The Path to Adhere: From First Fill to Demonstrated Duration

The Path to Adhere runs from a first fill to the duration the clinical trial actually demonstrated, and it is the third of three paths on which pharmaceutical value survives or is lost. It covers the unglamorous months in which an efficacy claim either becomes true for a particular person or does not. Organizations tend to be attentive at the start of a relationship and distracted by the middle. This path is almost entirely middle.

A qualification belongs at the front of any page about adherence. Some attrition here reflects sound clinical judgment, a tolerability problem, a change in circumstance, or an informed decision by a patient who has weighed it and chosen otherwise. Those decisions deserve respect rather than remediation. The work on this path is to separate them from the cases where somebody could not move forward because information was unclear or responsibility was unresolved.

The three paths are separate because they fail for unrelated reasons and respond to unrelated work. The Path to Prescribe fails before a decision exists. The Path to Fulfill fails in the administrative space immediately after it. This one fails slowly, across a period when a patient has stopped being anyone's active concern.

A journey with no name has no owner, no budget line and no place on a scorecard. That may be why this path persists largely untouched inside organizations otherwise exacting about cost. The model underneath all three is the move from a commercial funnel to a flywheel, and a funnel stops at the purchase. In pharma the written prescription occupies that position, which places this path several stages beyond where commercial attention usually ends.

What the Path to Adhere actually covers

The path begins at the moment a patient has the medicine and has to live with it. Titration, side effect management, injection technique, refill timing, insurance renewals and the slow administrative attrition of a specialty pharmacy relationship all sit inside it. None of that is clinically dramatic and all of it is consequential.

Three transitions carry most of the loss I see on this path. The first weeks are the hardest, because side effects often arrive before any benefit does. The point around ninety days matters because an initial supply runs out and a renewal process has to work. The annual benefit reset matters because a formulary change can end a working therapy without anyone intending it.

The parties present at each transition are different again. A prescriber sees the patient at intervals measured in months. A specialty pharmacy sees a transaction. A manufacturer sees a dispense record arriving with a lag. Nobody in that arrangement is watching the week in which the patient actually decided.

Which discontinuations deserve respect

The distinction between a reasoned stop and an unsupported one carries the whole ethical content of this path. A patient who discontinues after a frank conversation about tolerability has been well served. A patient who discontinues because she could not get an answer about a refill has not been. The two look identical in persistence data, which is part of why this path resists measurement.

A page about adherence that skips this distinction reads as wanting patients on drugs rather than wanting patients served. The commercial interest and the patient interest align only in the second group, where they align completely. Clearing unclear information and unresolved responsibility does not push anyone toward a therapy they do not want. It removes the obstacles between a decision somebody already made and the outcome that decision was meant to produce.

Separating the two groups requires something I have rarely found inside an adherence program. It requires knowing why a particular patient stopped, at the time she stopped, from a source closer than a claims record. That is a listening problem before it becomes an intervention problem, which is why generic adherence messaging often performs poorly.

How this path fails

This path fails slowly, in a period when the patient has stopped being anyone's active concern. The prescriber has moved on to the next presenting problem. The hub has closed the case as a success, because by its own definition it was one. The field has recorded the win and moved its attention to the next account.

Each of those actions can be defended inside its own frame. A hub that keeps every case open forever cannot operate. A field colleague who never moves on cannot cover a territory. The design gap is that nobody's frame extends as far as month seven, so the patient leaves the system's field of view while still inside the period her therapy was tested across. A closed case is not necessarily a continuing patient.

An efficacy claim is a claim about duration

The reframing that makes this path commercial rather than charitable is simple to state and harder to absorb. An efficacy claim is a claim about a duration. A trial demonstrated a result over a defined period, under defined conditions of continuation. A patient who stops at week six did not receive the product that was tested.

That has consequences for how a brand team should think about its own evidence. The label describes a therapy taken as studied. Every month of early discontinuation moves the delivered product further from the studied one. A company can hold a strong efficacy claim and still deliver, across its real patient population, something measurably weaker than the claim.

The tenet I work from states it plainly. 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. This path is where continuation and benefit either happen or fail to, which makes it the final arbiter of whether the science did what it was shown to do.

Where the cost of a first fill still decides

This path begins slightly earlier than most organizations assume, at the pharmacy counter. Abandonment at that counter is the first discontinuation, and cost is the clearest predictor of it. IQVIA data reported by Managed Healthcare Executive found that of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients. A therapy that was prescribed, approved and dispensed can still fail to begin.

