companies are very sophisticated business operations. They could clearly muster the resources and energy to make appropriate moves to shift if it became apparent that an alternate emerging business model was proving to be more in line with the future trends. The biggest challenge ahead will be identifying and developing future leaders with a profound level of transformation and adaptation leadership skills who could link change and flexibility tangibly to their mission and role with customers, society, and shareholders throughout the global landscape.

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Prescription for the Future

While there may be some long-standing problems that need to be addressed and some new ones to consider, the future still looks bright for the pharma/biotech industry. Demographics is the elixir the industry has in its own medicine cabinet to help nourish its growth as it moves forward. Data suggests that the number of people over the age of 50 will grow to 118 million in 2020. Emerging markets account for 80 percent of the world’s population, providing them with a strong purchasing power for products and services. Demand for products should continue to rise over the next 10 to 12 years. Encouraging, yes!

However, the environment in which these companies promote their products has become increasingly complex over recent years as a number of factors, trends, perceptions, and new stakeholders drive these changes to create challenge and uncertainty. All too often while looking for that magic plan to meet these challenges, some executives and their direct reports get caught up in managing at the expense of leading.

The everyday work of organizations consists mostly of structured activity designed to accomplish the goals of the organization. It truly is the work of those in charge to manage, that is, to align resources (including people) within established processes to achieve predetermined objectives. This is good. People need structure and process to perform. Managing provides essential stability.

There is a fundamental paradox, however, of what brings out the best performance in people. People work beyond minimum effort only when they voluntarily choose to do so. Leading is the art of giving people a genuine choice of yes or no and making the choice for yes compelling. The true act of leading is determined not by the “leader” but by the person who chooses to “follow.” Leading can be defined as the act of gaining willing followers for a course of action when the way forward is uncertain or unknown. Remove change and uncertainty from the equation, and simply managing would be sufficient. At its core, leading is about change, the showcase challenge of today’s pharma/biotech world.

Effective organizations always have a creative tension between leading and managing. During times when big changes are being asked of employees, the heightened uncertainty and corresponding hunger for stability cause this creative tension to be accentuated. Good managing is critical, but to make changes effective, good leading is vital.

A key to leading change is inviting people to a collective future. What is more inspiring; “Let’s increase sales 16 percent,” or, “Let’s be recognized as the innovative leader in each of our therapeutic classes who brings value to the global healthcare community?” Numbers are great for measurement but to get to people’s hearts, goals need to speak to values or qualities.

Whenever there is a change there is uncertainty and a sense that the future is unknown. No one can predict the future, but leaders can share what they know about what lies ahead, both the challenges as well as the vision for things to come.

It’s a fact of life that people give deference to others who are in positions of power. This means that any invitation to change can be perceived as compulsory. It’s best to acknowledge this dynamic, while at the same time cultivating a track record of empowering others. The implications of choice –as in “an invitation” to a future vision and gaining “willing” followers –is perhaps the most important aspect of leading. People give their best when they do so voluntarily. To bring out the best in people, they must choose to follow rather than be compelled to do so.

While each side of the leadership coin–leading and managing–is distinct, most executives must use a combination of both. They must do so artfully, taking into account the situational context of their personal qualities, particularly in today’s world of mergers and acquisitions, when dealing with the nuances of blending different cultures.

Effective leadership action requires knowledge, skill, and experience that are distinct from either technical expertise or business know-how. The big question that pharma/biotech must continue to ask themselves is whether to invest resources and effort in initiatives to develop their organization’s leadership capacity or to ultimately step aside and relinquish the reigns to competitors with more leadership vision who want to capitalize on the foreseeable demand for pharmaceutical and biotech products in the years to come.

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What is the customer thinking?

Samples can be helpful. Brochures can gain attention. Demos can be effective. But what is the primary tool used by sales professionals ?


Whether spoken or written, words can help  make sales happen….or  maybe  not !!

Too many salespeople (and marketers and advertisers) use the same words. Words used so often, that to some customers ,  they’ve become meaningless to describe their products and services. Let’s pretend for a moment that I’m a potential customer or client. Here’s how I might react as a possible devil’s advocate should you choose to indiscriminately  use the following:  ( subjective on my part, yes …. provocative for you, I hope so… or at least maybe giving it a second thought ?)

“Customer focused.’  Talk about redundant; should you be anything but customer focused?  If your goal is to imply that other providers are not customer focused, tell me how: faster response time, greater availability, customized processes or systems… tell me in concrete terms how you will meet my specific needs. ( If you don’t know my needs and therefore can’t address them, shame on you.)

