Experience: The Third Leg of Pharma's Value Proposition

The third leg of a pharmaceutical value proposition is experience, meaning the practical work a patient and a prescriber must do to obtain a medicine and stay on it. It belongs beside product and brand because it largely determines whether either of those two ever reaches the person they were made for. Most industries discover late that they have been selling three things rather than two. Pharma industrialized two of them and left the third to assemble itself.

The product is engineered to a standard almost no other industry can approach, through decades of regulated rigor and patient capital. The brand is built with evidence, governance and very large investment, by people who are rarely amateurs at the work. The third leg has no comparable history, because no function was ever handed the brief to build it. That absence is a design gap rather than a failure of competence, which is why it survives inside companies full of capable people.

Experience here operates as something other than a softer companion to the other two legs. A therapy may change biology. The experience around it decides whether that biology arrives.

What the first two legs have that the third does not

Product and brand each have four things the third leg has never had. Each has a named owner, a budget line, a measurement system the executive committee recognizes, and a professional body of practice that trains people to do the work. Experience in this industry has fragments of the fourth and almost none of the first three. A capability without those supports can be described, discussed and even admired, yet it cannot be managed.

That is why the third leg tends to appear in strategy documents and disappear in operating reviews. Nobody defends what nobody has been asked to hold. The question of who owns the experience returns a list of partial owners in most commercial organizations, each accountable for a stage and none accountable for the path. The arrangement produces activity without authority, and it can run for years without anyone behaving badly.

Why does the third leg matter more now than before?

Three forces have moved experience from a courtesy to a condition of competing. Clinical differentiation is narrowing across crowded categories, where profiles converge faster than brand teams can plan around. Product and brand can both be excellent and still fail to separate one company from the next. When the molecule stops doing the separating, something else has to.

The second force is defensibility. Experience is harder to copy than either of the other two legs, because it is produced by how an enterprise is built rather than by what it makes or what it says. A competitor can read a label and a campaign. It cannot read an operating model.

The third force is the standard itself, which patients and prescribers now set outside the category. Someone tracks a parcel to the minute and changes a flight on a phone in ninety seconds. Then she calls a manufacturer's hub and repeats a date of birth four times. She compares the company to the last competent transaction she had, not to another pharmaceutical company.

That bar has a name in our practice. Consumer-Grade describes the expectation a customer carries into a therapeutic category from everywhere else in her life, and it does not adjust downward for the difficulty of the science. The distance between that bar and the industry's view of itself is wide. Deloitte research published in 2025 found only 28 percent of HCPs believe pharma's engagement strategies meet their needs, against 82 percent of life sciences executives who say they are satisfied with those same strategies. A gap that wide is rarely a shortage of information.

Where the third leg is built or lost

The third leg is built or lost along three paths, each of which crosses functions, systems and parties that were never organized around one another. The Path to Prescribe runs from an undiagnosed patient to a clinical decision. The Path to Fulfill runs from that decision to the medicine in a hand, through benefit verification, prior authorization, affordability support, specialty pharmacy coordination and first fill. The Path to Adhere runs from first fill to the duration the trial actually demonstrated.

Each path carries its own failure mode, and the three are not interchangeable. The Path to Prescribe fails quietly, through patients who never arrive and diagnoses that come late. The Path to Fulfill fails administratively, in the space between a decision and a dispense where no single party is accountable for the outcome. The Path to Adhere fails slowly, during the months when a patient stops being anyone's active concern.

The middle path is where the clearest public evidence sits. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7 percent of initial brand name attempts in 2024. The same study found that 48.4 percent of those rejected prescriptions were never followed by a fill of that drug or anything in its class within ninety days. Read the second figure slowly. A clinical decision had been made, a patient had agreed to it, and nearly half the time the therapy simply stopped existing for her.

