Key takeaways

• In first‑launch biopharma, sales leaders who enable cross‑functional decision‑making execute more effectively under complexity.
• High‑performing biopharma sales teams are built by leaders who lead authentically and keep patients as the primary decision anchor.
• First‑launch biopharma companies outperform expectations when commercial ambition is grounded in data, capacity and clear priorities.
• In emerging biopharma, differentiated customer experience is a primary competitive advantage against larger pharma companies.
• AI improves biopharma sales execution, but sustained performance depends on leadership, trust and sales culture—not technology alone.

What does it really take to lead a successful first-launch sales team in emerging biopharma? To explore this question, we sat down with Matt Cullen, head of sales at Madrigal Pharmaceuticals, for a candid conversation on leadership, culture and execution. With more than 35 years of experience across sales and market access, Matt brings a grounded, people-first perspective shaped by both large pharma and first-launch biotech environments.

The conversation below surfaced powerful lessons for today’s commercial leaders navigating complexity, investor pressure and rapidly evolving customer expectations.

Abhay Patil: Matt, looking back on your career, was there a defining moment that shaped how you lead today?

Matt Cullen: If I had to boil it down to one word, it would be “gratitude.” Early in my career, I made a personal decision to leave a company to be closer to my family. During my notice period, I took time to thank colleagues and acknowledge their contributions. A peer later told me, “That’s the most I’ve ever heard you say, ‘Thank you.’”

That comment really stopped me. I always felt appreciation; but I hadn’t always expressed it. What I learned is that words matter, especially when you’re in a leadership role. People are listening, and recognition carries real weight. Since then, I’ve made a conscious effort to never miss an opportunity to acknowledge the work people are doing.

That lesson still guides how I show up every day.

AP: There’s often skepticism around whether first-launch companies can execute at the same level as established pharma. Our ZS CX study emphasizes that even small companies can rival big pharma at basics. What’s the biggest misconception you’ve seen?

MC: The biggest misconception is that first-launch biotechs are reactive, that they lack the infrastructure, discipline or analytics to execute well. I had that perception myself before joining one.

What I’ve seen firsthand is the opposite. Smaller organizations can execute at an exceptionally high level and use data just as effectively, sometimes even more so. At Madrigal, we’ve demonstrated that you can build strong processes, leverage analytics and adapt quickly based on real launch learnings. Being early stage doesn’t mean flying blind.

Importantly, customers notice. We’ve heard thought leaders say that we “have our act together” and consistently approach engagement the right way. That feedback reinforces an important truth: execution quality isn’t determined by company size. It’s driven by intent, discipline and focus on the customer experience.

AP: Emerging biopharma often faces intense investor pressure. How do you balance ambition with realistic assumptions in a go-to-market plan?

MC: It starts and ends with the data. Objective data should drive your assumptions, which then drive forecasts and expectations. If you stay grounded in that truth, you’re in a much stronger position to make trade-offs thoughtfully.

Resources are finite. People have limited capacity. Data helps you focus on what truly matters and identify what not to do. When expectations rise, you can go back to the data and say, “Here’s what’s possible, and here’s what it will cost.”

That discipline helps you pivot intelligently rather than react emotionally.

AP: What advice would you give a new head of sales stepping into a first-launch environment under that kind of pressure?

MC: Put your people first, always. Sales teams are ambitious and smart. They want to understand the strategy and where they fit. If you rely only on metrics, rankings and dashboards, you’ll get compliance, but you won’t get commitment.

To truly execute, people need to believe in something bigger than themselves. That’s culture. As a sales leader, you set the tone. Be real. Be authentic. Meet people where they are and believe in them. If you do that and hold high standards, people will rise to meet them.

What you can’t allow is mediocrity to linger. High expectations paired with support create high performance.

AP: Hiring the first wave of sales talent is one of the most critical decisions in a launch. What do you prioritize?

MC: Balance is key. Experience and relationships matter, but they’re not enough. I look for consistent performance across different environments because past performance is a strong predictor of future success.

More importantly, I look for intrinsic qualities—integrity, trust, passion, a patient-first mindset and an enterprise perspective. Those things can’t be taught.

There are also red flags I watch for. Hiring purely based on relationships can be risky. Relationships may get you in the door, but effectiveness keeps you there. I’m also cautious of frequent job-hopping and what I call “launch addicts,” people who thrive only in the early excitement but struggle to sustain momentum.

The best reps succeed over time, not just at launch.

AP: Not every launch is an instant success. How do you build resilience within a sales organization?

MC: Communication is foundational. You need multiple forums to connect with your teams. I hold regular updates with the full sales organization and smaller forums with frontline leaders to understand field realities and share context from leadership discussions.

Context matters. People need the “why” behind the “what.” They’re adults. They can handle the truth. As an example, for initiatives like NBA [next best action], we are communicating the “why” behind the insights we are sharing with the field to build trust and a data-driven foundation to field suggestions.

It’s also important to celebrate both big and small wins. Field work can be isolating, and not everyone will be in the top 10. But people are making progress every day, and that effort deserves recognition.

Finally, transparency and trust within the leadership team enables clarity and purpose. That’s what allows an organization to weather both highs and lows without losing momentum.

AP: How has customer engagement evolved post-pandemic?

MC: It varies by specialty and practice environment. In our therapeutic areas, engagement remains strong, and there’s greater openness to virtual interactions than before COVID. Those tools add efficiency.

But virtual will never fully replace face-to-face. Human connection still matters.

The bigger challenge is access within health systems and IDNs [integrated delivery networks], where policies have become more restrictive. That’s where companies need to think differently, leveraging cross-functional partners like MSLs [medical science liaisons], key account leaders or even senior leadership to add value. This is where I’m excited to see how our industry will evolve and create unique experiences in the next decade.

What matters most is staying customer-focused, not role-focused.

AP: AI is everywhere right now. How do you see it shaping sales and commercialization?

MC: AI is already here and will only become more prevalent. Today, we’re using it primarily to improve efficiency, business analytics, planning and next-best-action tools—so, reps can spend more time selling.

Innovation is a core value for us, so AI fits naturally. But it will never replace human relationships. Technology can enhance effectiveness, but it can’t replicate trust or connection. Sales professionals aren’t going anywhere.

AP: What mindset shift is required for leaders moving from large pharma to a first-launch biotech?

MC: You have to embrace that it will be different. In big pharma, you’re resource-rich but heavily constrained. In biotech, you’ll need to roll up your sleeves and collaborate deeply across functions.

Cross-functional alignment becomes critical. Small organizations can also get highly matrixed, and without coordination, things can become chaotic for customers. Leaders need to understand what each function brings and how to work together compliantly.

The most successful teams I’ve seen are built on strong collaboration and thoughtful planning. You can’t do it alone.

AP: What excites you most about the future of biopharma commercialization?

MC: I’ve spent my entire career in this industry because we make a difference. We change lives. As long as patients remain our North Star, this work will always matter.

Good science, disciplined execution and genuine human connection will never go out of style.

This is the first interview in a series where we talk to sales leaders at emerging and growth-stage biopharma companies to understand the challenges they face in the industry. See the full interview here.