Which Part of What Worked

Global launch sequencing taught me humility. The specialty channel turned out to be the whole thing.

The discipline in taking a US launch abroad is naming which part of what worked was the part that mattered. The answer was the channel: pharmacy networks, prior authorization, patient support and hub operations, each a place a prescription can fail. Once you can name the places patients leave, you can price them.

Decision context

Moving from a single US launch into global launch sequencing puts a specific temptation in front of you: repeat what worked. The clinical story is the same everywhere. Almost nothing else is.

The pathway is different. The payer is different. The site of care is different. And the point at which a patient falls out is different in every market. A playbook that treats those as implementation detail will succeed in the second market for reasons it does not understand and fail in the fourth for the same reason.

My authority

I supported the sequencing rather than deciding it. What I could influence was which parts of the US experience were treated as transferable and which were treated as local, and that turns out to be most of the decision.

What I learned

• The discipline is not repeating what worked. It is knowing which part of what worked was the part that mattered, which requires being able to say why it worked, which most launch retrospectives cannot.
• The channel is not logistics. Supporting an oncology brand put me inside the specialty pharmaceutical channel and inside patient support programs as they actually operate. Limited distribution, specialty pharmacy, prior authorization, a hub making judgment calls all day, a copay program with its own rules. Each one is a place a prescription can stop moving.
• Nobody owns the whole path. Every participant owns one segment and optimizes it honestly. The losses happen between segments, where no function is accountable.

What I would do differently

I understood the channel as operations at the time. It turned out to be the whole thing. If I had understood that then, I would have spent the following five years mapping exit points instead of arriving at the idea a decade later.

Once you can name the places patients leave, you can price them. Before that, all you have is a variance nobody can explain.

Former employers and products referenced are matters of professional history. The views expressed are my own and are not made on behalf of any current or former employer, and no commercial outcome for any named product is attributed to me personally. All trademarks belong to their respective owners.