No competitor took that value. Work I published with TheyDo traced the shape of the erosion as an illustrative compounded scenario rather than a benchmark. A billion dollars of earned value becomes roughly seven hundred million after prescriptions that are never filled. It falls again after early discontinuation, and settles near four hundred and fifty million once adherence erosion is counted. The pattern has a name in our practice, value leakage, and it is what converts a question of service into a question of yield.

The relationship between the three legs is multiplicative rather than additive, which is the reason a weak third leg is so expensive. I express it as a formula in our work. Realized value is brand multiplied by product multiplied by experience, raised to the power of culture, and then discounted by one minus Customer Value at Risk. A company can hold two strong factors and a weak third one and still watch the product of the three collapse, because nothing in a multiplication survives a weak term.

Why has the third leg stayed unbuilt?

An unnamed leg has no owner, no budget line and no place on a scorecard. Imported consumer customer experience could describe this system, though it was never given authority over it. The discipline arrived from industries where one company controls the whole transaction, sets the price and employs the person the customer meets. Pharma controls almost none of that, so a method built on single party control describes the problem accurately and cannot move it.

What follows is measurement without governance, which produces awareness without change. Surveys accumulate, dashboards improve, and the friction a patient meets on the way to therapy stays roughly where it was. Some commercial leaders read that as evidence the work does not pay. The more likely reading is that insight without authority has no mechanism by which to pay.

Regulation takes most of the remaining blame, and it deserves less of it than it receives. Regulation here governs claims rather than burden, which means almost none of the friction a patient meets is legally required. Four identity checks in one call are not a compliance obligation. The leg is unowned rather than mandated, and that distinction is what makes it available to anyone willing to build it.

How to tell whether the leg exists in your company

A leg is load bearing or it is decorative, and the difference shows up in measurement rather than in language. The share of earned value that becomes sustained therapy is the Realization Rate, and the distance between earned and realized value is where the third leg either works or does not. Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, expressed in the currency a finance committee already uses. A company with no Realization Rate does not have a third leg, it has a hope.

That single number does more than report. It forces the three paths into one conversation, because a shortfall can originate in diagnosis, in fulfillment or in the months after first fill. Leaders who hold a Realization Rate stop debating whether experience is worth funding and start arguing about which path is costing them the most. That argument is the beginning of a third leg, though it is rarely a comfortable one to start.

What holds the third leg up

Experience of this kind cannot rest on discretionary effort, which is how most of it is currently delivered. Capable people routinely prevent these gaps from becoming visible failures, often by working outside the process they were given. Their effort deserves respect rather than audit. Heroics operate as a subsidy, letting an organization deliver promises its routine processes cannot reliably support.

A subsidy of that kind has two properties that matter here. It conceals the design gap from the people who could fix it, and it runs out, usually at the moment volume arrives. The leg becomes load bearing only when the enterprise is structurally predisposed to help, which means the easy path and the right path are the same path.

That condition is built in the operating model rather than in the campaign, and it is the work of Customer Excellence as a discipline. In the work I have done inside large commercial organizations, the companies that got furthest treated the third leg as architecture rather than attitude. They did not ask people to care more. They changed what the system made easy.

Key Takeaways

Pharma industrialized product and brand, then left the third leg of its value proposition to assemble itself.
Experience determines whether a product's biology and a brand's promise ever reach the patient they were built for.
The third leg is built or lost along the Path to Prescribe, the Path to Fulfill and the Path to Adhere.
Rejection and abandonment evidence shows that much of the loss occurs after a clinical decision has already been made.
A company with no Realization Rate cannot claim a third leg, because it has no measure of what it realizes.
The leg becomes load bearing only when the enterprise is structurally predisposed to help rather than dependent on heroics.

Diagnostic Questions to Consider

Name the executive accountable for the whole Path to Fulfill rather than for one stage of it.
State your current Realization Rate and the method used to calculate it.
Identify which of the three paths is costing you the most earned value this year.
Describe how much of your experience delivery depends on individual effort rather than designed process.
Explain which pieces of patient friction in your category are legally required and which are simply inherited.

