Kandybin genova (2012) big pharma's uncertain future
strategy+businessissue 66 SPring 2012Big Pharma’sUncertain FutureThe business model that drove the major drugmakers’success isn’t working anymore. The survivors will be those thatmake smart strategic bets supported by winning capabilities.by alex KanDybinanD veSSela genovareprint 00095
BIG PHARMA’S UNCERTAIN FUTUREfeature healthcare by Alex Kandybin and Vessela Genova The business model that drove the major drugmakers’ success isn’t working anymore. The survivors will be those that make smart strategic bets supported by winning capabilities. 1 In the pharmaceutical industry, nothing is quite as (including Lipitor, Zyprexa, Plavix, and Seroquel) will exciting as a new molecule in the pipeline — especially be coming off patent in the next few years, opening the one that has a chance of solving some major human way to generics and eroding a major source of the in- health problem. In the last few decades, pharma com- dustry’s profits. To be sure, there is still plenty of room panies have consistently developed and launched new for improvement in the medications people take, and no proprietary drugs, bringing hope to sick or at-risk pa- shortage of human suffering to alleviate. But it is doubt- tients, and providing enviable financial returns for the ful whether big pharmaceutical companies will be able companies’ shareholders. Indeed, global pharmaceutical to pursue these goals within the old model of developing Illustration by Oliver Burston companies have been built around the idea of discover- exclusive new pills that they can sell under patent protec- ing blockbuster drugs that solve medical problems com- tion. For one thing, pharma companies in the past were mon to tens of millions of people. They have supported able to develop drugs for health problems that had never that approach with huge investments in their innovation before been addressed. When anti-cholesterol drugs were programs and marketing and sales operations. first launched, for example, they created entirely new, But the era of the blockbuster drug is nearing an multibillion-dollar markets. Today, in contrast, few such end. In the U.S. alone, branded pharmaceuticals ac- unaddressed categories remain, meaning most newly de- counting for some US$120 billion in annual revenues veloped drugs will be competing with existing ones.
Alex Kandybin Vessela Genova Also contributing to this email@example.com firstname.lastname@example.org article was consulting editor is a partner with Booz & is a senior associate with Booz Robert Hertzberg. Company in New York who & Company in Los Angeles. works with clients in the She works with clients in the consumer healthcare and life consumer healthcare, life sciences industries to develop sciences, and media industries strategies and capabilities to help them develop that help them achieve capabilities-driven strategies competitive advantage. to grow competitively and enter global markets. In addition, the pharma companies are feeling The next decade for the pharmaceutical industry is pressure from every direction — from regulators setting shaping up to be not only a period in which the leading the rules for drug effectiveness and safety, from man- companies don’t know what’s going to happen, but onefeature healthcare aged care organizations and employers pushing back on in which they can’t know what’s going to happen, be- prescription drug costs and reimbursement, from com- cause so many of the conditions under which they oper- petitors coming to market with alternative brands or ate are in such an unusual state of flux. generics, and from disgruntled shareholders. Internally, None of the new businesses into which the phar- the number of molecules in pharmaceutical company maceutical companies are expanding have the same pipelines is shrinking, and the risk/reward ratio for re- margins as branded drugs, and that raises doubts about search and development outlays is worsening. Overall, whether pharmaceutical companies will be able to these trends have resulted in lower revenue, reduced maintain their past levels of profitability. (See Exhibit profitability, and declining P/E valuation ratios for most 1.) “Some will, some won’t, because there won’t be as major pharmaceutical companies. big a proprietary market to go around in the near term,” The question, however, is more fundamental than says Miles D. White, the chief executive of Abbott Lab- what pharma companies will do for an encore in the post-blockbuster era: The question is whether they can survive at all in their present form. There is no consen- Exhibit 1: Less Attractive Margins 56 3 sus about what comes next, as evidenced by the different Pharmaceutical firms looking to move into adjacent businesses will need to accept lower levels of profitability. strategic moves the major companies have made with mergers, acquisitions, and divestitures in recent years. Average Operating Margin A few have chosen to double down on branded phar- Pharmaceuticals 29% maceuticals, betting that the bad times won’t last and that by adding new