At Asembia 2025, Jeff Berkowitz, CEO of Real Endpoints, pulled back the curtain on the evolving complexities of pharmaceutical market access, urging a shift from siloed strategies to data-driven, cross-functional collaboration that puts affordability and patient access at the center of innovation.

Please share your name, title, and a brief overview of your professional history.

Jeff Berkowitz: My name is Jeff Berkowitz and I am the CEO of Real Endpoints, a boutique market access consultancy and technology developer with the central mission of creating affordable access for patients to pharmaceutical innovation.  After practicing health care law for a decade, I made an unusual transition to the business side. I’ve worked at organizations representing most of the key verticals in global health care, holding executive and senior roles at United Health Group, Walgreens Boots Alliance, Merck, and Schering-Plough.  Being one of the few executives who have worked through multiple verticals in health care delivery, I often say I’m scarred by the points of disconnection in the US system, particularly as they relate to the pharmaceutical industry. It’s become my life’s work to help create solutions to those points of disconnection, identifying opportunities to bring stakeholders together to ensure that patients can access innovative and transformative medicines.  In addition to my role as Real Endpoints CEO, I am a board member of several publicly traded pharmaceutical companies, which has given me an entirely new frame of reference and perspective.

Please share a brief overview of the presentation you participated in at Asembia 2025. 

Berkowitz: I moderated the panel, “The Capabilities Gap: How to Succeed in Pharmaceutical Market Access by Really Trying!”  The explanation mark is unironic.  The genesis of the panel was to have a “no holds barred”, transparent conversation about what it takes to lead a pharmaceutical manufacturer market access team in today’s complex environment. Executives from Novartis Pharmaceuticals, Vertex Pharmaceuticals, and AstraZeneca joined me to discuss the growing headwinds facing the industry, including the vertical and horizontal integration in the health care ecosystem that has created a small number of very large payers, increased regulatory pressures such as the Inflation Reduction Act (IRA), and more tactical issues like 340B pressures and internal market access understanding. 

The panelists shared how their organizations are adapting and highlighted emerging capabilities, such as data-driven decision-making, artificial intelligence (AI)-enabled efficiencies, and the ability to balance short-term access wins with long-term value creation. The panel spoke to a packed audience looking for solutions to managing today’s tough environment. It was great to see so many new faces in the room. I believe the panel’s insights provided real value to those navigating today’s market access complexities.

How has the integration of insurers, PBMs, and wholesalers impacted traditional market access strategies, and what data trends have you observed that highlight these shifts?

Berkowitz: The integration of insurers, pharmacy benefit managers (PBMs), and wholesalers—through both vertical and horizontal consolidation—has significantly reshaped traditional market access strategies. These large, integrated entities now exert far more leverage in coverage and formulary negotiations.

With just 3 players effectively delivering care to 80% of the US population, the power imbalance makes it increasingly difficult for manufacturers to "plug in" and negotiate meaningful access without significant concessions. This consolidation also limits incentives for disruption. 

The pharmaceutical industry has responded to this power imbalance by shifting its development strategy toward higher-cost specialty therapies in areas where, historically, pricing flexibility was high: oncology and rare disease. However, the challenge is that companies are now trying to launch high-priced products in even more niche areas. When competition is significant, we lack the pricing freedom we had in the past. 

Data trends underscore these shifts. First, the number of formulary exclusions by the big 3 PBMs continues to rise year-over-year and now includes several specialty products. Second, there is a widening gap between list prices and net prices, which reflects the growing rebate burden and the “pay-to-play” nature of modern market access. Recent moves in the glucagon-like peptide-1 (GLP-1) space illustrate this dynamic: CVS’s exclusion of Lilly's product Zepbound in favor of Novo Nordisk’s Wegovy shows just how critical it is to win at the rebate negotiation table—not just at the clinical one.

Finally, another critical and growing factor affecting market access is payers’ integration of provider networks. Health plans now own or operate physician practices, influencing prescribing behavior and further tightening control over patient access. UnitedHealth Group alone employs roughly 10% of the health care workforce in the US, a staggering statistic that underscores how vertical integration is changing market access.

In this environment, manufacturers must now navigate a tightly consolidated ecosystem where traditional levers—clinical differentiation and provider engagement—must be supplemented by strategic contracting, real-world data, and robust patient support to maintain relevance and access.

