Key takeaways:

• Chief commercial officers (CCOs) should seek to understand the experience and motivations of their board members. Many scientifically or financially focused directors lack commercial operating experience.
• Instead of presenting details of their commercial operating plans, CCOs should focus on explaining how commercial investments create long-term value and drive strategic outcomes.
• CCOs (especially those coming from larger organizations) will need to design commercial budgets that are ruthlessly practical and show sensitivity to broader company priorities to balance cash needs and fundraising mechanisms.

After starting her career at Johnson & Johnson, Nithya Desikan moved on to launch a new hemophilia division at Biogen and then eventually to Rhythm Pharmaceuticals, where she spent three years as the company’s CCO. Now as an experienced investor and board member of several emerging biopharma companies, she sees perspectives from both sides of the aisle. She sat down with ZS Principal Adam D’Luzansky to discuss learnings from her path to the boardroom and how CCOs can engage better with boards.

Adam D’Luzansky: Let’s start with your journey from Johnson & Johnson to leadership in emerging biotech. What were some of the catalysts?

Nithya Desikan: My journey wasn’t a straight path. I started at J&J in a leadership development program, moving through various commercial roles over 12 years. One pivotal moment came after I took a leadership role in China. You get a much broader aperture when you go into a smaller market than the U.S. I went from having a very narrowly defined job to owning diverse responsibilities on a leadership team. When I came back to the U.S., I started to feel like a tiny cog in a big machine. So, when an opportunity at Biogen emerged to launch their brand-new hemophilia division, I took the leap.

AD: What were the biggest challenges you faced in transitioning to the emerging biotech environment?

ND: Going from J&J to launching a brand-new division at Biogen meant I went from a well-oiled machine with endless resources to a startup environment where we were building everything from the ground up. We started with just six people and had to be incredibly strategic about hiring. I brought my J&J experience of careful talent selection, interviewing 70 people over three and a half months to build the right team.

Another major challenge is obviously having fewer resources. In big pharma, you have resources to do everything. At Biogen, and later at Rhythm Pharmaceuticals, I had to ruthlessly prioritize. It wasn’t about doing everything but doing the right things.

AD: What did you learn about engaging boards as a member of senior management in emerging biotech?

ND: Most biotech boards are populated by venture capitalists, physicians or scientists who understand science but don’t comprehend or are not particularly interested in commercial operating realities. During one of my leadership stints, I spent a series of dinners teaching board members about commercial strategy the night before our quarterly board meeting. While everyone else ate, I’d be explaining market access, commercial planning and why certain commercial investments were critical.

Looking back, I recognize how important it was for me to understand the experience and incentives of my board. For me to be successful at educating them, I needed to speak in a language they could understand. Being a student of the ownership structure of your company is incredibly important for first time CCOs of emerging biotechs.

AD: Are there specific gaps you think typical emerging biotech boards get wrong about commercial?

ND: Yes, I believe a critically important and often overlooked commercial issue in emerging biotech is market access. Most CCOs come from marketing or sales backgrounds and don’t fully understand market access strategy. And the scientifically focused board members don’t naturally understand market access. Especially for emerging biotech companies, early on in their clinical development, they need to be thinking about what payers’ needs are, how their endpoints can meet those needs, and how to create a compelling value proposition for more than just physicians and patients. The CCO must be the champion that the company’s success is not just about creating a great product but about proving its value to healthcare systems and insurers.

AD: Now today you’ve changed seats at the table. You invest in biotechs, and you are the one on the board. What advice would you give to current or aspiring emerging biotech CCOs about engaging boards?

ND: My number-one piece of advice is to be adaptable. You can’t be a perfectionist in a small biotech. You must understand financial management—it’s crucial. Many CCOs from big pharma struggle because they’re used to unlimited budgets. Now they are managing cash burn and need to be strategic about every investment. So, my advice is that they learn to prioritize. Be rigorous about testing and be willing to pivot quickly.

Another challenge I see in new CCOs from my position on the board is that they are too easily drawn into talking to me about tactical details, perhaps because I am the person on the board with commercial experience. But my advice to them is to focus on the bigger picture and explain how their strategy will translate into financial success for the company overall. While I might understand a ridiculously long brand presentation, I don’t need to waste my time hearing it. Tell me what you are going to do to improve productivity and how you are going to measure return on the commercial investments you are making.

Finally, I would recommend engaging your board as a thought partner. Seeking to engage them and find what aspects of running the commercial organization they can add value to will help both sides of the relationship.

AD: What are some learnings or challenges facing first time emerging biotech CCOs that you want to highlight?

ND: Earlier I spoke about my experience at Biogen building out the hemophilia business. We had to scale our talent quickly and we invested a lot of time and energy in recruiting the right people. I believe talent acquisition in emerging biotech is very challenging below the senior executive level. Especially for first launch companies, the senior executives (CCO, VPs) take up the broadest roles and remit, which means there is less true authority left to delegate to director-level leaders. When you land a highly talented person with a single-asset company, you often have limited career progression to offer them. Now as an investor, my focus is helping senior management attract better talent by helping them communicate a broader vision. If we can generate success with our current asset, then we can position ourselves to add additional assets to our portfolio, which will create more opportunities for individuals to grow.

The last thing I’ll say about talent is that I look for senior executives who are humble and focused on great internal communication. Humble leaders are more curious about what their teams have to say. In these emerging biotechs, very few processes are established and the opportunity to influence and create the outcome is motivating for the entire team. If leaders are invested in great internal communication and show real emotional intelligence, then they can unlock the best potential of their teams in the dynamic, agile environment of emerging biotech.

AD: Nithya, this has been tremendous. Thank you for taking the time to share your experiences. I know our readers will benefit from your perspective.

This is the second of our interview series, where we talk about the CCO function in emerging biopharma. See the first interview here.