Rethinking market access as a commercial growth engine for pharma

Fighting the wrong battle

Across the pharmaceutical industry, commercial, market access, and medical teams often operate in silos, each focused on their own priorities. With sporadic cross-functional collaboration, launches can underperform—and sometimes, newer players outpace legacy organizations.

Most leaders would agree that pricing, reimbursement, and market access considerations have the most significant impact on how pharma companies realize the full potential of their products. Yet business models and governance haven’t adapted to this new reality. 

For years, the pharmaceutical industry’s commercial engines have been obsessed with brand messaging, physician targeting and engagement, share of voice, and demand generation. The uncomfortable truth is that this is increasingly becoming the wrong battlefield. 

Ultimately, if there’s no access, there’s no script. Even the slickest commercial strategy will become expensive theater if a drug is mispriced, non-formulary, outside of treatment guidelines, or lacking a reasonable medical policy. Case in point: Lilly’s Zepbound. Despite significant commercial investment, it faced a July 2025 National Drug Code block by CVS Caremark, the largest pharmacy benefits manager in the U.S.

That type of action has also affected the commercial performance of multiple biologics for severe asthma. For these reasons, many “blockbusters in the lab” suffer a quiet demise during payer negotiations. 

Why is this important now? 

While brands have traditionally focused on gaining approval and engaging healthcare professionals, the market has changed in several key ways.

• Payers are the new prescribers. They decide if your drug even enters the game.
• Health technology assessments are the new regulators. Regulatory approval means little if payers won’t pay.
• Patients are the new activists. They demand affordability and access, not just innovation.

Despite this, market access efforts within most pharma companies still sit in a silo—brought in too late, underfunded, and too often seen as a bureaucratic hurdle rather than a major growth driver.

For launches to succeed in this new environment, commercial and market access teams must merge. That doesn’t mean just aligning or collaborating more. It means structurally fusing into a single go-to-market engine where payer value is centrally incorporated into the brand strategy from day zero.

This approach is increasingly common at smaller companies, in actions if not in governance. It’s aided by aligned personal incentives and a collective sink-or-swim mentality focused on effective decision-making. 

How does merging market access and commercial functions create value? 

By combining market access and commercial functions into one team, brands can create value in several ways. Health economics and outcomes research (HEOR) and real-world evidence (RWE), for example, should no longer be considered merely appendices or academic departments—they ARE the marketing story. Pricing strategy becomes a more powerful competitive differentiator, not just a finance exercise. And access wins are commercial wins, because a reimbursed patient is worth more than a hundred rep lunches and some glossy promotional materials.

Commercial teams have traditionally owned the customer relationship. But if the definition of “customer” doesn’t include payers, policymakers, and patient advocates, brands risk stranding their brilliant science behind reimbursement barriers.

Why haven’t brands already adopted this approach?

While the notion of integrating commercial and market access may appear obvious, merging the two requires consideration of why they were separated in the first place, such as:

• Differing priorities. Commercial runs on volume. Market access runs on value. These two entities rarely meet.
• Data blind spots. Commercial often leans on physician insight panels, while market access focuses on payer and economic models. Neither is building a full 360-degree view of the patient journey.
• Misaligned incentives. Commercial leaders want immediate sales uptake, but market access is judged on reimbursement wins and profitable sales. These KPIs clash.
• Changing times. The U.S. has historically been a “price-taking” market, in which pricing and value have been relatively independent considerations, but that’s changing. The one thing American politicians agree on is that healthcare costs are too great, and population health outcomes don’t correlate with this spend. 
• Inertia and risk aversion. Everybody loves to benchmark, but few like to lead. “If it ain’t broke, don’t fix it” is a binary, conservative, widely prevalent belief. If we don’t change the risk aversion mindset, we won’t realize full value.

How can my firm put this into action? 

Here are six ways you can re-envision market access to enable growth for your brand and position your organization as an industry leader:

1. Break down silos by redrawing your org chart.
Commercial executives frequently sit a few levels above their access counterparts. If pricing, payer evidence, and reimbursement determine more than 70% of revenue outcomes, why is access not structurally elevated? Unified strategy and equal footing have become especially important as payers and providers have consolidated, and access to decision-makers has gotten more challenging. 

Key action: Redraw your organizational chart to make market access an executive position. Access leaders should have an equal seat at the table at both the brand and regional levels—not just in principle but in terms of actual decision-making autonomy and authority. Some organizations are even beginning to explore the more executive position of “Chief Access Officer” reporting to the Chief Commercial Officer.

Imagine a world where there’s no market access team down the org chart. Instead, there’s a growth architecture office that blends pricing, evidence, system engagement, and commercial strategy into one integrated structure. No silos, no “owners” versus “helpers,” and no handoffs. Just one accountable team that designs, sells, and delivers value from day one.

