Two-thirds of drug launches miss the target. The molecule is rarely why

Article 1 of 4 in the Launch Decision Architecture series.

About two-thirds of drug launches miss their pre-launch forecasts.¹ That notorious McKinsey figure has barely moved in twenty years.

The newer numbers carry more bite. Only one in ten launches between 2020 and 2024 cleared $100 million in year-one revenue, half the rate seen in the five years before.² Year-one revenue isn't the prize; peak revenue years three to seven are, and the successful assets reach multi-billion annual run-rates. But year one is the most reliable leading indicator of whether a launch will reach the prize. Only one in ten launches improves its trajectory meaningfully after the first six months on market.³ Whatever the launch looks like at the half-year mark is, with high probability, what it will continue to look like for the next two years.

The size of the bet hasn't held still either. Top-15 pharma companies now spend on the order of $350 million per launch per year on commercial and HCP engagement activity. That adds up to close to $3 billion across the four years around a major launch, per company.⁴ It sits on top of development costs that reached $2.67 billion per asset in 2025, up from $2.23 billion the year before.⁵ Those bets only earn out if the asset reaches the peak annual run-rate the development case was built on. A slow start at launch doesn't deliver that, and the trajectory locks in within the first six months.

When the gap between investment and outcome is this large, the molecule is rarely the right place to look for the cause.

What ZS found in 340 launches

ZS Associates analysed 340 launches between 2008 and 2025.⁶ Clinical differentiation alone moves the overperformance rate from 44% to 49%. Worth having, but it is clearly not the bigger lever.

Adding sustained organisational commitment to barrier removal, support infrastructure, access build-out, and institutional follow-through moves overperformance from 49% to 67%.⁶

The molecule is necessary. The HCP engagement architecture around it determines the outcome.

The cause is upstream of the data

Most launch underperformance comes from a failure to convince HCPs to change their diagnostic and treatment behaviour in ways that benefit both their patients and their own clinical practice. That failure doesn't stem from the science being unconvincing. It happens because the foundations underneath the launch weren't built to land the conversation in the way HCPs needed to hear it.

HCPs don't care how a pharmaceutical company has organised itself internally. They expect to be engaged on their own terms, in their own clinical contexts, on the channels they choose. The output they see is the only thing that matters to them: a conversation that was designed around them, or one that wasn't.

Most HCP engagement programmes in life sciences underperform for a single underlying reason. The foundations they rest on were built for an earlier era, in which the company decided what to communicate and the field force pushed that message through a small number of channels. The HCP world moved past that approach years ago. Most platforms layered on top of older foundations (think of the omnichannel tech stack, content factories, and now everything AI) can't compensate for a base built on the wrong assumption about who controls the engagement. This is the well-documented gap between digital investment and digital ROI the industry has been writing about for a decade.

At Fractal Force, our work is to rebuild those foundations from brand-centric to customer-first, so the digital, AI, and other HCP engagement investments organisations have already made finally start to deliver the ROI they were meant to deliver in the first place.

Why the first six months stay where they land

Foundations always matter. In a launch, they matter more, for two reasons that compound each other.

The first is that a launch team doesn't have years to repair the foundations beneath an established brand. Whatever data architecture, segmentation logic, engagement journeys, operating model, and measurement framework the organisation has in place at launch is what the asset will run on for the next three years. There is no opportunity to fix it once the asset is in the market.

The second is what happens to HCPs in the first six months. It's when HCPs form their prescribing habits with the new asset. They try the therapy on a few patients, see how it performs in their own hands, and build a posture toward it: positive, negative, or indifferent. Once that posture has formed, the cost of changing it goes up sharply. The clinical data have stopped being new. The conversation has been had. The next moment when a given HCP is genuinely open to changing their mind on the asset is months away.

A slow start isn't a slow start that recovers later. It's the start of a trajectory that the organisation will spend years trying to bend. That is what the IQVIA finding on the half-year mark actually tells us.

The Five Foundation Pillars

What sits underneath every HCP engagement programme that works is the same set of interconnected foundations. At Fractal Force, we call them the Five Foundation Pillars: data and analytics architecture, customer segmentation, engagement journey design, the operating model that runs the engagement, and the measurement framework that says whether it actually works.

In any HCP engagement setting, these are what determine whether engagement compounds across cycles or quietly disappears. In a launch, they determine whether the asset has a year-one trajectory the organisation can live with.

The work of a launch isn't to invent the Five Pillars from first principles. The work is to decide which parts HQ sets centrally and holds across every market, which parts country teams set locally for their specific conditions, and how both parts evolve as the market itself evolves. That's what we mean by the Launch Decision Architecture.

Three layers, held together by the Glue

The Architecture has three layers. HQ sets “the Spine”. Country teams pick “the Choice”. “The Cycle” moves with the market. Across all three sits ‘the Glue”: a cross-functional Launch Sequencing Council that decides, and a Launch Cockpit that shows the Council where attention is most needed across every market in real time.

The structure works the same way for a single brand launching into a single market as for a portfolio of brands launching across 30 markets. The variables change, but the structure doesn't.

Sources

1. McKinsey & Company, "The secret of successful drug launches." Approximately two-thirds of drug launches miss pre-launch expectations. https://www.mckinsey.com/industries/life-sciences/our-insights/the-secret-of-successful-drug-launches

2. IQVIA, "Modern Launch: The New Playbook for Brand Commercialization in Pharma." Only one in ten launches between 2020 and 2024 cleared $100M in year-one revenue, half the rate of the previous five years. https://www.iqvia.com/locations/united-states/blogs/2025/10/modern-launch-the-new-playbook-for-brand-commercialization-in-pharma

3. IQVIA, "Launch Excellence." Roughly 80% of launches continue the trajectory established in the first six months on market; only one in ten improves its trajectory meaningfully thereafter. https://www.iqvia.com/library/fact-sheets/iqvia-launch-excellence

4. ZS Associates, "Pharma launch strategy in an era of uncertainty." Top-15 pharma companies spend on average $350M per launch per year, close to $3B over four years per company. https://www.zs.com/insights/navigating-uncertainty-pharma-launch-rules-no-longer-apply

5. Deloitte, "Measuring the return from pharmaceutical innovation 2025." Average cost to develop a drug from discovery to launch reached $2.67 billion in 2025, up from $2.23 billion in 2024. https://www.deloitte.com/ch/en/Industries/life-sciences-health-care/research/measuring-return-from-pharmaceutical-innovation.html

6. ZS Associates, "Why your best science is losing and what wins in pharma launches." Analysis of 340 launches between 2008 and 2025. Clinical differentiation alone moves overperformance from 44% to 49%. Adding sustained manufacturer commitment raises overperformance to 67%. https://www.zs.com/insights/build-a-pharmaceutical-launch-strategy-and-operating-system