The Case for Strategic Outsourcing of Corporate Payer Account Teams

Executive Summary

Market Access Launch Plan: Built for a World That No Longer Exists or the One That Is Evolving?

The pharmaceutical and biotech industry is navigating a new world of product launches, an environment defined by inflation and uncertain economics, unprecedented FDA unpredictability, and payer complexity that has outpaced the commercial models most companies still deploy.

Modern launches now achieve roughly half the performance levels seen seven to ten years ago, according to data presented at Asembia in April 2026. Launch windows increasingly stretch to 18 or even 36 months. Healthcare provider (HCP) engagement costs continue to rise, while payer controls and prior authorization requirements have become significantly more restrictive. Additionally, 70% of new-to-brand specialty prescriptions face a Day 1 rejection.

Against this backdrop, the traditional commercial model, hiring four to six Account Directors at up to $350,000 each in annual salary, six to twelve months before a PDUFA date, represents a significant investment in a world that has changed significantly and may no longer even exist. It assumes fast ramps, predictable approvals, and payer access that can be built from scratch in time to matter. These assumptions may not hold true today.

In this environment, a different approach may make more financial and strategic sense: Consideration of strategic outsourcing of corporate payer account teams. With their pre-existing payer relationships, multi-client access frequency, deep launch pattern recognition, and cost structures that flex with launch realities rather than compound them, such teams may be more effective while avoiding costly investments that may not be required until products launch.

With a 27-year track record in payer-account management, VS Health Group is rooted in a founding insight that has only become more relevant with time: Outsourced market access, executed effectively, is structurally superior to fixed headcount in every way that matters.

Section 1

How Launches Have Changed: The Numbers

For much of the past two decades, pharmaceutical launch success followed a recognizable pattern. Products that gained formulary access in the first six months established trajectories that held. Breakeven came in Year 1 or Year 2 for most specialty brands. The commercial playbook, field force, managed care team, hub services, speaker programs, was well understood and reliably executable.

That era is over. The data, presented at Asembia, documents the scope of the shift:

The implications are significant. A launch that ramps slowly for 18 to 36 months before reaching trajectory carries fixed commercial costs, headcount, infrastructure, vendors, through an extended period of uncertain returns. That math worked when launches ramped in six months; it does not work now.

Compounding this is a payer landscape that has grown structurally more restrictive. Medicare Part D benefit design options dropped 49% between 2024 and 2026. The top 25 branded products captured 87% of growth in 2025, leaving most launches competing for a diminishing share of formulary attention.

More than half of launches fail to reach even $250 million in peak revenue, according to L.E.K. Consulting. Prior authorization hurdles have intensified. Day 1 rejection rates have reached levels that would have been considered a crisis a decade ago.

“The six-month launch window is now a rarity, not a certainty. Success belongs to organizations that are poised to adapt.”

VS Health Group

This is the environment every pharma and biotech company launching a product today is navigating. And it is the environment against which every commercial model decision, including the build-vs.-partner decision for market access, must now be evaluated.

Section 2

FDA Unpredictability: The Hidden Risk Multiplier

Deteriorating launch economics alone would be sufficient to prompt a rethinking of commercial infrastructure strategy, but they are not the only pressure companies face. The FDA of 2026 is a fundamentally different institution from the one that existed even three years ago, and its unpredictability has added a new category of risk to commercial planning.

The numbers are striking. The FDA lost 3,859 employees in 2025, with an additional 473 cuts in early 2026. Approximately 90% of senior leaders have departed since early 2025. Of more than 3,200 replacement hires needed, only 350 had been completed as of April 2026. On-time PDUFA completions have dropped from a historical 85–90% to 78%, meaning one in five PDUFA dates now slip. The approval rate at PDUFA stands at approximately 67.7%, meaning roughly one in three drugs reaching a PDUFA date does not receive approval on that cycle.

The practical consequence for commercial planning is severe. A company that hires five National Account Directors (NADs) 12 months before a PDUFA date now faces a 22% probability that the launch date will shift and a 33% probability that approval will not come on that PDUFA date at all.