2. Stop “busy work” and start owning the value narrative.
Access teams often spend too much time chasing dossiers, health technology assessment submissions, and local adaptations. While these are necessary requirements, teams are often responding to regulatory and reimbursement requirements and processes instead of setting the tone. Access teams need to shift to a mindset of proactive market shaping to control the narrative and drive successful, profitable access. 

Key action: Make market access the owner of the value narrative. From clinical trial design to launch messaging, market access leaders should drive how the product is positioned across patients, providers, payers, and policymakers. Commercial team members should be responsible for amplifying this narrative—not reinventing it.

Imagine if every phase II/III protocol were designed with payer strategy baked in and used as one of the stage gate criteria. This would empower leaders to halt trials that weren’t payer-ready, ensuring adequate focus on real-world endpoints, budget impact indicators, and reimbursable outcomes.

3. Unify field teams.
In most pharma companies, access field teams and commercial reps run in parallel. Sometimes they even call on the same accounts and stakeholders within an account—often with uncoordinated or conflicting messaging. This needs to change. Payers, providers, and health systems are increasingly integrated, and health system access is becoming just as important as third-party reimbursement. 

Key action: Tear down silos and improve the stakeholder experience by creating account-based growth pods consisting of sales, access, and medical roles. Assign each pod to priority health systems and payer-provider networks, and create a single shared plan across roles with unified KPIs. 

Imagine if pharma leveraged integrated deal teams instead of single-function departments. This would empower team leaders to focus beyond the brand on value items such as outcomes, contracts, evidence, and services. 

4. Align early on KPIs that matter.
 Access shouldn’t be measured just on time-to-reimbursement, nor should sales be measured on script counts alone. These incentives sometimes clash, pitting teams against each other and creating blame games when things don’t go as desired. Shared success metrics force collaboration instead of finger-pointing.

Key action: Rebuild KPIs around joint outcomes for such indicators as formulary depth, patient initiation speed, persistence, and system-level value delivered. This forces real integration and shared accountability.

Imagine if you just had one overarching metric for your entire team: patients on therapy at sustainable value. If commercial and access teams can’t each move that dial, they don’t deserve separate scorecards. This should be the priority before measuring secondary KPIs like sales and time-to-reimbursement.

5. Use RWE as a bridge to reimbursement. 
Too often, pharma companies treat HEOR and RWE as peripheral functions. These teams run models, publish papers, and build budget-impact dossiers (which often don’t meet payer scrutiny) that are used in payer negotiations but not integrated into commercial marketing. RWE shouldn’t be relegated to a supporting role in an environment where payers, health systems, and even physicians demand proof of value. 

Key action: Use RWE to empower functions. Access teams can build payer-relevant RWE, while commercial teams can scale it across every channel—physician, payer, policymaker, and patient. Find, train, and measure forward-looking HEOR talent to make this a reality. 

Imagine if every HEOR output were designed for commercial deployment first and publication second. Think interactive RWE dashboards, contracting models, and outcomes calculators instead of just PDFs. HEOR and commercial teams should co-own a single RWE platform—a living outcomes database that informs not just payer submissions but physician messaging, market development, and even patient activation campaigns. 

6. Redefine field access talent. 
Access has long been staffed with ex-pricing analysts, policy wonks, or local contract negotiators. This has improved as leaders have hired more senior talent in key field roles, but pharma needs consistent, strategic leadership and teams overseeing this critical area. Teams need to reinvent themselves as growth architects and system strategists to enable the commercial model of the future.

Key action: Build growth mindset-oriented market access field teams that favor people who understand health economics, system strategy, and commercial influence. Train them like dealmakers, not just gatekeepers. 

Imagine if access staff transformed into “growth engineers,” acting like corporate development or private equity professionals capable of structuring value-based agreements, bundling services, negotiating across ecosystems, and creating win-win deals.  

Failure to evolve will render some pharma functions obsolete

If market access teams cling to an aging identity of dossiers, HTA/payer dossier submissions, and tactical negotiations, they risk becoming functionally irrelevant. AI will likely automate submissions and standardize formulary decision-making processes, reducing access personnel to operational administrators. 

The most effective market access leaders in single-payer markets already have both commercial and market access knowledge because they must combine these skills to deliver results in single-payer systems. While it’s highly unlikely that the U.S. will adopt this model any time soon, the underlying need to demonstrate value for medicines is becoming geography-independent. Having pricing, evidence, sales, contracting, and marketing all aligned under one roof, one P&L, and one strategy can demonstrate value to an increasingly integrated U.S. healthcare industry.