Good morning, Nitin.

IA From the InTune Desk

Two insights anchor today's edition — an Execution Gap in the field and a fast-moving Pineapple competitive threat. Both are time-bound. Both connect.

Daily Rundown · 4 min listen

Today's Mango+Pear briefing — Execution Gap and the Pineapple Threat.

My insights & alerts

9 insights filed today across Mango+Pear, Papaya, Dragonfruit

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High confidence · r=+0.97

Q1 2026 · Feb survey

Doctors prefer Mango+Pear over Strawberry for the first time ever — LTIP +6 points, Share of Voice at widest margin on record (+12 over Strawberry).
Field Execution Attainment at 68% — down 14 points in 6 months, 13 below goal, decline tracks the Pineapple entry timeline.
3 territories drive 62% of the decline; 47 high-intent accounts sit below 60% FEA, 8 of the top 10 are single-outlet.

Why this matters FEA has a near perfect lag to revenue (r=+0.97), so Q2 and Q3 share is already being written. The likely cause is targeting drift — reps reacting to Pineapple's entry instead of working high-intent accounts.

Recommendation

Move field effort to the 47 high-intent accounts.
Brief the 3 territories by Friday.

Physician intent has never been higher, but the field has been working the wrong accounts. FEA fell 14 points to 68%, concentrated in 3 territories driving 62% of the decline and 47 high-intent accounts below 60% FEA. Because FEA has a near perfect lag to revenue, Q2 and Q3 share is already being written.

Recommendation

Reallocate the field to the 47 high-intent accounts this quarter. Brief the 3 territory leads by Friday.

Medium-high confidence · inferential

Dec 2025

Pineapple entered second line in July 2025, growing 6x faster than Dragonfruit, expansion ratio 22-27% QoQ.
8.2% new second line patient share in 5 months — fastest entry on record, harvesting from All Other and Orange.
Concentrated in community accounts where field execution is weakest; no first line presence yet.

Why this matters The growth shape matches Strawberry's early phase, which reached academic formularies in 2 quarters. Once Pineapple gets there, the threat becomes structural — and the window to contain it is open today.

Recommendation

Escalate to brand leadership this week.
Build a second line defense playbook before the academic move.

Pineapple entered second line therapy in July with zero share and is now at 8.2% new patient share, the fastest entry the category has ever seen. It is growing 6x faster than Dragonfruit, concentrated in community accounts where field execution is weakest. The growth pattern matches Strawberry's early phase, and Strawberry used community footholds to reach academic formularies within 2 quarters. Once that happens, the threat becomes structural.

Recommendation

Escalate to brand leadership this week and build a second line defense playbook before the academic move.

High confidence · actuals

Feb 27 2026 · 9-week

Orange Mango is +112.7% over JU over 9 weeks, no revision issued; Green Mango also beating at +17.6%.
But Mango+Pear is -0.67pp under NU in December, the worst monthly miss of the year, widening since June.
The two forecasts have diverged for 6 months with no reconciliation event; Pear is the only brand accurate to both.

Why this matters Leadership is being shown two different versions of the same brand. The JU view says we are overdelivering; the NU view says we are underdelivering. Both are true, and the decisions made off each will differ.

Recommendation

Reconcile the forecasts before Q1 close.
Decide which is the operating baseline for H1 decisions. Owner: Brand Finance + Brand Lead.

Orange Mango is running +112.7% over the JU forecast with no revision issued, while Mango+Pear came in -0.67pp under the NU forecast in December — the worst monthly miss of the year. The two forecasts have diverged for 6 months running. Leadership is being shown two different versions of the same brand, and the decisions made off each will differ.

Recommendation

Reconcile the forecasts before Q1 close and decide which is the operating baseline for H1 decisions.

High confidence · Q4 study

Q4 2025

Mango NPS +33 points in 6 months (12 to 45); Pear +28 to 31. Fastest trajectory in the category, Strawberry still at 77.
MAC score stalled at 37 for 2 consecutive quarters; Q1 2026 data still 90+ days dark.
Closing rate at 48%, still 10 points behind Strawberry despite 18 months of gradual improvement.