Cautionary Tales

Recent launch experiences underscore the growing unpredictability of the FDA approval process. Products supported by strong clinical data, real-world evidence packages developed in consultation with regulators, and even approvals in other major markets have nevertheless received Complete Response Letters (CRLs) or unexpected regulatory delays.

The implications for launch planning are profound: When approval timelines and evidentiary standards become less predictable, fixed commercial infrastructure shifts from an investment in growth to a source of financial risk. Commercial models that cannot flex with regulatory realities are increasingly misaligned with today’s launch environment.

Section 3

The Traditional Model: Built for a Different World

The traditional corporate payer account model was designed in an era of faster, more predictable launches. Its structure reflects those assumptions: Hire a team of experienced NADs before launch, build payer relationships during the pre-launch window, secure formulary access, and drive pull-through. When it works, it works. The problem is that the conditions under which it works have become increasingly rare.

The Cost Structure

A typical traditional launch model involves five NADs at approximately $350,000 each in base annual compensation. That adds up to $1.75 million per year in salary alone, before benefits, bonuses, travel, tools, and management overhead. Loading those costs at a conservative 40–60% brings the fully loaded annual cost to $2.45–$2.80 million. Over a three-year launch horizon, the total investment reaches $7 million to $9 million or more. That investment is made against assumptions that increasingly fail to hold.

Head-to-Head: Traditional Model vs. Strategic Outsourcing with VS Health Group

The following comparison reflects current launch environment realities:

The Relationship Problem

Perhaps the most structurally underappreciated flaw in the traditional model is the relationship timeline. Building genuine, trusted relationships with national and regional payer decision-makers can take years, not months. A newly hired NAD, even an experienced one, arrives at their first payer meeting as a new face representing a single product. They are asking for time and formulary consideration from people who have many competing priorities and limited bandwidth.

A high rate of employee turnover at payer organizations further compounds the relationship-building challenges. Faced with new demands, including the need to design additional rebate agreements to comply with FTC settlements, payers have less time to meet with manufacturers’ NADs, especially those with only one drug to launch.

By contrast, a payer-facing team with pre-existing relationships, ones built and maintained across dozens of launches and years of continuous interaction, arrives as a known entity. The conversation starts at a different place. That difference is not marginal; it is often the difference between a Day 1 rejection and a Day 1 approval.

The traditional model was designed for its environment and performed accordingly, yet that environment has changed fundamentally, and the model has not kept pace.

Section 4

The VS Health Group Advantage

To understand why VS Health Group is well positioned to address these challenges, it is worth understanding the history of the firm and the background of its founder.

Bill Finneran’s career spans both sides of the market access equation, pharmaceutical manufacturers and the payer organizations that shape coverage decisions. Finneran joined Eli Lilly and Company in the late 1980s and was part of the first team that began calling on payers directly in 1993–94, when they reached out to mail-order pharmacy Medco. The department evolved, as it did at other companies, to teams of regional and national account directors, a model that became the industry standard for the next three decades. Finneran realizes, like many others are beginning to, that this model no longer fits in today’s market landscape.

After roles at Eli Lilly, PCS Health Systems (now CVS Caremark), and Astra USA, Finneran co-founded Viking Healthcare Solutions in 1999, creating what became widely recognized as the pharmaceutical industry’s first outsourced market access team. The premise was straightforward: Teams with continuous payer engagement across multiple clients and therapeutic categories could deliver advantages that single-company internal teams could not.

Viking grew to assist numerous emerging companies across dozens of product launches, spanning novel formulations of existing products to medications for ultra-rare conditions, across both pharmacy benefit and medical benefit channels.

Formed as a merger in 2024, VS Health Group combines Viking’s 25 years of experience with Strategic Access Solutions and Insights, a market access strategy consultancy. VSHG extends and deepens Viking’s model for product launches, evolving with the times to best serve its clients.

“I was part of the first group of account mangers established by Eli Lilly in 1993 and have experienced its evolution and changes. The current environment is very different than it was just five years ago, but many companies use the same age-old formula.”

