The Path to Prescribe: From Undiagnosed Patient to Clinical Decision

The Path to Prescribe is the journey that runs from an undiagnosed patient to a clinical decision, and it is the first of three paths on which pharmaceutical value survives or is lost. It covers everything that has to happen before a prescriber can act, including the patient arriving, the condition being recognized, the evidence being available and the moment being right. Institutions tend to measure the things they already know how to see. That habit explains a good deal about why this path is the best instrumented of the three and still incomplete.

Three paths exist rather than one because they fail for entirely different reasons, sit with different functions and respond to different work. This one fails before a decision is ever made. The Path to Fulfill fails in the administrative space after it, and the Path to Adhere fails during the months when nobody is watching. Collapsing them into a single journey produces a diagram rather than a diagnosis.

The model behind all three is the move from a commercial funnel to a flywheel, which I worked through in the chapter on commercial DNA. A funnel is built to acquire and is sub-optimized for everything that follows acquisition. In pharma the written prescription sits roughly where the purchase sits in a consumer funnel, and the industry has largely organized itself to reach that point and stop.

What the Path to Prescribe actually covers

This path begins long before a brand team becomes involved, with a person who has symptoms and no name for them. It continues through primary care, referral, diagnostic workup and specialist assessment, each of which can add months to the elapsed time. It ends at the point the therapeutic value chain treats as its pivot, the clinical decision itself. Everything the commercial system does here has one purpose, which is to put the state of the art in front of that decision before it is made.

The path carries the work of several functions that rarely share a scorecard. Medical Affairs carries scientific exchange and the evidence environment a clinician actually reads. The Field Force carries the relationship and the account context that determine whether any of it lands. Marketing carries the message, the channel mix and the demand generation that brings patients into care at all. The Brand Team sits above all of it as the named owner, here and on the other two paths.

Why three paths rather than one journey

A single journey map flattens three different kinds of failure into one picture, which makes the picture useless for allocating work. Each path has its own failure mode, its own cast of parties and its own remedy. Treating them as one encourages a company to fund a general improvement effort and then wonder why so little moved.

There is a second reason, and it is the more uncomfortable one. An unnamed journey has no owner, no budget line and no place on a scorecard. That may explain why these paths survive untouched inside organizations that are otherwise exacting about cost. Naming them is less a semantic exercise than a precondition, because a name is what makes accountability assignable.

How this path fails

This path fails quietly, which is what makes it the hardest of the three to argue about in a commercial review. Patients who never arrive leave no record. Diagnoses that come late tend to appear in the data simply as diagnoses. A condition carried for years without a name is invisible to every system this industry has built.

The clinician side fails just as quietly. A specialist may hold the evidence and never meet the moment where it would have changed a decision. A guideline may be current while a habit is considerably older. Nothing on a dashboard registers a patient who was never seen, so the loss on this path is real and almost entirely unbooked.

The one path pharma genuinely industrialized

Fairness matters here more than provocation. Of the three paths, this is the only one pharma has genuinely industrialized, and it has done so across roughly four decades. Launch excellence, marketing excellence and sales excellence were each built to operate on this path, and they operate well. The instruments are strong, the talent is deep, and the practice behind them is real.

That strength is also the reason the gap is so easy to miss. Excellence concentrated in one place can read as excellence overall, particularly when the measurement system lives in the same place. A company can run a textbook launch, win share of voice, hold a strong recall position and still lose most of what its science earned. The losses occur on paths the instruments do not reach.

Where the brand team's instruments run out

The structural problem sits in a mismatch between what the brand team owns and what it can see. The brand team ostensibly owns the brand end to end, which means across all three paths. Its instruments sit almost entirely in this one, namely prescribing data, market research, message testing, share tracking and promotional response. Each of those is a capable instrument for the question it was built to answer, which is whether a prescriber can be persuaded.

None of them was built to answer whether a decision survived. A share tracker cannot report that a clinically justified prescription was rejected by a payer in February. Market research cannot report that a patient stopped at week six because a form went unanswered. Those events belong to the Path to Fulfill and the Path to Adhere, where the brand team holds accountability and very little instrumentation.

