Launch Excellence in Pharma, and What Its Window Cannot Reach

Launch excellence is the discipline of maximizing a brand's performance in the window where its long run trajectory is set. It is the most mature and best resourced discipline in pharmaceutical commercial practice, and the industry was right to build it that way. What it misses sits outside the window rather than inside the discipline. Almost everything a launch is measured on stops at the prescribing decision.

Organizations tend to govern what they can see inside a reporting period, and a launch is the most tightly bounded reporting period in commercial pharma. That boundary is the source of both its rigor and its blind spot. The discipline deserves respect before it deserves examination, so the respect comes first.

What launch excellence does well when it is resourced properly

A well run launch does several things no other commercial discipline in pharma attempts. It establishes cross functional readiness ahead of approval, so that medical, marketing, access and field are capable on day one rather than in month four. It orchestrates those functions against a single date that cannot move. It drives speed to first prescription and speed to peak, the two measures that most reliably predict a brand's lifetime performance.

The underappreciated part is the sequencing. A launch carries hundreds of dependencies, many of them owned by functions with different clock speeds and different definitions of ready. Holding that structure together against a fixed regulatory date is organizational discipline of a rare kind. People who have never run one tend to underestimate how much judgment it takes.

None of this is ceremonial. Launch excellence is where pharma's operating capability shows at its best, and it sits inside the wider category of commercial excellence in pharma as the most developed of the established domains. Any argument about what it misses has to start from that fact. A discipline this good does not fail by carelessness.

What a launch is actually measured on

A launch is measured on the formation of demand within a window. Awareness, trial, first prescriptions written, share of voice, formulary wins, depth of prescribing and breadth of prescribing are the standard instruments. Every one of them is real, properly constructed and genuinely useful. Every one of them is also an intent metric, which means each stops at the prescribing decision.

Intent is the right thing for a launch to create. The difficulty is that intent is also the last thing a launch is asked about. A brand can hit each of its uptake targets and still convert well under half of what it earned into patients on sustained therapy. That conversion happens after the window closes, by which point the team that produced the intent has usually been redeployed.

My first doctrinal position bears directly on this. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written. Written prescriptions are intent rather than realized value. A launch scoreboard built entirely from intent metrics can read as a complete success while a large share of earned value quietly fails to arrive.

Why intent became the whole scoreboard

Launch metrics did not become intent metrics by accident. They became intent metrics because intent was the only thing the organization could observe inside the window and attribute to the launch. Fulfillment data arrives late, sits with third parties and resists attribution to any single commercial action. Choosing measurable intent over unmeasurable realization was a reasonable decision taken under real constraints.

What has changed is the constraint. Claims data, specialty pharmacy reporting and frontline intelligence now make progression observable in something close to operating time. The measurement problem that justified the intent scoreboard has largely been solved, while the scoreboard itself has not moved. That lag is ordinary institutional behavior rather than negligence.

Why the gap is structural rather than careless

The launch window and the realization window do not overlap. Prescribing intent forms in weeks. Fulfillment runs in days to months, through benefit verification, prior authorization, specialty pharmacy routing and copay support. Persistence runs in quarters and years, long after launch governance has been stood down.

A launch organization is therefore dissolved on a calendar that predates the outcome it was built to produce. Core team members move to the next asset, the war room is retired and the launch dashboard is archived. What remains in market is the first cohort of patients, handed to whoever happens to still be in the role. That handover may be the most consequential moment in a brand's life and the least designed one.

No individual decision inside that sequence is wrong. Redeploying scarce launch talent to the next asset is rational. Retiring a dashboard that measures a period which has ended is rational. The outcome is still that accountability for realization has no home at precisely the moment realization begins.

What happens to intent once the window closes

The scale of what happens after the window is now measurable. A 2026 JAMA study summarized by Johns Hopkins found that insurer rejections reached 40.7 percent of initial brand name attempts in 2024. Of those rejected prescriptions, 48.4 percent were never followed by a fill of that drug or anything in its class within ninety days. The first figure describes friction, while the second describes abandonment.

Those outcomes land squarely inside the launch period for a new brand. A rejection at first attempt arrives within days of the prescribing decision the launch team worked two years to earn. Nobody on the launch scoreboard is measured on it, because it happens on the Path to Fulfill rather than the Path to Prescribe. The clinical intent was created exactly as designed, then met a system the launch was never instrumented to see.