Why this matters Because MAC has a near perfect lag to revenue (r=+0.97), the advocacy surge is sitting in front of a conversion bottleneck. The likely cause is the rep handoff — physicians want the brand, the field is not closing the loop. Same accounts as the Execution Gap.

Recommendation

Pair NPS gains with a rep-mediated conversion brief for the 47 high-intent accounts.
Connect this work to the Execution Gap response.

Mango climbed +33 points in six months, the fastest trajectory of any brand in the category. Pear followed at +28. But the MAC score has stalled at 37 for two quarters, and the closing rate is still 10 points behind Strawberry. Physicians are reporting satisfaction; they are not yet converting that satisfaction into prescriptions. Because MAC has a near-perfect lag to revenue (r=+0.97), the advocacy surge is currently sitting in front of a conversion bottleneck.

Recommendation

Pair NPS gains with a rep-mediated conversion brief for the 47 high-intent accounts identified in the Execution Gap. The advocacy is built; the conversion needs the field.

Medium confidence · cause hypothesis

Feb 2026

Maintenance volume down 41% over 3 months (7,549 to 4,462 units); Dragonfruit is 4.7x larger than Lychee but losing the high-volume base.
SUD flat at +2.4%, new starts are not the problem; top 10 accounts run 78.5 to 289 units/outlet.
Decline accelerating, monthly drop worsened from -15% in January to -25% in February, no stabilization signals.

Why this matters Maintenance is the retained revenue base, new starts replace it rather than add to it. The likely cause is Lychee pull, not Dragonfruit failure — Lychee account growth is 6x faster in the same accounts. Switching, not churn.

Recommendation

Pull a switching analysis on the top 10 Dragonfruit accounts.
Confirm Lychee pull before responding. Owner: Comp Intel + Account Lead.

Dragonfruit maintenance volume is down 41% over three months (7,549 to 4,462 units), and the decline is accelerating from -15% in January to -25% in February. But SUD is flat at +2.4% — new starts are intact. Meanwhile Lychee account growth is running 6x faster (+373% vs +58%) in the same accounts. This is switching, not churn — Lychee pull, not Dragonfruit failure.

Recommendation

Pull a switching analysis on the top 10 Dragonfruit accounts and confirm Lychee pull before responding.

High confidence · cross-indicator

Q1 2026

LTIP +6 over Strawberry (intent — leading).
Share of Voice +12 (attention — leading).
Closing rate -10 vs Strawberry (behavior — lagging).
MAC score -26 vs Strawberry (behavior — lagging).
Total share -67 vs Strawberry (behavior — lagging); pattern held for two quarters.

Why this matters The brand has earned a position the market has not yet given it. Every other card on the homepage is a different face of this gap — position earned, conversion not yet caught up.

Recommendation

Treat the lead as earned position to defend, not victory to celebrate.
Evaluate every Q1 action by whether it closes the leading-to-lagging gap.

Mango+Pear leads Strawberry on every leading indicator — +6 on intent, +12 on share of voice, both at category records. But the moment the measurement turns behavioral, the lead inverts: -10 on closing rate, -26 on MAC, -67 on total share. The brand has earned a position; the conversion machinery has not yet caught up. This card is every other card on the homepage in one frame.

Recommendation

Treat the leading-indicator lead as earned position to defend, not victory to celebrate. Evaluate every Q1 action by whether it closes the leading-to-lagging gap.

High confidence · NTS actuals

Q1 2026 · 9 weeks

Orange Papaya NTS BP Attainment at 118.4% over 9 weeks; no JU revision issued.
Green Papaya is -3.2% under JU, the weakest of the Fruit Basket 1 portfolio.
Fruit Basket 1 rollup shows +6.1% mix-driven blend, obscuring the variance underneath.

