Pharmaceutical Managers Research Articles

The Sustainability Strategies in the Pharmaceutical Supply Chain: A Qualitative Research

Sustainability in the pharmaceutical integrated supply chain ecosystem is understood as a balance between environmental, social, and economic pillars. Therefore, indicators for sustainability development in pharmaceutical industries therefore must cover all three dimensions of sustainability. The traditional supply chain was more about reducing costs and maximizing revenue and profit. Now the corporate goal is also about considering the environmental and social impact of their products and services journey through the entire value chain — from plan to source, to make, to deliver, to the service domain. Sustainability as part of corporate responsibilities is now mandatory to be mentioned as part of the broader commitment to safeguarding the planet. This multiple qualitative case study aimed to investigate the role of sustainability in the efficient pharmaceutical supply chain. Sustainability is also the key driver for the long-term growth of a pharmaceutical company. The study involved interviewing various pharmaceutical managers with proven strategies for implementing sustainability-related strategies. The theory of constraint was used as the conceptual framework for this qualitative multiple case study. Data from interviews and supporting documents were analyzed using data triangulation to discover themes. Three main themes emerged from data analysis: (a) known or unknown constraints, (b) business operational model change, and (c) training and building sustainability capability. Seven key strategies were developed pertain to these three themes. These themes were identified based on interview data inputs and documentation provided by participants. Identified themes and strategies are summarized in the system model. Researchers and industry leaders can utilize themes and strategies to identify constraints, risks, and issues in the current system and work towards a sustainable supply chain integrated ecosystem.

Practitioner Perspectives on Key Challenges in Pharmaceutical Marketing and Future Research Opportunities

This article offers marketing and public policy researchers and professionals a peek into pharmaceutical marketing from the practitioner's perspective. Through an interview process with eight active pharmaceutical marketing managers and medical doctors, the authors highlight some of the most pressing challenges facing pharmaceutical marketing practitioners today. They identify three key themes: (1) the need to overcome strongly rooted negative patient perceptions of the pharmaceutical industry, (2) the need to communicate overwhelming amounts of complicated information to patients and physicians, and (3) the need to break away from a stale promotional model. The authors briefly summarize the practitioners’ views on each topic, highlight relevant findings from marketing and public policy literatures, and offer avenues for future research to help address these challenges.

Digitalization of Pharmaceutical Cold Chain Systems using IoT Digital Enabler

Compared to the other classic supply chain, the pharmaceutical supply chain has many critical challenges, such as cold chain transportation, temperature monitoring, long lead time, and counterfeiting prevention. Pharmaceutical products, such as medicines, drugs, vaccines, and specialty treatments, work as intended within a specific specified temperature. Below +25°C (controlled temperature), +2°C to +8°C (temperature-sensitive products), -20 °C to -40 °C (negative temperature), and -70 °C (ultra-low temperature) are some of the precise and regulated storage thresholds for various types of pharmaceutical products. The cold chain includes production, transport, and storage. It requires a reliable infrastructure to maintain a precise temperature when transporting from manufacturers to patients. This multiple qualitative case study aimed to investigate the role of the Internet of Things (IoT) in the pharmaceutical cold chain. The study involved interviewing various pharmaceutical managers with proven digital strategies for implementing IoT-based digital enablers. The theory of constraint was used as the conceptual framework for this qualitative multiple case study. Data from interviews and supporting documents were analyzed using data triangulation to discover themes. Two main themes emerged from data analysis: (a) Known or unknown constraints in the current cold chain system and (b) implementation of IoT-based digital enablers. Six key strategies were developed pertain to these two themes.

Correlates and Clusters of Factors Influencing Perceived Organizational Performance of Pharmaceutical Managers in Nigeria: A Cross-Sectional Study

