Sheldon Koenig of Esperion: Lessons I Learned From Last Year To Take Our Organization to the Next Level in 2025
An Interview With Chad Silverstein
Be open to opportunities. The partnerships Esperion has created with strong companies like DSE and Otsuka offer us the opportunity to expand globally in a way and at a pace we couldn’t do alone. We remain open to opportunities both for partnerships in other markets and to joining with companies developing innovative therapies that would be a good fit with our current portfolio.
This series aims to discuss the experiences and lessons learned by top executives over the past year, and how these insights are shaping the landscape for change and innovation in 2025. The past year has been a time of unprecedented challenges and opportunities, requiring adaptive leadership and innovative strategies. We believe that sharing these experiences can inspire and guide others in their endeavors to drive positive change in their organizations and industries. I had the pleasure of interviewing Sheldon Koenig, president and CEO, Esperion Therapeutics, Inc.
Sheldon L. Koenig has served as chief executive officer of Esperion Therapeutics, Inc., since May 2021 and was also appointed to the Board at that time. Before assuming these positions, Mr. Koenig served as the company’s chief operating officer since December 2020. Prior to joining Esperion, Mr. Koenig was the executive vice president and chief commercial officer at Portola Pharmaceuticals, Inc. Previously, Mr. Koenig was senior vice president and head of the cardiovascular franchise for Sanofi S.A., where he led U.S. business operations and product launches internationally, and earlier as vice president and global brand leader for the cardiovascular division of Merck & Co., Inc. where, for more than 25 years, he took on roles of increasing responsibility within the company’s cardiovascular and thrombosis franchises and led marketing for the launch of ezetimibe.
Esperion Therapeutics, Inc., is a commercial-stage biopharmaceutical company focused on bringing new medicines to market that address unmet needs of patients and healthcare professionals. The company developed and is commercializing the only U.S. Food and Drug Administration (FDA) approved oral, once-daily, non-statin medicines for patients who are at risk for cardiovascular disease and are struggling with elevated low density lipoprotein cholesterol (LDL-C).
Thank you so much for doing this with us! Can you share a little about your background and what pivotal moments led you to your current position as an executive?
It has been my privilege to work in the pharmaceutical industry for more than 35 years. It has always been my professional passion to help bring potentially life-saving medicines to healthcare providers and their patients. However, it was not until I realized my own health challenges, first with cancer and then with cardiovascular disease, that my profession became my driving personal passion as well. Four years ago, I was leading the commercial business at a small biopharma company and considering retirement. Then, Esperion approached me with the opportunity to lead their organization first as chief operating officer and later as president and CEO. After researching the company, its products and potential, I knew this position was not only an ideal fit because of my extensive background with cardiovascular therapies but also a strong fit personally as I deal with uncontrolled high LDL cholesterol myself. It was also a turning point for Esperion where I felt confident I could steer the company on a stronger path to success.
What were the early challenges you faced in your career, and how did they shape your approach to leadership?
Early challenges have included addressing the critical need to treat cardiovascular disease, the world’s largest cause of death, and truly educate patients. This is an ongoing challenge that cannot be taken for granted. Pharmaceutical companies and physicians need to work together to educate patients and make them aware of family history and other risk factors to open a discussion about what those patients can do about their risk.
This situation made it very clear to me the profound impact medicines can make for people dealing with potentially life-altering diseases. I also came to fully understand that, while medicines can have a positive effect for those dealing with health challenges, negative side effects can also be a hindrance in the successful management of a disease — and not all medications are right for everyone.
When it comes to cardiovascular disease, I learned early on that “one size” does not fit all. Even the most safe and effective treatment for one person can cause intolerable side effects for others. It is critical for healthcare providers — and patients — to have options to ensure all people have appropriate medications to treat their specific conditions.
We often learn the most from our mistakes. Can you share one that you made that turned out to be one of the most valuable lessons you’ve learned?
My biggest learning — especially from migrating from a major pharmaceutical company to small biotechnology company — was the art of really understanding return on investment (ROI). I no longer had a large shelf of capital where I could pull down money and just try everything. Now, at a small biotech, it’s all about the ROI and understanding how a dollar spent on a consumer campaign will make a difference vs. a dollar spent somewhere else. No longer could I run a pilot or a test and if it didn’t work say, “Oh well, let’s do better next time.” In biotech we need to be more precise and find the balance of the right spend to get our message out to the target audience. At Esperion we have found that balance between personal and digital promotion and are doing our best to address the needs of healthcare providers and patients.