Why this matters Reporting at the basket level masks divergent brand trajectories. Decisions made off the rollup will mis-resource Green Papaya and over-credit Orange Papaya.

Recommendation

Revise Orange Papaya JU upward before Q1 close.
Diagnose Green Papaya gap separately. Owner: Brand Finance.

The Fruit Basket 1 rollup looks healthy at +6.1%. Inside the basket, Orange Papaya is running +18.4% above BP with no JU revision issued, and Green Papaya is tracking -3.2% under JU. Decisions made off the rollup will mis-resource Green Papaya and over-credit Orange Papaya.

Recommendation

Revise Orange Papaya JU upward before Q1 close and open a separate diagnostic on Green Papaya.

Medium confidence · share actuals

Feb 2026

Yellow Papaya share has dropped 2.1 percentage points over two quarters, the steepest fall in the Papaya family.
Red Papaya is holding share within ±0.3pp; Green Papaya is gaining +0.8pp.
Yellow Papaya is -1.4pp under NU forecast, the only Papaya variant missing.

Why this matters The Papaya family read is stable but one variant is in decline. Without sub-brand visibility, the issue stays invisible to leadership.

Recommendation

Open a Yellow Papaya-specific share review this week.
Surface sub-brand variance in the next leadership pack.

The Papaya family read looks stable, but the rollup is hiding a 2.1pp share drop in Yellow Papaya over two quarters. Red Papaya is holding, Green Papaya is gaining +0.8pp, and Yellow Papaya is the only Papaya variant missing NU forecast. Without sub-brand visibility, the decline stays invisible to leadership.

Recommendation

Open a Yellow Papaya-specific share review this week and surface sub-brand variance in the next leadership pack.

High confidence · account hierarchy

Q1 2026

Productivity Goal at 101% — output is intact at the account level.
But Top Parent Writers Goal at 74%, down 14 points since November.
The remaining writers are concentrated in 3 top parents, accounting for 58% of total volume.

Why this matters Volume looks healthy because concentration is masking writer attrition. If any of the 3 top parents shifts to Lychee, the productivity number collapses.

Recommendation

Audit the 3 concentration accounts for switching signal.
Set a writer-recovery target for Q2. Owner: KAM lead.

Dragonfruit Productivity Goal is sitting at 101% — output looks intact. But Top Parent Writers Goal has dropped to 74%, down 14 points since November. The remaining writers are concentrated in 3 top parents accounting for 58% of total volume. If any of those 3 shifts to Lychee, productivity collapses.

Recommendation

Audit the 3 concentration accounts for switching signal and set a writer-recovery target for Q2.

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Field execution scan

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Checked 12 sources and found 47 high-intent accounts below 60% FEA.

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JU and NU views disagree on the brand story. Agent needs the operating baseline before packaging.

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TREMFYA Q2 Performance Review

A signals-and-story brief on where the brand is, why, and where the next decisions need to land — assembled from 5 pinned insights and 14 source signals.

Forecast attainment at 95% — 5pp behind plan, concentrated in induction pack.

Share-driven, not market-driven — TREMFYA declining faster than the IL-23 category.

4 Must-Win IDNs concentrate the gap; field activity tracking 30% below plan in those accounts.

Counterweight: Centene win opens ~280k eligible lives ahead of H2.

KBQ 1 The Forecast Story 5 min read Filed today, 04:18 IST

TREMFYA is missing forecast — but not because the IL-23 market is shrinking.

A four-step walk through where the 5pp gap actually lives, why it's a share problem and not a category problem, and what the next decisions need to focus on.

IA InTune Intelligence Packet · Sources: NPA/DDD · XPO/DDD · ATC · Verified

01 Signal Weekly cadence · Forecast vs Actuals

Weekly units sit 5pp below forecast — and the entire gap is in induction pack.

IV maintenance is on plan. Existing patients are refilling at expected rates.
Induction pack carries the miss. The front-door product for new starts is soft.
The gap has held for ~8 weeks. Persistent, not a one-week anomaly.

