Launch trajectory is set long before first prescription. The commercial decisions, cross-functional alignment and change readiness built in the 18 months before launch determine outcomes more than anything that happens after.
The pharmaceutical industry spends years and billions of dollars developing products that work. And then, with regularity that should prompt more reflection than it does, those products fail commercially — not because they are ineffective, but because the organisations launching them were not ready.
The 90-day window referred to in the title is the period immediately following launch. But the decisions that determine whether that window is used well are almost all made in the 12–18 months before it opens. Commercial strategy, payer positioning, medical education, patient pathway design, cross-functional alignment — all of these are set before the first prescription is written. By the time launch arrives, the trajectory is largely fixed.
Analysis of specialty pharma launches consistently shows that products which achieve strong payer coverage and HCP awareness in the first 90 days establish trajectories that are very difficult to alter, in either direction. Brands that launch slowly rarely recover. Brands that launch well rarely decline without external cause.
"Launch trajectory is set in the 18 months before approval. The launch itself is the execution of decisions already made — or the consequence of decisions that were not."
The implication is significant: the question for a launch leader is not "how do we maximise performance in month one?" It is "how do we ensure the organisation is genuinely ready to execute when the moment comes?"
The McKinsey Influence Model identifies four conditions required for behaviour change at scale: a compelling change story that builds understanding of why the change is needed; role modelling by leaders whose behaviour signals what matters; reinforcing mechanisms — processes, incentives and structures — that make the new behaviour easier than the old; and capability building that ensures people have the skills to perform as required.
Applied to pharma launch, this framework reveals where most commercial readiness programmes fall short. The value story is developed but not internalised — medical science liaisons can recite the clinical data but cannot translate it into the payer narrative their audience needs. Leaders talk about the importance of market access but continue to resource and reward sales activity. Incentive structures remain aligned to volume metrics that are meaningless in a restricted formulary environment. Training programmes deliver knowledge without building capability.
Specialty pharma launches require extraordinary levels of cross-functional coordination. Medical affairs, market access, commercial, patient services, supply chain and regulatory must operate in genuine alignment — sharing information, resolving conflicts and making joined-up decisions under time pressure. In most organisations, these functions have different reporting lines, different incentive structures, different planning horizons and years of practice operating independently.
ADKAR provides the diagnostic lens. Does the market access team have awareness of the commercial imperatives that make early payer coverage critical? Does the commercial team have the desire to engage with HTA submissions and health economic models? Does medical affairs have the knowledge to translate clinical evidence into the language of value-based contracting? Do all functions have the ability to work in the genuinely collaborative way the launch requires?
The answer in most pre-launch readiness assessments is: not yet. And the question is whether there is enough time and organisational will to close the gaps before the window opens.
Genuine launch readiness is not a checklist. It is an organisational condition — a state in which every person in a launch-critical role understands what success requires of them, has the capability to deliver it, and is operating within a structure and set of incentives that supports rather than undermines the required behaviour.
Building that condition requires a change management programme that starts 18 months before launch, not a training sprint in the final quarter. It requires leadership that role-models cross-functional collaboration rather than departmental ownership. And it requires the intellectual honesty to conduct genuine readiness assessments — not ones designed to produce a green status.
Commercial strategy, launch excellence and cross-functional change management in pharma are core capabilities of our Pharma & Life Sciences practice. We work with commercial, medical affairs and market access teams to build the readiness that launch success requires.
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