For Steven Blum, director of health economics for Forest Laboratories, being aware of budget impacts is fundamental to the job. "Our role is to help support and communicate the product's value proposition," he explains. Blum and his team do this by keeping track of data and performing various studies throughout a product's lifecycle, including retrospective studies, electronic medical records analyses, surveys, and prospective studies looking at data alongside clinical trials.

Though Blum now spends his time charting the prospective value of new drugs, three years ago he wore a different hat—sales and marketing. "Transitioning over to the scientific side and not having a scientific background, there was a learning curve," Blum says.

Blum also advocates mentoring as a key mark of good leadership. In that spirit, what would Blum say to the new leaders in the industry, who are inheriting such a politically and financially different world? "Somehow pharma always winds up being the bad guy. Health reform [and cost control] is like squeezing a balloon—you squeeze in one area and it expands in another. What you need to do is find a way to let some air out of the balloon," he explains.

Jessica Monroe recalls a former boss who would always ask, "What is a leader?" He would then answer that a leader says, "I have a plan. Follow me." Director of state government affairs and policy for Johnson & Johnson, Monroe tries to integrate this approach into her own goals and objectives as she works with governments, operating companies, and other healthcare and pharmaceutical interests on a daily basis.

Monroe followed the road less traveled by most of her pharma peers, when she started a career in government and then transitioned to pharmaceutical sales. Her atypical journey led her from work as a legislative aide for the Louisiana Senate all the way to Washington as a Congressional staff assistant and then back to Louisiana to work in the office of Governor. Her start at Johnson & Johnson came as an office-based representative in its operating unit, Janssen Pharmaceuticals. In 2002, she arrived at her current position. "In the years I have worked in government affairs, I have learned that many voices are stronger than one, and my interactions with advocacy groups and government officials have shown me that disparate groups can share similar aspirations of helping patients and their families," says Monroe, who was involved in the healthcare rebuild after hurricane Katrina.

In an environment of change, Monroe believes it is important to maintain a positive outlook, think about how to have an influence, see what the obstacles at hand may be, and work around them. "Those of us in the industry must be prepared to face the implications of policies that impact our businesses. Everything from marketing reform in some states, to overall healthcare reform has led to—and will continue to—create changes in how we all do business," she says. "I have learned that even within a lean organization, there are still significant opportunities to grow our businesses." Being able to show an ROI from traditionally "soft" functions such as public and government affairs is also important. With the impact of government on the industry destined to grow in the future, demonstrating this is likely to be less difficult—and emerging leaders of tomorrow will need to embrace awareness of the external environment as a key skill.