Closing Reflection

Most companies do not need to be persuaded that experience matters. They need a name for the thing, an owner for it, and a number that makes its absence visible on a scorecard. Once those three exist, the work stops being advocacy and becomes engineering, which is a far more comfortable register for this industry.

The science here is often extraordinary and the experience surrounding it is frequently ordinary. That gap is not a verdict on anyone's character or capability, and I have rarely found a company where it was. It is the predictable output of a value proposition built on two legs and asked to stand on three.

A third leg does not arrive through conviction. It arrives when somebody is made accountable for the distance between what a therapy earned and what a patient realized, and given the authority to close it. That is a structural decision, available to any company prepared to make it.

About the Author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse.

The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

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[PRACTICE NOTE] Your Call Plan Isn’t the Problem. Your Customer Context Is.

March 15, 2026

Why healthcare professionals now judge pharmaceutical engagement against the best experiences in their lives, and what that means for the future of commercial leadership. When commercial performance falters, the reflex inside many pharmaceutical organizations is to adjust the machinery of field execution. Leaders revisit call plans, recalibrate targeting models, and increase the volume of activity in the hope that more precision or more frequency will restore momentum. For decades this system has been treated as the central instrument of commercial performance, determining which physicians are prioritized, how frequently representatives engage, and how resources are deployed across territories. Yet the growing gap between commercial effort and commercial impact suggests a deeper issue. T he problem is rarely the design of the call plan itself. It is the context in which healthcare professionals now operate. Physicians are navigating increasingly complex clinical, administrative, and informational environments, and that evolving reality now shapes prescribing behavior far more than the cadence of promotional interactions. What many organizations are experiencing is a widening Customer Context Gap. Commercial systems were designed for a time when prescribing decisions could be influenced primarily through promotional interaction and product information. Today physicians operate inside a far more complex reality shaped by administrative burden, reimbursement constraints, digital information overload, and growing expectations for seamless support across the entire care journey. In this environment the physician’s decision is influenced not only by clinical evidence but also by how easily a therapy fits into the practical realities of care delivery. When commercial models remain anchored in promotional activity while the customer’s context has fundamentally changed, even the most disciplined call plan struggles to deliver the outcomes it was designed to produce. Closing this gap requires a different way of thinking about commercial performance. The question is no longer how to optimize promotional activity but how to align the organization around the real journeys through which physicians help patients receive therapy. Prescribing decisions unfold within complex sequences of clinical evaluation, reimbursement navigation, patient readiness, and ongoing support. When commercial strategy is designed around these journeys rather than isolated interactions, the role of the field force begins to evolve. Representatives are no longer positioned primarily as messengers of information but as partners in removing barriers that slow care. Organizations that recognize this shift begin redesigning their commercial systems accordingly, aligning field engagement, digital support, access programs, and patient services around the same goal: helping healthcare professionals help patients move from clinical intent to successful treatment. From Promotional Activity to Customer Journeys The pharmaceutical industry has historically organized commercial activity around the moment of promotion. Call plans, targeting models, and message sequencing were designed to influence prescribing behavior primarily through informational engagement with healthcare professionals. While this model brought structure and scale to commercial operations, it reflects an earlier era in which the path from clinical awareness to prescribing action was comparatively linear. Today the journey is far more complex. Physicians must navigate an intricate landscape of clinical evidence, treatment guidelines, payer requirements, prior authorization processes, patient affordability concerns, and adherence challenges. Prescribing a therapy is no longer a single decision point. It is the beginning of a chain of events that determines whether a patient ultimately receives and remains on treatment. This is why the commercial conversation must expand beyond the traditional moment of prescription to encompass three interconnected journeys. The first is the Path-to-Prescribe , where scientific evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. The second is