When people talk about “tough stakeholders” in market access, the usual suspects are regulators, HTA bodies, and payers. Challenging? Absolutely. Critical? Yes. But in practice, the single toughest stakeholder to align isn’t in Mumbai, Ankara or Manchester; it’s your own company.
Internal misalignment kills more launches than any external obstacle. R&D wants speed, commercial wants differentiation, market access is screaming for evidence that was never collected, and medical affairs tries to hold the middle ground. By the time the drug is ready, nobody agrees on what success actually looks like.
Take a recent oncology launch. The R&D team had designed endpoints regulators loved — clean, statistically elegant, and precise. Commercial assumed that those endpoints would automatically convince payers. Market access begged for health economic data that hadn’t been collected. Medical affairs tried to mediate, but the message became a tangled knot. The therapy underperformed on launch day, not because it was ineffective, but because the internal story was misaligned.
The damage doesn’t stop with metrics. Conflicting internal priorities often lead to inconsistent messaging. One department tells payers, “this therapy is transformative,” while another says “we’re still gathering evidence.” Payers are astute; they notice. And when patients are waiting for access, internal confusion can translate into delayed adoption and, ultimately, human cost.
Why is internal alignment so hard? Because it forces uncomfortable truths. Teams must confront inconvenient questions: Should the trial be redesigned? Should the launch be delayed? Who gets to compromise on KPIs for the greater good? These conversations aren’t easy — they challenge authority, budgets, and entrenched incentives.
The fix requires early, deliberate work:
- Shared objectives: define what “success” actually means across functions.
- Cross-functional governance: empower teams to raise concerns without fear of blame.
- Integrated KPIs: align incentives so no one benefits from undermining another function.
- Scenario planning: anticipate internal conflicts and surface them before launch.
The irony is that your toughest internal stakeholder is often the person sitting right next door — whose goals, incentives, and assumptions may silently sabotage the product’s success. Misalignment here is far more lethal than any regulatory roadblock or payer negotiation.
And for a touch of British realism: you can’t just send an email titled “Align, please!” and expect miracles. Collaboration takes work, patience, and sometimes the stubborn persistence of a particularly determined corgi.
Ultimately, recognising that their internal colleagues are the toughest stakeholders allows teams to invest where it truly counts. Internal alignment improves the odds of successful external conversations.
In pharma, the fiercest opposition is rarely a regulator with a red pen. It’s the colleague whose KPIs don’t match yours. And unless that gap is closed early, no external stakeholder will ever buy what you’re selling.