There is limited evidence to show how pharmaceutical managers are profiled based on managerial roles: operational, product, and strategic management level, using clustering and multivariate analyses. The constructs evaluated were:self-efficacy (SE), reward-structure (RS), policy-involvement (PE), task-environment (TE), communication-engagement (CE), and perceived organizational performance (OP). Study objectives were to investigate the profile of pharmaceutical managers based on functional roles and task constructs influencing their performance. Secondly, to assess the influence of SE, TE, PE, CE, and RS on OP of pharmaceutical managers. A literature-guided questionnaire cross-sectional study was administered by stratified random sampling to 241 managers involved in pharmaceutical marketing in Nigeria. Multivariate analyses were used to examine relationships between variables. Two-step Cluster analysis was used to explore the distinct structure of constructs. Kruskal Wallis test compared cluster groups at p≤.05. Associations existed between demographic attributes and managerial roles except for gender (p=0.085), and qualification as pharmacist or non-pharmacist (p=0.124). The regression model showed that SE, TE, and PE were significant predictors of OP. CS and RS had no significant influence on OP. Significant positive relationships were found between six constructs. Three clusters were computed with an overall median cluster score of 24.13. Strategic managers formed the dominant cluster 1 (mean=24.39) with comparatively higher value of PE than Clusters 2 (product managers) and 3 (operational managers). Higher performance scores were related to higher levels of perceived self-efficacy among managers. The study recommends need-specific interventions to address role-specific challenges affecting managers. Adopting improved communication and reward systems to improve overall performance is recommended.

Assessment of medicine stock-outs challenges in public health services

Background: Essential medicines are important in the provision of healthcare services. In order to promote effective management of diseases, essential medicines should be consistently available at various healthcare service points. However, in several parts of South Africa and other African countries, there are challenges with essential medicines provisioning, as evidenced by public health sector stock-outs occurring when patients visiting the healthcare services do not get all the medicine prescribed for their health conditions. This research investigated the problems involved in the provision of essential medicines in order to propose strategies that will reduce medicine stock-outs.Aim: This study aimed to investigate the problems involved in the provision of essential medicines within the district healthcare services in order to propose strategies to promote reduction in medicine stock-outs.Method: A qualitative exploratory research design was utilised. Data collection was carried out through semi-structured interviews with pharmaceutical managers identified as information-rich participants, as they have first-hand experience in the provision of essential medicines. The data were analysed using thematic analysis.Results: The study identified the various aspects including inadequate appointment of post-basic pharmacist assistants and manual medicine stock management systems have a negative impact on medicines provisioning in the public health sector. Rural health facilities experience more challenges with essential medicines provisioning.Conclusion: Based on the challenges identified, the study concludes that a comprehensive strategic framework should be implemented including placement of Post-Basic Pharmacist Assistants in the primary healthcare facilities and deployment of electronic medicine stock management system to facilitate consistent provisioning and availability of medicines in particular for the rural health facilities.

Marketing training strategies that pharmaceutical sales managers use to reduce unethical behavior.

BACKGROUND:Some pharmaceutical company sales representatives are using bribes to encourage increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge related to bribing doctors to prescribe the company's medications. Using Hunt and Vitell's general theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies some sales managers in the pharmaceutical industry used to improve marketing training to reduce unethical sales representative behavior.MATERIALS AND METHODS:Data were collected from company reports and documents provided by sales managers and semistructured interviews with five sales managers of different pharmaceutical companies in the northeast region of the United States. Data were analyzed using thematic analysis and Yin's 5-step process of compiling, disassembling, reassembling, interpreting, and concluding thematic data analysis.RESULTS:Three themes emerged from data analysis: developing ethical standards, developing organizational policy, and implementing training and development programs. A key recommendation is that pharmaceutical sales managers identify ethical standards to inculcate in their business practices to achieve ethical marketing training that can result in sales representatives’ ethical behavior. The implications for positive social change include the potential for sales managers to develop strategies to reduce unethical behavior in the pharmaceutical industry.CONCLUSION:Reducing unethical behavior may lead to more trust between patients and physicians, improving patient satisfaction and promoting prosperity for the community through enhancing the quality of health care.

The Counterproductive Effect of Pharmaceutical Marketing in Pakistan: A Qualitative Study

This study explores the effects of pharmaceutical marketing on patients and society in Pakistan. Pharmaceutical marketing is an integral part of the drug industry, which channels product-related information to healthcare professionals. Physicians are the target audience as they prescribe medicine to the users. The pharmaceutical industry mobilizes all resources to influence physicians’ prescriptions in favor of their brands. It is commendable from the organizational perspective, however; it leads to unintended negative consequences for society. The primary reason is the blind pursuit of commercial interest and near-total neglect of ethical behavior in marketing drugs. This study conducted open-ended 20 interviews from primary stakeholders of this issue that includes physicians, pharmaceutical managers, and officials of drug regulatory authority through purposive sampling. The findings show that misleading promotional strategies influencing physicians are responsible for the misuse and abuse of drugs and antibiotics. Pharmaceutical drug incentivization, the personal obligation for physicians, skewed data, and inappropriate promotions were the major categories developed during analysis. The study recommends various steps to minimize these ill effects.