the Path-to-Fulfill, where access, affordability, patient readiness, and operational support determine whether that recommendation ultimately becomes therapy in the patient’s hands. The third is the Path-to-Adhere , where ongoing patient support, monitoring, and engagement determine whether patients remain on therapy long enough to realize the intended clinical benefit. Science drives the Path to Prescribe, where evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. Experience shapes the Path to Fulfill, where access, affordability, and patient readiness determine whether that recommendation becomes therapy in the patient’s hands. Sustained outcomes depend on the Path to Adhere, where ongoing support, monitoring, and engagement ensure patients remain on therapy long enough to realize its intended clinical benefit. When commercial organizations focus almost exclusively on the first while leaving the latter journeys fragmented and burdened, a significant portion of therapeutic value is lost between intention and impact. In many therapeutic areas, the result appears in the persistent gap between prescriptions written, prescriptions filled, and therapies sustained—gaps that reflect not a failure of science but a failure of system design. Recognizing these three journeys shifts the unit of focus from promotional activity to the real-world pathways through which care is delivered. It reframes the role of the field force, the purpose of digital engagement, and the design of patient support programs around a single objective: reducing the friction that stands between clinical intent, treatment initiation, and sustained patient outcomes. Customer Context Is the New Commercial Variable For much of the pharmaceutical industry’s history, commercial performance was largely explained by a familiar set of variables. Product efficacy, clinical differentiation, promotional reach, and sales force execution determined the trajectory of most brands. When performance lagged, leaders adjusted those levers by refining segmentation, optimizing targeting, and recalibrating call plans. Today those traditional levers still matter, but they no longer explain commercial outcomes on their own. A far more powerful variable has entered the equation: customer context. HCPs now operate within an environment defined not only by clinical complexity and administrative burden but also by rising expectations shaped by their experiences outside healthcare. Physicians are also consumers. In their personal lives they interact daily with companies such as Apple, Amazon, Tesla, and Netflix that anticipate their needs, remove friction, and simplify complex processes through thoughtful design. These experiences quietly reset the benchmark for competence, responsiveness, and respect for their time. When those same physicians step into their clinical roles, they do not shed those expectations. They carry them with them. The contrast between the seamless orchestration of their consumer experiences and the fragmented systems surrounding many healthcare interactions becomes difficult to ignore. What once felt acceptable now feels unnecessarily burdensome. This dynamic represents the Consumer-Grade Imperative. Healthcare professionals increasingly evaluate pharmaceutical engagement not against other pharmaceutical companies but against the best experiences they encounter anywhere in their lives. In this environment even a clinically superior therapy can struggle if the surrounding system makes it difficult to initiate treatment, navigate reimbursement, or support patient adherence. Customer context therefore becomes the new commercial variable. It determines whether scientific differentiation translates into practical adoption. It shapes whether prescribing intent becomes therapy initiation and whether therapy initiation becomes sustained patient outcomes. Call plans were designed to manage activity. Customer context requires organizations to manage journeys. The Field Force in the Era of Customer Context Recognizing customer context as the defining commercial variable inevitably reshapes how the role of the field force is understood. For decades the pharmaceutical sales representative has been positioned primarily as the carrier of scientific information. Call plans optimized the frequency and sequencing of these interactions to ensure that physicians received consistent messaging. That role does not disappear, but the environment surrounding it has changed profoundly. Physicians today are navigating administrative burden, payer complexity, digital information overload, and increasing time pressure. In this environment they are not simply seeking more information. They are seeking clarity, simplicity, and support that helps them navigate the complexity surrounding treatment decisions. This shift transforms the representative from a messenger of information into something far more valuable: a partner in removing friction from the care journey. Conversations move beyond repeating clinical claims toward understanding the practical barriers that physicians and their teams face as they attempt to initiate and sustain therapy for patients. The most effective field forces are therefore supported by commercial systems designed around journeys rather than activities. Representatives are equipped not only with scientific messaging but with