Human, data and digital forces drive
go-it-alone strategies

But today’s ambitious cohort are not all operating in ultra-niche segments. Some are striking out in bigger diseases – inspired, perhaps, by successful mass-market launches such as that of Biohaven’s Nurtec ODT (rimegepant) in migraine, which went on to attract a $11.6bn buyout by Pfizer in 2022, or Vertex’s parade of cystic fibrosis blockbusters, including the latest, triple combo Alyftrek (vanza-, teza-, deutivacaftor), expected to reach $10 billion by 2030.Madrigal Pharmaceuticals is selling the first drug for MASH (metabolic associated steatohepatitis) – a liver condition estimated to affect over 20 million US adults. Verona Pharma’s newly approved Ohtuvayre treats chronic obstructive pulmonary disease (COPD), burdening 10 million Americans. BridgeBio’s Attruby addresses a heart condition called ATTR-CM (transthyretin amyloid cardiomyopathy) that affects fewer than 200,000 people in the US. But it is up against Pfizer’s Vyndaqel/Vyndamax (tafamidis) in a David versus Goliath battle where Goliath has a five year start and annual sales approaching $5.5 billion.

Other tailwinds driving these biotechs onto the commercial battlefield in the 2020s: more flexible workforces, improved data management systems and targeted digital marketing. "Accessing the right people is critical to launch success," says Chris Martin, Chief Commercial Officer at Verona. The advice isn’t new, but finding the right people is easier nowadays thanks to the efflux of Big Pharma expertise and the increase in flexible working brought about by the Covid-19 pandemic, which broadens firms’ geographic reach. "We had 6000 applications for 120 field positions," illustrates Martin.This means biotechs can afford to be selective. Early hires along the commercialization journey are particularly important: they must be adaptable and have the right attitude. "One bad hire makes or breaks the culture, and [potentially] the entire launch," cautions Matt Outten, Chief Commercial Officer at BridgeBio.Better data systems are another game-changer. Usage patterns among physicians and patients can be tracked close to real-time, allowing adjustments and improvements to outreach and supply plans. "[The right] Data infrastructure can give small biotechs a huge competitive advantage," says Martin.This is not only because of the insights that data provide – for instance, into where patients and prescribers are, and how they are responding – but also because of biotechs’ reaction time. "When things aren’t going right, we pick that up fast, brainstorm a solution and put it into action. The level of focus, agility and speed are very different" to Big Pharma, says Carole Huntsman, Chief Commercial Officer at Madrigal, and previously head of specialty care North America and US country lead at Sanofi.Finally, the expanding scope and variety of digital marketing channels enabling more targeted, effective outreach may disproportionately benefit nimbler smallcos, better positioned to adapt and react to trends and feedback. Unlike Big Pharma, most biotechs are not distracted by a broader commercial portfolio with one or two leaders driving the bottom line.

Unlike Big Pharma, most biotechs are not distracted by a broader commercial portfolio with one or two leaders driving the bottom line.