Weekly IV + Induction Pack Total Units vs Forecast (26 BPA)

W/E Dec 5 2025 — Feb 27 2026 · Units (thousands)

Forecast (26 BPA) Actuals

Source: NPA/DDD · ATC Non-Commercial Units · Refreshed 04:12 IST today

Drill down on the data

Through twelve weeks of 2026, TREMFYA's combined IV and Induction Pack volume sits roughly 5% below the 26 BPA forecast. The gap first opened in late January and has held — not widening dramatically, but not closing either. That kind of persistent, narrow shortfall is the worst kind. It's not a one-week anomaly you can dismiss, and it's not a cliff that forces a structural response. It just sits there, eating into the run rate.

So the right question isn't "are we missing forecast" — we know we are. The right question is why is induction pack soft, when IV is fine? That's where the next chapter takes us.

02 Drill-down Category vs brand · IL-23 induction

It's a share problem, not a market problem — Skyrizi is taking the volume.

TREMFYA is bending faster than the IL-23 category. Our line drops more steeply than the segment overall.
Skyrizi is the destination. The volume isn't disappearing — it's relocating.
This changes the playbook. Share-loss requires fighting for volume, not accepting trajectory.

GI IL-23 Weekly EqU Induction trends — TREMFYA vs Skyrizi vs Market

EqU = Equivalent Units · 13-week trailing

TREMFYA Skyrizi IL-23 Market

Source: NPA/DDD · Most recent 13-week trend

The category is softening. But Skyrizi is bending shallower than we are — which means our volume isn't disappearing, it's relocating. — InTune analytical pattern · Confirmed across 3 reference periods

Drill down on the data

When a brand misses forecast, the first reflex is to ask whether the whole category is soft. In this case — the IL-23 induction market overall has softened in Q1. So that's a real factor. But it's not the full explanation.

The chart shows TREMFYA's induction volume against the IL-23 category and against Skyrizi specifically. Every line is bending down — confirming the category-wide softening. But TREMFYA's line is bending faster than the category's. The gap is share moving, not just market moving.

This matters because the two diagnoses lead to opposite responses. If it's a market problem, you accept the trajectory. If it's a share problem, you fight for the volume — and you fight for it where it's moving.

03 Drill-down Account-level concentration · Class of Trade

4 of 7 Must-Win IDNs concentrate the gap — and the causes split clean.

Must-Win IDNs are the only segment declining. Beyond MW, IOIs, and Others are flat or growing.
2 IDNs show formulary tightening that took effect early Q1.
2 IDNs show call frequency below target on priority decile through the same window.

TREMFYA Induction volume growth by Class of Trade

Indexed: Jan 2025 = 100 · Year-over-year volume trajectory

Must-Win IDNs Beyond MW IOIs Others

Source: XPO/DDD · Class-of-trade indexed view

Drill down on the data

The next layer is Class of Trade. Breaking the same volume out by COT exposes the actual geography of the problem. Most segments are flat or modestly growing. Must-Win IDNs are the exception: declining growth in the most recent month, doing most of the work pulling the topline back.

Inside that segment, the concentration tightens further. Four of the seven Must-Win IDNs are responsible for the majority of the volume decline. Two have formulary tightening that took effect early Q1; two have call frequency below target through the same window.

This is where the story gets actionable. A 5pp brand-level miss is not, by itself, a thing you can act on. But four named IDNs, with two distinct root causes, are problems with owners and timelines.

04 Hypothesis · Next 48h Account view · Available Mar 18

The response splits clean: 2 Access plays + 2 Field plays.

Access (2 IDNs): formulary tightening — likely a contract revisit; MAcc team confirms feasibility this week.
Field (2 IDNs): reallocate call effort + re-brief on IL-23 positioning material.
Centene is the counterweight. 280k newly-eligible lives don't fix Must-Win, but change H2 math before steerco.