That asymmetry is why a company can be excellent on this path and still lose most of what it earns. Excellence at generating intent does not confer visibility into whether intent became therapy. The written prescription is intent rather than realized value, which is the first of the tenets I work from. Scientific value is realized when the patient accesses, starts, continues and benefits, not when the script is written.

What customer consciousness asks of this path

The best work on this path happens before a market exists. Customer consciousness in its upstream sense means reading a customer's world deeply enough that what their life is making them need becomes visible before any market has formed around it. That is a research posture rather than a forecasting exercise, and it is rarer in this industry than the sheer volume of market research would suggest.

In our practice that question sits inside the Convergence Readiness Model, which names seven conditions that tend to precede a category forming. They are persistent need, normalized burden, identity intensity, cultural readiness, self recognition, scientific unlock and ecosystem potential. Categories that look sudden from the outside often satisfy most of those conditions years in advance. The GLP-1 phenomenon is the clearest recent instance, and its signals were legible well before the market was.

Reading those conditions early is a Path to Prescribe capability, though it rarely sits where the rest of the path's instruments sit. It asks a brand team to study a life rather than a market. It also asks for patience, because the signal appears long before the revenue does. Companies able to do both tend to arrive in a category as its author rather than its fourth entrant.

How progression on this path is measured

Progression on all three paths is measured on one ladder, which is what makes them a single commercial system rather than three initiatives. The stages are Scripts Written, Filled, Therapy Started, 90-Day and Persistence. This path is accountable for the first stage and, more importantly, for the size of the population that reaches it at all. A company counting only that first stage is measuring intent and reporting it as performance.

The yield question follows from the ladder. The Realization Rate is realized value divided by earned value, and it 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 converts a shortfall into a figure a finance committee already knows how to read. Both measures span the three paths, because a shortfall can originate in diagnosis, in fulfillment or in the months after a first fill.

The ladder also changes what field intelligence is for. Field intelligence is observed rather than recalled, account specific rather than sampled, current rather than lagged, and already attached to the moment progression broke. That combination makes it the most unimpeachable and actionable intelligence in the commercial system, and it is largely uncollected. An operating blueprint for field intelligence and activation exists to turn that observation into assigned work rather than anecdote.

Read that way, field force effectiveness stops being a question about coverage and call plans. It becomes a question about how much of what the field already sees survives the trip into a decision somebody makes. Very little of the friction on this path is discovered by headquarters first. Almost all of it is seen by somebody in a parking lot outside a clinic.

Key Takeaways

The Path to Prescribe runs from an undiagnosed patient to a clinical decision, and it is the first of three paths where earned value survives or is lost.
It fails quietly, through patients who never arrive and diagnoses that come late, which leaves the loss real and almost entirely unbooked.
Pharma has genuinely industrialized this path across four decades of launch, marketing and sales practice, and its instruments are strong.
The brand team owns all three paths while its instruments sit almost entirely in this one, which is why excellence here can coexist with large losses elsewhere.
Customer consciousness in its upstream sense reads a customer's world before any market has formed around it, which is where new categories become visible.
Progression is measured on one stage ladder across all three paths, running from Scripts Written through Persistence.

Diagnostic Questions to Consider

Name the function accountable for the patients in your category who never reach a diagnosis at all.
List the instruments your brand team currently holds that report on anything occurring after a prescription is written.
State how long a patient in your category typically carries the condition before it is named.
Describe the signals you would have needed in order to see a converging category three years before it formed.
Identify your current Realization Rate and which of the three paths accounts for most of the shortfall.

Closing Reflection

The Path to Prescribe is the path this industry knows how to work, and that deserves saying plainly rather than grudgingly. Four decades of launch, marketing and sales practice produced real capability, and the people who built it were not wrong about what they were building. The limitation is one of scope rather than quality.

What follows is a question about boundaries rather than about effort. The commercial funnel in pharma ends too early, at the written prescription, and prescribe, fulfill and adhere belong inside one commercial system. A company that accepts that proposition then has to extend its instruments past the point where its current ones stop, which is an uncomfortable budget conversation rather than a philosophical one.

I have rarely found an organization that lacked the will to do this. What tends to be missing is a named path, an owner who holds it whole, and a number that makes its condition visible in a quarterly review. Those three things are structural decisions, available to any company prepared to make them.

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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