That figure describes a decision made in a few seconds on incomplete information. The patient at the counter rarely knows whether a copay card exists, whether a lower cost channel is available, or whether the price she was quoted is the real price. She makes a rational choice inside the information she holds. The design gap sits in what she was given to decide with.

Why the commercial funnel ends too early

The tenet that matters most here concerns the boundary of the commercial system itself. The commercial funnel in pharma ends too early, and prescribe, fulfill and adhere belong inside one commercial system. Three paths measured on three scorecards by three functions will behave as three separate businesses. Value does not travel that way, because it either survives the whole distance or it does not.

Experience is the third leg of the value proposition and the one this industry never built, which Customer Excellence exists to build as an enterprise capability rather than a program. The fourth pillar of commercial excellence sits alongside launch, marketing and sales excellence for the same reason. The first three were each built to operate on one path. The fourth is the one accountable for the whole distance.

How progression on this path is measured

Progression on all three paths is measured on one ladder, which is what makes them a single system rather than three initiatives. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. This path owns the last two and shares the third. Those are also the stages most commercial organizations report least often and understand least well.

The yield measures sit above the ladder. The Realization Rate is realized value divided by earned value, which reports what share of what the science earned actually became therapy. Customer Value at Risk is earned value multiplied by one minus that rate, which puts the shortfall into the currency a finance committee already reads. Measured that way, adherence stops being a patient support topic and becomes a yield question belonging in a business review.

An illustrative compounded scenario I published with TheyDo traced the shape of the erosion across all three paths. A billion dollars of earned value becomes roughly seven hundred million after prescriptions never filled, falls again after early discontinuation, and settles close to four hundred and fifty million in realized value once long term adherence erosion is counted. No competitor takes the difference. The final two steps of that decline belong to this path.

What ownership on this path would look like

Ownership here means something rather different from the other two paths. On the Path to Fulfill, ownership means holding a chain of parties to an outcome none of them individually owns. On this path, it means sustaining attention across a period during which nothing is scheduled to happen. That is an operating model question rather than a messaging one.

Practically, it means a named owner for the 90-Day and Persistence stages and a signal source closer to the patient than claims data. It also means a mechanism that assigns each identified barrier to somebody able to clear it. Consumer-Grade is the standard that applies here, because the expectation a patient brings to month seven was set by every other service in her life. None of those services forget she exists after the first transaction.

Key Takeaways

The Path to Adhere runs from a first fill to the duration the trial actually demonstrated, across the months in which an efficacy claim becomes true or does not.
It fails slowly, in a period when the prescriber has moved on, the hub has closed the case and the field has recorded the win.
Some attrition reflects sound clinical judgment or informed patient choice, and the work is to separate those decisions from unresolved ones.
An efficacy claim is a claim about a duration, so a patient who stops at week six did not receive the product that was tested.
Of prescriptions with a final cost above 250 dollars, 61 percent are not picked up by patients, which makes abandonment the first discontinuation.
Progression is measured on one ladder across all three paths, and this path owns the 90-Day and Persistence stages.

Diagnostic Questions to Consider

Name the person accountable for a patient in month seven of therapy on your largest brand.
State your current persistence rate at twelve months and the method used to establish it.
Describe how you currently distinguish a clinically reasoned discontinuation from an unsupported one.
Identify your earliest available signal that a patient has stopped, and how many weeks it lags her decision.
List what changes in a business review when adherence is reported as a yield figure rather than a support metric.

Closing Reflection

Adherence has been discussed in this industry for decades, mostly as a patient support topic and occasionally as a moral one. Neither framing ever gave it a budget line that survived a difficult quarter. Treating it as the final stage of value realization does, because a yield figure competes for funding on the same terms as everything else in a commercial review.

The qualification from the opening of this page holds all the way through it. Some patients stop for reasons that are entirely sound, and no commercial system should be built to talk anyone out of a considered decision. The target is narrower and more defensible, which is the patient who wanted to continue and could not find out how.

The destination is three paths measured on one ladder, with a single owner accountable for the whole distance. That arrangement is unusual in this industry and entirely available to it, because nothing in the regulation or the science prevents it. What it asks for is a company willing to measure what its science earned against what its patients actually realized.

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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