Medical Affairs in Small Biotech: Lessons from Rachel Couchenour of Travere Therapeutics

Building a Medical Affairs function inside a small or emerging biotech is one of the hardest -- and most underrepresented -- challenges in the field. The playbooks written for large pharma rarely translate, and the margin for missteps is thin.

In Episode 14 of OnPoint: The Medical Excellence Podcast, Scott Thompson sits down with Rachel Couchenour (VP of Medical Affairs at Travere Therapeutics), a Medical Affairs leader who has navigated both ends of the spectrum -- from large pharma infrastructure to lean, resource-constrained biotech environments. Rachel shares what it actually takes to build and lead a Medical Affairs function when you're a team of one, why getting the scientific narrative right before deploying field teams is non-negotiable, and how small teams can create real omnichannel impact without big-company budgets. Whether you're considering a move to a smaller organization or building from scratch right now, this episode delivers grounded, practical perspective you won't find in a textbook.

Key Takeaways:

• Start with the scientific narrative -- Before activating field teams or engagement strategies, Rachel emphasizes building a clear, credible scientific story. Without it, field efforts lack direction and internal alignment suffers.
• Prioritization is a survival skill -- In resource-constrained environments, everything feels urgent. Rachel offers a practical framework for identifying what actually moves the needle and protecting the team's capacity for highest-value work.
• Small doesn't mean limited -- Lean teams can drive meaningful omnichannel impact by being strategic about partnerships, agency relationships, and technology choices rather than defaulting to headcount.
• Cross-functional alignment starts early -- Building relationships with Commercial, Market Access, and other functions from the outset prevents the silos that derail Medical Affairs influence later.
• Career growth looks different in small biotech -- Traditional ladder climbing doesn't apply. Rachel reframes career development as breadth of ownership and depth of impact -- a perspective that resonates beyond small organizations.
• Culture is built intentionally -- Even the smallest details matter. Rachel shares how informal team rituals, including an unexpected stuffed animal mascot, can shape cohesion and morale in high-pressure environments.

About Our Guest

Rachel Couchenour is VP of Medical Affairs at Travere Therapeutics, a rare disease biopharmaceutical company focused on developing and commercializing therapies for rare kidney diseases. She brings extensive experience leading Medical Affairs functions across both large pharma and emerging biotech, with particular expertise in building teams and strategies from the ground up in resource-constrained environments.

Connect with Rachel on LinkedIn: https://www.linkedin.com/in/rachelcouchenour/

Bonus: Learn about “Flossy the Focused Flamingo” and how stuffed animals are shaping team culture!

About OnPoint: The Medical Excellence Podcast

OnPoint: The Medical Excellence Podcast delivers insightful conversations on the most pressing issues facing top Medical Affairs professionals. Listen to stay ahead of industry trends and be inspired by leaders shaping the future of Medical Affairs.

Find more episodes on our OnPoint YouTube channel.