As an executive, how do you define success, both personally and for your organization?
It has always been my passion to be part of an organization that is bringing life-saving medicines to patients in need. As a cancer survivor and someone dealing with the risks associated with uncontrolled high cholesterol, this passion has only grown stronger as I experienced my own health challenges and realized the benefits of appropriate medications. Additionally, I have seen others who have positively benefited from the medicines I’ve had a role in bringing to market. So, my definition of success is simple both for me and for Esperion: Discover, realize and bring life-saving medicines to healthcare providers and their at-risk cardiology patients.
Reflecting on 2024, what was the most unexpected challenge you faced, and how did you navigate it?
For Esperion, 2024 was a watershed year. Through our landmark cardiovascular outcomes trial, we realized a goal I’d identified upon taking the helm at Esperion to expand the appropriate indications for our products well beyond the highly restrictive label that was in place when I joined the company. Additionally, through the dedicated work of our CFO, Ben Halladay, and his team, we restructured the capital structure of the company, putting us in a much more advantageous position financially.
We also strengthened our partnership with Daiichi Sankyo Europe (DSE) and continue to enjoy a positive alliance with our Japanese partner, Otsuka Pharmaceutical Co. Ltd. (Otsuka). And, with an eye to further global expansion, at the end of 2024, Esperion announced our future global expansion through a partnership with Neopharm Israel. Our team looks at these accomplishments as critical building blocks to create a strong global foundation for the company in 2025 and beyond.
With all this activity in a relatively short period of time, the challenge for me as CEO was and continues to be to ensure that we focus our team on our overarching goal to establish a strong foundation for future growth for Esperion.
What was a significant risk you took last year, and how did it turn out?
Esperion is a relatively small company and managing multiple goals in any one-year period can certainly be considered a risk. We ran the risk of key people being pulled in too many directions, thereby diminishing their overall effectiveness. However, I’m happy to say that our teams remained focused and now that we have realized our goals, the distractions have diminished, and we are now even more focused on the future.
How has your company’s mission or purpose affected its overall success? Can you explain the methods or metrics you use to evaluate the impact of this purpose-driven strategy on your organization?
Esperion’s mission is to deliver innovative medicines that help patients reach their goals today, tomorrow and into the future. We offer the therapies to help people with uncontrolled LDL cholesterol, and we have seen payer access and physician acceptance growing steadily since the realization of our expanded label. To evaluate the impact of our strategy, not only do we look at overall sales performance but we are gratified that so many recognized leaders in cardiovascular medicine support and endorse our brands. However, we see this as only the beginning. Our R&D team is actively looking at new applications for our pipeline assets not only in cardiovascular disease but in other underserved medical conditions as well.
Have you ever faced a situation where your commitment to your purpose and creating a positive social impact clashed with the profitability in your business? Have you ever been challenged by anyone on your team or have to make a tough decision that had a significant impact on finances? If so, how did you address and reconcile this conflict?
I think we can create a good balance to reach the goals of our organization that will also have a significant social impact. It is all about making tradeoffs within the organization and valuing every dollar invested. I really want patients to get their lipids checked, know their family history and their risk. I take that very seriously and I invest my own time to passionately share my commitment so friends, family, and loved ones can get the care they need and deserve. I encourage everyone at Esperion to do so as well — not only by my words but also by my example.
Could you list the top five things you’ve learned in 2024, with specific examples of how these lessons impacted your decisions or strategies? If you can, please share a story or example for each.
1 . The past does not dictate the future. In 2024, we turned a significant corner for our company. Through the FDA approved label expansion, we took products with a highly restrictive label to ones that can now serve more than 70 million patients for both primary and secondary prevention of the risks associated with uncontrolled cholesterol, such as heart attack or stroke. By taking an unbiased look at the needs of our organization, we have built a solid foundation for growth. It isn’t always pleasant, but recognizing your weak points and determining how you can strengthen them is what puts a company on track for future success.
2 . Most situations can be resolved. I am particularly proud of how we addressed our capital structure in 2024. By being open to and exploring creative ideas and solutions, we were able to successfully restructure our financials, setting the company up for a strong future.
3 . Engage your team to support their strengths. While our team at Esperion is small, we are fortunate to have leaders with significant pharmaceutical experience in a variety of disciplines. It is my role as CEO to identify those strengths and then give my team the bandwidth to do what they do best. For example, we have a highly experienced market access team who developed creative strategies to engage payers, leading to an increase in adoption and coverage at a faster rate than we had planned.
