Why 70% of pharma partnership spend misses patients

More than $300 billion in branded prescription sales, roughly one sixth of the industry's annual revenue, loses patent protection between 2025 and 2030 (Evaluate, cited in PharmaVoice, 2026). Keytruda, Eliquis, Stelara, the diabetes franchises: the expiry dates are filed with patent offices, so this is arithmetic, not forecast.

Every divisional budget feels it, and almost every team responds the same way: do something new. Stand up a scouting motion, run an accelerator, build a patient app, launch a campaign, pilot a shiny tool. Each ships its own press release, then delivers almost nothing that reaches a patient at scale. The same trap plays out in Digital and IT: despite $30 to $40 billion spent on enterprise GenAI, 95% of organisations saw no measurable return, and external partnerships succeeded roughly twice as often as internal builds (MIT, The GenAI Divide, 2025).

Finding a start-up or building an app is the cheap part; combining capabilities into something that scales across markets is the expensive part, and closer to 70% of what pharma spends to scout, pilot, build, and partner produces nothing a patient ever sees.

The failure is in how you build, not whether you partner

Partnering looks like a coin toss. Alliance success has long hovered near 50%, by some measures the failure range runs to 60% or 70%, and the number has barely improved in a decade (Hughes and Weiss, Harvard Business Review, 2007; Ernst and Bamford, Harvard Business Review, 2005). But the average hides the most useful finding in the field. Ernst and Bamford found that joint ventures that broaden or adjust their scope as they grow reach a 79% success rate, against just 33% for ventures left unchanged after signing, and a 2004 McKinsey study found more than 70% of companies sitting on major alliances that needed restructuring they never did.

The failure is not instability, but rigidity: sign a clean thesis, walk away, and eighteen months later somebody is unwinding a partnership nobody kept building.

One start-up cannot run a programme across markets

Take the work each part of the house owns. Marketing and advocacy need disease awareness and activation at national scale, which takes a technology that works, a brand patients trust, an advocacy network with real relationships, and a delivery channel that survives the local system. No seed-stage company holds all four. Clinical operations need recruitment across geographies; market access needs a story that lands with very different payers. The start-up that nails Germany is unready for Brazil, Poland, India, or Saudi Arabia.

Context kills these programmes, and it does not travel. Consent and data rules, reimbursement, clinician workflows, language, infrastructure, and the transparency bar for any transfer of value all change at the border. A tool validated in Western Europe stalls in Central and Eastern Europe on reimbursement alone; reach in the Gulf depends on relationships a foreign start-up does not have. Global health has a word for it, pilotitis: tools tested, praised, and abandoned because no single vendor carries them into a real system. A programme that crosses markets needs a combination of ventures whose strengths cover each other. Scouting hands you one piece and leaves you the hardest, most expensive part: the assembly.

The market has already moved. Disclosed healthcare partnerships rose from 2,675 in 2021 to over 4,000 in 2024, the largest category being multi-party collaborations, not two-company deals (Galen Growth, 2025). Capital alone no longer wins markets, ecosystems do, and single-start-up scouting is bad at building them.

The budget case, in CFO language

Engage one venture and you pay twice: once to de-risk it, then again for every integration, the partners, the structuring, the per-market adaptation, the measurement. Run that across several divisions, each scouting alone, and you pay the same fixed costs over and over.

Buy a ready-made partnership instead, and the assembly is done once by a neutral party who keeps doing it, and you are buying the 79%, not the 33%. The board questions that kill programmes late, vetting, capital protection, data and privacy, transparency on transfers of value, are answered before the money is spent. The proves are live: e.g., a cardiovascular-screening partnership pairing a Rwandan patient-engagement venture with a Canadian contactless-diagnostics company reached more than 1.6 million people and completed over 75,000 screenings in roughly a year across East Africa, numbers neither reached alone. The same logic carries wherever underserved demand meets a capable local partner: Southeast Asia, the Gulf, Latin America, Central Europe.

The Agile JV: An old structure, run a new way

Put the two findings together and a model falls out. JVs win when they keep evolving; programmes win when capabilities are combined, not scouted one by one.

