New Perspectives forUnlocking Value in Pharma:
The Power of Outside-In
Kevin Simpson | Günter Kloucek
OXYGY WHITE PAPER JULY 2023

New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

TODAY’S REALITY CALLS FOR OUTSIDE-IN“We are blinded to new opportunities tobetter serve patients, support physicians
and meet the needs of payers by our focus
on internal activities.”At OXYGY we have the privilege ofworking with many small, medium
and top 10 pharma companies atcorporate and local levels, worldwide.
From early research through tolifecycle management it is exciting tohelp our clients achieve sustainableimprovements in performance in avolatile world.
The functions, geographies and teams
with whom we engage all exhibit a
powerful intent to do better for patients,
and a drive to ensure life changing
medicine gets to those that need it.
Naturally, such ambitious missions
present a number of challenges,of which there are three trends inparticular we have regularly observed
across our life sciences clients:

for more patients at affordable prices.
We believe there is a common, consistentthread through all of the challenges:
perspective.
While the pharma industry aspires
to “put the patient in the center of all
we do” the day-to-day perspective
and focus is still internal. Historically,
the industry has been predominantly
science driven, not patient-driven;
understandably when a single newmolecular entity could generate wellover $1 billion in annual sales throughpatent protected products. Today’s reality calls for:1. superb insights beyond
patients and traditional healthcare professionals

1. The shift to specialty andRare Disease medicines, and theassociated evolution of operating
models.

2. demonstration of better
health outcomes rather thansimply providing clinical trialdata

2. The drive to reduce time tomarket for new products, withthe broadest possible access

3. agile ways of operating thatdeliver greater value to stakeholders
and the health care system.

3. The need to effectively run
multiple go-to-market (GtM)
strategies, for products from Gxto Digital.

Adapting to the new reality starts withchanging perspective to Outside-In.

It is clear from the trends we see in
the industry that the ways of workingin Pharma are changing. R&D costs
doubled in the last 10 years, while
peak sales forecasts have halved, soPharma must alter its approach tobring access to life changing therapies

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

LET’S SET THE SCENE WITH THREE
STORIES…
Let’s consider 3 real examples from senior pharma leaders facing criticalscenarios, that highlight the issues raised above.
JENNIFER

Jennifer, General Manager of a large
EU affiliate for a well-known global
pharma company, started anotherweek managing the challenging
launch of a new asset. The first launchin this field for many years, great
patient unmet need, first to market,
great phase 3 data, but yet launch
uptake was very slow.
The positioning was just not resonating.
Yes, the patient outcomes seen inphase III trials were exceptional,

but HC systems were reluctant toengage, and the strategies pushedfrom HQ were not unlocking accessfor broad populations. An adherence tohistorical, traditional marketing andsales message delivery through broad
coverage and frequency of target HCPs,
now integrating digital elements of anomnichannel strategy, was failing totruly reach the contacts it was supposed
to and was generating very limitedengagement.

MEERA

In the global HQ, Meera, the commercial
lead for early products, was fretting.
“We are now entering criticaldevelopment decision phases. Clinical& Technical R&D are aiming forregistration and are pushing hard toaccelerate time to market; but we aresimply not structured to get insightsfrom the systems/hospitals into which
the product will launch.” Irreversible

decisions are being made which willdrastically affect commercial viability– e.g. the preparation, the patient
populations targeted, even thepackaging. While the company hascommercial presence and visibility
within this specialty, without datatransferability or fluidity they do nothave access to historical insights tolean back on.

IVAN

As GM for a cluster of countries,
Ivan considered the long list oflaunches for new indications for his
key immunology asset, as well as
three new Rare Disease products
coming in as part of an acquisition.
Historically, his organization has beenvery successful with three selfcontained business units (BU) built

around three major small molecule
products. Each BU has its own uniquestrategy, plans, field forces. Looking
ahead to the loss of exclusivity,and dramatically reduced access tophysicians, Ivan must be more agile
and innovative in how his organization.
operates in future.

