After two decades in pharma and market access, I’ve seen launches succeed spectacularly, stumble unexpectedly, and sometimes collapse entirely. Through all of it, one lesson stands out above the rest: start with the system, not the science.
Science dazzles. It wins awards, headlines, and boardroom applause. But the brilliance of a molecule doesn’t guarantee it reaches patients or delivers value. Access is decided, not in laboratories, but in boardrooms, ministries, hospital committees, and clinics. Without understanding stakeholder pressures like budgets, politics, and workflow constraints, even the best drug can be unused.
I recall a cardiovascular therapy that was clinically transformative. Trial data was impeccable, endpoints were clear, and the molecule was practically a miracle in a pill. Yet adoption lagged because the launch team had ignored payer concerns about budget impact. Clinicians were enthusiastic but found the pathways confusing. Patients faced financial barriers. Months of delay followed. It wasn’t a science failure — it was a system failure.
Contrast that with a modest rare disease therapy. Not the most revolutionary compound, but the team had designed trials to generate evidence that mattered to payers, built patient pathways in parallel, and trained clinicians in advance. Adoption was rapid. Patients accessed the treatment quickly. Budgets were managed, and trust with stakeholders strengthened. In other words, systemic design mattered more than molecular brilliance.
The lesson remains relevant today because pressures on healthcare systems are growing, driven by ageing populations, tighter budgets, and increasing scrutiny on value. Drugs that succeed are those that not only work biologically but also fit operationally. Without system alignment, therapy can get attention but won’t gain users or money.
So, what does this mean for teams? Start with questions like:
- How will this therapy integrate into existing workflows?
- What barriers will payers, clinicians, and patients encounter?
- Which outcomes matter most to each stakeholder?
- How can we simplify access without compromising evidence or compliance?
And for a touch of understated British humour: the best molecule is about as useful as a teabag without a mug, if no one can actually use it. Functional design matters more than scientific elegance when it comes to real-world impact.
Ultimately, this lesson focuses on the system, not just the science. This will save more launches than any revolutionary mechanism of action ever will. It’s not glamorous. It won’t make the evening news. But it ensures that patients receive therapies that actually work for them in the real world, which is the point of all the science in the first place.
