Pharma R&D productivity has lagged despite high investment, with rising regulatory and pricing pressures shrinking returns. IQVIA’s analysis shows that between-phase success rates, especially in Phase II and III, are the biggest drivers of efficiency. Improving Phase II success from median to top-quartile can save $383M per approval, while poor rates can add $821M. Front-loading attrition in early R&D, enhancing discovery quality with genetics and AI, and managing clinical-stage risk are key levers. Companies like Pfizer and AstraZeneca demonstrate that systematic portfolio focus and robust governance can triple success rates and cut costs.

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