“Now I’m going to show you a beautiful fake,” she said with a smile. These words were spoken to me by a PhD-level scientist and computer vision engineer who develops AI-based technology to detect counterfeits. She has seen thousands of scans of fake pharmaceutical packaging, and this one stood out. 

What impressed her was how well the counterfeit matched the real thing, down to the smallest details. The technology still flagged it as a fake, but it was nearly indistinguishable from the genuine article. Even an experienced analyst may not have been able to spot the difference upon manual inspection. And forget about a patient or healthcare professional being able to tell the difference.

Counterfeiters thrive on deception, fraud, and avoiding detection, and, as this anecdote demonstrates, they keep getting better at it. It’s not just higher-quality packaging reproduction, though that is an area that gets a lot of their attention. We’re seeing increasing sophistication across the entire illicit value chain—from manufacturing to logistics to commercialization and money laundering. Combating counterfeiting and illicit trade is a cat-and-mouse game, with organized crime demonstrating increasing adaptability, ingenuity, and operational maturity.

Beyond “beautiful fakes” and the well-known proliferation of illicit trade online, fraudsters are employing a variety of other tactics to take advantage of market disruptions, adapt their supply chains, and exploit mechanisms designed to facilitate and enhance legitimate global trade. They target whatever gaps and vulnerabilities they see to infiltrate legitimate trade networks, making detection even more difficult.

Exploiting market disruptions and geopolitical conflicts

Counterfeiters are opportunists. Economic instability, currency devaluations, drug shortages, sanctions, and geopolitical conflicts all create fertile ground for illicit trade. When legitimate supply chains falter or prices spike, counterfeit networks step in to fill the void. During the global COVID-19 vaccine shortages, for instance, several regions saw a wave of falsified vials entering online and private-market channels.

 Criminal networks know that constrained access and urgent demand make buyers more vulnerable—and less critical—when evaluating product authenticity.

One of the most significant evolutions in recent years is the shift toward small-parcel shipping. Instead of moving counterfeit medicines in bulk, many networks now rely on thousands of micro-shipments sent through postal services and express couriers. According to OECD/EUIPO analysis, 79% of all counterfeit shipments now contain fewer than ten items.

 This long-tail logistics model overwhelms inspection capacity, reduces the risk to perpetrators, and makes meaningful interdiction extremely difficult for regulators and law enforcement.

Free-trade zones (FTZs) are vital enablers of global commerce, but they also offer blind spots. Counterfeiters exploit FTZs to obscure product origin, assemble and repackage goods, and commingle authentic and illicit goods. Several major pharmaceutical counterfeiting investigations have revealed FTZs in the Middle East, Africa, and Latin America being used repeatedly as repackaging and transshipment hubs.

Their rapid turnaround times and limited oversight make them ideal environments for illicit traders seeking to erase tracks and confuse provenance.

We are also seeing an increase in localized production, as illicit manufacturers move their operations away from “hot spots,” such as China, to avoid enforcement actions and increase profits. Local production reduces transportation risk, shortens lead times, and allows counterfeiters to tailor packaging, labeling, and serial numbers to local regulatory expectations. This decentralized model complicates investigations and makes illicit production harder to detect through traditional enforcement triggers.

These tactics remind us that illicit trade in pharmaceuticals is a dynamic and innovative business; it evolves with markets, supply chains, global forces, and efforts to stop it. Criminal networks have a distinct advantage in that they are typically more agile and able to adapt faster to exploit opportunities than legitimate businesses and stakeholders. Indeed, they are a formidable adversary, and one we must continue to fight every day to protect patients and the integrity of our products and supply chain.

Sean O’Hearen is the founder and principal consultant at 1st Line Partners.

1. Schuster S. "Tip of the Iceberg": Interpol Says Fake COVID-19 Vaccines Were Smuggled Across Continents. 

https://time.com/5943581/interpol-face-covid-vaccine/

2. Mapping Global Trends in Fakes: Global Trends and Enforcement Challenges. OECD. May 7, 2025. 

https://www.oecd.org/en/publications/mapping-global-trade-in-fakes-2025_94d3b29f-en.html

Articles

Counterfeit pharma networks are becoming more sophisticated—leveraging advanced packaging, fragmented logistics, and global trade gaps—making detection harder and patient risk greater than ever.

A 'Beautiful Fake': Pharma Fraudsters Upping Their Game 

For far too many Americans, regardless of insurance coverage, increased healthcare-related out-of-pocket (OOP) costs are creating barriers to the care they need and deserve.