4 . Stay current with trends and be prepared to change. The past few years have dramatically changed the way pharmaceutical products are marketed today. As a small company, we knew we needed an innovative approach to sales and marketing to optimize the opportunities of last year. Knowing the current landscape of pharma sales gave us the insights we needed to make the right decisions for our company which included a strong digital campaign targeting both healthcare professionals and prospective patients.
5 . Be open to opportunities. The partnerships Esperion has created with strong companies like DSE and Otsuka offer us the opportunity to expand globally in a way and at a pace we couldn’t do alone. We remain open to opportunities both for partnerships in other markets and to joining with companies developing innovative therapies that would be a good fit with our current portfolio.
How have these top five lessons from 2024 changed your outlook or approach for 2025?
Since 2024 was such a transformational year for Esperion, I believe the lessons we implemented last year allow us to be firmly focused on driving growth and supporting innovation for a promising future. The lessons of 2024 also reinforced our commitment to staying flexible in a dynamic market and being ready for new trends as they arise.
In terms of innovation and adaptation, what’s one change you implemented in 2024 or plan to do in 2025 that you believe will be crucial for the future of your business?
With the FDA approval of our expanded label, which holds the potential to significantly change the trajectory of our company, it is natural to want to shout it from the rooftops. In preparation for the launch of the expanded label, we took two critical actions regarding our sales and marketing programs. First, we increased our sales force, but only to a size that would optimize our efforts in today’s market. To support the field, we then launched a highly innovative and targeted marketing campaign that our chief commercial officer, Eric Warren, and his team developed to expand our awareness among prescribers and patients. The campaign, featuring memorable animated characters called the Lipid Lurkers, primarily uses digital platforms rather than pricier direct to consumer advertising venues. This strategy is working well for us and is financially appropriate for a company of our size.
As a leader, how do you foster a culture of continuous learning and improvement within your team or organization?
Our leaders and teams are empowered to think creatively and explore options that are nontraditional while adopting new technologies, such as Artificial Intelligence (AI), to support efficiencies and maximize budgets. I also encourage cross-functional teamwork at Esperion, which provides the opportunity for our colleagues to learn from other team members and generate new ideas and solutions. I believe in being a present leader, so I often attend team meetings, host regular coffee talk roundtables, and emphasize the importance of asking questions in different forums throughout the year. Culture is a priority at Esperion, and I’m very proud that we became a designated Great Place to Work® in 2024.
Looking at the broader industry landscape, what emerging trends do you think will be most influential in the coming year?
The industry landscape will always be challenging, whether by regulatory or reimbursement situations. The real imperative is how do we continually support patients and help them work through the haze of our healthcare environment. I think using social media, AI initiatives and simple online education will enable patients to be more aware of their health and to remind them to take care of themselves earlier rather than later.
If you and I were having a conversation one year from now, and we were looking back at the past 12 months, what specifically has to happen for you to be happy with your progress?
First, I’d like to tell you that our primary products continue to achieve sales growth and gain even more acceptance among the health care providers who recognize the need for more viable options to treat their patients with uncontrolled LDL cholesterol. I’d also like to report that our R&D initiatives are on track to discover new treatment options to address areas of high unmet needs in rare and orphan drug categories. I’d further like to emphasize how the Esperion team continues to be engaged, energized and dedicated to our mission to deliver innovative medicines that help patients reach their goals today, tomorrow and into the future.
How can our readers further follow your work or your company online?
More information on our company is available at esperion.com. More information on our scientific advancements and innovation is available at esperionscience.com. Follow Esperion on LinkedIn and X.
This was great. Thanks for taking time for us to learn more about you and your business. We wish you continued success!
About the Interviewer: Chad Silverstein is a seasoned entrepreneur with 25+ years of experience as a Founder and CEO. While attending Ohio State University, he launched his first company, Choice Recovery, Inc., a nationally recognized healthcare collection agency — twice ranked the #1 workplace in Ohio. In 2013, he founded [re]start, helping thousands of people find meaningful career opportunities. After selling both companies, Chad shifted his focus to his true passion — leadership. Today, he coaches founders and CEOs at Built to Lead, advises Authority Magazine’s Thought Leader Incubator.
Sheldon Koenig of Esperion: Lessons I Learned From Last Year To Take Our Organization to the Next… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.