“Best in class.” There might be two problems with this phrase: Who defined your “class” and who determined you were the “best” in it ? ( My guess is, you did.) Still,  maybe you are that awesome. Prove it. Describe your accomplishments, awards, results, etc.  As a customer I don’t need best in class, I need best for me – so tell me, in objective terms, how you provide the best value for my needs.

“Low-hanging fruit.” When you say, “We’ll start with the low-hanging fruit,” I hear, “We’ll start with the really easy stuff you are not able to recognize or do yourself.” No business wants to hear they have low-hanging fruit. Just describe, in cost-benefit terms, how you prioritized  your list of projects, initiatives or activities for me.

“Exceed expectations.” Admirable goal, one every business should aspire to, but exceeding expectations is an internal goal. Tell me you will exceed expectations and exceeded expectations becomes an expectation. (I know, that’s kinda ZEN.) Just tell me what you will do every time; if you consistently pull if off I’ll be delighted. Always let the customer judge whether you go above and beyond.

“Unique.” The ever-increasing pace of commoditization means few products or services have no like or equal for long. If I’m considering choosing your firm or buying your products, “unique” means nothing to me. Tell me, in concrete terms, how you are better.

“Value added.” This term is often used to imply I’ll get something for no or very little incremental cost. That means what I will  receive isn’t value added – it’s part of the overall deal. So tell me the deal, explain all the options and add-ons, and help me figure out how I can take full advantage of what you provide.

“Expert.” Margaret Thatcher once said, “Power is like being a lady; if you have to say you are, you aren’t.”  Show your expertise instead. “Web2.0 expert” often reads as  “We can slap videos and theoretically interactive applications on your website. “We developed curriculums for…” and ”Created applications that…” lets potential customers evaluate your level of expertise and it’s suitability for their needs.

“Exceptional ROI.” We all seek a return on investments and we all love a great ROI. But without access to my numbers you can’t accurately calculate my ROI. Therefore your estimates are either theoretical or based on another customer’s results, and either way I know those estimates are absolutely best-case. “Provides an exceptional ROI” reads as… “and you’re a terrible business person if you don’t do this.” Show the costs, don’t hide anything, and trust me to calculate my own ROI. If I’m not smart enough to do so I probably don’t have purchase authority anyway.

“Partner.” Long-term business relationships are great, but being “real “ partners is a stretch because while your hand reaches into  my pocket, mine will never reach into yours. Still, maybe one day I will see you as a quasi-partner… but that is something I will decide on my own based on your performance, not on your marketing.

“Turn key/Off-the-shelf.” I love these solutions as much as the next guy, but few solutions truly are. No matter how comprehensive the offering I always wind up participating more than I was led to expect, so when I hear “turn key” I’m naturally skeptical…that is, unless you thoroughly break down what you will provide and what my participation will be, both during implementation and after. Turn key is in the eye of the beholder and the customer is always the beholder.

What are you thinking ?  Please feel free to share.

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… a quick post to congratulate our friends at Situational Leadership® on their new website – They’ve been hard at work getting ready for ASTD over the past few weeks. Launching a new site at the same time is a daunting challenge indeed. Well done!

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The Time vs. Quality Tug of War

It seems that no matter what the project, internal human resources and training organizations are constantly battling the time versus quality “tug of war.” Our clients face a constant struggle to deliver at the speed of business which translates to less time for us, the vendor, to deliver the high-quality product they have come to expect.

This begs the question; when is the best time to bring in your vendor? Customers often decide to leave their vendor out of upfront project discussions for fear of increased cost or churn. This might be an effective strategy if a vendor is unknown to the customer; however, when a trusting relationship exists, it’s often more cost-effective to include the vendor in strategy sessions in order to gain agreement on project objectives. Ultimately, doing so can also reap rewards beyond dollars.

This idea is a paradigm shift for most customers who see vendors as serving a purely transactional role in project deliverables versus one of partnership in helping to shape strategy and long-term outcomes. It has been my experience that our most cost-effective and creatively successful projects have resulted from gaining an invitation to the blank whiteboard in a consultative capacity with key internal stakeholders at project inception. It is there that we can assist our customer in fleshing out objectives and matching those with capabilities. Often, our customers are astounded at what we can do versus what they may have “assigned” to us in lieu of our involvement in the brainstorming process.

If the bottom line is the ultimate concern, it has also been our experience that being in sync with the customer’s vision and objectives and understanding the key project drivers cuts down on dreaded scope creep. When vendors are only allowed limited access to internal background information they run the risk of making project decisions that are not in alignment with customer goals – resulting in further revision cycles (time) and increased cost. Conversely, knowledgeable vendors are able to make more informed decisions and consult with customers on a deeper level throughout the life cycle of a project.