While it’s important to note that some progress was made in 2025 for people enrolled in Medicare through the Medicare Part D cap,

 premiums and other healthcare costs continue to increase. And individuals with commercial insurance are also facing higher costs, as deductible and OOP spending are becoming unaffordable for many.

A recent national poll conducted by the PAN Foundation’s Center for Patient Research found that with these rising healthcare costs and OOP spending, most insured adults (86%) want policymakers and elected officials to keep affordability top-of-mind when considering healthcare issues in 2026. The top affordability factors of concern are prescription medication costs (33%) and health insurance premium costs (32%).

In addition, many adults (67%) also think policymakers should keep access- and coverage-related factors in mind, namely protecting access through Medicaid (22%). In fact, more than half of adults (57%) are concerned that the "One Big Beautiful Bill" passed this year may prevent access to care for millions of Americans through Medicaid.

Other key findings from our national poll point to a rice in OOP healthcare costs, including:

Four in 10 adults (40%) will spend more than $1,000 on healthcare-related OOP expenses by the end of 2025. Of those, 9% will spend more than $5,000, including adults with rare diseases (16%), who are most likely to face these higher costs.

Nearly four in 10 (39%) reported experiencing increased healthcare-related OOP spending between 2024 and 2025.

More than half of adults (51%) have taken an action this year to afford their healthcare costs, most commonly using their credit card (19%). About 1 in 10 are taking other steps, such as stretching out their prescriptions to make them last longer (11%), delaying/cancelling treatments to afford care (11%), and not filing prescriptions (10%).

Over one-third of adults (34%) will have spent more than $1,000 on monthly insurance premiums by the end of 2025, with 18% having spent more than $2,500.

Nearly half of adults (46%) experienced an increase in healthcare/prescription premiums between 2024 and 2025.

Health insurance premiums (31%) were the OOP costs that most negatively impacted personal budgets in 2025.

Nearly half of adults (49%) are concerned about the expiration of the premium tax credits for people via the Affordable Care Act (ACA) marketplace, which are set to expire Dec. 31, 2025, without Congressional action.

So, as we begin a new year, we hope that policymakers and elected officials will ensure access to healthcare for all Americans by continuing to explore strategies to lower what Americans pay for prescription medications at the pharmacy counter while working toward a healthcare system that addresses the total cost of care and ensures healthcare is affordable and accessible to everyone—regardless of where they live, their income, or their background.

Amy Niles is chief mission officer at PAN Foundation

1. What Is the Medicare Part D Cap? PAN Foundation. 

https://www.panfoundation.org/understanding-the-medicare-part-d-cap/

2. Facing Rising Costs, Insured Americans Want Healthcare Access Protected in 2026. PAN Foundation. October 30, 2025. 

https://www.panfoundation.org/facing-rising-costs-insured-americans-want-healthcare-access/

Rising healthcare-related out-of-pocket (OOP) costs are creating significant barriers for many Americans, despite insurance coverage. A national poll indicates that most insured adults want policymakers to prioritize affordability, particularly concerning prescription medication and insurance premiums. Many adults are also concerned about access to care, especially through Medicaid. The poll highlights that a significant portion of adults are spending substantial amounts on OOP expenses and insurance premiums, leading to financial strain. Policymakers are urged to explore strategies to lower costs and ensure healthcare accessibility for all.

Rising prescription costs and premiums are forcing more than half of patients to take drastic measures to cover OOP costs.

Americans Call on Policymakers to Prioritize Healthcare Access and Affordability

After 17 drug companies received threatening letters to lower US drug prices or face the introduction of most-favored nation (MFN) price controls, Pfizer and AstraZeneca were the first two companies that made an agreement with President Trump. On Nov. 10, the Centers for Medicare & Medicaid Services (CMS) published a “GENEROUS” model

 that is describing the methodology used for MFN pricing arrangements that seems consistent with the Medicaid price concessions in the two deals.

Medicaid pricing to match prices of other developing countries, presumably corrected for per capita income

Use of a TrumpRx website to provide links to direct-to-patient discounts programs (important for Medicare Part D and Obamacare, where patient co-pays sometimes exceed net drug cost)

A three-year exemption from import tariffs on pharmaceutical ingredients in return for expanding US manufacturing operations

Both Pfizer and AstraZeneca committed to offer prices comparable to other developed countries (known as MFN pricing) to state Medicaid programs. The CMS GENEROUS model is referencing the United Kingdom, France, Germany, Italy, Canada, Japan, Denmark, and Switzerland to calculate the second lowest country-specific manufacturer-reported net price, adjusted by gross domestic product per capita using a purchasing power parity method. Net prices are calculated at the NDC-9 level as the average net price in each country for the previous 12-month period, after all rebates, discounts, and other price concessions provided by the manufacturer are deducted from the list price.

