This blog is part of an ongoing series, A Brave New World: Finding life science success in modern markets.

Launching a new pharmaceutical product has always been a high stakes endeavor. But in today’s environment, the rules have changed. The traditional 6-to 12-month window for measuring launch success has expanded into a 36-month horizon, driven by evolving payer dynamics, shifting provider behaviors, and increasingly complex patient engagement strategies. This new reality demands a recalibration of expectations, investments, and strategic planning.

The Harsh Truth: Launch Conditions Are Tougher Than Ever

Pharma manufacturers are facing the harshest launch conditions in recent history. First-year sales performance has declined across the board, regardless of therapeutic innovation or disease area. Uptake curves are shallower, adoption is slower, and payer restrictions are more aggressive.

In fact, in a recent study of 559 launches, only 1 in 10 products launched between 2020 and 2024 exceeded $100M in first-year sales, compared to 1 in 5 during the 2015–2019 period. Even more striking, among the launches studied over the last decade, only 11 surpassed $1B in their first year, half of which occurred in the last three years, driven by glucagon-like peptide-1s (GLP-1s) and RSV vaccines. These figures underscore the growing difficulty of achieving commercial success but also highlight that it is still possible.

Three Forces Reshaping Launch Performance

The modern launch environment is shaped by three interdependent forces:

1. Payer control and access suppression

Payers are exerting unprecedented control over new therapies. Launch year rejection rates have climbed steadily, with durable rejections now affecting over 60% of new patients for many brands. Even when coverage is technically available, abandonment rates, where patients choose not to fill prescriptions, are rising, often due to high out-of-pocket costs.

Manufacturers are increasingly reliant on transitional assistance programs to overcome these barriers, but such support is not sustainable in the long term. The takeaway: access is no longer guaranteed, when achieved it costs more than ever, and payer engagement must begin well before launch.

2. Provider adoption lag and share of voice

Healthcare provider adoption rates vary for new launches as some are slower to adopt new therapies. A recent analysis of over 26,000 oncology providers across all launches between 2012-2025 revealed that only 20% of providers consistently adopted a new product within the first two years post launch. It was much more common to see adoption occur in years 3 and 4 than any other period following launch. This could be driven by early questions on drug efficacy, the need for evidence beyond Phase III clinical trials, the role of key opinion leaders in their network, or payer coverage obstacles in a complex payer environment. Regardless, understanding provider adoption behavior across all launches, not just within the therapeutic area of interest, is now a required launch strategy.

This lag is compounded by promotional intensity. In highly competitive specialties like oncology with many launches, complex regimens, and clinical pathways, manufacturers must invest heavily to be heard. Conversely, in less promotionally intense areas, a smaller investment can yield a louder share of voice. Understanding these dynamics is critical to optimizing promotional mix and spend as well as understanding the level and cost of effort required to activate providers.

In a study of the Medicare Open Payment Data (MOPD), often referred to as the Sunshine Act data, competitive intensity in high launch volume specialties becomes clear. Medicare Open Payments Data is a publicly available, federally mandated database of financial relationships between the healthcare industry and physicians and teaching hospitals, as required by the Affordable Care Act. Comparing the number of Open Payments to the number of prescribers within a specialty demonstrates just how much activity is occurring and how it is concentrated. It is no surprise that the most competitively intense specialties are those with the highest number of launches.

Consider oncology as a case study. Broadly, there were 501,087 MOPD interactions against 16,187 unique oncology providers in 2024. That averages just over 30 interactions per prescriber. Breaking out the distribution of interactions in oncology demonstrates the high level of activity concentrated in a relatively small number of providers. With over 350,000 MOPD interactions against 2,747 providers, the level of aggregate noise competing for share of mind is high. Pharmaceutical manufacturers must understand the totality of promotional effort that goes into a specialty when designing launch strategies. Both underinvesting and overinvesting carry consequences.

3. Patient Activation and Consumerism

Patients are increasingly influential in therapy selection, especially in chronic and lifestyle-related conditions. Direct-to-Consumer (DTC) strategies are being deployed earlier and more aggressively, reflecting a shift toward consumer-driven healthcare. However, patient activation alone is insufficient without payer coverage, provider endorsement, and an effective patient support program to prevent leakage.

Manufacturers must orchestrate a coordinated, three-pronged engagement strategy that targets patients, providers, and payers simultaneously that can drive uptake and sustain momentum.

The New Launch Window: 36 Months to Success

One of the most critical challenges in modern launch is the phenomenon of launch suppression, characterized by a plateau or decline in performance after the initial six months. This trend often leads to premature budget cuts and reduced promotional activity as launches fail to meet internal forecasts. The expectation gap between post-launch performance and pre-launch assumptions can be stark. Knowing the real drivers and barriers of performance earlier can both highlight and accelerate necessary remediations.

However, trends tend not to deviate past six months unless the launch plan accounts for environmental changes. Success may not be visible in the first year, but with the right strategy, growth can continue well into the second and third years.

Given these dynamics, brand performance expectations and forecasting must reflect significant milestones over a 36-month launch window, rather than the traditional 12-months. Staging investments to happen when those milestones are reached can prevent investing too far in front of market readiness. In launch, to use a football term, it is very easy to outkick your coverage.

Manufacturers must recognize that:

• Medicare access may take years to open up
• Prescriber habits evolve slowly beyond early adopters
• Payer negotiations and formulary placement are constant challenges
• Evidence or Key Opinion Leader support is often required to activate certain stakeholder segments

Cutting funding or scaling back promotional efforts at the 12-month mark, especially those based on outdated performance expectations, can be fatal. Brands that continue to invest strategically beyond year one are more likely to achieve sustained growth and ROI.

Optimized Indication Strategy

Indication stacking is also a critical but often overlooked consideration in launch planning. Bimzelx offers a compelling example of how a modern launch strategy can yield strong results, even in a competitive and suppressed market environment. Launched in late 2023, Bimzelx achieved notable sales despite spending significantly less than its peers during launch.

Within its first year, Bimzelx added three additional indications: psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. Later in 2024, it expanded further into hidradenitis suppurativa. This rapid indication stacking allowed Bimzelx to broaden its prescriber base and patient reach quickly.

What makes Bimzelx’s success particularly noteworthy is its optimized promotional spending. Compared to competitors, Bimzelx operated with a comparatively leaner budget but achieved similar uptake. This demonstrates that strategic targeting can outperform brute force promotional intensity.

However, this approach to additional indications may not be universally applicable. The decision to stack or sequence indications should be guided by product characteristics, therapeutic adjacency, lifecycle strategy, and payer preferences. There is no one-size-fits-all method, but every product needs a strategy.

Rethink, Reinvest, Realign

Pharma manufacturers must embrace the modern launch paradigm with a renewed mindset. The call to action is clear:

• Think long term: Success may take 36 months, not 6.
• Think above brand: Understanding physician, system, and market behavior means expanding study to look at all brands not just those within a therapeutic area or class.
• Invest strategically: Don’t cut funding prematurely, rather align spend with uptake curves, market dynamics, and stage investment based upon milestones.
• Engage holistically: Activate patients, persuade payers, and educate providers in parallel. Think multi-dimensional on how evidence can be used across stakeholders.
• Customize your approach: Tailor strategies by specialty, geography, and therapeutic area.

The modern launch environment is complex, but it is navigable. With the right data, insights, and execution, manufacturers can overcome suppression, unlock access, and achieve meaningful impact.