Exploring the effects of individual innovativeness dimensions on performance: a study with pharmaceutical managers

Background and Aims: Innovation is a crucial factor for individuals and businesses, particularly in the period of Industry 4.0. The objectives of the present study are to explore the factor structure of the Individual Innovativeness Scale (IS) in a manager sample, and then to investigate the dimensions’ impact on performance. Methods: A questionnaire was administered to managers in the pharmaceutical industry. Factor structure of the Individual Innovativeness Scale was determined via exploratory and confirmatory factor analyses. Afterwards, impacts of the dimensions on performance were assigned. Results: After exploratory and confirmatory factor analyses, three dimensions emerged: resistance to change, openness to experience, and opinion leading. The regression model showed that opinion leading and openness to experience were significant predictors of performance. Conclusion: The IS is three dimensional in the pharmaceutical manager sample. Performance of pharmaceutical managers are affected from opinion leading and openness to experience. This paper has both theoretical and practical contributions.

Avoiding medicine wastes: Introducing a sustainable approach in the pharmaceutical supply chain

While unused medicines, by proper planning, can help people who need them but do not have access to them, huge medicine wastes in many pharmaceutical supply chains (PSCs) lead to severe economic losses and environmental/social damages. This paper aims to investigate a novel collaborative model to mitigate the entry of medicine wastes into the environment in a two-echelon PSC with an upstream-member (pharma-supplier) and a downstream-member (pharma-retailer) under the triple-bottom-line of sustainability. In this regard, a donation program is introduced to enhance the social aspect of the channel, and a take-back strategy is also presented to preserve the environmental and economic aspects of the PSC. In the investigated PSC, the pharma-supplier determines medication donation quantity; subsequently, the pharma-retailer by the aim of alleviating the risk of shortages decides on medication order quantity. Regarding the demand uncertainty and medications' fixed shelf-life, the probability of facing huge volume of outdated medicine is high. This study introduces a take-back strategy to reduce the risk of large volumes of medicine waste that includes collecting surplus items to use as part of donation programs or alternatively selling them in the secondary market. A bi-level optimization scheme is developed to coordinate the channel. The numerical results show that using the proposed bi-level optimization collaborative scheme not only can enhance total channel profit but also persuade both members to decide based on integrated sustainable PSC goals. Furthermore, the proposed model provides some practical orientations for pharmaceutical managers to reduce pharmaceutical waste, enhance the health level of the society, as well as maintaining all aspects of PSC sustainability.

'Are we a fertility or an infertility company?' A Learning expedition inviting dialogic reframing

In this article, I present, illustrate and analyze a learning expedition (LX) of pharmaceutical company managers, uncovering processes fostering generative dialogue to develop new collective understanding. Applying a dialogic lens to a sequence of exchanges with partner organizations and internal dialogic circle settings, managers’ unquestioned assumptions in describing their own business become clear and can then evolve. Enabled by different facilitation elements, the LX suspends organizational routines and triggers generative dialogues that encourage organizational change. The study contributes by showing: first, how context and practices used in establishing the LX aid in suspending organizational routines and second, how the context of multiple interorganizational events and exchanges (understood as a cycling between different dialogues) enables dialogue and reflexivity fostering organizational development (OD) and third, how the LX enables double loop learning that invites reflexivity, altering managers’ assumptions.