Despite the fortunate situation of having one or more launches of promising
new assets with strong data ahead, despite organizational efforts to accelerate
time to market, despite a track record of successful past launches, the 3
protagonists are struggling.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

LOOKING INTO EACH, CAN YOU SEE A
COMMON ROOT CAUSE?
In each of those three examples – lets dig into each and see the themes thatemerge:
For Jennifer, of course there is huge pressure to achieve targets.
Executives at very senior levels of the company were involved in goal setting andthey were very excited about the potential of the asset. There was a predominant
attitude of ‘it’ll sell itself’ and confidence in traditional approaches which weresuccessful in the past. Therefore, very few questions were asked by global tothe markets on HC system needs/challenges to gather insights for strategy
development.
This demonstrates a failure to understandthe reality: that a first-in-class productmeant significant changes in patient andprescription management – everythingfrom diagnosis to maintenance would
require adjustments to protocols,guidelines, staffing, pharmacy management
etc. at the center, hospital and healthauthority levels in most markets. But
global gave limited air time to this in
the strategy, operations or deliverables,hamstringing local success.
The Patient journey understanding in theglobal brand plan was limited to points
which would influence prescribing only,with a focus on opportunities to changeprescription.
The result was a highly brand centric
Omnichannel strategy focused on pushing messages that matter to the company
but were not resonating or meaningful tothe HCPs they were aimed at. This was
further complicated by the fact that thelaunch strategy focused solely on HCPs,
while the most important stakeholders
were those in administrative or managementlevels within the HC systems, for whomno strategy at all was developed.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

For Meera
At this early stage, there was majorpressure on C&T R&D to reduce longdevelopment cycles and to demonstrate
the potential of this new compound as
quickly and cost-effectively as possible.
Registration was the primary driver
for the team, which led to a strong
focus on appropriate patient outcomes
meaningful for key experts, trial leads
and regulators, but not sufficiently
reflecting realistic clinical practice norbroader population or system needs
i.e., registration rather than access forpatients was the goal.
While this was not a new therapeuticarea for the company, historical dataand insights were not efficiently used
to challenge assumptions or to
uncover blind spots, due to a lack ofdata sharing and appropriate analytics.
Moreover, trial sites were inconsistently
managed, with a poorly-balanced mixof CRO, Clinical Development andMedical Affairs involvement resulting
in unclear customer accountability
and a focus on internal tasks only.
Proper cross functional collaborationand insights sharing was further
impeded by recent restructuring whichplaced global functions as the key
decision makers, with scarce opportunity
for affiliate engagement.
As such, clinical and technicaldevelopment decisions were based
primarily on internal drivers, withlimited understanding or appreciationof the implications of broader
commercialization needs.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

For IvanHistorical success has created inertia in traditional commercial approaches
and solidified the common belief that every brand strategy has to be driven
completely independently.
Marketing capability and intent washighly traditional. The patient and systemperspective were largely ignored or basedon HCP memory and perception.
Only parts of the patient journey werecovered lacking a comprehensive andrealistic view from all stakeholder
perspectives. Brand and engagement
plans were derived based on Primaryand Secondary Market Research ofHCPs only, and executed in the style ofadvertising and awareness, with thedriver being repetitive messaging.
Large, brand dedicated sales forces,
with limited collaboration or sharedplanning between sales lines or acrossfunctions, were driving demand with astrong emphasis on differentiation versus
competition, largely underestimating
success drivers such as patient identification,referrals, diagnosis, affordability, adherence
etc. in specialty and rare diseases.
However, small molecule approaches
based on share of voice, coverage andfrequency are no longer relevant to muchsmaller and specialized audiencesand definitely no longer useful andaffordable for small and midsized
assets in rare diseases.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-InWhite Paper July 2023

