Customer Excellence: The Fourth Pillar of Commercial Excellence

Pharma has built three domains of commercial excellence and named all three: launch excellence, marketing excellence and sales excellence. The fourth domain, the one the industry has not yet named, is Customer Excellence. Institutions tend to perfect whatever they can already describe, and they rarely notice the thing they have no vocabulary for. That is roughly where the commercial model sits after four decades of refinement.

Launch excellence secures early momentum in the window where a brand's trajectory is set. Marketing excellence shapes narrative, evidence and credibility. Sales excellence sustains presence and relationship capital in the clinical community. Each of the three has a body of practice, a budget, a function, a vocabulary and people who have spent entire careers inside it.

Why three named domains are no longer sufficient

None of the three is outdated and all three remain necessary. What has changed is the sufficiency of the three taken together. Each one optimizes performance within a category that already exists, and each shares a single boundary condition that four decades of refinement never removed. Not one of them owns whether the value the enterprise earns is actually realized.

A launch can be excellent and the medicine still not reach the patient. A campaign can be excellent and a prior authorization still fail. A sales organization can be excellent and a prescription still go unfilled. The three domains are each accountable for creating clinical intent. No single one of them is accountable for whether that intent survives the journey.

The gap shows up most plainly in what customers say about engagement they already receive. Deloitte 2025 research 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 of that size is not a measurement error. Two populations are looking at the same commercial system and seeing different things, which usually means one of them has been measuring the wrong variable.

What is the fourth domain of commercial excellence?

Customer Excellence is the fourth domain. I define it as the enterprise capability that designs, delivers and scales coherent experiences across the three paths a customer travels, and that governs whether clinical intent becomes realized therapy. It is not a program, an initiative or a layer added to the other three. Customer Excellence is the discipline that makes the organization behave in alignment with what it claims to stand for.

The three paths a customer travels are concrete rather than conceptual. The Path to Prescribe carries evidence into clinical decision. The Path to Fulfill carries that decision through access, authorization and dispensing. The Path to Adhere carries the therapy through the months and years in which benefit either accumulates or quietly disappears. Intent created on the first path can be lost on either of the other two, and often is.

Why a domain rather than a function

Launch, marketing and sales excellence are not departments either. They are disciplines with owners, measures and standards that cut across departments. Customer Excellence belongs beside them on that same plane, not beneath them as a service function, and not inside any one of them as a workstream. The moment it is filed under marketing, it inherits marketing's boundary and loses the authority that was the whole point of creating it.

The question of who owns the customer inside a pharma commercial organization is rarely settled by an org chart. Placement decides more than title does. A capability positioned as a service to three stronger functions will spend its time producing material those functions request, which is useful work and almost never governing work. Reporting lines express what an enterprise actually believes about priority, whatever the strategy deck says.

What the fourth domain is accountable for

Accountability becomes real only when it can be stated without adjectives. The fourth domain owns the consequential handoffs between functions and between the enterprise and outside parties. It sets standards for resolving exceptions rather than relying on heroics to rescue them. It measures progression rather than sentiment. It carries explicit authority to act across organizational boundaries, which is the part most customer programs are never granted.

Each of those four commitments can be tested without much ceremony. A handoff either has a named owner or it does not. An exception either has a documented resolution standard or it waits for someone willing to make a call that falls outside their role. Progression either appears on a dashboard leadership reviews or it survives only in anecdote. Authority either exists in writing or it has to be borrowed every time it is needed, which is another way of saying the authority was never really there.

Its number is the Realization Rate, the share of earned value that survives all the way into sustained therapy. The distance between earned and realized value is value leakage. Earned value multiplied by one minus the Realization Rate gives Customer Value at Risk, which needs no translation in a finance conversation. Heroics operate as a subsidy in this territory, quietly paying down context debt that no budget has ever recognized.

Work I published with TheyDo put a shape on the shortfall. A billion dollars of earned value becomes roughly seven hundred million once prescriptions that are never filled are subtracted. Early discontinuation then takes a further share of what remains. Long term adherence erosion leaves close to four hundred and fifty million in realized value. No competitor takes the difference, because the money does not move to a rival at all.

