Bristol Myers Squibb's top executive, Chris Boerner, indicated that the company's internal atmosphere was the unacknowledged factor in his approach to managing the 'patent cliff'.

This interview has been edited and condensed for clarity.  

We’re on the cusp of such an interesting period of innovation. What should we focus on? 

I don't believe I've encountered an industry facing such a pivotal moment, with scientific advancements occurring at an astonishing pace. We're close to developing treatments for extremely challenging illnesses, including Alzheimer's, dementia, and certain forms of cancer that have resisted conventional cures, let alone the possibility of chronic management, much like we handle many other cancer types.  

I recently delivered a presentation concerning artificial intelligence and its capacity to expedite therapeutic development, enabling us to operate with greater speed and effectiveness, and ultimately to uncover medications that would have remained undiscovered.  

How do you navigate what’s going on in Washington?   

Amidst considerable global uncertainty, people often feel inclined to withdraw and avoid involvement. I believe it's crucial to actively counter this impulse, as it's during such times that one must discover methods for engagement.  

Three years back, we opted to substantially increase our personnel. We completely revamped our team in D.C., recognizing the necessity for a more robust presence there. This would allow us not only to collaborate with trade associations and similar groups but also to establish our own platform for disseminating our message and narrating our story directly. Firstly, engagement is crucial. Secondly, clearly defining your objectives is essential. While we must act in the company's best interest, that interest must also align with the broader industry's context.  

Weeks remain until that may potentially reverse course (Approximately 10.9 million U.S. Citizens might lose their health coverage due to the Big Beautiful Bill, based on the nonpartisan Congressional Budget Office). 

Certainly. We must increase our efforts to guarantee that individuals can afford the medications we provide. I'll provide you with an illustration. This holds special significance for me, having been raised in Arkansas. This medication was introduced last year, approximately at this point, marking the initial novel therapeutic approach for schizophrenia in thirty years. This is a profoundly groundbreaking treatment. Half of the counties across the United States lack a psychiatrist who is actively practicing. More than half of all U.S. Counties are experiencing critical deficits in mental health services. These individuals are unable to obtain the medication due to their inability to consult a physician for a prescription. Tackling those genuine difficulties is extremely crucial, and it won't be accomplished by depending on the states or depending on the national administration. Numerous diverse groups will need to unite to achieve that outcome. Innovation holds a significant function. I believe that as we tackle the genuine concerns, particularly regarding cost and availability, we must proceed in a manner that doesn't jeopardize our current success, ensuring the United States maintains its prominent position in this sector, a goal I'm especially focused on. 

I engage in discussions with numerous executives from health insurance providers, hospital networks, companies such as Philips involved in technological advancements, and other entities within the healthcare sector. What is your perception of how other participants are managing within this landscape?  

To achieve significant advancements in healthcare treatment and reform, numerous stakeholders must collaborate. The current healthcare sector frequently functions as a sickness management system, addressing ailments only after individuals become severely ill. Consequently, certain aspects of initiatives like the MAHA (Make America Healthy Again) campaign hold considerable merit. The central question is how to proactively maintain people's well-being. 

Through GLP-1 medications and things like that? 

I believe the issue is even more fundamental. How do you guarantee individuals can obtain healthy food? To the degree that GLP-1s assist individuals in staying active and reducing weight, that contributes to the solution. Our focus is on the area where, when individuals become unwell, you require our treatments. You need a firm like ours that is diligently engaged in that field. However, one must consider the healthcare system as a whole, with various stakeholders collaborating to address some of these challenging issues. I recently attended an event in Arkansas; Alice Walton is constructing a new medical school. 

I'm familiar with that. Her comprehensive strategy for community health and well-being is quite inspiring. 

This is quite thrilling. During this gathering, attendees included individuals from every group necessary to collaborate for significant advancements in healthcare. This is the method by which progress will eventually become apparent. It won't be achieved by a single group acting independently.  

How is your role evolving? 

We've traditionally believed that once a doctor prescribes one of our medications, our role is complete. This perspective is inaccurate. Our work is finished when a patient experiences positive outcomes from the medication. Consequently, we've dedicated considerable time and effort recently to determining how to ensure that after a medication becomes accessible, we tackle challenges such as the absence of a psychiatrist in a significant portion of U.S. Counties who could authorize that prescription. 

Does this involve greater collaboration with insurance providers, healthcare facilities, or all of these entities?  

It's somewhat of a mixed approach. A portion of it involves collaboration with external entities to locate individuals and ensure access to our treatments. Upon introducing our immunotherapy drug, Opdivo, for lung cancer, our company was the initial one to bring IO (immuno-oncology) to the lung cancer market, which was a significant achievement. In the 2015-16 period, lung cancer was perceived as a grim and hopeless condition. There had been no truly groundbreaking advancements for an extended duration. The advent of immunotherapy led to considerable praise for our efforts in bringing this medication to consumers.  