therapeutic areas or becoming more Biologics 25% adept at using technology they can continue to gener- Devices/Diagnostics 22% ate large profits from formulations they own exclusively. Many others are looking elsewhere, and have expanded Consumer Healthcare/OTC 20% into such sectors as diagnostics, consumer health, gener- Animal Health 17% ic drugs, biosimilars, nutrition, and wellness. Generics 12% “I don’t think there’s been a time in recent history strategy+business issue 66 where the industry has had a more divergent approach Services 8% to the future,” says Cavan Redmond, group president Drug Wholesalers 2% of corporate strategy at Pfizer Inc. “It means that we’ll have different ways of dealing with healthcare, especial- Source: “Mapping the Healthcare Landscape: Bringing Pharmaceuticals into Focus,” ly on the pharmaceutical side, and less homogeneity.” Datamonitor, November 2009
The question is more fundamental than what pharmaceutical companies will do for an encore. It’s whether they can survive at all in their present form.oratories, which is in the process of separating into two Multiple Unknownscompanies, one focused on diagnostics and medical de- Just how uncertain a time has Big Pharma entered?vices, the other on prescription drugs. Consider a balloon in different weather conditions. features title of the article feature healthcare To survive — and perhaps thrive — in this un- Release the balloon into a light sea breeze, and it maypredictable future, pharmaceutical companies need to bounce a little from side to side, but it will inevitablymake some bets about the way the future of the indus- and predictably fly in the direction of the wind. Repeattry will unfold, and design their diversification strate- this experiment and the results will be almost identicalgies to position them for success in one or more of the to those of the first try. This is an example of a deter-scenarios they envision. We think these need to be stra- ministic process, meaning you can predict the balloon’stegic bets, which mesh with the companies’ key capa- behavior and ultimate location with a high degree of ac-bilities systems — the things each company does with curacy by knowing its aerodynamics and the speed anddistinction that provide its competitive advantage. We direction of the wind.recommend that companies begin that journey with a Now try to predict what will happen with a balloonfive-step process for identifying the best opportunities. in an unstable weather condition like a tornado, withExhibit 2: Pharma Acquisitions, 2004–10 57 4Overall, the acquisition activity of the 10 largest pharmaceutical firms in recent years seems chaotic. Number of Acquisitions Value of Acquisitions Average Size of Acquisition (US$ Millions) (US$ Millions) Pharmaceuticals 39 339,442 8,704 Biologics 31 33,620 1,085 Generics 11 55,210 5,019 Consumer Healthcare/OTC 10 76,629 7,663 Devices 10 10,493 1,049 Diagnostics 3 4,367 1,456 Services 2 140 70 Animal Health 1 4,000 4,000 Biosimilars 1 350 350 Nutrition/Wellness 1 320 320Source: Capital IQ Database
Most industries go through periods of both deterministic and stochastic development.... The pharmaceutical industry is entering a stochastic period. Exhibit 3: Pharma Divestitures, 2004–10 The 10 largest pharmaceutical companies have also been selectively divesting businesses as they reposition themselves for changing markets.feature healthcare Number of Divestitures Value of Divestitures Average Size of Divestiture (US$ Millions) (US$ Millions) Pharmaceuticals 9 3,025 336 Consumer Healthcare/OTC 5 3,614 723 Diagnostics 4 713 178 Nutrition/Wellness 3 8,245 2,748 Animal Health 2 13,250 6,625 Services 2 2,300 1,150 Devices 2 1,128 564 Generics 2 485 243 Biologics 1 590 590 Source: Capital IQ Database 58 5 the wind gusting in different directions. Even if you let It became impossible to predict where the computer two balloons go at the same time, they will end up in industry was going, and in the early 1980s the incum- totally different places. You can’t predict the outcome bent players’ strategies diverged significantly. Some bet of this experiment any more than you could predict that the old mainframe paradigm would prevail; others that Dorothy and Toto would end up in a brilliantly expanded to new product and service areas. The out- colorful place called Oz. A balloon in a tornado is an come was stark: Many companies didn’t survive (case example of a stochastic process — the outcome is inher- in point: Cray), and others (such as IBM) survived only ently unpredictable. by making significant changes to their business models Most industries go through periods of both deter- and product portfolios. ministic and stochastic development. For instance, the After years of steady and predictable growth, the computer industry in the 1960s and 1970s had all the pharmaceutical industry is entering a stochastic period strategy+business issue 66 characteristics of a deterministic process. IBM, Bur- of its own. That pharmaceutical companies have diver- roughs, Cray, and others pursued similar strategies, gent views of how the future will evolve is evident in selling giant data processing machines known as main- what they’ve done in the area of mergers and acquisi- frames. The personal computer changed the dynamics tions. On an aggregate basis, M&A activity involving of the industry, triggering a turbulent stochastic period. the 10 largest pharmaceutical companies looks pretty
