Pumas-AI co-founder here. Indeed, Pharma is conservative due to the impact it can have on patient lives (good or bad). If something is working, it stays, and something failed them, it gets axed, both people and tools. Having said that, let's give them some credit, as along with the regulators at the FDA, pharma has come a long way from the days of SAS. Even the regulators at the FDA have started gravitating away from SAS into more R-based workflows. While it was a good switch away from SAS, scientists started realizing the bottlenecks with R and the requirement to learn multiple tools to get things working, especially when one has to scale up for the new age analytics. While it is good to have a swiss army knife of tools, there is more overhead in making them work together. I think that is why SAS had shined for the longest time. But as you rightly said, it is cost prohibitive and in the hands of very few.
Pumas and the Julia ecosystem are about integrated modeling speak across multiple sectors that are composable and the best part is that one does not have to develop in one environment and switch to another for production. Your point about Salesforce may be right for trial operations, but someone has to do the anlaytics that connect back to the first principles of physiology and pharmacology. Pumas provides this connection to first principles from the core, and lets you build on it for both internal decision making or to serve the stakeholders with fancy UI's.
A subtle but important point here is that compared to a 30-40 years ago since when SAS became a mainstay, I would argue that more of the younger generation are not averse to coding. In fact programming at the basic level is a fundamental expected skill set, and I personally see more and more life-science majors be efficient coders, thanks to the democratization of tools and education. Combined with this new workforce, and tools like Pumas and Julia, we are not far away from disrupting this sector.