Ask yourself the following questions to determine when it is the best time to bring a vendor to the table for your next project:

  • Will this project require tight turnaround?
  • Do you trust your vendor?
  • Does your vendor truly understand your business?
  • Do you lack a clear understanding of all of your vendor’s capabilities?
If you answered yes to any or all of these questions, you should consider inviting your vendor to the table when project discussions begin to increase your chances that the time vs. quality tug of war will result in a draw – leaving you a winner in the eyes of your organization.

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Trust Me: Two Simple Words or Not

Here we go … my very first blog entry.


In my 20 plus years as an Instructional Design Consultant, as both an internal partner in a major corporation and as an external vendor partner, I’ve had the opportunity to develop relationships with many clients. I’ve been fortunate in that most of those relationships have been effective and, as a result, I’ve been involved in the design and development of many successful training and performance improvement solutions. No, I’m not conceited and I’m not bragging. Some solutions were more successful than others and some relationships were more effective than others. There were also a few situations that resulted in half-baked cakes and one or two client partners that didn’t recommend me to their friends.

As I reflect on over two decades of projects, I can say that competence and commitment heavily contribute to one’s success as an Instructional Design Consultant, but the most critical success factor is trust. How often have you said “trust me” to another individual, a group, or an entire organization in words or through your actions? It sounds like a simple request, but it’s not. Instructional Designers are called upon to develop the capabilities of human resources and, in turn, positively impact companies’ bottom lines. In other words, the stakes are often high. Additionally, timelines are typically tight, resources are stretched, and projects are highly visible. In light of these factors, I know when I ask clients to trust me that I’m asking them to take a risk.

In some cases, the degree of risk is minimal, but it still exists. A good example is a recent Talent Management program I developed for a client that I’ve worked with previously. She knows my work process, is familiar with the quality and style of deliverables our team produces, and I was able to share with her similar projects that I did for other clients. In other cases, the risk can be great. My first pharmaceutical product training comes to mind. I had worked with the client many times before developing soft skills workshops. Although I had developed product training before, my experience with pharmaceutical product launches was zilch as was my knowledge of the relevant disease. I was surprised that the client trusted me with such a huge responsibility.

In his book The Speed of Trust, Stephen M.R. Covey says, “Simply put trust means confidence.” As an Instructional Design Consultant, it’s my job to build clients’ confidence in my abilities, the abilities of my colleagues whom I partner with to design and develop appropriate solutions, and the capabilities of the company we all represent. As the client that trusted me to develop product training for a launch of a new drug, although I lacked experience in this area, said to me, “Based on your track record and your company’s track record, I’m confident that you will deliver an effective, high-quality program on time.” When I think about that situation, I’m reminded of the importance that a “track record” plays in the trust equation and that confidence or trust is built through actions. I’ve found that practicing the 13 behaviors of “high-trust people” that Covey describes in his work have enabled me to build effective and rewarding relationships with clients. I hope they work for you, too, no matter who you want to trust you!

  1. Talk straight. (When I agree with clients’ ideas and opinions, I say so. When I disagree, I also say so and explain why.)
  2. Demonstrate respect. (Everyone deserves it. The “golden rule” was drilled into me at a young age.)
  3. Create transparency. (I don’t want my clients to be surprised about anything related to their projects … except pleasantly surprised that the project turns out better than they imagined.)
  4. Right wrongs. (I like to admit mistakes and take corrective action. I find it much easier than the ongoing effort required to cover up mistakes.)
  5. Show loyalty. (Clients are special. Without them I can’t do what I enjoy doing.)
  6. Deliver results. (I truly believe that what I deliver is a reflection of me.)
  7. Get better. (I know I can always improve my skills, my work, and my relationships.)
  8. Confront reality. (If the client wants to put 10 pounds of potatoes into a five-pound bag, I think it is important to discuss that upfront.)
  9. Clarify expectations. (I’ve learned from experience; it’s not fun to get near the end of a project and hear, “That’s not what I thought you were going to do.”)
  10. Practice accountability. (My project, my fault if the client’s expectations are not exceeded, or at least met.)
  11. Listen first. (I learn a lot when I listen, and I rarely learn anything when I’m speaking.)
  12. Keep commitments. (Not keeping them is disrespectful. If I can’t keep one, I communicate why as soon as possible: another application of the “golden rule.”)
  13. Extend trust. (I believe that my clients are my partners. I trust that they want to succeed as much as I do.)

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Are Sales Representatives Still Relevant?