the insight and coordination required to address obstacles across prescribing, reimbursement, and patient support. Field engagement becomes a catalyst for problem solving rather than simply a vehicle for promotion. From Call Plans to Customer-Aligned Commercial Systems If customer context has become the defining commercial variable, then the systems designed to support the field must evolve accordingly. The traditional call plan was built to manage activity. It provided structure for how frequently physicians were engaged, how territories were covered, and how resources were deployed. Yet activity alone does not determine whether therapies ultimately reach patients. What determines impact is whether the commercial system surrounding the physician reduces or increases the burden of delivering care. A customer-aligned commercial system begins with the journeys through which physicians help patients move from diagnosis to treatment and beyond. Marketing clarifies the scientific story. Sales provides trusted relationships and real-time understanding of physician needs. Access teams simplify reimbursement pathways. Patient support programs reduce administrative burden. Digital engagement reinforces and extends human interaction. The result is a commercial system that operates less like disconnected functions and more like an integrated network designed to help physicians help patients. This is the essence of Customer Excellence. It aligns the entire commercial enterprise around the real-world context in which care is delivered. The problem was never the call plan. The problem was the context. Key Takeaways Commercial performance in pharma organizations has traditionally been managed through field execution mechanics, yet the effectiveness of those mechanics increasingly depends on how well they reflect the real-world context in which physicians operate. Customer context has become the most pivotal commercial variable as administrative burden, payer complexity, and consumer-grade expectations reshape how prescribing decisions are made. HCPs now evaluate pharmaceutical engagement against the best experiences they encounter anywhere in their lives, raising the standard for clarity, responsiveness, and ease. Optimizing promotional activity alone is no longer sufficient. Commercial success depends on reducing friction across the journeys physicians navigate as they move patients from diagnosis to treatment. Customer Excellence represents the structural response, aligning marketing, sales, access, digital engagement, and patient support around the real journeys of care delivery . Diagnostic Questions to Consider Are we optimizing the activity of our field force, or designing commercial systems that support the real journeys physicians navigate to help patients receive therapy? How well do we understand the administrative, reimbursement, and operational barriers physicians encounter after they decide to prescribe a therapy? Do our commercial systems reduce the burden placed on physicians and their staff , or unintentionally add to the complexity of care delivery? Are we benchmarking our engagement against other pharma companies , or against the best experiences physicians encounter in their lives as consumers? Have our investments in digital platforms simplified the physician’s experience, or multiplied the number of disconnected interactions they must manage? Are we still managing performance through activity metrics alone , or beginning to understand the context that ultimately determines whether therapies reach patients? Closing Reflection The pharma and life sciences industry has spent decades refining the mechanics of field execution. Call plans, segmentation models, and targeting systems brought structure and discipline to commercial organizations. Yet the environment surrounding physicians has evolved far more rapidly than the systems built to support them. Healthcare professionals now operate in a world defined by consumer-grade expectations for clarity, responsiveness, and ease. When the experience of engaging with a pharmaceutical company fails to reflect those expectations, the contrast becomes impossible to ignore. Organizations that recognize this shift will redesign their commercial systems around the realities of modern care delivery. They will move beyond managing activity and toward understanding the context in which physicians help patients receive treatment. In doing so they will close the gap between scientific innovation and real-world impact. Your breakthrough science deserves experiences worthy of it. Together, we turn customer excellence into real-world impact. About the Author Wayne Simmons is a hands-on commercial excellence architect and founder of The Customer Excellence Agency, where he partners with pharmaceutical and life sciences leaders to turn customer-centric ambition into durable commercial advantage. He previously served as Global Customer Excellence Lead within Pfizer’s Chief Marketing Organization and has held leadership roles with Bayer Pharmaceuticals and The Ritz-Carlton Leadership Center. Wayne writes The Customer-Centric Marketer newsletter and is the author of The Customer Excellence Enterprise: A Playbook for Creating Customers for Life. The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

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