THE BIGGEST TREND THAT WE SEE…

What do you see? In all three stories
there was an adherence to the past, towhat has been successful, to repeating
the strategies that leaders mistakenly
believe they could fall back on. In all
three examples, decision making wasdriven from a company and brandperspective rather than a stakeholder
and system perspective. In all of them,development and preparation efforts
were driven from siloed, functionalviews not incorporating the perspectiveof all 5Ps (patient, physician/HCP,provider, payer, policy maker) and thehealthcare system as a whole i.e.,taking an Inside-Out approach.
Yes, pharma has a patient centricmission (although that can always
be improved!), and yes it has its own
performance targets – but we cannot
forget that everything between ourgoals and the patient’s needs isfundamental to patient access, outcomesand pharma success. Where arehealthcare systems.and all theirstakeholders in pharma’s missions
and visions?

are most relevant to them? Whatchannels should we use for thoseinteractions?
Inside-Out. It is no longer enough to
be focused on what a brand needs tobe successful, on what we want to tellour healthcare system stakeholders
and HCPs. They, quite rightly, are notlistening.
Outside-In. Now, to succeed for patients,for HC systems and for the company,
we must evolve to look broadly anddeeply at the healtcare systems weenter and consider consistently whattruly drives better patient outcomesas well as the value impact of ourresearch, products and services.
We must widen our lens! Fromindividual patient or HCP over toprovider and account to the entire
healthcare ecosystem.

The reality is that portfolio, market
and technology evolution continue ata pace which calls for new ways ofworking. We are still talking about
patients, and about human interaction
between pharma and healthcare, butwith whom should that interaction
now be? What content and dialogue

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

…AND HOW YOU CAN DEAL WITH IT
The common inhibitor to overcoming high value problems is the habit of thinking
Inside-Out. Internal goals and pressures, and siloed, functional views dominate
internal processes and thinking, resulting in reduced speed and quality of decision
making, and ultimately leading to long development cycles, limited approval,
restricted access and reimbursement, and slow adoption due to limited
understanding of the world outside of the company.
As pressure and failures ramp up, this only becomes exaggerated and behaviors
retreat further into traditional entrenched mindsets such as weak and too latecross functional collaboration, engagement intent focused on push, and in-fieldroles not leveraged to bring “voice of the customers” into the organization,building incomplete patient journeys and limited insights due to focus on HCPs,etc.
Hence, the shift from Inside-out to Outside-In for pharma is inevitable andinexorable. The question is how will you get there and how to do so quickly?
First, what do we mean by Outside-In? Outside-In is the ability to continuously
guide decision making through relationships and insights into the health careecosystem.
The essential piece is to re-engineer operating models and refocus go-to-market
models by considering Outside-In at each stage of building your organizational
capabilities with the aim to achieve a transformed patient and health careecosystem understanding and engagement for elevated market acceptance.
In our experience, companies have successfully made the shift by embracingand embedding 7 principles in their operating model and culture/mindset:
1. Stakeholder & System centricity: Put patient populations, HC systems
and all their stakeholders at the center, and at the beginning of strategic
thinking.
2. Focus on value creation: Make the value created for patient populations
in a HC system the touch stone, the main point of reference, for decision
making and investments.
3. Partnerships for better patient outcomes: Partner for solution creation
with those who know best what it means to live, provide care, or pay for acertain condition as well as with those having access to the technology fordesired solution.
4. Aligned engagement intent: Develop clear engagement intent, purpose
and strategy for all customer facing functions, going beyond “sell more”.
5. Effective customer engagement tools: Drive customer experience
excellence via omni channel engagement according to channel preferences.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-InWhite Paper July 2023

6. Excellent cross-functional collaboration: Collaborate for holistic,
integrated strategy, planning and execution.
7. Outside-In leadership: Provide visible leadership, sponsoring and rolemodelling of Outside-In thinking.
While building the required capabilities and enabling platforms to collect,
share, process and store data and insights for value generation, pay attention
to creating an Outside-In supportive organizational environment and mindset.
Design workflows, processes, and team structures appropriately. Expect
challenges such as belief in dogmas or traditional approaches that have beensuccessful in the past and invest sufficiently in proper change management andeducation activities. Especially, rethink goal setting and incentive systems andplan for reinforcement of Outside-In driven behaviors and ways of working.