Pesquisa da qualidade de vida do profissional farmacêutico de rede de drogarias

Objetivo: O presente estudo teve como objetivo avaliar a qualidade de vida entre farmacêuticos, em especial de rede de drogarias. Metodologia: O instrumento adaptado foi de WHOQOL, sendo utilizado 5 domínios (biológicos, psicológicos, nível de independência, relações sociais e trabalho-moradia), sendo estabelecido scores para os domínios e para a qualidade de vida. Foram incluídos no estudo 21 farmacêuticos de ambos os gêneros, de várias idades e tempo de profissão, que trabalhassem em uma drogaria de rede nas funções de gerentes farmacêuticos (GF) e responsável técnico (RT). Resultados: Houve predomínio de mulheres, RT, entre 20-40 anos, que na maioria dos domínios foram classificas como bom a muito bom. Entretanto, no domínio III (nível de independência), 20 farmacêuticos demonstraram reduzido nível e tiveram uma nota inferior a 5 e apenas 1 a nota foi 5. Para os demais domínios, os números de farmacêutico com nota inferior a 5,0 (classificado como ruim) foram: DI biológico- 4, DII psicológico-2; DIV relações sociais-4 e DV trabalho moradia- 2. Entretanto, devido as baixas pontuações em DIII, 8 farmacêuticos foram classificados como baixa qualidade de vida. Percebeu-se também que o instrumento permite rastrear alguns problemas de saúde, de relacionamento, problemas trabalhistas, além da avaliação da qualidade de vida. Conclusão Apesar do número reduzido de participantes, os resultados não devem ser desconsiderados. Eles podem indicar que muitos farmacêuticos possam estar enfrentados sérios problemas de saúde, relacionamentos e no trabalho. Neste contexto, é importante que novos estudos sejam realizados para a avaliação da qualidade de vida e o rastreio dos possíveis problemas enfrentados pela classe.

Key determinants of quality in the pharmaceutical supply chain

PurposeEmpirical studies on the supply chain quality management (SCQM) of the pharmaceutical sector are scarce and scattered. This paper investigates a set of key quality determinants in the pharmaceutical sector to offer a holistic quality control framework for its supply chain (SC).Design/methodology/approachA mixed-method design was used. A focused group discussion with seven pharmaceutical SC managers summarized the narratives of the SCQM in this sector and helped to develop a questionnaire. The survey data were collected from the managers of 299 pharmaceutical firms.FindingsThe statistical results show the key determinants are leadership (LS), customer focus (CF), process integration and management (PIM), supplier relations (SR), quality practice (QP), human resource practices (HRP) and safety (SF). Unlike many other sectors, in the pharmaceutical SC, logistics and inventory costs have been proved to be not as important as other measures in the eyes of the SC managers and as part of SCQM performance measures, which can be a result of the priority systems influenced by the World Health Organization standards.Originality/valueThe study is distinctive in its scope as is carried out in a developing country with focus on concept of SCQM with reference to pharmaceutical SC. It shows great potential for further studies and improvements in logistics and warehousing in this sector, for the interest of the pharmaceutical SC managers and regulators who aim to ensure safety and quality in the health-care sector.

Pharmaceutical R&D project portfolio selection and scheduling under uncertainty: A robust possibilistic optimization approach

Due to the costly and risky nature of research and development (R&D) projects and limited shared resources in pharmaceutical companies, it is essential to simultaneously address the selection and scheduling decisions, and this strongly prevents schedule slippage and poor resource management. Herein, we present a mathematical programming model to periodically select and concurrently schedule an optimal portfolio of R&D projects subject to varying levels of market and technical uncertainty over the desired planning horizon. More specifically, the technical risk of R&D projects is captured using a risk-adjusted net present value (rNPV) approach and their market risk is handled by developing a robust possibilistic programming (RPP) approach which can maximize the mean value of R&D project portfolio and control optimality and feasibility robustness. Given a set of potential R&D projects, limited resources, and a predefined time horizon, the proposed model determines the projects to be executed in each period, decides on the optimal outsourcing policy, and simultaneously concludes the optimal financial resources’ planning. We believe that our model can serve as a strategic decision-making tool to assist pharmaceutical company managers in analyzing various investment scenarios and selecting a balanced portfolio. The significance of the applicability of the developed model is demonstrated via a numerical example and some sensitivity analyses on the data taken from the literature.

