I left the company in late 2025 after running commercial for two oncology biologic launches over the previous five years. The IRA — Inflation Reduction Act — has materially changed the launch playbook in ways that the broader market hasn't fully digested.
Pre-IRA, the standard biologic launch was characterised by aggressive list price-setting at launch, followed by years of rebate negotiation with payers. The implicit assumption was that the list price set at launch would carry through the product lifecycle with annual price increases, even as effective net prices drifted downward through rebates.
IRA's negotiation mechanism — and the smaller-molecule analogue that's already operationally biting — changes this completely. The list price you set at launch is now a much more durable commercial reality. Aggressive launch pricing locks you in. Conservative launch pricing forecloses some near-term revenue but preserves long-term commercial flexibility. The strategic calculus is meaningfully different.
The operational implications are everywhere. Market access teams have rebuilt their negotiation models. Commercial finance has restructured launch revenue projections. The board-level discussion of launch pricing now involves a different mix of stakeholders, with regulatory affairs and government affairs having materially more influence.
For a top-10 pharma like the one I worked at, the response was a structural shift toward more disciplined launch pricing. Our last launch — early 2025 — was priced 30% below where comparable products had been priced three years earlier. The board accepted this on the explicit thesis that pricing flexibility preserved through the IRA-era was worth more than the near-term revenue we were foregoing.
The interesting unsettled question is whether this discipline holds across the industry. The biotech companies and emerging biopharma players don't have the same long-cycle commercial discipline. They face the same IRA exposure but have shorter cash runways and different shareholder pressures. I expect to see continued pricing variance across the industry through 2026 — and to see the disciplined launchers like us pick up market share on access metrics over time.