The Rise of the Chief Market Access Officer

Market access is evolving into one of the most strategically important functions in pharma—impacting pricing, reimbursement, and ultimately determining whether a drug succeeds commercially. Across the industry, there is a growing recognition that access must be embedded early in development, fully integrated into corporate decision-making, and led by top-tier strategic talent. With this recognition of strategic importance, biopharma companies are increasingly appointing global heads of value & access / chief market access officers to sit alongside commercial and medical leadership, sometimes reporting directly into the CEO.

We interviewed top market access talent at some of the largest pharmaceutical companies to get their perspective on the evolution of the market access role and its recent elevation to the C-suite. Here’s what we learned.

1. The best market access leaders are multi-disciplinary and have skillsets that span “soft” skills (such as communication, leadership, adaptability) and “hard” skills (such as data analysis, HEOR, pricing strategy). Successful access leaders are not just functional experts, but business strategists who shape company-wide decisions.
   
   
2. The industry has shifted away from a “launch first, access later” mentality. Market access must be embedded throughout the pipeline of drug development and engage with external stakeholders more than ever before.
   
   
3. While the global market is seeing a shift toward value-based pricing and cost effectiveness frameworks, the US remains a complex mix of PBM-driven reimbursement restrictions and shifting pricing mechanisms. Understanding the different challenges facing US and rest of world access is key.
   
   
4. AI and real-world evidence will reshape access strategies. Companies that embrace data-driven decision making will have the upper hand when it comes to their launch strategies.
   
   
5. The pharmaceutical industry is undergoing significant macroeconomic and policy disruption, with future changes still uncertain. This environment demands forward-thinking, proactive talent with deep market access expertise and the ability to effectively partner with, and influence, policy makers.

The best market access leaders are multi-disciplinary and have skillsets that span “soft” and “hard” skills

Successful market access leaders today go beyond traditional health economics and reimbursement expertise. They combine deep analytical expertise with strategic and commercial acumen. Further, they must possess strong quantitative skills to navigate rebate structures, payer contracting, and financial modelling while also being sharp negotiators who can pivot in real time. A strategic mindset is critical, as access decisions shape investment priorities, R&D direction, and corporate growth. The best leaders also have cross-functional awareness, bridging medical, commercial, and policy functions. Increasingly, companies seek talent from within payer organizations, PBMs, and consulting firms. These are individuals who understand pricing dynamics firsthand. As market access becomes more data-driven, expertise in AI, data science, and predictive analytics is an emerging differentiator. For biotech startups, securing a top-tier market access leader early is essential to ensuring commercial viability from day one.

 

"You still need your PhD in epidemiology or quantitative science...but you also need the person who has the strategic vision… asking questions like, ‘how do I work with R&D?’  ‘How do I convince the commercial organization?’ ‘How do I shape external policies?’"

Executive at a Top 10 Global Biopharma Company

 

The industry is moving away from a “launch first, access later” mentality

Market access has evolved from an internally focused function – where companies concentrated on justifying pricing decisions within their own organizations – to a strategic, externally driven discipline that demands early engagement with payers, regulators, and patient advocates. The traditional “launch first, access later” approach is no longer viable; without a clear reimbursement pathway, even the most promising therapies may struggle to reach patients. For innovative treatments like cell and gene therapies, access leaders must work years in advance with external stakeholders to shape sustainable pricing and reimbursement models. Beyond conventional payer negotiations, companies are exploring alternative access models, such as direct collaborations with healthcare providers, specialty pharmacies, and technology firms, to broaden coverage and improve affordability.

As market access has become a fundamental pillar of drug development, it now requires integration into investment decisions, R&D planning, and clinical trial design from the earliest stages, not just as a launch consideration. This shift has been driven by the increasing diversification of market access leadership, bringing in professionals from commercial, medical, finance, and policy backgrounds who understand how to shape payer strategies and advocate for patient-centered access solutions. Leading companies now recognize that success hinges on external partnerships—whether with advocacy groups, healthcare systems, or emerging tech firms—to drive innovative access models and influence policy decisions. As competition intensifies and payers exert more control, organizations that fail to embed market access into their core strategy risk costly delays, pricing pressures, and diminished market potential.

While the global market is seeing a shift toward value-based pricing, the US remains a complex mix of PBM-driven reimbursement restrictions

In the United States, Pharmacy Benefit Managers (PBMs) continue to dominate, leveraging aggressive rebate and formulary management strategies that shape drug access and pricing. The Inflation Reduction Act (IRA) introduces direct government negotiations, adding another layer of complexity to an already challenging landscape. PBMs are tightening reimbursement restrictions, increasing out-of-pocket costs for patients, and demanding steeper discounts from manufacturers. Simultaneously, hospital pricing mechanisms like 340B and rising healthcare costs are shifting more financial pressure onto employers and patients, further straining access models. Payers are intensifying their use of step edits, prior authorizations, and tiered cost-sharing, making it critical for market access leaders to have a deep understanding of PBM contracting, rebate guarantees, and employer-driven decision-making.

While the US market remains distinct, global access models are converging toward value-based pricing, health technology assessments (HTAs), and cost-effectiveness frameworks. Countries are increasingly sharing pricing data, posing new challenges for manufacturers navigating international pricing strategies. Beyond traditional markets, Saudi Arabia is emerging as a key player in global pricing discussions, particularly in middle-income regions. To stay ahead, pharmaceutical companies must engage proactively with governments and payers early in the drug development process, shaping policy discussions rather than reacting to shifting regulations and access barriers.

