Every launch team asks: “Who benefits if we succeed?” Patients, shareholders, and sometimes physicians all make the list. But very few ask the opposite, arguably more important, question: “Who loses if we win?”

This question is powerful because every new therapy disrupts someone’s world. Maybe it’s a competing drug that will now see reduced sales. Perhaps it’s a hospital department whose revenue depends on old procedures. Or a policymaker who has promised savings from a rival approach. Ignoring these stakeholders is tempting because they’re inconvenient to influence, and occasionally… well, unpleasant. But they won’t quietly disappear. They will push back, lobby and slow adoption.

Consider the example from a recent cardiovascular launch in Europe. The therapy promised clear clinical benefits, and the launch team meticulously highlighted its advantages. What they didn’t anticipate: a well-connected supplier of older generics saw its market share threatened. Within months, lobbying delayed reimbursement in several regions. Adoption lagged despite a compelling value proposition. If the launch team had asked “Who loses if we win?” earlier, mitigation strategies could have been implemented — from early payer engagement to targeted education campaigns, potentially saving millions in lost revenue.

Asking this question shifts the mindset. It forces teams to plan for resistance, not just optimism. Further, it highlights the need for political awareness alongside clinical insight and reminds us that access isn’t solely about evidence or biology — it’s also about navigating the winners and losers of the health system.

A few practical ways to embed this question into pre-launch planning:

• Stakeholder mapping: Identify both beneficiaries and potential resistors.
• Influence analysis: Evaluate who can delay or block adoption.
• Mitigation strategies: Plan communications, education, and negotiation efforts for those likely to resist.
• Scenario planning: Simulate launch outcomes factoring in both support and opposition.

Ignoring the “who loses” perspective is like sailing a ship while pretending rocks don’t exist. You may be moving fast, but you’re almost guaranteed to hit something. In pharma, the “rocks” are often internal politics, competing therapies, or entrenched budget structures.

And for a touch of British realism: every victory in pharma has someone sulking in the corner, muttering about lost budgets, reduced influence, or disrupted routines. Anticipate it. Plan for it. Engage it.

Because in pharma, as in life, the losers rarely go quietly. Gaining a better grasp of potential losses empowers you to ensure a launch that benefits patients and the company.

How Cross-Functional Misalignment Destroys Launch Value

Cross-functional misalignment is one of the most expensive mistakes in pharma. It doesn’t make headlines, but it quietly eats launch potential, revenue, and credibility. And often, it’s entirely avoidable.

Consider a recent oncology launch. The R&D team had designed endpoints that delighted regulators because they were precise, statistically sound, and rigorous. Commercial assumed these endpoints would automatically convince payers and clinicians. Market access was asking for health economic data that hadn’t been collected. Medical affairs tried to bridge the gap, but by launch day, the narrative was tangled, inconsistent, and ultimately ineffective. Patients who should have benefited were left waiting, and adoption lagged. The therapy worked perfectly — it just wasn’t positioned properly in the real world.

Or take a rare disease therapy priced for Wall Street rather than health systems. The launch looked brilliant on paper, but hospitals and payers balked at the cost. Adoption was delayed, frustration grew, and trust eroded. Again, it wasn’t science that failed; it was alignment. Teams worked hard, but in silos. Everyone assumed someone else was asking the tough questions.

The consequences aren’t just financial. Misalignment undermines credibility with payers, frustrates clinicians, and, most importantly, delays patient access. Every month of delay isn’t a statistic — it’s a real person waiting for a therapy that could change their life.

The fix isn’t more meetings or PowerPoint slides. It’s shared accountability and clear governance. Here’s how:

• Common KPIs: Align incentives across functions to reward adoption, not just regulatory approval.
• Early integration: Include market access and commercial insights in trial design. Ask: “Will this data convince payers?” before the protocols are finalised.
• Scenario planning: Anticipate conflicting priorities and map out mitigation strategies.
• Clear communication: Ensure every team understands the shared definition of success and their role in achieving it.

Expecting a launch to succeed with misaligned teams is like expecting a polite queue on the underground tube during rush hour — it might happen once in a blue moon, but you’ll mostly just get chaos and grumbles.

Ultimately, cross-functional alignment is a pre-launch investment. It costs time and effort upfront but saves far more downstream, in lost revenue, delayed adoption, and, most importantly, patient outcomes. A launch isn’t just a regulatory milestone. It’s the culmination of coordinated effort across every function. Miss that, and the therapy underperforms, not because it isn’t effective, but because the team wasn’t speaking the same language.