chaotic — no clear pattern is visible in their behavior Exhibit 4: Investment Focus Areas, 2004–10from 2004 through 2010. (See Exhibits 2 and 3.) Capi- When M&A is viewed on a per-company basis, the pharmaceutical companies’ strategies become more clear.tal transactions in animal health, consumer health, de- features title of the article feature healthcarevices, generic drugs, and branded pharmaceuticals allaccounted for tens of billions of dollars in acquisitions, Co ns umdivestitures, or both. The one exception is biologics, a N er ut Ph He ri ar An tiotype of medicine that everyone seems to agree will be al m im Di Bi th n/ ac ag os ca W Bi al Ge Se eu De el no re im ol Heimportant in the future. ne rv tic ln og vi /O st ila ic al ri es ce al ic ic TC es cs rs th s s s s s When you look at M&A activity on an individual Sanoficompany basis, however, the pharma companies’ behav- Pfizerior looks considerably less chaotic. Most of them have Abbottused deals to narrow their focus to two or three areas GlaxoSmithKlinebesides core pharmaceuticals and biologics. (See Exhibit Novartis4.) The other focuses they’ve selected are the result of an Johnson & Johnsonassessment by each company of where it might succeed, Rocheand the amount of diversification it can support. AstraZeneca Merck 59 6Value of Strategic Bets BayerThe diversification moves that pharmaceutical compa-nies have made may look like they meet our definition Source: Capital IQ Database, Booz & Company analysisof strategic bets: Bets designed to position the companyfor success in one or more specific business scenarios,that are either aligned with the company’s existing key by some linkage” with other units, he says.capabilities systems or that include a plan for developing This is still the common mind-set in the industry,or acquiring other capabilities that will be needed for and the underlying assumption — that business unitssuccess. Instead, in many cases, pharma companies seem should be managed separately, and their individual prof-to be merely adding new lines of business designed to its maximized — makes perfect sense in a deterministicbroaden their portfolios and reduce the volatility of rev- environment. But in a stochastic environment, in whichenue and earnings. “The baseline is they have to stand no company can know how the future will evolve, wealone,” says one pharmaceutical company CEO, describ- believe this stand-alone pieces-of-a-portfolio approach ising his company’s diverse businesses, which he has fine- insufficient to position a company to adapt successfully.tuned with the help of almost a dozen acquisitions in This does not imply that diversification in a stand-alonerecent years. “I expect them to actually be able to suc- business cannot be successful. Often pharmaceuticalceed independently of that extra opportunity afforded companies build successful businesses and create sig-
Scenarios for early trials suggest Benlysta works remotely monitor hypertension pa- well with certain patient populations, tients’ key health indicators. By im- Success but not with African-Americans, who proving compliance, Novartis says, have a high incidence of the disease. it hopes to help improve patient out- Pharma + consumer. This sce- comes and drive down costs. T he positioning needed for phar- maceutical firms to succeed will evolve in ways that are still un- nario assumes that a more holis- tic approach to health — embrac- ing such approaches as preventive Pure pharma + a focus on thera- peutic areas. In this scenario, suc- cess is a matter of slowing the last known. Some possibilities: medicine, wellness services, and few years’ decline in R&D productiv- Pharma + diagnostics. In this nonprescription drugs to treat mild ity, and potentially reversing it. Com- scenario, the success of a company’s symptoms or side effects — is here panies looking to do this would con- patented pharmaceutical business to stay, and could both strengthen a centrate their capital on therapeutic depends on its diagnostics business. company’s prescription drug busi- areas that offer the greatest chance The idea stems from the likelihood ness and leverage that business’s for technical and commercial suc- that payors and customers will even- research breakthroughs. The shift cess. That is what Novartis has been tually reward proprietary and differ- toward consumer-centric healthcare doing in eye care; it purchased Alcon, entiated clinically effective diagnostic is already reflected in some phar- an eye-care company, for US$51.6 bil-feature healthcare services rather than simply paying maceutical companies’ moves, such lion in April 2011 and is now a global for readily available commodity ser- as Sanofi’s effort to extend the life of leader. As