In this rapidly evolving landscape, the role of a market access leader demands more than just a well-established network. Success increasingly hinges on agility, strategic foresight, and the ability to navigate shifting dynamics in real time. Leaders must blend deep policy fluency with commercial acumen, collaborate cross-functionally with R&D and HEOR teams, and adapt quickly to new reimbursement models, regulatory shifts, and stakeholder pressures. It’s no longer just about who you know, but how fast you can interpret signals, reframe strategy, and drive access solutions that resonate across markets.

 

"The tools haven’t changed in 20 years - prior authorization, patient out-of-pocket, medical appeals - but the intensity of the patient out-of-pocket variance and the exclusion lists have increased dramatically. You have to master the PBM game; the negotiation game. To do that, you must fully comprehend everything they’re analyzing before you start the negotiation."

Executive at a Top 10 Global Biopharma Company

 

AI and real-world evidence will reshape access strategies

AI is poised to transform market access by enabling more precise, data-driven strategies in payer negotiations, price modeling, and contracting. Predictive AI models will analyze PBM rebate structures, simulate negotiation outcomes, and optimize pricing strategies in real time, allowing companies to move from reactive adjustments to proactive decision-making. As AI adoption accelerates, market access negotiations may evolve into AI-driven interactions, where pharmaceutical pricing models compete against PBM algorithms in a battle of predictive analytics. This shift will make AI expertise and data science capabilities increasingly essential, as companies that harness these technologies will gain a competitive edge in optimizing access, pricing, and reimbursement strategies.

 

"AI will help make negotiations smarter and faster... Eventually, it’s going to be my AI against your AI and the human interface."

Executive at a Top 10 Global Biopharma Company

 

The pharmaceutical industry is undergoing significant macroeconomic and policy disruption, with future changes still uncertain

The pharmaceutical industry is navigating a period of profound macroeconomic and policy disruption, driven by the Inflation Reduction Act (IRA), looming Most Favored Nation (MFN) pricing mandates, and rising anti-globalization sentiment. These policy changes and U.S. negotiations are here to stay, and will potentially be supercharged in the future. This is fueling legal uncertainty, reshaping global launch strategies, and prompting companies to reconsider whether to launch in Europe at all or instead prioritize the U.S. market. Simultaneously, the threat of tariffs and geopolitical tensions are complicating clinical trial execution and increasing costs.

The evolving landscape is fundamentally altering the talent needs of the biopharma industry. Companies can no longer rely solely on traditional commercial leaders who rose through sales and marketing; instead, they need talent who deeply understand market access, pricing policy, and global health systems. Unfortunately, there is a critical lack of professionals who can translate complex policy developments into actionable access strategies, influence cross-functionally, and communicate value in clear, compelling terms. Many organizations are responding to uncertainty with layoffs, including cutting key capabilities like HEOR, despite their rising importance.

As the talent market shifts from shortage to surplus, companies have an opportunity to raise the bar: prioritize candidates with launch experience, therapeutic relevance, and soft skills like influence without authority, and policy fluency. The rise of the chief value & access officer reflects this shift, signaling that value, access, and policy navigation are no longer supporting functions, but central to enterprise strategy.

 

“A competency we do not see often is the ability to liaise and translate between public policy and market access. More than ever, we need to appreciate the intended and unintended consequences of policies, and educate our corporate and government affairs colleagues as they are having conversations with policy makers.”

Executive at a Top 10 Global Biopharma Company

 

What’s next for biopharma companies and the evolving chief market access officer role

Pharmaceutical companies looking to hire a chief market access officer must recognize that this role is no longer a back-office function, but a core strategic leadership position that directly influences pricing, reimbursement, and overall commercial success. The ideal candidate will be an enterprise-level thinker and should possess deep quantitative expertise in contracting, pricing, and financial modelling, coupled with strong negotiation skills to navigate complex payer landscapes. Additionally, a cross-functional mindset is essential, as access decisions intersect with commercial, medical, and regulatory functions. Given the increasing complexity of US and international payer dynamics, including the dominance of PBMs, IRA-driven pricing reforms, and evolving reimbursement structures, companies should prioritize candidates with firsthand experience in payer contracting and government pricing. Leading organizations often recruit talent from PBMs, payers, and consulting firms, ensuring a deep understanding of market access strategies from both the manufacturer and payer perspectives.

Structurally, the CMAO should be positioned at the highest levels of the organization, and might report directly to the chief executive officer or chief commercial officer to ensure that access considerations are embedded into corporate strategy from day one. Market access should be on equal footing with commercial and medical leadership, influencing investment decisions, R&D prioritization, and clinical trial design to secure a viable reimbursement pathway well before launch. Given the unique complexities of the US market, domestic access teams should operate separately from global pricing functions, allowing for tailored strategies that align with evolving regulatory and payer demands. Companies that integrate market access into corporate decision-making, investor relations, and long-term business planning will gain a competitive edge, while those that treat it as an afterthought risk pricing pressures, market access barriers, and commercial failure.

 

“Best advice: think big picture, think really broadly and diversely.  I feel like I’ve always benefitted from having a team with a very diverse array of backgrounds, and opinions, and skillsets.”

Executive at a Top 10 Global Biopharma Company

 

Authors

Cameron Findlater is a member of Russell Reynolds Associates’ Healthcare Knowledge team. He is based in New York.
Yvonne Lu co-leads Russell Reynolds Associates’ Global Biopharma practice. She is based in San Francisco.
Hayden Melecio is a member of Russell Reynolds Associates’ Biopharma practice. He is based in New York.