Bill Finneran, Founder, VS Health Group

Five Structural Differentiators

VS Health Group (VSHG) was not designed to replicate the traditional corporate account model at a lower cost. It was designed to be structurally superior to it, to deliver outcomes that fixed headcount cannot achieve. That structural advantage operates on five dimensions:

1. Pre-Built Payer Relationships

VSHG maintains active relationships across 74 million covered lives, including major PBMs, commercial plans, Medicare Part D, Managed Medicaid, and VA/DoD. These relationships are not built during launch preparation; they already exist through ongoing engagement with payer decision-makers. As a result, conversations begin with established credibility and can focus immediately on the product’s clinical and economic value rather than introductions and relationship building.

2. Multi-Client Access Frequency

Because VSHG supports multiple clients and therapeutic categories simultaneously, its account directors engage with payers far more frequently than any single manufacturer can. Regular interaction creates familiarity, responsiveness, and greater access to decision-makers. This frequency of engagement provides a level of visibility and influence that is difficult to replicate through a dedicated internal team.

3. Risk-Adjusted Cost Structure

VSHG’s engagement model is designed to flex with launch realities. If a product encounters a PDUFA delay, Complete Response Letter, or slower-than-expected uptake, the scope can adjust accordingly. Unlike fixed headcount, where salaries and overhead costs continue regardless of launch timing, the outsourced model aligns costs more closely with commercial progress and risk.

4. Launch Pattern Recognition

With experience spanning dozens of launches across specialty, rare, and ultra-rare products, VSHG brings a broad perspective on how payers evaluate new therapies. The team understands evolving coverage requirements, prior authorization trends, and formulary decision-making processes based on experience across multiple products and categories rather than a single launch experience.

5. Vertically Integrated Strategy and Execution

VSHG combines market access strategy, analytics, and payer engagement within a single team and accountability structure. Our team includes former PBM and health plan executives who have worked for payers, providing strategic insights and key relationships. The same group that develops the access strategy is responsible for executing it and measuring results, reducing the disconnect that can occur when planning and field execution are handled by separate organizations.

Section 5

VSHG Payer Engagement Capabilities: What the Team Delivers

The VSHG payer engagement practice covers the full spectrum of market access requirements across national and regional payer segments:

• National and regional payer account management across all major PBMs, commercial health plans, Medicare Part D, Managed Medicaid, and VA/DoD
• Formulary access strategy and execution, including clinical presentation preparation, PIE/PVP meeting support, and Pharmacy and Therapeutics (P&T) committee preparation
• Rebate contracting assessment and implementation, including strategy development, request for proposal (RFP) support, contract negotiation, and business review support
• Payer insights and landscape analysis, including Federal Trade Commission settlement and PBM reform implications, Inflation Reduction Act analysis, and pharmacy and medical policy assessment
• Regional payer engagement across 70+ regional plans representing 74 million lives
• GPO and PBM interaction, including pull-through coordination and formulary positioning optimization
• Account Director training and mock P&T discussions for clients building internal capabilities
• Payer risk assessment and market access contingency planning

The regional footprint is particularly significant. VSHG’s regional team maintains established virtual meeting cadences with GPOs and PBMs, and active relationships with health plans including Cigna, Highmark, Premera, United Healthcare, Kaiser, Humana, Elevance, HCSC, Florida Blue, Cambia/Regence, Horizon BCBS of NJ, and dozens of others spanning Commercial, Medicare, and Medicaid segments.

Conclusion

Our Ever-Evolving New World Demands a New Model

The pharmaceutical launch environment has changed in ways that are not cyclical. The deterioration in launch economics, the structural disruption at the FDA, and the intensification of payer controls are not temporary conditions that will self-correct. They represent the new baseline against which commercial models must be evaluated.

The traditional corporate payer account team model was built for a different environment. It assumes fast ramps, predictable approvals, and relationships that can be built in time to matter. In today’s environment, none of those assumptions hold consistently enough to justify the fixed cost and structural inflexibility the model requires.

Strategic outsourcing of the corporate account function to VS Health Group offers a structurally superior alternative: pre-built payer relationships across 74 million lives, multi-client access frequency that no single manufacturer can replicate, cost structures that flex with launch realities, and 27 years of launch pattern recognition spanning dozens of products.

That is not a vendor relationship. It is a structural and strategic advantage, one that was designed for exactly the environment the industry now finds itself navigating.

“The rules have changed. We’ve leveled up.”

VS Health Group