Brief <i>Amicus Curiae</i> J. Gregory Sidak in Support of Appellees

Justice Holmes said that “the law” is merely a “prophec[y] of what the court[] will do” in the next case to come before it. Economists would call Holmes’ definition of the law a “rational expectation.” An antitrust economist examining Sanofi’s appeal in this case would ask: Would we rationally expect five members of the current Supreme Court to displace the well-established “equally efficient competitor” principle and replace it instead with the novel “effective entrant burden” heuristic, which the district court rejected below? Surely not. There is no serious prospect that the Supreme Court is about to strip the law of monopolization down to the studs and give it an entirely different facade. Nor is there any sound reason why the Court should want to do so. To the extent that any factual premise is necessary to frame amicus curiae’s economic arguments, it can be concisely summarized. Sanofi accused Mylan of monopolizing the market for epinephrine auto injectors, like Mylan’s EpiPen and Sanofi’s Auvi-Q. EpiPen had a high market share going back many years before Sanofi entered in 2013. Mylan had always paid small rebates to the pharmaceutical benefit managers (“PBMs”). After Auvi-Q entered, Mylan paid larger rebates, often in exchange for preferential or sometimes exclusive positions on PBM formularies. After a year or more of being disinclined to compete on price, Sanofi began to respond to PBM requests for competitive rebates and did much better in formulary coverage and market share. Some PBMs gave Auvi-Q exclusive coverage, and there Mylan’s share of EpiPen shrank close to zero. In mid-2015, however, Auvi-Q was withdrawn for unreliable dosing, and Sanofi gave up the product. Sanofi’s expert economic witness, Professor Fiona Scott Morton, opined that Mylan had monopoly power, as evidenced by its share, and that its exclusionary rebates anticompetitively foreclosed the market, making competition impossible. Scott Morton relied on Mylan’s documents expressing its intent to win. She also relied on her 2017 law review article arguing that discounts can be foreclosing where much demand is non-contestable. Scott Morton opined that the rebates in essence taxed Auvi-Qs so they could not compete. The district court found undisputed proof that Sanofi and Mylan could compete vigorously over rebates for preferential positions on PBM formularies and eventually did so (once Sanofi decided to compete on net price); that net prices consequently fell; that there was little foreclosure of entry under any economic definition; that there was little non-contestability of demand for EpiPens; and that Sanofi ultimately exited the market following problems maintaining its own product’s quality. This brief is a rifle shot addressing solely the economic merits of Sanofi’s last-gasp argument. Sanofi cannot win on the facts under existing law. Its only recourse is to ask this Court to replace the equally efficient competitor principle as the controlling law with Scott Morton’s novel theory and then decide the case in Sanofi’s favor—not based on whether the challenged conduct harmed competition and consumer welfare, but rather on the presence or absence of an “effective entrant burden.” That novel theory would flout Supreme Court antitrust jurisprudence by incorrectly elevating competitor welfare over consumer welfare. It finds no support in current antitrust law or economic principles, and it could not plausibly become the law of monopolization in the Holmesian sense. This Court should affirm.

Balancing Conflicting Goals in Interorganizational Collaborations in the Pharmaceutical Industry: A Contractual Dynamics View

This study examines how contractual dynamics allow company managers to balance conflicting goals in interorganizational collaborations. While the literature on contractual governance has mainly investigated single contracts through a static view, this paper advances a ‘contractual dynamics view’ to explore how the dynamics of related contracts allow managers to balance conflicting goals in interorganizational collaborations. The study involves a longitudinal case study of a collaboration among a pharmaceutical company, a biotech firm, a foundation, and a university. Exploring contractual dynamics from the perspective of the pharmaceutical company's managers, the study finds that related contracts allowed them to balance goals through an unfolding process of differentiating and integrating goals and responding to changing goals. By presenting a ‘contractual dynamics view,’ the study advances understanding of contractual governance and offers implications for management.

Direct-to-Consumer Prescription Medication Advertisements and Use of Different Types of Media

The authors are not aware of any research for Internet social media direct-to-consumer prescription medication advertisements (DTCA) related to consumer behavior. The authors study (n=635) the association of traditional and digital media DTCA including Internet social media with the intentions to seek and behavior of obtaining additional information about a prescription medication after seeing a DTCA. This research found that advertisements seen on traditional/cable television were associated with decreased behavior. Advertisements seen on Internet television were associated with increased behavior. Seeking additional information of reading print content on the Internet was associated with increased behavior. No social media advertisements were associated with either intentions or behavior. Companies designing Internet and social media advertising platforms, pharmaceutical brand managers, and pharmaceutical marketers should consider these findings when tailoring their DTCA campaigns.