Why imported customer experience never became this discipline

Customer experience arrived in pharma largely intact from retail, hospitality and financial services, where one organization controls the full transaction. Here the prescribing decision is made by a physician, funded by a payer, adjudicated by a pharmacy benefit manager, dispensed by a specialty pharmacy and lived by a patient. A manufacturer controls none of those actors and can rarely compel any of them. The imported discipline measured how a journey felt while holding no authority over whether that journey progressed. Measurement without governance produces awareness without change.

That structural mismatch explains why well run customer experience programs in pharma so often produce insight nobody can act on. The teams doing that work are capable and their methods are sound. The structure they were dropped into gives them no standing at the seams where value is actually lost. Design gaps of that kind rarely yield to better effort, though they tend to absorb years of it before anyone says so out loud.

The honest objection about cost and ceremony

The objection deserves respect rather than a rebuttal. Adding a fourth domain looks like adding cost and ceremony to a commercial organization that already carries plenty of both. The answer is repricing rather than addition. If less than half of created intent survives to realization, then the marginal dollar spent creating more intent competes directly against the marginal dollar spent protecting intent that already exists. In most portfolios the second dollar now earns more.

The fourth domain is simply where that second dollar gets spent deliberately instead of accidentally. Some of it is already being spent today, inside hub services, case management, field escalations and the quiet work of colleagues who refuse to let a patient fall through a seam. What the organization lacks is a discipline that governs the spending and measures its return. Unmanaged recovery is expensive, and it tends to look like goodwill rather than the operating cost it has become.

What makes the fourth domain hold

A capability of this kind rarely survives on a mandate alone. It becomes durable when Customer Excellence is embedded in four layers rather than assigned to a function. Leadership DNA determines whether the commitment survives contact with a quarterly target. Organizational DNA determines who owns the seams between functions when nobody is watching.

Operational DNA determines whether helpfulness is repeatable without an exceptional colleague in the room. Commercial DNA determines whether measures, incentives and investment decisions reward realized value rather than declared intent. Companies that get the first two layers right and leave the last two alone usually end up with conviction at the top and unchanged behavior nearly everywhere else. I have seen that outcome often enough to treat the final two layers as the real test of commitment.

The three existing domains will keep earning their budgets, and they should. The fourth domain decides what those budgets actually produce in realized terms. A commercial model organized around realized value looks materially different from one organized around reach and frequency. The industry is already drifting toward the first of those without naming the discipline that would make the drift deliberate.

Key Takeaways

Three domains of commercial excellence are named, funded and mature. Launch, marketing and sales excellence each optimize performance inside a category that already exists.
All three create clinical intent and none governs its survival. That shared boundary condition is the gap Customer Excellence exists to close.
Customer Excellence is a domain rather than a function. Filed under marketing, it inherits marketing's boundary and loses the authority that justified creating it.
The fourth domain carries a measurable number. The Realization Rate, value leakage and Customer Value at Risk translate experience into language a finance conversation already accepts.
Imported customer experience could not become this discipline. Measuring how a journey felt without authority over whether it progressed produces awareness without change.
Durability comes from four layers rather than a mandate. Leadership, Organizational, Operational and Commercial DNA together determine whether the capability outlives the executive who sponsored it.

Diagnostic Questions to Consider

Identify the single executive accountable for whether created clinical intent becomes realized therapy, and confirm the accountability appears in writing.
State the current Realization Rate for the lead brand from prescribing decision through sustained therapy, without estimating the figure in the room.
List the handoffs between internal functions and outside parties that carry no named owner and no exception standard.
Calculate Customer Value at Risk for one brand and set it beside next year's promotional investment for the same brand.
Determine whether incentive plans reward declared intent or realized value, and name which measures would have to change.

Closing Reflection

Commercial organizations become very good at the work they have named. Pharma named launch, marketing and sales excellence, built real disciplines around each, and produced four decades of genuine improvement inside those boundaries. What went unnamed went ungoverned, which is why the distance between a prescribing decision and a patient on sustained therapy remains the least managed stretch of the commercial system.

Naming the fourth domain is not an administrative act. It assigns ownership to a stretch of the journey where ownership has been ambiguous, and ambiguity in that position has a price the enterprise pays whether or not it measures it. The companies that move first will likely look slower for a while, because governance work rarely photographs as well as campaign work does.

The work ahead belongs to whoever decides that the next commercial model should be judged by realized value rather than by created intent. Three domains got the industry to extraordinary science. The fourth determines how much of that science ever reaches the person it was made for.

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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