The second lowest calculated price will dictate US pricing for Medicaid. All of the referenced countries have government-dictated drug prices, often referencing the lowest prices they can find in other countries to get the best deal.

State Medicaid programs already have significant discounts, as by law, they essentially pay the lowest price available to any US customer with only few exceptions. However, for recently launched drugs, where Medicaid discounts are often limited, the deal may result in significant price reductions for Medicaid programs.

In contrast to the original MFN pricing proposals in 2020, the impact of the two deals and the GENEROUS model is limited to Medicaid pricing and does not affect Medicare Part B or Part D drug pricing. The Inflation Reduction Act of 2022 (IRA) has initiated price controls for Medicare Part D and Part B drugs seven years post launch for chemical drugs and 11 years post launch for biologics, thus skimming profits from the most profitable years prior to generic or biosimilar competition but leaving pricing uncontrolled for the first seven to 11 years.

Under the Pfizer and AstraZeneca deals, drugs with a heavy Medicaid population will be less attractive to develop. Drug prices in the referenced countries can potentially slash US market potential due to MFN pricing. It takes only two countries with prices much below the US to substantially hurt US return on investment. Particularly, European countries usually insist on long-term patient outcomes data before they approve premium pricing, forcing companies to choose between a lower price and long launch delays. With competition on their heels and limited patent life, companies often choose speed. Given the impact on US market pricing, companies will need to consider tighter global pricing policies and options for a later launch (with stronger data) in foreign countries.

Drug price controls have been in place in many countries for many years. History in those countries has taught us that price controls often don’t deliver the promised savings and are then usually followed by more price controls. Since Medicaid drugs already receive sometimes substantial discounts, we can expect future disappointments over the savings achieved with MFN pricing. A natural next step could be to extend MFN pricing to Medicare Parts B and D, as was the plan in the original Trump administration plans.

The implication of this scenario is that international pricing will be even more critical than today. Careful analysis of the impact of various drug development options on prices across countries will become more important than ever, particularly since most of these decisions are made five or more years before US launch.

Ed Schoonveld is a value & access advisor for Schoonveld Advisory, LLC and author of The Price of Global Health.

1. GENEROUS Model Request for Applications from Applicable Manufacturers. Centers for Medicare & Medicaid Services. November 14, 2025. 

https://www.cms.gov/files/document/generous-rfa.pdf

Various agreements with the Trump administration could have long-term ramifications for Medicaid access and global pricing strategy.

The Longer-Term Impact of MFN Pricing

In today’s commercial arena, pharma leaders are flooded with more data than ever, but too often, it’s like swinging chairs in every direction with no clear target. The challenge isn’t lack of information; it’s a lack of connection.
 
Traditional analytics models weren’t built for the speed, complexity, and scale of the modern health data ecosystem where every EHR signal, claims transaction, or digital touchpoint carries commercial value. Biopharma teams sit at the intersection of prescribing data, patient access metrics, and new technologies, yet disconnected systems keep them from making real-time moves at the point of care, where it matters most.

From my experience across provider networks, data platforms, and life sciences partnerships, I’ve seen one truth hold up in every match: the next competitive advantage won’t come from more data; it will come from smarter connections. When we integrate directly into the systems where physicians and patients already make decisions, we’re not just adding intelligence; we’re creating a new playing field for how engagement happens in healthcare.

Redefining commercial efficiency through connected intelligence

The era of commercialization isn’t about who has the most data. It’s about who knows how to link their moves across systems, teams, and moments of care. When information flows across clinical, access, and engagement channels, pharma brands get a full-ring view of what’s happening—and physicians and patients receive more relevant, actionable support at the moment of need.

Commercial excellence isn’t achieved by buying more technology, but rather, by uniting what you already have so every move connects seamlessly and compliantly. The companies mastering this balance of precision, compliance, and connection are the ones rewriting the playbook for commercial success.

As data becomes more connected across health systems, insights evolve from static reports into living intelligence. The most forward-thinking commercial teams aren’t collecting more, they’re connecting better. By linking prescribing, payer, and engagement data, they gain the agility to adjust strategy in real time, not after the quarter closes.

