PE: The barrier is clearly being placed higher in terms of establishing differentiation and securing access to the reimbursement rolls.

GG: Higher prices coupled with the life-extending impact of many such drugs can attract critical attention, typically raising three key questions. What is the real value of a drug that allows for an improvement in quality or longevity of life? Can the price be justified when compared to existing therapies? And does use of the drug lead to a reduction in overall health costs, for the long term?

Payers expect Pfizer to provide metrics that can answer these questions. This in turn is driving a revolution in information and new diagnostic technologies. Specialty is where the key experiments are taking place to anticipate and bend the cost curve, such as targeting therapy toward the cohort of patients most likely to benefit from a drug, or building economic models to drive outcomes that improve patient status and enhance public health.

GG: Yes. The complexity of the science that bring these medicines to market and the importance of a "high touch" approach to administering the medicine to patients means that we have to do more than supply the pill. The potential for these drugs depends on a networked approach, covering not just the right therapeutics but also a service infrastructure that can be mobilized to support the provider and the patient in managing his condition. This has led to many industry-led innovations in coordinating care, educating around patient compliance, mitigating adverse event risks, and finding the right price points to accommodate the significant variety in how, where and when these medicines are used.

PE: Can you provide an example of Pfizer leadership in building this necessary service infrastructure?

GG: One Pfizer "best practice" is the International Growth and Metabolic Data Bases programs we have developed for children and adults with growth hormone deficiencies treated by our endocrine franchise therapies, Genotropin and Somavert. It contains evidence on key drug performance and outcome indicators drawn from a 60,000-member patient file across 50 countries, compiled over 20 years. The two programs are a link between Pfizer, prescribing physicians, and national health authorities in monitoring not only the safety and efficacy of the two medicines but also other broad outcomes measures like health services utilization, quality of life, and productivity.

PE: The specialty segment is increasingly crowded, with more than 800 new compounds in various stages of commercialization. Market leadership thus requires a high degree of differentiation. What is unique in the way Pfizer is approaching the business?

GG: We confront competition from three sources: other large, diversified pharma companies; mid-size players with a focus on niche products; and smaller biotech companies dependent on licensing and other forms of partnership. Building market share depends on providing a distinct advantage to the customer base. Pfizer's unrivaled market reach—Jeff Kindler calls it the "spirit of small and the power of scale"—is actually something that sets us apart. Our product portfolio is the largest in the industry, with 24 medicines and vaccines in 11 different disease areas, including top-selling global products for inflammation, infectious disease, hemophilia and ophthalmology. Another 25 new compounds or indications are in various stages of development.

Pfizer's broad portfolio means we can provide customers with integrated solutions rather than one-off sales. There is no single delivery or payment model in specialty—there is a big injectible/infusion delivery component, administered in-hospital or by physicians; and there are primary care–like products dispensed through pharmacies, for example our antipsychotic medicines. Vaccines require a direct distribution approach. Because we operate through several different business models, we work to leverage the expertise across the business, finding and adopting best practices to tailor a comprehensive value proposition serving the needs of each of our customers. This, I believe, separates us from the competition.

Additionally, Pfizer management is challenging us to extend our capabilities to customers by filling the "white space" that exists between Pfizer's nine BU's, covering biopharmaceuticals and the diversified businesses like consumer health and nutritionals. For example, there are new personalized medicine tools whose development can benefit from our contacts with the Oncology BU. With the Emerging Markets BU, we are exploring how specialty medicines can address the distinct patterns of disease in Asia and Latin America—as incomes in these regions rise, so too is their ability to pay for innovative treatments. The tolerability and effectiveness of many specialty drugs can also be enhanced with products that influence diet or maintain standard indicators of good health. Overall, the idea is to share resources and creative approaches that provide additional value to the customer.