Across the first five articles of The Great Repricing, we have established that the U.S. biopharmaceutical market is no longer operating under a single economic model. Commercial insurance remains important, but its high wholesale acquisition cost (WAC)/high-rebate structure is under increasing pressure. Government has evolved from another payer segment into the industry's largest price-setting force, and cash has re-emerged as a legitimate commercialization channel rather than simply an option for uninsured patients or products approaching loss of exclusivity. The implication is bigger than gross-to-net compression, as I originally intended this series, or another round of payer disruption. What I’ve observed and concluded is that the basic assumptions manufacturers and the industry have relied on to price, launch, grow and manage pharmaceutical products across their life cycles are changing. In this final article, rather than predict a single new pricing model, I want to challenge seven core model assumptions that have guided pharmaceutical commercialization for most of my career and examine what happens when they are no longer true.