I'll always recall visiting Kentucky (a state with the nation's leading rate of new lung cancer diagnoses). We shared a meal with individuals representing the entire healthcare spectrum, from the governor and scholars to patient advocates, and it marked the successful launch of this product. Near the conclusion of that gathering, a nurse practitioner remarked, "This has been a pleasant occasion, but I must admit, it feels removed from my daily experience. In my practice in Appalachia, patients lack access to fundamental healthcare, let alone specialized cancer treatment. If they are aware of an oncologist, they're journeying hundreds of miles to consult them. They're unaware of this medication, and even if they were, they wouldn't be able to afford it or obtain it." It was a concise yet impactful statement that conveyed, "This approach isn't effective for me." 

Consequently, we embarked on establishing screening initiatives for these individuals. Our aim was to collaborate not only with major academic institutions but also with general practitioners within these locales. We initiated partnerships with religious organizations to disseminate information through their bulletins to congregants and to utilize vehicles for transporting patients to treatment facilities. Thus, we commenced adopting a more comprehensive approach to ensuring Opdivo's accessibility for those requiring it, regardless of their residential location. This identical perspective has now been applied to the schizophrenia case previously mentioned. A significant factor driving my strong desire to collaborate with Alice's group is to explore how they can assist us in commencing the effort to address healthcare access in remote areas.  

Let me shift the focus to you for a moment. You pursued economics and completed a doctoral degree focusing on the influence of organizational elements on biotech firms during their new product creation. I'm interested in understanding how that research has shaped your leadership approach or perspective. 

Many things are simply beyond foresight. While a strategy can be devised, it echoes the well-known sentiment attributed to Mike Tyson: everyone possesses a strategy until they're struck.  

When I accepted this CEO role (two years back), I had a strategy. Our objective was to successfully manage a phase of LOEs (loss of exclusivity, occurring when a drug's patent protection ends). Eli Lilly experienced a similar phase, as did AstraZeneca. Examining past experiences and their approaches provides valuable insights. We were aware of our robust pipeline, excellent medications currently available that address significant health concerns, and the necessity to fully capitalize on those prospects. Our company is currently in a very solid financial state, supported by exceptional personnel. I had, in essence, outlined the entire strategy. 

During that time, which I've dedicated considerable effort to since, I didn't determine how we maintain everyone's concentration on achieving that objective. We've invested significant time in the company's culture. How do we provide individuals with a chance to discuss workplace events, and then guide them back to managing what's within their influence, remaining concentrated on the company's purpose? That involved resolving issues. We must ascertain how to navigate this situation. One must pause and declare, 'Let's adopt a protracted perspective.' My father frequently advised me, 'Hey, calm yourself down.' 

Stay calm! That’s what doctors learn to do in a crisis, right?  

Take a moment to reflect on the future, dedicate some effort, establish guiding principles for your actions, and then proceed to address the issue.  

In his final shareholder correspondence, Warren Buffett begins by recounting that he would have perished as a child if not for an urgent appendectomy, a procedure made possible by a conscientious physician. How can we, as a country, fulfill our duties to ensure this system benefits the largest possible population? 

For a considerable duration, our approach to addressing the challenges in rural American healthcare has involved training individuals to serve in those areas. While this is an admirable objective, we must acknowledge the reality that it hasn't yielded the desired results. 

Why not? 

I believe a portion of it relates to individuals. These are areas that don't draw those seeking to return and contribute to those locales. Many folks from my upbringing departed my native town.  

Well, your career would be very different if you hadn’t done that. 

Indeed. Significant efforts can be made to retain individuals. I believe Alice is contributing to this through the new medical school. However, something more is required. This is where I believe technology can be immensely beneficial. If there's a positive outcome from Covid, it's the rapid increase in the availability and use of digital tools within a brief period. When you combine that with technologies like AI and the capacity to pinpoint healthcare deserts, becoming highly specific about the needs of patients in those areas, you create a substantial chance to broaden the potential for access to excellent medical care for people in those communities.  

In the in other nations, you frequently encounter healthcare insurance frameworks where a single entity is responsible, enabling them to exert significant influence over pharmaceutical costs. A common belief is that other countries benefit from subsidies provided by The United States, which shoulders a greater financial burden for prescription medications. The question arises whether these other nations are contributing adequately to the expenses associated with the creation of costly new drugs. 

Upon closer examination of this sector, one significant aspect we've completely failed to control the discussion around is the lifespan of our pharmaceuticals. More than 90% of the medications dispensed within the United States are generic versions. What is understood about generics? In the United States, generics are actually more affordable compared to most industrialized European nations, owing to the distinct market forces present here and, candidly, how those other nations approach generics. Therefore, when discussing the cost of medications in the United States, it's important to remember that you won't obtain a generic if a thriving, branded pharmaceutical sector isn't maintained.  

