The most dangerous moment isn't when consultants reorg your function. It's when you start agreeing with them.

I have watched smart, senior HEOR leaders defend the absorption. Justify the split from RWE. Explain why being siloed inside R&D is "actually a good thing." There is a word for that. Stockholm syndrome.

The worst case of sibling rivalry I have ever seen in pharma is between HEOR and Medical Affairs. And the resolution that keeps getting sold — fully integrate them, they'll work better — is the kind of resolution you give two kids fighting in the back seat. It is not strategy. It is conflict avoidance dressed up as org design.

HERE IS WHAT NOBODY WANTS TO SAY OUT LOUD.

HEOR is an enablement function. We exist to serve. We serve Medical Affairs by generating evidence for HCP and scientific engagement. We serve Commercial by building the value story. We serve R&D by informing the TPP and trial design. We serve BD by diligencing assets before money moves. We serve Pricing & Access by defending the price, expanding the population, sustaining the brand across LOE.

We are the second line of payer value defense.

We are also the second line of payer value offense.

Both. Not one or the other. Both.

That is the function. That is what got lost when the slide showed up.

NOW THE ACCOUNTABILITY PART.

The McKinsey slides did not draw themselves. Somebody handed an executive a deck. The executive walked into a room with HEOR leaders. And we failed to show enough value, often enough, in language clear enough, to make absorbing or splitting the function seem like the dumb idea it usually is.

That is on us. Not on Bain. Not on McKinsey. Not on the SVP who signed the reorg.

On us.

We let the framework land because we did not build a better one. We let the function get absorbed because we did not make ourselves indispensable. We let outsiders define our value because we did not define it ourselves — loudly, repeatedly, in language an executive could repeat in a board meeting.

What happened happened for a reason. Let's own the reason.

THE ACUTE ANGLE.

My mentor once told me the pharma lifecycle becomes an acute angle the longer you stare at it. Upstream, the lines are close — small shifts produce massive downstream value. Downstream, the lines have diverged. It takes a mountain to move a needle.

If you want to influence outcomes, you do it early. This is why I obsess over BD due diligence. This is why I am a fanatic about payer value and pricing work pre-IND. This is why I want a reimbursable TPP going into Phase I.

Access does not start at launch. Access starts when the first drop of ink lands on the TPP.

If access starts there, that is where HEOR starts too. Not at launch. Not at evidence publication. At the TPP. At the diligence call. At the moment somebody is deciding whether to advance an asset.

THE CALL TO ACTION.

We do not get our stature back by complaining about the reorg.

We get it back by taking responsibility for losing it. By rebuilding the case in language executives can repeat. By showing up upstream — at pre-IND, at diligence, at TPP — and proving the math on the value we produce. By refusing to let Medical Affairs and HEOR be cast as siblings fighting over the same parent, when we are actually two functions serving the franchise in different, parallel, both-essential ways.

Take the power back.

It starts with us.

— Sanket

P.S. Hit reply with the question you've never been able to ask anywhere else. I read every one.