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A year ago, Vasant Narasimhan became CEO of Novartis, one of the world’s oldest and largest pharmaceutical companies. Just 42, Narasimhan—a Harvard-trained physician and McKinsey alum—is working to reinvigorate the Swiss company. While much of his focus is on expanding its arsenal of cutting-edge gene-therapy medicines and pushing for more technology in drug development, he’s also trying to change the corporation’s culture to give its 125,000 employees more autonomy. That means doing away with an autocratic, top-down management style built up over centuries (Novartis’s roots date to 1758) and enabling “servant leaders” to manage “un-bossed” workers. He says he wants to “unleash the power of our people.”

Like most Big Pharma CEOs, he’s also fighting accusations that its medicines are overpriced, and hopes to head off US price controls. Unlike other pharma CEOs, he’s had to explain why Novartis paid former Donald Trump attorney Michael Cohen $1.2 million for consulting work.

Quartz spoke to Narasimhan about the high cost of its drugs, the promise of AI and the perils of being over-scheduled.