Summary
Pfizers failure on Exubera were not of safety issues, or complicated device, or even consumer marketing problems. Their biggest issue that brought failure was the lack of payer coverage. Almost no payer in the US added Exubera to their formulary or saw any value over injectable insulin at the price being commanded by Pfizer.
Analysis
Exubera, the first alternative delivery form for insulin, had extremely weak sales. The pipeline for alternative delivery forms for insulin are quite large, including inhaled, oral and transdermal. The biggest issue to face will be the ability for pharmaceutical companies to provide evidence that payers (such as PBMs, Health Plans, Government..etc) will want to cover these products. Pfizer did a terrible job trying to convince payers. In fact Pfizer was relying on the consumer and physician demand to push payers into coverage. This is a common philosophy Pfizer has historically utilized. What they didn't realize is that payers can not afford to take their existing budget allocated for insulin and expand that by a multiple of about 5 to cover these products. Other pharmaceutical companies will have to face the same hurdle in the next few years as their products are ready to launch.