the world’s population vices. In such a world, the ability to Allegra, an antihistamine, by selling ages, Novartis sees eye disease as an stratify patient populations via diag- it over the counter, and Pfizer Inc.’s increasingly widespread problem and nostics — to match the right patient reported interest in doing the same therefore a lucrative area of focus. with the right treatment at the right with its cholesterol drug Lipitor. In general, Novartis has bucked dose — would create significant value A holistic consumer focus can the trend toward declining R&D pro- and essentially enable a personalized take forms other than over-the- ductivity. That has enabled it to con- approach to patient care. In this case, counter versions of prescription tinue to invest heavily in new drug pharma businesses will derive signif- drugs. Consumer businesses bring development. “We have a highly com- icant advantages from offering both a unique capability for understanding petitive and robust pipeline with 63 diagnostics and medicines. The diag- consumers and their behavior, and NMEs [new molecular entities], and nostics will also give drug companies this understanding can significantly higher success rates at every stage of better insights about what molecules improve patient compliance. For in- development than our competitors,” 60 7 to pursue. Human Genome Sciences stance, Novartis AG, in collabora- says Chief Executive Joseph Jimenez. Inc.’s lupus medication Benlysta has tion with several regional payors in —A.K. and V.G. benefited from patient stratification; Europe, is using new technologies to nificant value by entering adjacent spaces. However, if self in a stochastic environment — flexibility in terms these businesses are not linked with the core pharma- of the directions in which they can move, and have ceutical business, they won’t help the company prepare, implications for the companies’ market positions, their or reposition itself, for the future. In such cases, it may operating models, and the evolution of their capabili- make sense to split the successful independent business ties. Without question, strategic bets should have the from the core pharmaceutical operation to realize the potential to enhance the core drug business, the source created value, as Abbott recently decided to do, splitting of every pharmaceutical company’s greatest potential strategy+business issue 66 its drugs and medical products businesses into separate profits. However, implicit in the idea of a bet is that publicly traded companies. it may not be a winner. This explains both why it is This is where the approach of strategic bets comes essential to make several bets as opposed to bank- in. As we’re defining them, strategic bets give pharma- ing on one, and why the company must be willing to ceutical companies — or any company that finds it- move quickly, doubling down or lightening up, after it
To date, most of the shuffling of parts in the pharmaceutical industry has involved portfolio diversification, not strategic bets.sees how the bet is faring. diagnostics becomes a commodity service offering that A strategic bet begins with some hypotheses about is readily available from multiple third parties, it willthe future and an attempt by a pharmaceutical com- not be necessary to have these capabilities in-house, and features title of the article feature healthcarepany to position itself to take advantage of that future. expansion in diagnostics may not be necessary.(See “Scenarios for Success,” page 7.) The hypothesis To date, most of the shuffling of parts in the phar-might be that disease management will gradually have maceutical industry has involved portfolio diversifica-less to do with prescription drugs and physician over- tion, not strategic bets. Consider Johnson & Johnsonsight, instead becoming more the responsibility of the (J&J). This company, which has more than $60 billionpatient. In that scenario, the company may want to in revenue and more than 250 global subsidiaries, hashave a consumer healthcare business — not necessar- traditionally operated under the philosophy that busi-ily for the stand-alone profits the business can generate, ness unit autonomy is the best way to ensure good deci-but in the belief that a consumer healthcare unit will sion making and accountability and to drive financialbecome an essential partner with pharmaceuticals in results. That philosophy has served it well in a deter-a changing disease-management landscape. If the sce- ministic environment. Recently, however, closer collab-nario it has built about the future comes true, the com- oration between J&J’s diagnostics and pharmaceuticalpany will already have the platform in place to make its businesses, as well as between its pharmaceutical andoverall business more successful. If the scenario doesn’t consumer businesses, suggests that J&J may be reexam- 61 8materialize, the company making the strategic bet can ining the strategic bets it is making to succeed in a sto-alter its treatment of the unit — managing it for profit chastic environment.or selling it off. A