What capabilities or competencies are emerging as most critical for pharmaceutical companies to secure access and reimbursement in today’s landscape? 

Berkowitz: I think of market access as a spectrum that spans from early clinical development to patient adherence and support. In such an environment, securing product coverage and access requires more than strong relationships—it demands a strategic, cross-functional approach.  It is simply not enough for an account manager to have friendly relationships with a payer anymore.  

Strategic business acumen is essential. With a few consolidated players controlling most coverage decisions, manufacturers need teams that can navigate complex negotiations, supported by financial modeling to evaluate trade-offs between rebates, pricing, and revenue impact. Executive leadership must also play a bigger role. As we heard in our panel at Asembia, CEOs may need to engage directly in access discussions, especially for high-impact launches. Knowing when and how to escalate these conversations is becoming a core competency, and preparation is key. 

It's not just who should engage that is important—how you talk to payers is also critical. Companies need to craft clear, payer-relevant narratives starting in phase 2 development. The companies that do this most successfully embed market access insights into their clinical trial and real-world evidence designs.
Finally, with rising out-of-pocket costs, robust patient support services—covering affordability, navigation, and adherence—shouldn’t be seen as separate from market access. These programs can drive broader access over time, often more sustainably than upfront discounts.

Can you describe how the role of data analytics, real-world evidence (RWE), or predictive modeling is shaping access strategies in response to the diminishing role of traditional relationships?

Berkowitz:  It’s trite but no less true that data is today’s currency. Data providing clinical differentiation and utility in the real world matters disproportionately more in an environment where product access no longer relies on personal relationships. My panelists at Asembia agreed that payers and PBMs now operate more like sophisticated financial entities; manufacturers’ market access teams have to do the same. That means using analytics and predictive modeling to understand what level of access is being contracted for at a given price so that companies can make smart trade-offs between price and access, while preserving long-term opportunity. 

RWE is also critical, but payers won’t always take the manufacturer’s word for it. Partnering with payers to co-generate RWE can build credibility and help ensure the data is both trusted and actionable.

What are the most significant challenges market access teams face in adapting to the new health care ecosystem, and how might research help address or anticipate these issues?

Berkowitz: It’s tempting to think that the biggest challenges in market access now are technological, such as how AI might be used to determine which patients are eligible for coverage or not. But to me, the biggest challenges aren’t technological—they are organizational. Too often, market access is seen as a cost center when it’s a strategic lever that should shape decisions across research and development (R&D), commercial, and patient support.

Siloed functions lead to missed opportunities. For example, when patient affordability programs aren’t coordinated with pricing and contracting strategies, both domains suffer. I frequently interact with companies that haven’t optimized their patient support services to support the contracting strategy. As a result, they may be underresourcing an important activity that could increase market uptake. Alternatively, they may be spending too much money on free drug programs that negatively impact the bottom line.  Or, given today’s complex benefit designs, they may not truly understand what their rebate dollars are buying from a product positioning perspective.

The pace of change also demands closer collaboration across the organization. Market access teams need to work closely with government affairs, R&D, commercial, and investor relations teams to coherently respond to shifting state and federal policies and evolving payer models. There’s too much churn to respond to every market access shift happening today. To compete, companies need focused, cross-functional leaders who understand how access decisions ripple across the business and affect the patient journey. Constant internal education is now critical.

Are there any other key messages you wanted your audience at Asembia 2025 to walk away with?

Berkowitz: I want to reinforce a point I made earlier—market access is a spectrum. It’s no longer just about payer coverage. It’s also about system affordability, patient affordability and navigation, and long-term engagement. The most effective strategies are holistic and grounded in the reality of today’s ecosystem. The discussion at Asembia reinforced that companies need market access team members with financial acumen and the ability to balance pricing, contracting, and patient support activities in ways that create business value. 

While negotiations can be tough, it’s also helpful to remember that stakeholders have a shared purpose. Whether you're sitting across from a payer, wholesaler, or provider, remember that behind the suits are people who want to do the right thing. Finally, don’t overlook your blind spots. Get into the field, spend time with trade partners and customers, and build a deeper understanding of their needs. In a complex system, that kind of intelligence will drive better business decisions.