The C-Level Hiring Guide · CMO
It is totally useless to have a superb CMO when you are three years away from first in human, Jan De Kerpel said on Willing to Win. He is right. The CMO becomes due around Series B, when medical decisions start to outnumber scientific ones and nobody owns them full-time. From there the seat changes twice more. This page walks it through the stages and lays out the package.
Three jobs share the title
The CMO who designs Phase 2 is almost never the CMO who runs Phase 3 in seven markets. Write down which one you need, and one more line: when medical and science disagree, who decides.
Takes the molecule into humans. IND or CTA, the protocol, the first sites, the first regulatory meeting, the medical story behind the round.Often the only physician in the building. The Series B CMO.
Phase 3 across countries. Owns the label conversation, builds the medical function underneath: safety, medical writing, medical affairs.A leadership job as much as a clinical one. The Phase 3 CMO.
Payers and access, medical affairs at scale, KOL networks per market, defending the label after approval.Closest to commercial.
The seat, stage by stage
Six stages, one seat. The label is the state of the seat at that stage; the line under it is what the seat has to deliver. All ten roles on one timeline.
Not yetSeed, preclinical. An independent scientific and regulatory advisor. Start the relationship with your future CMO now; the seat has a long lead time.
Not yetSeries A, heading for IND. In most cases there is no CMO yet, and there should not be. A medical advisor or a fractional CMO, two days a month, builds the path to IND beside the CSO. In a business-led company the seat can fire a stage early.
First permanent hireSeries B, Phase 1b/2. The biggest science risk at this stage is a Phase 2 designed by your CRO rather than by you. The CMO is the first senior medical and development owner. In the US the hire leans toward FDA interactions, in Europe toward EMA and CTIS.
UpgradeSeries C, Phase 2. The Phase 2 readout defines whether the company exists in three years. Development splits out under a CDO, and the CMO question becomes whether the person who designed the trial can carry the registrational programme.
RegistrationalPhase 3, pre-commercial. Multi-site Phase 3, end-of-Phase-2 and pre-NDA conversations with regulators, a clinical organisation of thirty to eighty people, the public face of the science together with the CSO.
SuccessionFiled, approved, selling. Medical affairs and the label after approval. The next CMO is planned, not improvised.
Three patterns I see again and again
Patterns, not real companies. Each one had a different fix than a search.
After the IND he kept answering the medical questions himself. The CMO arrived fourteen months later, after half the Phase 2 had been committed by people who had never designed one.
Signed eighteen months before the IND, with nothing to own. He left four months before the filing.
Phase 3 planning turned her job into governance. Visible a year earlier, in what she stopped volunteering for.
Which shape
A permanent CMO is the second or third most expensive person on your payroll. Count backwards from the readout: twenty-one months out means three of search, three of notice, three of ramp and a year in the seat before the data. If that date is behind you, hire an interim medical lead now and search behind it.
Pre-IND through the first regulatory interaction. Two days a month at seed, a full-time CMO about eighteen months later.An interim lead can own trial design and the first patients.
During a Phase 2 readout, or when the CMO leaves mid-trial.An interim lead leaves once the design is locked. At the readout you want someone who was there from the start.
Twelve to eighteen months before the readout that defines the value of the asset, typically late Phase 1b or early Phase 2.Companies that delay pay in trial momentum and regulatory missteps. Companies that hire too early pay a senior salary for an underemployed executive.
The package
Base, bonus, equity, change of control, severance. The structure is the same in every market. The numbers and the contract law are not.
What the package covers
The one number everyone quotes and the least informative one. It moves with market (Boston and Basel differ), stage and whether the company is listed. Private biotechs pay double-digit percentages below listed peers at C-level.
A target as a percentage of base, paid on milestones the board can verify. I tie it to outcomes, never to activity. Listed US biotechs set targets around 40 to 50 percent of base for non-CEO roles and 60 to 66 percent for the CEO (Bedford Group, FY2023 proxy data).
In a private company a percentage of the fully diluted shares, usually options, vesting over four years with a one-year cliff, refreshed at the next financing rather than annually. Listed companies grant an annual value, increasingly a mix of options and restricted stock.
Often the real negotiation. Candidates walk over trigger terms and unvested equity more often than over base. Double trigger (deal plus loss of the job) is what governance advisers and proxy firms prefer; over 85 percent of listed US biotechs allow some acceleration.
Private companies write one number in months of salary. Listed US companies: twelve months for the CEO is the norm, nine to twelve for the others, and eighteen months of salary plus target bonus on a change of control for the CEO (Pearl Meyer; Bedford). Notice periods in Europe are a contract matter, see the country layer below.
Sign-on appears from Phase 1 and 2 onward, rarely preclinical. Relocation is the honest conversation more often than people admit. Outside commitments (board seats, advisory work, an academic post) get settled before the offer, not after.