few companies’ M&A moves certainly come Another scenario might be that diagnostics will be close to meeting our definition of strategic bets. One isamong the essential pieces of the pharmaceutical tool the development of a generics business by Novartis AG,kit in the future, a way of identifying patients who can to coexist alongside a branded pharmaceutical businessbe helped by particular drugs (and patients who can- that has developed leading drugs in areas like heart dis-not) and helping scientists aggregate data much more ease and cancer. “Fundamentally, we are pro-patent,”quickly. If this scenario develops in such a way that di- says Joseph Jimenez, chief executive of Novartis. “Butagnostics services become proprietary, highly differenti- we believe that when those patents expire, it is our ob-ated, and profitable, it will be essential for major phar- ligation to offer low-cost, high-quality generics to helpmaceutical companies to develop advanced diagnostics lower total healthcare costs.”capabilities. In that scenario, the combination of the Another move that has the look of a strategic bet isdiagnostics and pharma businesses would become an the focus on diagnostics at Roche Holding Ltd. In ad-essential way to improve R&D effectiveness and clini- dition to now representing more than a fifth of Roche’scal outcomes of disease treatment, and could become a revenue, Roche says, its diagnostics technology hasprofitable area of activity for the company. If, however, made its core pharmaceutical business more successful
Pharma’s longer patent protected but that carry Novartis AG is building a vaccine the imprimatur of a trusted manufac- plant in Brazil and a pharmaceutical Common turer, such as GlaxoSmithKline PLC and generics plant in Russia, says its Commitment to or Abbott Laboratories. “It’s important for us to be in the chief executive, Joseph Jimenez. In addition, the company is setting up a Emerging Markets top five in branded generics in some biomedical research center in China in emerging markets,” says Miles White, the belief that local R&D work will give CEO of Abbott, who spearheaded the its scientists better insights into local F or all the things that are unclear about pharmaceutical compa- nies, one thing is certain: More of their company’s 2010 acquisitions in this area, of Solvay Pharmaceuticals and Piramal Healthcare of India, and who patient needs. “The incidence of chronic diseas- es like diabetes, obesity, and cardio- future profits will come from emerg- will cede the management of them vascular disease is rising dramatically ing markets. to another Abbott executive, Richard in China,” Jimenez says. “I’ve seen this To be sure, drug markets out- Gonzalez, when Abbott’s planned split firsthand from my own travels and side North America and Europe have becomes effective in 2012. White adds talking with government officials. very different characteristics. For that Abbott’s investment in emerg- “The work we’re doing in China,” instance, in potentially huge pharma- ing markets is a long-term play, and he adds, “is going to give us a strongfeature healthcare ceutical markets such as India and that it will take “a decade or two” for lead in enabling us to address the pop- China, consumers are gravitating to- those markets, as a whole, to “reach ulation’s rising demand for healthcare ward so-called branded generics — a scale and size” similar to that of the and significant unmet medical needs.” generic versions of drugs that are no United States. —A.K. and V.G. by identifying new therapeutic targets and screening A company that has a world-class system for com- out poor drug candidates. municating with doctors, for example, would want to make sure that its strategic bets take advantage of that How Pharma Can Move Forward capability (the generic drug business as a strategic bet Strategic bets in pharmaceuticals, as in any other in- would benefit greatly from this capability). A company dustry, must take into account what a company already that had world-class expertise in cancer therapy, with its does well. In other words, the bets should leverage the many challenges, would want to make sure that its stra- company’s capabilities system, made up of the three to tegic bets took advantage of that expertise (as it might 62 9 six activities that truly differentiate the company and al- if the strategic bet were a nutrition line optimized for low it to compete effectively both in the market position the needs of cancer patients). If a strategic bet suggests it has staked out and with the products and services in that new capabilities will be needed, they should be de- its portfolio. In our experience, companies that exhibit veloped or acquired in such a way that the company’s a high degree of coherence in these three elements (their overall capability system remains coherent. If the system capabilities system, market positioning, and product/ is not coherent, the strategic bet will have a high chance service portfolio) tend to thrive in their industry sector; of failure. companies that exhibit lower degrees of coherence tend Identifying the right strategic bets should be the to have trouble keeping up. Coherence is an especially highest strategic priority for the company, and the effort important discipline in stochastic times, because with- should be led by the CEO or a committee that includes out it, companies tend to make unrelated investments the CEO, because in most cases these steps will lead to a and spread themselves too thin. (See “The Right to different or substantially modified strategic direction for strategy+business issue 66 Win,” by Cesare Mainardi with Art Kleiner, s+b, Win- the company. We suggest a five-step process: ter 2010.) 