This shift changes the role of analytics from observation to orchestration. Market access, marketing, and field operations can finally act from a shared, trusted view of what is happening in the care environment. Below are some examples of how connected intelligence creates real impact:

Integrating prescribing and access data reveals where coverage barriers slow therapy starts, helping teams focus on interventions where they’ll move the needle most.

Transparent, system-verified reporting shows who, where, and why decisions occur—so every message lands with intent, and every investment drives measurable outcomes.

Intent-based analytics detect prescribing signals weeks before pharmacy data appears, allowing accurate demand forecasting and early-adoption tracking. Combined with payer and pharmacy data, this foresight pinpoints bottlenecks before they become backlogs.

Precision outreach replaces guesswork, guiding engagement toward the right specialists, offices, and care teams. When these capabilities converge, commercialization shifts from reaction to anticipation, driven by insight that lives where care decisions are made.

Turning fragmented signals into connected strategy

In today’s commercial arena, the biggest opponent pharma teams face isn’t a shortage of data—it’s the chaos created by signals flying in from every direction with no unified game plan. Data lives everywhere, but trust lives nowhere. Just like stepping into the ring without knowing your opponent’s next move, disconnected intelligence leaves teams guessing instead of executing.

The future advantage will belong to the organizations that can turn scattered signals into coordinated strategy. Too often, commercial teams are forced to react to lagging indicators—claims data that arrives weeks late, pharmacy reports that miss early intent, or fragmented field updates that tell only part of the story. By the time these signals land, the match is already in the later rounds.

But when intelligence is unified upstream—directly inside the systems where physicians and patients make decisions—everything changes. Suddenly, teams aren’t fighting blind. They’re seeing openings in real time, anticipating barriers, and making the right move.

This shift turns fragmented insights into a shared, trusted view. When clinical, access, and engagement signals align, the entire ecosystem becomes stronger: patients move through access friction faster, physicians get timely support, and payers gain the clarity they’ve been demanding.

And just like any great competitor, the commercial teams pulling ahead are the ones using real-time insight to shape their next move. Instead of reacting to market swings, connected intelligence helps them predict which physicians are on the verge of adopting therapy, where access hurdles will appear, and how to engage before momentum is lost. That’s the difference between playing defense and owning the match.

We’re entering an era where data doesn’t just describe what is happening—it calls the next play. In a landscape defined by speed, pressure, and constant competition, the companies that master connected strategy will be the ones raising their hands in victory.

As AI and interoperability evolve, the future won’t belong to the teams that collect the most data, it’ll belong to the ones who connect it best. The real transformation isn’t AI itself; it’s the systems that feed it. Intelligent, compliant, connected frameworks are what make AI valuable, measurable, and scalable across healthcare.

The pharmaceutical industry has spent years chasing more data. Now, the main event is about connection across care settings, systems, and stakeholders. Those who build trust inside existing workflows, where care and decisions happen, will stand tall as the new champions of commercialization.

The next phase of commercialization isn’t about adding more data. It’s about connecting what we already have in smarter ways within the existing healthcare systems. Because when care, access, and action are finally connected, data stops being just analytics and becomes intelligence that moves healthcare forward.

And in this next decade of healthcare, the winners won’t be the ones shouting the loudest—they’ll be the ones making the right connections, at the right time, in the right ring.

Angelo Campano is the CEO of Flora Health, a healthcare technology company.

Pharmaceutical leaders face challenges not from a lack of data, but from disconnected systems that hinder real-time decision-making. The future of commercial success lies in integrating data across systems to create connected intelligence, enabling agile, data-driven decisions. This approach transforms analytics from mere observation to orchestration, allowing for precision access enablement and intent-based analytics. The shift from fragmented signals to coordinated strategy empowers teams to anticipate and act on market dynamics. Ultimately, the future belongs to those who connect data effectively, transforming it into actionable intelligence.

When intelligence flows across clinical, access, and engagement channels, commercialization shifts from reactive to predictive, giving teams the real-time edge to win in a fast-moving market.

Pharmaceutical Commerce - December 2025

A 'Beautiful Fake': Pharma Fraudsters Upping Their Game

Americans Call on Policymakers to Prioritize Healthcare Access and Affordability

The Longer-Term Impact of MFN Pricing

From Data Overload to Intelligent Commercialization: How Pharma Can Turn Connection Into Competitive Advantage