What's pending and what's next

The full account-by-account view will be ready Mar 18, when XPO refreshes its Q1 IDN-tier data.

That's not a decision yet — it's a scaffold for one. The next 48 hours should produce the named accounts and a first-pass owner map. The week after, the Market Access team confirms whether a contract conversation is feasible inside Q2.

Pin this chain and InTune will assemble a 4-slide storyboard around the narrative — signal, drill-downs, hypothesis. Editable.

01 Situation Mango+Pear · Q1 2026 · Feb survey

The brand is in its strongest position ever — but the field is not converting it.

Doctors prefer Mango+Pear over Strawberry for the first time on record. LTIP at 71%, +6 points over the leader.
Share of Voice is at the widest margin ever recorded. Reps are in more rooms than the competition.
But Field Execution Attainment has fallen for 6 straight months. Effort is in. Conversion is not.

The story behind the numbers

For the first time in the brand's history, physician intent has crossed Strawberry. Long Term Intent to Prescribe sits at 71% — six points clear of the long-standing leader. Share of Voice is at its widest gap on record. By every leading indicator that has historically predicted share, this brand has earned the right to win.

The field has not converted that position. Field Execution Attainment has dropped from 82% in September to 68% today — 13 points below the 81% goal, and still falling. Reps are visiting accounts at record rates. They are just visiting the wrong ones.

02 Evidence Where the gap is concentrated

The gap is not spread evenly — it sits in a small set of accounts.

3 territories drive 62% of the FEA decline. The rest of the country is largely on plan.
47 high-intent accounts sit below 60% FEA. These are doctors who said they want to prescribe and reps are not showing up.
MAC Score has stalled at 37 for 2 consecutive quarters. Physician advocacy is not converting into actual prescription.

FEA trajectory · September 2025 → February 2026

Six months of decline · 82% → 68% · Goal: 81%

FEA actuals Goal 81%

Source: Field Force Survey · February 2026 · Q1 2026 data pending

Drill down on the where

Three territories are doing the bulk of the damage. Together they account for 62% of the national FEA decline. The rest of the field is largely on plan — which means this is not a structural issue with the field force. It is a targeting issue with a small subset.

Inside those territories sit 47 high-intent accounts with FEA below 60%. These are not random accounts. They are accounts where doctors have explicitly expressed strong intent to prescribe Mango+Pear — and reps have not visited at the cadence required to convert that intent. The MAC Score plateau at 37 for two quarters confirms it. Advocacy is in place. Prescription is not.

03 Why this matters FEA → Revenue lag · r = +0.97

This is not a warning — it is a forecast.

FEA has a near-perfect lag to revenue at r = +0.97. What the field does today determines share two quarters out.
Q2 and Q3 share is already being written. Today's execution gap is tomorrow's revenue miss.
Every week of delay compounds the miss. The math does not flatten — it accumulates.

Field Execution Attainment is the most reliable leading indicator of revenue we have in this brand. At r = +0.97, it is not a signal we monitor. It is a signal we are already living inside. — InTune analytical pattern · Confirmed across 8 quarters of historical data

Why the math is unforgiving

The correlation between FEA and forward revenue is the strongest of any leading indicator in the brand's measurement stack. Over eight quarters of historical data, FEA at quarter T predicts revenue at quarter T+2 with a Pearson correlation of +0.97. That is not a statistical curiosity — it is operational physics. Reps work accounts. Accounts convert at predictable rates. Conversions become prescriptions two quarters later.

The implication: a 14-point FEA decline over six months is not a future risk. It is a present commitment. Q2 share is being decided right now by where the field is and is not showing up. Q3 follows. There is no version of the math where this self-corrects.

04 Most likely cause Targeting drift · Pineapple-related

Targeting drift — reps are playing defense when they should be playing offense.

Reps are reacting to Pineapple's competitive entry. They are defending accounts under threat instead of working accounts ready to prescribe.
The fix is reallocation, not effort. The field is working hard. It is working the wrong list.
This is the same accounts Pineapple is taking. The execution gap is creating the vacuum Pineapple is filling.