1. Embrace change as inevitable. The current Hence, companies need to have the judgment to “blockbuster” model, defined as relying on traditional focus their strategic bets on areas that use capabilities capabilities, faces extinction. The issue here is chang- that they already have — or that they could develop. ing the mentality of senior management. For companies
where this attitude prevails and new capabilities are not Ticking off these challenges, Abbott CEO Milesdeveloped, survival is a real question mark. White, who has run the company for the last 12 years, 2. Develop a vision for several potential future and who will head up the medical devices companyscenarios. The stochastic environment and people’s once Abbott’s split is complete, says, “My sense is thereinability to predict the future do not mean that every are several models that will ultimately succeed.”outcome is equally possible. A dynamic evaluation of And therein lies the opportunity. As industriespotential future states (wargaming) can help compa- evolve, stochastic periods such as the one the pharma-nies develop views of, for example, how disease man- ceutical industry is entering don’t last forever; determin-agement will evolve. istic periods return, allowing companies to move away 3. Understand the inherent capabilities that the from multiple strategic bets and pursue a new strategy.company possesses. Although turbulent times bring For pharmaceutical companies, the challenge will be toinevitable change, and doing what you have always make strategic bets both to survive today and to position features title of the article feature healthcaredone is unlikely to be effective, it is vital to have a clear themselves for the next period of deterministic growth.sense of what is differentiating about your capabilities By the time that happens, they’ll be very different com-system. With this knowledge, a company can deter- panies than they are today. +mine which new capabilities it should be adding. Reprint No. 00095 4. Identify strategic bets that can position the com-pany as a winner. No matter which future scenario ma-terializes, companies need to determine the capabilitysets that are required to win for each of the strategicbets and, most important, that will support the newstrategic direction. 5. Develop an organizational and business modelthat most effectively supports the new strategic direc-tion and identified coherent capability set. Companies Resourcesneed a plan for evolving their corporate culture, creat- Ram Charan and Michael Sisk, “Strategic Bets,” s+b, Summer 2011, 10 63ing a new business model and building new capabilities strategy-business.com/article/00063: Another view of make-or-break shifts in direction when facing uncertainty.as future scenarios unfold and the external environ-ment changes. Matthew Herper, “Rallying Pharma’s Rebels,” Forbes, August 3, 2011: Former executive at Eli Lilly and Company offers a blueprint for fixing the broken system of pharmaceutical industry R&D.Survival Comes First Peter Loftus, “Pfizer Looks at Lipitor over Counter,” Wall Street Journal,If anything, the challenges that pharmaceutical compa- August 4, 2011: How the U.S. Food and Drug Administration has stoodnies face seem to be mounting, especially in the U.S., in the way of allowing statins to be sold over the counter.the biggest market for prescription drugs. Generics now Eva Von Schaper, “Novartis’s Jimenez Has Blockbuster Plans foraccount for upward of three-quarters of all prescriptions Diovan after Patent Expires,” Bloomberg Businessweek, August 5, 2011: A discussion with the CEO of Novartis on how the company isin the U.S., versus 56 percent in 2005. Pharmaceutical maneuvering to avoid having its best-selling drug be destroyed by thecompanies have fewer resources, having shed 150,000 expiration of its patent.jobs, many of them in sales. In the U.S., the Food and Duff Wilson, “Drug Firms Face Billions in Losses in ’11 as Patents End,”Drug Administration has become much more zealous New York Times, March 6, 2011: Why the scramble is on for pharma- ceutical companies to reinvent themselves and shed their dependence onabout safety. And some of the specialized drug treat- blockbuster drugs.ments that are coming to market — priced at $30,000 For more thought leadership on this topic, see the s+b website at:a year and higher — face resistance from insurers who strategy-business.com/health_care.are questioning their value and refusing to pay.