Strategies, which might have been successful for Big Pharma in the past, no longer have the desired impact in an ever-changing environment. Big Pharma is standing at the crossroads, feeling the urge to rethink their strategy. Biosimilars have entered the spotlight of innovative pharmaceuticals companies. The regional focus is starting to shift away from China to second tier emerging pharmaceuticals markets, diversification has come to its limits and companies are starting to re-focus. The growing impact of payers and regulatory bodies has not only influenced the overall approach to market access but also R&D decisions and business models. In most pharmaceutical markets risk-sharing contracts have been established in the light of market access tactics. Big Pharma is redesigning R&D and building global co-operations and networks targeting more specialized therapeutic areas with fewer patient numbers. Innovation for Big Pharma is no longer limited to drugs; today it includes diagnostics, patient monitoring and digital health solutions. Big Pharma is undergoing a process of change. Still many changes are yet to come. We support our clients from the pharmaceuticals industry in mastering their strategic challenges all along the value chain.