Ranges, with sources
Numbers move every quarter, so treat these as the shape of the market, not as an offer. Medians and ranges, native currency, source and year in the last column.
| Market and stage | Base | Bonus | Equity | Source |
|---|---|---|---|---|
| US, listed (small cap) | Base median $482K to $490K | Target 40 to 47% of base | Annual grant median $252K to $1.46M | [1] |
| US, private, preclinical | Recruiter offers $280K to $340K; a 2022 Pave sample shows $450K median | 25 to 35% | 0.5 to 1.2% fully diluted | [2] |
| US, private, clinical (Series B, C) | $380K to $460K | 35 to 50% | 0.2 to 0.6%; sign-on starts to appear | [2] |
| US, private, late and commercial | $440K to $520K | 40 to 60% | Annual refresh grants | [2] |
| Europe, listed | Immunocore head of R&D $540K | Immunocore 40%; Idorsia executives 50% | Idorsia LTI 100% of base | [3] |
| Europe, private | no reliable public figure | no reliable public figure | no reliable public figure | [4] |
No public survey covers venture-backed European biotech at C-level. The listed-company figures above are mid and large caps and overstate what a Series B company pays. Sector-wide German data exists (Michael Page 2026: C-level in healthcare and life sciences €170K to €500K, depending on the role), but it mixes industries. On a call I give you the range from my own mandates, for your stage and your city.
What I tie it to. Bonus tied to filing quality, data integrity and milestones met. Not to enrolment speed. A remote CMO who will not travel to the sites is a consultant. The change-of-control line matters more here than in most seats, because a medical function is often redundant after an acquisition.
[1] Bedford Group Transearch, Biotech Compensation Report 2024 (FY2023 data, 189 Nasdaq-listed biotechs under $2B market cap). [2] Alden Search, life sciences executive pay 2026 (recruiter offer data, indicative). [3] Immunocore proxy statement 2025. [4] Michael Page Gehaltsreport 2026, C-level healthcare and life sciences (sector-wide).
The country layer
The Geschäftsführer is an organ of the company, not an employee: a service contract, no protection under the Kündigungsschutzgesetz, no statutory severance. Because the statutory notice period is disputed, the contract has to fix it. Terms of two to five years are common, a post-contract non-compete runs at most two years, D&O cover is standard. Removal as organ does not end the service contract; both have to be handled.
Vorstand members are appointed for at most five years (section 84 AktG). The Corporate Governance Code caps severance at two years of pay and the remaining term, and asks boards not to agree change-of-control payments.
Statutory notice runs from one month in the first year to three months after ten years, and most executive contracts set more; Idorsia's executives sit on twelve months. In listed companies severance for board and executive committee members has been prohibited since 2023, and shareholders vote on aggregate pay.
Six to twelve months of notice at the executive level, defined-contribution pensions, and tax-advantaged option schemes (EMI, CSOP) in place of US ISOs. Listed companies put the remuneration report to an annual advisory vote.
At-will employment with the economics written into the offer: severance, change-of-control terms and acceleration carry the protection a European notice period would. Four-year vesting with a one-year cliff is the market standard.
Where the person comes from, and what to ask
You do not need to be a physician to interview a CMO. You need the questions that separate 'decided' from 'executed'.
Sitting CMO at a small biotech, usually between assets or after a failed programme. VP Clinical Development at a mid-cap, the strongest and most underused pool for a first CMO. Big pharma clinical lead, the registrational seat. CRO medical director, who executed rather than decided. Academic clinician or KOL. Ex-regulator, one bottleneck, rarely a whole CMO.
The primary endpoint on your last trial, who disagreed? A safety signal you had to make the call on. Your last meeting with a regulator, what did you concede? Fourteen months of runway and a protocol that reads out in twenty, what do you do? A CRO relationship that went wrong, how late did you catch it?
Medical licence and standing (state board, GMC, Landesärztekammer, MedReg). Degrees via the registrar. The FDA debarment list and the investigator disqualification database. Every trial on the CV matched against ClinicalTrials.gov and EU CTIS. In March 2026 a Nasdaq-listed biotech announced a board-certified oncologist as CMO; in July the Coast Guard boarded his yacht. Twenty-one years on the run.
The first ninety days
Days 1 to 30: read everything, meet the CRO leads and three site investigators in person, one written assessment. Not a listening tour, an opinion. Days 30 to 60: own the development path to the board. Days 60 to 90: one decision the company has been avoiding, usually with a dose in it.
You already have a CMO
Grow into it, and the tell is that they hire people unlike themselves. Hire beside: a clinical development lead who owns the trial while the current lead keeps medical strategy, with the decision rights rewritten. Or move on, with a CMO who has taken a programme through this phase while the current lead becomes medical advisor. Before any of it, decide who holds the trial on the Monday after, and what the CRO, the sites and the regulator hear that same week, from you.
Anna is the common case.
Let's talk
Sixty minutes on a call, no brief and no pitch. I name the role, the reason and whether it should be permanent or fractional.