Some share of that attrition reflects sound judgment and deserves respect. A rejection can be clinically appropriate, and a patient may reasonably decline a therapy once they understand what it asks of them. The portion that reflects pure friction is the portion belonging to the commercial system. Separating the two is work, though it costs considerably less than assuming the whole figure is unavoidable.

What a launch instrumented for realization adds

A launch built for realization keeps every instrument it already has. It adds four, and each can be built before approval rather than after the first stall. The first is progression measured from the first week rather than at the first annual review. The ladder I use runs from Scripts Written to Filled, then Therapy Started, then 90-Day, then Persistence.

The second is a named owner for the Path to Fulfill, appointed before launch rather than once a stall becomes visible in the numbers. The third is baseline friction mapped while the brand is still pre market. Every party that will administer that friction is known in advance, including payers, benefit managers, specialty pharmacies and the practices that submit the paperwork. Mapping how they behave is a readiness activity rather than a post launch investigation.

The fourth is a handover that transfers an operating measure rather than a dashboard. A dashboard tells the receiving team what happened. An operating measure tells them what they are accountable for changing, which is a different inheritance entirely. The Realization Rate works well in that role, because realized value divided by earned value survives a change of owner without losing its meaning.

What this changes about how launches are judged

Judging a launch on realized value rather than created intent reorders launch planning. Access and fulfillment design stop being a workstream reporting into readiness and become a condition of it. The question moves from whether the brand can be prescribed to whether it can be received. Value leakage is the term I use for the distance between those two, and it is often at its widest in the first year.

None of this requires a larger launch team. It requires a different allocation inside one, and a measure that outlives the window. Launch excellence remains the right discipline for the first window, while the fourth domain of commercial excellence is what carries the brand past it. The relationship between the two is set out in a separate piece on the fourth pillar of commercial excellence.

A launch is the best opportunity an organization ever gets to design realization in rather than retrofit it later. The team is cross functional, the funding is unusually available and the governance already exists. Those three conditions rarely coexist again in a brand's life. Spending some of that moment on the window after the window may be the highest return decision available to a launch leader.

Key Takeaways

Launch excellence is pharma's most mature commercial discipline and deserves to be treated as such. Readiness, orchestration, speed to first prescription and speed to peak are genuine operating achievements.
Almost every launch metric is an intent metric. Awareness, trial, formulary wins and depth of prescribing are all real measures that stop at the prescribing decision.
A launch can hit every target and still lose much of what it earned. The conversion from intent into sustained therapy happens after the window closes.
The gap is structural because the two windows do not overlap. Intent forms in weeks, fulfillment runs in days to months, and persistence runs in quarters and years.
The intent scoreboard was a rational response to a measurement problem that has largely been solved. Progression is now observable in close to operating time, while the scoreboard has not moved.
Four additions make a launch readable in realization terms. Progression measured from week one, a named Path to Fulfill owner, friction mapped pre market, and a handover that transfers an operating measure.

Diagnostic Questions to Consider

List every metric on the current launch scoreboard and mark which ones describe events occurring after the prescribing decision.
Name the person accountable for the Path to Fulfill on the next launch, and confirm the appointment exists before approval.
State the share of first prescriptions expected to be rejected at first attempt, using evidence rather than an estimate made in the room.
Identify what the launch team will hand to the receiving organization, and determine whether it is a dashboard or an operating measure.
Establish when the first cohort of patients will be reviewed for persistence, relative to the date the launch team is redeployed.

Closing Reflection

Launch excellence was built to answer a question the industry asked with great precision. How does a new medicine earn clinical conviction and reach peak as quickly as the evidence allows? Four decades of practice answered it, and the answer holds. The question nobody attached to the launch was what happened to the conviction once it existed.

I have come to see that omission as a matter of boundaries rather than of care. A launch is bounded by a date, and work that falls past the date falls past the mandate. People inside launch organizations are frequently aware of the problem long before the organization names it, which is usually how design gaps reveal themselves. They show up first as frustration among capable people doing exactly what they were asked to do.

The window where a brand's trajectory is set and the window where its value is realized are not the same window. Treating them as one has cost the industry more than any single launch failure ever has. A launch instrumented for realization asks for very little that the organization does not already have, which is probably the most encouraging thing about 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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