Organization design
Your U.S. Commercial Team Does Not Have to Look Like Big Pharma
A practical way to decide what to build, what to buy, what to rent, and what not to fund yet.
The first U.S. commercial organization chart is usually drawn too early.
Boxes appear before the questions are settled: market access, sales, marketing, operations, analytics. Then the boxes create their own gravity. Candidates are interviewed. Vendors are invited in. A field-force number starts circulating until it becomes “the number,” even when nobody can point to the evidence that produced it.
The better question is not, “What does a pharmaceutical company normally have?” It is, “What must this manufacturer be able to decide, own, and execute for this product—and which of those capabilities should live inside the company?”
A commercial model is a capital-allocation decision
Recent McKinsey analysis found that 20–30% of first-time launchers exceeded launch expectations, compared with 40–50% of established companies. The same analysis estimates that a typical first-time launcher spends roughly $80–100 million annually on launch selling, general, and administrative activity.[1]
No manufacturer should copy that number into a budget. Product potential, prescriber concentration, treatment setting, access friction, evidence, service requirements, capital, and pipeline strategy all change the answer. The point is that commercial design consumes consequential capital. It deserves more than a familiar-looking org chart.
For an international company, this is compounded by the need to translate—not merely export—its home-market operating assumptions. The Korea Health Industry Development Institute identifies U.S. regulatory requirements, commercialization cost, insurance and pricing complexity, competition, IP, and cultural and business differences among the issues Korean manufacturers must navigate.[2]
Start with capabilities, not titles
Before approving a role or a vendor scope, map the capabilities the launch requires. Who will own market understanding? Who will decide the evidence strategy? Who will design the patient path, field model, distribution, data flow, operating cadence, and partner governance? Which decisions must remain inside the manufacturer even if execution is outsourced?
Then use six verbs: build, buy, rent, integrate, partner, and delay. They create a more honest conversation than “in-house versus outsourced.”
- Build when the capability is strategically differentiating, repeatedly needed, and important to retain.
- Buy a defined deliverable when the outcome and quality standard can be made explicit.
- Rent experienced capacity when the need is urgent, specialized, or unlikely to justify permanent headcount.
- Integrate when a proven system already performs the job and the real need is visibility or coordination.
- Partner when success requires shared risk, complementary assets, or market infrastructure the manufacturer should not recreate.
- Delay when the evidence is not mature enough to justify an irreversible commitment.
The field-force decision deserves its own evidence
Over 25 years in pharmaceutical commercial leadership, I have worked through multiple launches, interviewed more than 1,000 representative candidates, and hired more than 200 representatives and 30 district managers across large and smaller organizations.
That experience taught me not to begin with a rep count. Begin with the patient flow, addressable prescriber and account universe, treatment setting, call objective, access conditions, geographic reality, hiring timeline, manager span, expected productivity, and fully loaded economics.
Internal, contract, and hybrid models can each be right. The dangerous move is allowing a provider of field services to be the only party defining how much field service the manufacturer needs. A vendor can bring valuable expertise and execution. The manufacturer still needs a buyer-side view of the assumptions, tradeoffs, dependencies, and exit options.
Make optionality a design principle
The goal is not the smallest possible team. It is the smallest responsible commitment that preserves the ability to scale when the evidence changes.
That means distinguishing reversible choices from commitments that create fixed cost or lock the company into one vendor stack. It means revisiting the operating model at evidence gates rather than defending an annual-plan assumption for twelve months. And it means requiring every vendor proposal to state assumptions, dependencies, exclusions, governance, and the performance measures it will accept.
IQVIA’s own work with emerging biopharma companies emphasizes launch planning, readiness, governance, and operating-model design. The practical takeaway is that outsourcing execution does not eliminate the need for manufacturer-side orchestration.[3]
One founding member, one part of a broader team
My field and hiring experience is one input into UEM’s work. The broader UEM team brings additional perspectives across pharmaceutical commercialization, regulated distribution, technology, operating-model design, and scoped specialist disciplines. A credible commercialization office should never pretend one person covers every launch decision.
UEM translates that combined operator judgment into inspectable methods. LaunchOS makes assumptions, decision rules, evidence, and rationale visible rather than burying them in one expert’s memory or one vendor’s proposal.
Your first U.S. team should not be a miniature copy of someone else’s company. It should be the commercial system your medicine, patients, evidence, and capital require now—with a deliberate path to become what they require next.
Research and sources
- 1.
- 2.U.S. Market Strategies for Korean Pharmaceutical Companies
Korea Health Industry Development Institute
- 3.