How the drift happened

Six months ago, Pineapple entered the second line therapy market with zero share. By December it had captured 8.2% of new second-line prescriptions — the fastest competitive entry the category has ever seen. The field noticed. Reps started spending more time in accounts where Pineapple was active, defending share.

What the data shows now is that those defensive visits came at the expense of the high-intent accounts where Mango+Pear had already won physician preference. Reps were doing the right kind of work in the wrong places. The result is an FEA collapse concentrated in the exact accounts where conversion was easiest. Targeting drift, not performance failure.

This matters for how the conversation lands with the field. Framing this as a performance problem invites defensiveness. Framing it as a strategic reallocation — "we have an opportunity we are missing" — invites engagement.

05 Recommendation By end of Q2 · This week

Reallocate the field to the 47 high-intent accounts this quarter.

Brief the 3 territory leads by Friday. Hand them the 47 named accounts and the LTIP × FEA cross-reference.
Set a 75% FEA floor as a Q2 milestone. Named ownership at the territory level.
Frame internally as reallocation, not performance. The field needs direction, not scrutiny.
Do not wait for the next MAC refresh. The lag means every week of delay compounds the Q2 miss.

This insight pairs with Pineapple Threat — the same accounts the field is leaving unattended are where Pineapple is winning fastest. The two insights are two sides of one story.

01 Situation Mango+Pear · Competitive · Dec 2025

A new competitor is moving faster than the category has ever seen.

Pineapple entered second line therapy in July 2025 with zero share.
By December, it reached 8.2% new second line patient share. The fastest competitive entry on record.
Currently contained to second line and community accounts. No first line presence yet. No academic center foothold yet.

The story behind the speed

In July 2025, Pineapple launched into second line therapy with no measurable share. Five months later, it commanded 8.2% of new second line patients. To contextualize: Dragonfruit, the previous fastest entrant in this category, took roughly 18 months to reach equivalent share. Pineapple did it in five.

The threat right now is contained. Pineapple is only being prescribed at second line, and only in community accounts — not the major academic medical centers that drive formulary decisions and influence community prescribing. But the growth trajectory and the targeting pattern point somewhere specific, and the window to mount a structural defense is closing.

02 Evidence Where Pineapple is winning today

The growth is 6x faster than the last fastest entrant — concentrated where execution is weakest.

0 to 8.2% new second line share in 5 months. Fastest entry on record by a factor of 3.
Growing 6x faster than Dragonfruit in the same accounts. Expansion ratio of 22-27% QoQ vs Dragonfruit's 12-15%.
Concentrated in community second line accounts. Where field execution is weakest and physician reinforcement is lowest.
Orange and All Other brands are donating the share. Orange down 7.8pp YTD, All Other down 10.4pp YTD.

Pineapple new second line patient share · July 2025 → December 2025

Five months · 0 → 8.2% · Fastest entry on record

Pineapple new L2+ share

Source: XPO/DDD · ATC Non-Commercial Units · Confirmed across 3 reference periods

The targeting pattern

Pineapple is not winning everywhere. It is winning in community second line accounts — the exact accounts where Mango+Pear's Field Execution Attainment has collapsed over the same period. The overlap is not coincidence. These are accounts where field presence is lowest, physician reinforcement is weakest, and the path of least resistance is open.

The expansion ratio tells the same story. Pineapple is adding 22 to 27% new accounts quarter over quarter, against Dragonfruit's 12 to 15% at the same launch stage. Lychee account growth is +373% (44 to 208) versus Dragonfruit's +58%. Every leading metric of competitive momentum is pointed in the same direction, faster than precedent.

03 Why this matters The structural risk

If Pineapple reaches academic formularies, this becomes structural — and structural is hard to reverse.