How can we guarantee we're acting appropriately throughout the entire spectrum of medications available to patients? We certainly must improve our efforts to reduce drug costs for that specific aspect. However, as we pursue this goal, it's crucial we don't harm the system that allows us to introduce those exceptional medicines to the market initially, as generic equivalents won't exist without that system.  

Furthermore, we must improve the equalization of costs between the U.S. And other nations, especially within developed economies that possess the capacity and obligation to contribute more. I must commend this administration, as they are among the initial administrations to address this matter pragmatically, engaging in discussions where we state, 'Observe, if you do not commence allocating a greater portion of your GDP towards novel pharmaceuticals, then we shall employ trade mechanisms to impose sanctions for such inaction.'  

How does that help you? 

This capability allows for more straightforward discussions during price negotiations, enabling us to state, 'You must increase your payment.' When engaging in talks with a sovereign entity, and frequently encountering the commitment to ensure these medications are accessible, the situation often becomes a take-it-or-leave-it scenario. I believe the administration has adopted a rather constructive stance, emphasizing the necessity of higher prices internationally and the need for greater efforts within the U.S. To reduce costs. We've had highly productive conversations with the administration toward achieving this objective. 

Have you had any traction in negotiating with particular countries yet? 

We've engaged in productive conversations in the U.K., for instance. Following that, we'll move on to Germany and Japan. We've held numerous highly beneficial discussions beyond the U.S. Borders. We'll observe if these conversations yield tangible outcomes. Nevertheless, the fact that we're having these dialogues is noteworthy.  

We had stated our intention to introduce COBENFY, the medication for schizophrenia, available in the United Kingdom during the upcoming year, but at the same cost as its U.S. Price. We've engaged in numerous discussions with the U.K. Administration concerning the implementation of this plan.  

Have we shortened the time for medicines to come to market under this administration? 

I don't believe we've witnessed that. What could shorten that period is innovation. We're actively exploring methods to substantially reduce the duration from initial human testing to regulatory clearance, which can currently span over seven years. By implementing AI, we anticipate shaving off two to three years, and we're confident this could dramatically elevate the probability of success in a Phase 3 trial to nearly full certainty. 

Longitudinal research, inherently, observes individuals and their responses to medication. How could artificial intelligence potentially shorten that timeframe by two to three years? 

You have the ability to specify the locations for conducting these medical investigations. It's possible to achieve a far more accurate pinpointing of individuals. You can confirm that you have selected the appropriate researchers. You're able to detect issues that arise in clinical trials before they materialize. You can refine the planning of clinical trials. This is where regulatory bodies gain significance. We can commence the development of studies incorporating artificial control groups, for instance, by employing this innovation. We can achieve significantly shorter examinations of various outcomes through the use of this innovation. We've already demonstrated, for example, that it's possible to reduce the duration required for drafting official submissions by several months, utilizing this innovation. When you combine all these elements, the overall impact is quite substantial, and that's even before discussing the prospective utilization of AI in scientific inquiry and on the business side. 

A significant number of your peers are driven by a profound passion for scientific inquiry. It seems accurate to observe that the current prevailing mood doesn't reflect a strong affection for science. Does this situation affect how you communicate your message, whether to your team or to the public? 

It doesn't matter as long as it's just noise within the system. We must remember that this isn't our first challenging experience. We've been operating for 170 years. This doesn't imply we should disregard it. However, it does signify that when the initial pharmaceuticals this corporation produced were utilized during the Civil War's combat, and we were among the primary producers of penicillin throughout World War II, we've encountered significant events.  

A person I looked up to once remarked that leadership resembles a structure of illumination. For the most senior executives, the crucial element is for them to activate their own light switch—you establish the direction and approach—which then causes the subsequent level of light switches to activate, enabling them to permit the following group to carry out their responsibilities.  

So choose your team wisely. And then it’s ultimately about replacing yourself, right? 

The realization for me was that this individual was formerly a McKinsey partner. He remarked, ‘Chris, when you're leading a small group and a light bulb burns out, you handle the replacement yourself. However, when you're managing a team of that magnitude, the process must be systematic.’ It's essential to have an excellent group of leaders. This also involves the ability to motivate individuals and understand how to navigate the challenges we encounter.  

In the course of the Civil War, we observed an initial surge of medical documentation where individuals in their twenties exhibited ailments now typically linked to those in their fifties or sixties. Considering the present day, what do you imagine future generations will reflect upon with astonishment regarding our current tolerance for certain conditions?  

I'm inherently optimistic. It's important to pause occasionally and reflect on our achievements. Consider your most recent doctor's appointment, then compare it to one a decade prior. While the experiences might not have been dramatically dissimilar, during that same timeframe, approximately 500 novel treatments have been introduced, significantly improving prognoses for numerous cancer types. My aspiration is that future pharmaceutical advancements will yield comparable results for conditions like Alzheimer's and schizophrenia. We aim to be at the forefront of brain health. I trust that we'll move beyond the concept of healthcare deserts and instead see universal accessibility, regardless of one's location.