Elas: um estudo com gestoras no setor indústria farmacêutico

The objective of this study was to analyze the perception of women in managerial work according to pharmaceutical industry managers based in the cities of São Paulo and Rio de Janeiro operating in the region of Minas Gerais. This is a field study with a qualitative and descriptive approach. A semi-structured interview script was used to collect data, and the subjects of this survey were ten district managers. The results show that the management of people is punctuated as the main activity developed in the exercise of the function. No salary differences were found between men and women in the pharmaceutical companies surveyed. The clothing, that is, the care with the visual, as well as the understanding, sensitivity and care with the people were pointed out as a way to feel feminine in the managerial career. The managerial function was described as unisex and / or asexual and the way of managing is associated to the profile of each one. The availability for trips to the service was pointed out as an ideal activity for the men, but that does not prevent them from exercising the managerial function.

Impact of Pharmaceutical Product Dynamics on Social Norms and Values: An Empirical Study from Bangkok-Thailand

This study has examined the relationship between the dynamics of pharmaceutical products and social norms and values in the region of Thailand. The data was collected through questionnaire with a sample respondents of 226. For the analysis purpose, descriptive, frequency distribution, and regression techniques were applied on the collected dataset. Demographic factors cover the gender, age, educational background, and income level. Meanwhile, pharmaceutical dynamics are covered through ten factors ranging from A to J as explained under variable portion. For dependent variables, three factors like normative belief, social norms and attitude were observed. Findings of the study show that from the dynamics of pharma products, significant influence on normative belief, social norms and attitudes was found. In terms of implication, this study is highly suggested to the pharmaceutical managers, key decision makers and other officials who are dealing with the social influence of the pharma products, specifically in Thailand. However, our study is limited in terms of regional implications, sample size, and application of advanced techniques like structural equation modelling. Future studies are highly recommended to cover these limitations for more understanding and better implications.

A mathematical model for pharmaceutical supply chain coordination: Reselling medicines in an alternative market

Leftover/end of life (EOL) medications not only cause financial losses for the pharmacy but also lead to disposal costs and high governmental penalties for the pharmaceutical supplier. In this study, a two-echelon pharmaceutical supply chain (PSC), including a single pharmaceutical supplier (pharma-supplier) and a single pharmaceutical retailer (pharmacy) with one type of fixed shelf-life medicine, is analyzed. A reducing pharmaceutical wastes scheme is developed to decrease relevant costs of leftover/EOL medicines, avoid governmental penalties, and also ensure patient service level (PSL). In the proposed model, excess medications are collected from the pharmacy warehouse based on the realized demand at a specific time before the expiration date to be resold in the secondary/alternative market. The introduced model is investigated in decentralized and centralized model structures. A novel combination of buyback and shortage risk-sharing contract (B&SRS) is proposed to attain channel coordination, maximize the whole PSC profits, and motivate members to participate in the scheme. The numerical investigation demonstrates that the proposed B&SRS contract can coordinate the developed PSC, enhance the whole channel profit, and also guarantee both channel members’ profitability. Besides, the investigated model helps pharmaceutical managers to decrease EOL/expired medicines related costs and ensure PSL by making decision properly on buyback quantity.

“Stick or Twist?” Negotiating Price and Data in an Era of Conditional Approval

BackgroundChanges in the regulatory context enable faster approval of transformative medicines. They also lead to health technology assessment (HTA) agencies having to make decisions with less evidence. In response, HTA agencies have also initiated forms of conditional approval. When the evidence base for a new oncology treatment leaves substantial uncertainty, the new Cancer Drugs Fund allows the National Institute for Heath and Care Excellence to give the manufacturer two options: (1) offer a low price based on conservative assumptions and obtain immediate approval (“stick”) or (2) wait until the evidence base has further matured before finalizing a potentially higher agreed price (“twist”). ObjectivesThe purpose of this article is to explain how, using the theoretical framework of the expected value of sample information, simulation methods can help inform a manufacturer’s decisions when faced with the option to stick or twist. MethodsWe first summarize a general model to help frame the manufacturer’s negotiating strategy. We then use a motivating case study, based on a hypothetical immunotherapy, to illustrate how manufacturers can use simulation methods to robustly characterize the uncertainty inherent to further data collection and incorporate this uncertainty within their decision making. ResultsOur approach allows us to estimate the commercial value of generating additional data (the difference between the estimated net present value of stick and twist). We test the sensitivity of the results to different assumptions via scenario analyses. ConclusionsThis article shows that simulation methods can be used to help pharmaceutical managers make informed strategic decisions in contexts of uncertainty.