OXYGY DEVELOPS OUTSIDE-IN AS AN“ORGANIZATIONAL CAPABILITY” THAT
TRANSFORMS MARKET ACCEPTANCE• simplifying and articulating
the promise of your strategies• building the capabilities
required to realize the values ofyour strategies• translating your strategies into
globally scalable, lean processes,
workflows and new ways ofworking• infusing them into the employee
experience• challenging misconceptions andleading change• getting your leadership on thesame opportunities path
• unlocking the power of yourpeople in transformations

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

HOW JENNIFER TURNED THINGS AROUND
With each passing week, the customer
reach metrics continued a downward
spiral and structured conversations
with field leadership gave insights
into the cause. It became increasingly
apparent to Jennifer that not only
was the digital strategy not working,but physical access to customers andstakeholders was also declining due
to a failure to generate meaningful
engagements with customers andstakeholders.
A diagnosis highlighted that at alllevels of the healthcare system,
stakeholders reported a complete
lack of the company’s ability tounderstand the impact this new
medicine had on their practices,goals, processes, systems - basicallya failure to understand THEM.
Jennifer started a fundamental shift
to utilize the Cross Functional Field

Force (medical, market access, KAMand sales) as an insight generatingfunction, so that HQ teams could
ultimately develop solutions to HC
systems challenges and smooth theintroduction of new medicines.
This altered everything from the toolsthat the field force was provided forcustomer engagement, to the way thatmarketing plans were developed. All
now started Outside-In – engagement
tools were based on generating a
deep understanding of the problems
and issues in the patient journey, andcross functional brand strategy wasbased around the interrogation andintegration of this new wealthof field
generated insights to truly valuable
and impactful solutions.
This successfully altered physicalaccess, meaningful reach of digitalstrategies, and thus changed launch
trajectory.

WHAT YOUR ORGANIZATION CAN SEE,
HEAR AND FEEL WITH AN OUTSIDE-IN
SHIFT
When your organization has successfully
made the Outside-In shift• you can see your customer
facing roles living the engagement
intent, enabled by the righttools for the job and driven by
x-functional teams partneringfor better patient outcomes• you can hear ecosystem
vocabulary and customer insights
in every corner as well as
leaders talking Outside-In• you can feel the “spirit ofWE” and the pride in successfor patients• and finally, you can see,hear, feel the satisfactionof your stakeholders, andtheir acceptance of yourofferings driving company
success.

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New Perspectives for Unlocking Value in Pharma: The Power of Outside-In

White Paper July 2023

ABOUT THE AUTHORS
Kevin Simpson is an Associate Partner with OXYGY. Kevin has 25+ years working
for, and with, Pharma in local, regional and global corporate roles. His passion
has always been helping organizations transform to become more relevant andcredible to Healthcare Systems worldwide.
Günter Kloucek is a Director at OXYGY. Prior to consulting, Günter was theGeneral Manager of Takeda Germany. He has more than 25 years of experiencein the pharmaceutical industry and held operating company responsibility as
well as led corporate functions including business strategy for the Europe &Canada region.

Acknowledgement Thanks to Steve Crom, OXYGY chairman and partner, for his
contribution and advice.

ABOUT OXYGY
OXYGY helps clients transform and build the capabilities needed to thrive ina volatile world. We combine management consultancy, digital innovationand legal expertise to help business leaders turn risks and opportunities intosustainable value. We have a long-standing sector focus in Life Sciences working with clients to co-discover, co-design and co-deliver business solutions.
Our experienced global team of consultants and former executives from theLife Sciences industry have strong expertise in business model innovation,transformation and change projects.

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Kevin Simpson | Günter Kloucek
OXYGY WHITE PAPER JULY 2023