Patients + Profitability™
Gross-to-Net is the financial record of every commercial decision that touched the patient journey. Most of the leakage in it is not a pricing problem.
Everything written for the people who have to decide: commercial finance, market access, launch teams and the leaders who own the number. Twenty-four pieces, grouped by the problem they are trying to solve rather than by the date they were published.
Start here if you are new to this
One long executive guide that lays out the whole commercialization model, from pre-launch readiness through loss of exclusivity, and names where each function actually owns the outcome.
Launch and market entry
Everything that has to be true before a first paid dispense, and the reasons a launch misses a forecast that was never the real deliverable.
- The Launch Begins Long Before Approval Day
- A Launch Does Not Fail in the Forecast. It Fails in the Exits.
- The Forecast Is Not the Deliverable. The Decision Is.
- Building the Road to Revenue
- Meeting the Patient Before the Label
- Can We Actually Find Them
Patient access and affordability
Where the patient journey and the income statement touch, and why the friction almost never shows up labeled as access.
- Every Function Green, the Aggregate Red
- Rethinking Copay Accumulators: Focus on Days-on-Therapy Over Dollars Spent
- Structure Instead of Spend
- Aligning Patient Support Services with Gross-to-Net Strategy
Gross-to-Net and the close
Accuracy, accrual and governance, and the difference between a number that is right and a number that is the right number.
- You Can Be Exactly Right About the Wrong Number
- Accrual Design
- True-Up Governance
- Close Cycle Automation
- Finance Should Own the Number and Not the Operating Model
- One Method, Eight Countries
Government pricing, channel and 340B
The statutory and channel layer, where a calculation became a transaction and the data stopped telling you who you were selling to.
- Government Pricing Is No Longer a Calculation. It Is a Transaction.
- The Many Faces of 340B
- Which Part of What Worked
- The Pharmacy of the Future Will Not Compete on Dispensing. It Will Compete on Value.
Operating model and leadership
The organizational reasons the numbers come out the way they do, including the ones I caused myself.
- The Leak I Built
- Simplify, Standardize, Automate, Measure
- Talent Knows No Geographic Boundary. Why Does Pharma Still Hire Like It Does?
Where this thinking came from
Ten engagements across nearly twenty years, in the order they happened. Each one names the decision that had to be made, who owned it, and what the number did afterward. It is the same argument as the writing above, with the receipts attached.
The philosophy underneath all of it
Why the two halves of this site are the same argument.
- Patients + Profitability™ is the operating philosophy: patient outcomes and sustainable profitability are interdependent rather than opposed.
- Gross-to-Net Was Never About the Numbers traces revenue leakage back to patient leakage.
- The Frameworks Behind the Profile explains the frameworks and where each one applies.
- The glossary holds one canonical definition per term.
Also here
The rest of what this site holds, by format rather than by problem.
Patients + Profitability™. Conversations about what happens between the prescription and the patient, with the people who work inside it.
Nearly twenty years of work organized by framework and by Product Lifecycle Phase. Field guides, case files and frameworks.
The chronological stream. Everything in the order it published, newest first.
One canonical definition per framework term, linked from across the estate.
The same ten exits written for the person standing in them. Plain language, no product names, not sponsored.
Written from my own experience advising pharmaceutical and biotech organizations, and offered as commentary rather than as legal, regulatory, clinical or accounting advice.
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Gross-to-Net from someone who has run it. Tuesdays and Thursdays.
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