Academic formulary footholds are sticky. Once listed, drugs are not easily de-listed.
Academic centers influence community prescribing. A foothold there compounds across the broader market.
Cost of reversal multiplies once structural. Field-level response is cheap. Access-level response is expensive.

The window to mount a structural defense is open now and closing fast. The cost of acting this quarter is a defense playbook. The cost of acting after Pineapple reaches academic formularies is significantly higher and the response is significantly less likely to succeed. — InTune strategic assessment · Medium-high confidence

The math of structural risk

Drugs that win formulary positions at academic medical centers create three compounding effects. First, formulary lists are reviewed annually at best — typically less often. Once a competitor is in, removing them requires a clinical or economic case that takes years to build. Second, academic centers train the next generation of community prescribers, who tend to prescribe what they were trained on. Third, academic KOL endorsement carries into peer-reviewed literature and clinical guidelines that influence prescription decisions market-wide.

None of this is yet a confirmed signal. Pineapple has no academic foothold today. But the pattern — community entry, then academic, then first line — is the same pattern Strawberry used in its early growth phase. That is what the next chapter is about.

04 Most likely pattern Strawberry analog · 2-quarter window

We have seen this growth pattern before — it became Strawberry.

Pineapple's entry rate, account targeting, and expansion ratio all match Strawberry's early growth phase.
Strawberry used community footholds to reach academic formularies within 2 quarters.
Once academic access was secured, Strawberry moved to first line within 4 quarters.

The Strawberry analog

The reason this insight earns higher urgency than a typical competitive watch is the pattern recognition. Three leading indicators — entry velocity, account expansion ratio, community concentration — all match the early growth phase of Strawberry, which entered this category five years ago and has since become the long-standing market leader.

In the Strawberry case, community formulary footholds preceded academic medical center access by approximately two quarters. Academic access preceded first line therapy approval by four. That is the timeline this insight is implicitly forecasting if no proactive response is mounted.

Confidence on the pattern itself is medium-high. The entry data and the growth trajectory are reliable. The academic center prediction is inferential, based on the Strawberry precedent rather than confirmed Pineapple signal. No first line Pineapple data exists yet. The analog is strong, but it is an analog, not a forecast.

05 Recommendation Within 2 quarters · Escalate this week

Build the second line defense playbook before the academic move.

Map Pineapple active accounts against high-LTIP Mango+Pear accounts. Highest risk to lose, highest priority to defend.
Identify the community accounts where Pineapple expansion ratio is highest. These are the leading indicators of where it moves next.
Develop a clinical differentiation narrative specifically for second line. Pineapple is not yet winning on clinical — it is winning on presence.
Escalate to brand leadership this week. This is a proactive response, not a monitoring exercise.

This insight pairs with Execution Gap — Pineapple is winning in the exact accounts where Mango+Pear's field execution has collapsed. Fixing one helps fix the other.

Good morning, Nitin.

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Mango+Pear Commercial · DERM

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TREMFYA Q2 Performance Review

TREMFYA is missing forecast — but not because the IL-23 market is shrinking.

Weekly units sit 5pp below forecast — and the entire gap is in induction pack.

It's a share problem, not a market problem — Skyrizi is taking the volume.

4 of 7 Must-Win IDNs concentrate the gap — and the causes split clean.

The response splits clean: 2 Access plays + 2 Field plays.

The brand is in its strongest position ever — but the field is not converting it.

The gap is not spread evenly — it sits in a small set of accounts.

This is not a warning — it is a forecast.

Targeting drift — reps are playing defense when they should be playing offense.

Reallocate the field to the 47 high-intent accounts this quarter.

A new competitor is moving faster than the category has ever seen.

The growth is 6x faster than the last fastest entrant — concentrated where execution is weakest.

If Pineapple reaches academic formularies, this becomes structural — and structural is hard to reverse.

We have seen this growth pattern before — it became Strawberry.

Build the second line defense playbook before the academic move.

Mango+Pear Commercial · DERM

How is TREMFYA performing vs. forecast?

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