Reimagining global commercial teams in an era of U.S. pharma centricity

For decades, the pharmaceutical industry has relied on a predictable but increasingly sub-optimal operating model: leaders at global headquarters set product strategy and local affiliates execute.  

This formula worked when launches were less complex, payer influence was predictable, and the margin for error was wide as launches had more time to course correct. In today’s faster, vastly different market, this global–local dynamic has exposed its limits: too much top-down pressure, too little empowerment locally, and significant opportunity lost in between.  

Pharma’s attempt to balance needs across markets results in a weakest-link strategy. Global brand plans get diluted at every stage of launch, ultimately fitting no market well: U.S. affiliates feel constrained by global guardrails that slow down their commercial execution, non-U.S. affiliates rewrite global strategies for their market, and global leaders spend more time on managing alignment than creating competitive advantage. The result is a “one-size-fits-none" brand story with limited impact, compounded by wasted effort and unnecessary duplication. 

Global leaders must step back from planning and move toward a decentralized approach. By reversing their top-down culture and giving affiliates more influence over strategy and execution, brands can build frameworks that facilitate stronger, more agile collaboration between local and global teams. 

Why the traditional model can no longer survive 

Global leadership has historically emphasized upstream activities—scientific positioning, evidence planning, brand purpose—while treating downstream execution as tactical. As a result, local affiliates have been positioned largely as  “implementation agencies,” without the agility to adapt strategy to payer dynamics, digital maturity, or competitive threats.  

Yet today, competitive advantage lies in execution: how fast field teams pivot their messaging, how deeply access negotiations are tailored, and how effectively omnichannel engagement translates into prescribing behavior. That’s because the commercial and access landscape pharma brands are working within looks nothing like it did just a few years ago:  

• Payer power has localized: Market access is no longer defined by a single global health technology assessment dossier. Today, local leaders also need to negotiate with payers and providers, pursue outcomes-based contracts, and comply with regional policy. 
• A proliferation of digital channels has fragmented engagement: Physicians in China, the U.S., and Italy, for example, engage with patients and colleagues differently, with distinct communication preferences and content habits. While U.S. physicians almost exclusively use the EMR to communicate with colleagues and patients, it’s not uncommon for providers in emerging markets to use messaging platforms like WeChat and WhatsApp. Global templates for commercial strategy collapse under this variation. 
• The science has become more complex: Specialty medicines, cell and gene therapies, and radioligands require brands to coordinate with an entire ecosystem of providers, diagnostic partners, and regulators and help them work in tandem. These networks are unique to each market. 
• Speed is non-negotiable: With access to advanced analytics and AI modeling, competitors are now fine-tuning strategies in real-time—but affiliates that are constrained by global approval bottlenecks cannot. 

The truth: a global-first, local-last mindset is not commercially viable.  

Effective pharma brands will abandon this outdated playbook and rebuild the global–local operating model around a new principle, replacing rigid handoffs with agility and co-creation, from upstream product strategy to downstream execution. 

A better path forward

It’s time to rewire pharma’s operating model and flip it upside down with three critical shifts: 

1. From global custodianship to enablement: Global teams should focus on setting broad guardrails, creating scalable tools, and enabling local execution at speed. This includes modular content libraries, real-time data platforms, and plug-and-play evidence packages that streamline physician access to information—rather than 400-page brand plans no one reads. 
2. From local execution to local co-creation: Don’t limit affiliates to simply adapting global guidance—empower them to co-create strategy upstream. Launch sequencing, value propositions, and evidence planning should be designed with local affiliate leaders from day one. This requires early, structured collaboration mechanisms—not tokenistic local feedback sessions months before launch. 
3. From rigid planning to dynamic operating systems: Replace annual brand planning cycles with dynamic operating systems: cross-functional global–local squads that monitor market signals in real time and adjust both strategy and execution continuously. Think of it as pharma’s version of DevOps: rapid cycles, feedback loops, and continuous releases.

Brands that embrace this flipped model will launch faster with strategies that truly reflect market realities. They’ll strengthen trust with affiliates, unlock more entrepreneurial energy, and create meaningful competitive advantage at the front line of customer engagement. They’ll also reduce the waste that comes from duplicated work and the proliferation of local shadow strategies. 

The dawn of a new era: U.S.-first global strategy 

Doubling down on U.S. centrality is key. Capital markets reward companies that win in the U.S., and a U.S.-first model aligns with shareholder expectations and the market’s pace.  

The new global–local model should explicitly prioritize U.S. strategy as the anchor, with ex-U.S. markets adapting around it. Here’s what that looks like in practice:  

• Upstream product strategy: Design first for the payer and provider landscape that drives the greatest commercial impact—the U.S.—then scale globally. Anchor your global evidence generation plans in U.S. endpoints, guided by health economics and outcomes research, contracting needs, and real-world evidence (RWE) requirements. 
• Access strategy: Task local affiliates with co-developing payer archetypes and contract models specific to their market. The global team’s role should be to build the evidence repository, data-sharing infrastructure, and economic tools that can be deployed flexibly in support of those plans. 
• Medical affairs: Integrate local needs into evidence generation plans early in the process. No more “global decides, local requests.” A connected system of local registries, RWE studies, and key opinion leader insights should shape the global narrative, not the other way around. 
• Downstream execution: The U.S. affiliate should operate as the lead market, not another big affiliate. Other markets should focus on rapid adaptation of U.S.-driven playbooks, not reinventing them. 

Ultimately, global teams should function more like an extension of the U.S. affiliate, embedding payer insights, digital innovation, and commercial models pioneered in the U.S. into the core global framework. Global leaders should invest in tech stacks and analytics that empower affiliates to experiment with channel mix and content while maintaining visibility into what works across markets. 

Looking ahead 

Pharma’s global–local operating model was built for a world that no longer exists. Pharma companies headquartered in the U.S. risk becoming U.S.-first, world-second, missing growth outside their home market. Pharma companies headquartered outside the U.S. risk becoming fragmented federations, lacking the force of a unified global narrative.  

The winners of tomorrow will not be driven simply by U.S.-first or ex-U.S. models. They will be network-driven, marrying the contributions of global, U.S., and other affiliate teams to create a more adaptable and effective strategy. What matters most is execution agility in the last mile of patient and payer engagement—and that is local by definition. The industry’s challenge is not whether global can retain control, but whether it can cede influence to create greater value