Are Sales Representatives still relevant in today’s turbulent pharmaceutical industry environment? This is a question that, although it may seem a little out of place now, will become more scrutinized over the next few years.

The pharmaceutical industry faces a number of key resistors to growth, including the impending 2011 “patent cliff” set to erode some $78 billion in branded sales from drugs whose patents expire between 2010 and 2014. In addition, there will be $32 billion lost due to the continued erosion of already expired brands. These are big numbers. The priority for pharma is to ensure the successful navigation of this new landscape to maintain current growth rates.

While the imminent erosion of sales will no doubt be a major headache for the industry, many payers will be jumping for joy. Payers can expect to make savings of $44 billion in the US and $5 billion in the five European markets as generic prices take the bottom out of the branded market.

Companies can no longer expect that expensive drugs providing marginal benefit will be reimbursed at historically high prices. In response to this, there will be a transition from primary care drugs to the more specialist secondary care portfolios.

The planned launches of these new drugs will not, however, escape the attention of the payers. Competition for reimbursement will intensify given the high price points of these specialist/orphan indication drugs.

While globalization and expansion into newer markets is an additional strategy that will aid in successful navigation, the strategies most pertinent to the traditional pharmaceutical sales force are the cost containment strategies being implemented by large and mid-size pharma.

These cost containment strategies are encapsulated by the reduction seen in Research and Development spending and, hence, the increased focus on in-licensing. In addition, “mega mergers” have been a recent strategy to cut costs, grow sales, and ultimately boost profits. Roche/ Genentech and Merck/Schering are the most recent examples.

With the global economic downturn dominating headlines over the last couple of years, the negative press that would normally be associated with the 67,000 employees laid off across just 10 companies has escaped the attention of the media. Of this number, sales teams assigned to promote expired or soon-to-expire blockbuster drugs took the brunt of the hit.

So, is this just a small indication of things to come or will we see a reversal in this approach to cost cutting? The signs unfortunately seem to indicate a continuation of this trend. With the reduction in primary care type drugs, the focus will be on smaller sales teams with increased responsibility.

In order to remain competitive, the Sales Representatives of the future will have to have greater clinical knowledge as they get to grip with the complexity of rare diseases and oncology drugs, in addition to a solid understanding and articulation of health economics so that they can have credible discussions with the local payers.

The answer to the question, “Are Sales Representatives still relevant?” is, therefore, not straightforward and the relevancy of Representatives to the industry will very much depend on their skill sets and responses to change.

It is, therefore, the responsibility of both the pharma industry and the individual Representatives to ensure that they are not left behind and appropriate training is provided and/or sought in order to maintain a competitive edge.

Those who doubt the importance of the Representatives to the future success of the industry should not forget that one of the reasons the “patent cliff” is so high is the tremendous contribution that Sales Representatives have made over the last 10 years!

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Kissing the Blockbuster Goodbye

Industry giants are facing major new challenges as patents run out on many of the drugs that have kept them in clover the past two decades.

Lipitor® is one of the biggest selling prescription drugs in the world. It is produced by the giant pharmaceutical company Pfizer and has revolutionized the treatment of patients with high cholesterol.

In 2009, Lipitor® topped the best-selling prescription drug charts, generating $5.7 billion in sales in the U.S. and an additional $5.7 billion outside the U.S. It is what is known in the industry as a classic “blockbuster drug.”

The problem for Pfizer is that next year, the patent to exclusively produce and sell Lipitor® expires. This “coming-off-patent” process will allow other companies to produce and sell generic copies of Lipitor®, and it will take a hatchet to Pfizer’s revenue stream from the drug.

But the real issue for the sector is that Lipitor® marks the start of a coming avalanche of expiring patents of blockbuster drugs over the next few years, known colloquially as the “patent cliff.”

Some estimate that, over the next five years, drugs currently generating $142 billion in sales annually will lose patent protection. Leading pharmaceutical companies will lose between 14 and 41 percent of their existing revenues because of patent expiries. And, despite record levels in research and development, there appears to be few similar blockbuster drugs in the pipeline to plug the gaping revenue hole.

The sector is preoccupied with its own evolution, and, as this analysis shows, the challenges, and potential risks and rewards are immense. The “patent cliff” is the chief challenge facing the industry. Patents can sometimes be extended by making slight changes to the chemical composition through a process called “evergreening.”

The number of new medicines is at an all-time low and is as low as it has been since World War II. However, some analysts argue that the search for new blockbuster drugs is just not a good value for the money.

Discovering new drugs is not the only answer for the sector as there are new frontiers opening in emerging markets such as China, Brazil, India, Russia, and Turkey. These markets could produce revenue which could be equal to the revenue lost from drugs coming off patent.