The classic corporate JV is signed once and frozen, reopened only in crisis, years too late. An Agile JV is reshaped on a cadence, scope widened, a market partner added, governance streamlined, before performance slips. An Agile playbook means review every 6 to 12 months, build restructuring triggers into the terms, install a neutral lead director. Most corporates cannot, because their JVs sit outside normal planning cycles and change means renegotiating contracts between rival parents.

Young ventures and a neutral assembler change the maths. A seed-stage company is natively agile, with none of the rigidity that freezes a corporate JV. A neutral party holding a portfolio can play the lead-director role, and pull the most powerful restructuring lever, adding a partner with the market access the venture now needs, as a routine service, not a crisis. The corporate gets the upside of a JV without the rigidity that kills most of them.

What the leaders who win this will actually do

Four moves separate the executives who come out of this decade ahead from the ones explaining budget cuts to the board.

Protect your name before the cliff does it for you. Which list you land on in 2030, winner or cautionary tale, is being decided now by the bets you place this year. The people quoted on stage will be the ones who reached patients at scale while everyone else was still graduating cohorts.

Take back control of your own budget. Right now 70% of what you spend on scouting, building, and partnering produces nothing a patient ever sees, and your CFO will find that number before you do. Get there first, and you stop defending a line item. You become the person who found the money everyone else is about to lose.

Turn impact into share. Every reach programme that scales is revenue your competitor does not get: earlier diagnoses, activated patients, recruited trials, markets entered first. The combinations exist now, and the strongest ventures pair off once. Whoever briefs first gets the reach, the evidence, and the market; arrive second and you buy the leftovers.

Be the one who changes the model, not the one who defends it. Anyone can sign off another accelerator; it is safe, expected, and why most of the budget burns. The executive who gets remembered built something better and scalable, an Agile JV that keeps evolving instead of one more programme that dies off quietly consuming budgets. While you read this, a competitor is briefing a ready combination and will have a shortlist back before your next pilot clears its first gate.

Decide now. The cliff will not wait, and neither will your competitors.

References

Bamford, J., Ernst, D. and Baynham, G. (2020) 'Joint Ventures and Partnerships in a Downturn', Harvard Business Review, September-October. Available at: https://hbr.org/2020/09/joint-ventures-and-partnerships-in-a-downturn

Ernst, D. and Bamford, J. (2005) 'Your Alliances Are Too Stable', Harvard Business Review, June, reprint R0506J. Available at: https://hbr.org/2005/06/your-alliances-are-too-stable

Evaluate, IQVIA and Morgan Stanley estimates, reported in PharmaVoice (2026) How Big Pharma is navigating a $300 billion patent cliff. 30 January. Available at: https://www.pharmavoice.com/news/big-pharma-navigating-patent-cliff-300-billion-jnj-merck-abbvie/810915/

Galen Growth (2025) Who is really winning pharma's digital health innovation race in 2025? 2 December. Available at: https://www.galengrowth.com/pharma-digital-health-innovation-index-2025/

Hughes, J. and Weiss, J. (2007) 'Simple Rules for Making Alliances Work', Harvard Business Review, 85(11), November. Available at: https://hbr.org/2007/11/simple-rules-for-making-alliances-work

MIT NANDA (2025) The GenAI Divide: State of AI in Business 2025. Massachusetts Institute of Technology. Reported in Fortune, 18 August 2025.

About the author

Lucy Setian is the founder of Synergya.io - a Swiss social enterprise running a zero-fees, zero-equity joint venture business infrastructure for health and sustainability start-ups and scale-ups globally. Before founding Synergya, Setian spent 17 years building at the intersection of health innovation, digital transformation, and cross-sector partnership-building across more than 30 countries, including her current role as international marketing director at Novartis. Her earlier work at the Novartis Foundation took her from digital health strategy for cities and national governments to creating and leading HealthTech Hub Africa - a pan-African health technology accelerator based at Norrsken House Kigali. Setian is a rare disease patient expert and a female minority leader. She holds an MSc in Global Healthcare Leadership from the University of Oxford, an Executive MBA from Solvay Brussels School, an MSc in Political Sciences from Vrije Universiteit Brussel, and a BSc in Computer Engineering jointly from the Technical University of Sofia and the Technical University of Karlsruhe. Setian speaks five languages and is a published author on HealthTech policy, including a widely circulated analysis of why Africa lacks a HealthTech regulatory sandbox and what is needed to build one.