One half of the merger and acquisition dollars that have gone into acquiring companies has been in the emerging markets sector. Many of these companies that previously focused on branded products are looking to tap into the growing generic drugs market by setting up their own generic-drug producing and licensing arms to market their own “branded generics.”

As budgets are cut and health-care reform gets underway, many are buying or recommending only drugs that have a proven record and are cost-effective. The “payer-agenda” is much more powerful now than ever before, and the industry has to participate in the debate and demonstrate the value of its products.

At $518 billion, the size of the pharmaceutical industry is still significant. It could grow to between $800 billion and $1.3 trillion by 2020. The “grey factor” boosts the need for medicines dramatically. Global census figures suggest that four in five people aged over 65 take at least one prescription product, while more than a third take four drugs or more.

As each company works to redefine its own product portfolio, demographics is the elixir the industry has in its own medicine chest to help nourish its growth as it moves forward.

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The Pharma Trifecta

What three trends are most important to pharma these days? Generics, emerging markets and personalized medicine, according to the Harvard Business Review (HBR).

Branded generics are the wave of Big Pharma’s future. These are branded versions of off-patent meds sell at higher prices than regular generics do, but are cheaper than the branded meds themselves. They give a measure of assurance to patients worried about counterfeit meds, and to those concerned that unbranded generics don’t work as well as their branded counterparts. They also offer drug makers a niche in emerging countries.

That leads us to the second trend: Emerging – markets growth is a “beacon of hope” for the drug industry. With India and China growing so quickly, everybody who’s anybody in pharma is seeking a piece of that business. But there are pitfalls, including pricing pressure (hence branded generics), and the fact that drugs developed in mature markets sometimes aren’t “relevant” in emerging countries. Furthermore, insurance and payment systems are different in those nations, something that might be a problem (or an opportunity).

Finally, personalized medicine: Gene testing has identified cancer patients who are most likely to respond to certain drugs. As pharma targets drugs more tightly, it will change their economic model, HBR argues. Marketing will have to become highly specialized. Some companies might abandon vertical integration and focus instead on a few core areas such as drug discovery or development. And all will have to get more involved in diagnostics, one way or another.

By understanding who the target patients are based on their genetic data, pharmaceutical firms can anticipate who their ideal subjects for the new compound are. This could reduce the substantial development time of clinical trials and result in lower development costs. A technology disruption such as personalized medicine could very well become the driver of widespread industry transformation.

It is just a matter of time before all three initiatives are out of the starting gate and picking the right strategy will set apart the winners from the losers.

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Impact on Pharma: Post Healthcare Reform

Healthcare reform and the mandate for insurance coverage for all US citizens would appear to represent new growth opportunities for the pharmaceutical industry. This can be true for the companies that begin to adapt to the realities of this evolving new healthcare market. Nothing in the current legislation seems to be dramatically different than what has been discussed and debated now for months … no surprises! Also, keep in mind, the plan will take about four years to unfold and become a reality. That doesn’t mean pharmaceutical companies can or should wait. In fact, the evolving new market will mean significant changes will be necessary to the traditional pharmaceutical business model which will also take time for companies to implement and execute.

Despite the upsides of potentially having more than 32 million new prescription drug customers, the closing of the “doughnut hole” for seniors that will increase the prescription refill rate, and the 12-year “exclusivity window” to sell biologic medicines, here are some implications the industry must prepare for:

  • The market for prescription drugs will progressively change from healthcare providers and patients to payers, insurers, and managed plans.
  • Payers (insurance companies and government programs) will have to become increasingly cost-conscious to ensure sustainable affordability.
  • Generic drugs will become the work horses for drug plans, including being used in place of branded products that fail to demonstrate meaningful clinical benefits over generic drug options.
  • There will be tremendous cost-savings incentives for the market to push for and demand a clear regulatory pathway for generic biologics.
  • To secure premium pricing, newly launched branded medicines will have to meet an even higher standard for proving their value over other therapeutic options, including generic drugs.
  • Information technology, including e-prescribing, will be employed to a much greater extent to help manage compliance and costs.
  • Traditional Sales and Marketing will have less influence on product availability at the drug plan level and even less influence on physician prescribing practices which ultimately may result in more Sales Representative layoffs.
Pharmaceutical companies that anticipate these new dynamics can make the necessary adjustments and determine what they need to do to remain competitive in an industry that currently has annual global sales of about $750 billion, with about $300 billion in US revenue, and margins close to 30%.

Overall, drug makers fare well and the approval of these provisions in the legislation is likely to be applauded by Wall Street and could benefit the stocks of drug makers in the long term.

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