What Is Value Leakage in Pharma? The Definition

Value leakage in pharma is the therapeutic and commercial value that is earned when a clinician decides to prescribe and then lost before the patient starts, continues and benefits from therapy. It happens in the interval between prescription and patient, at the handoffs between access, fulfillment, support and the field. You measure it as Customer Value at Risk, the share of earned value exposed to friction, fragmentation and failed handoffs. The Customer Excellence AGENCY uses the term throughout its work, and this page is the definition we work from.

What is value leakage, in plain terms?

You create intent. Through science, evidence, brand and field engagement you persuade a clinician that your therapy is right for a patient, and the clinician writes a prescription. Most commercial systems count success right there. The books close before the story does. Between the script and the patient, that prescription can be rejected by a payer, abandoned at the pharmacy, delayed in a hub, started and then dropped, or never filled at all. In most organizations nobody holds a consolidated account of how often that happens or why. The value you lose in that interval is value leakage.

Be precise about what is leaking. A written prescription is intent, not realized value. Realized value exists only when the patient accesses, starts, continues and benefits from the therapy. So every point of value leakage is revenue you already paid for and did not collect. On the patient side it is a clinical benefit that was decided on and never delivered. Both losses come from the same operating failure, even though they show up, when they show up at all, in different reports.

Where does value leak?

Across three paths. The Path to Prescribe runs from awareness to the prescribing decision. This is where your commercial engine is strongest and leakage is lowest. The Path to Fulfill runs from the written script through access, authorization, dispensing and first dose. This is where the largest and least visible leakage happens. In some therapeutic areas as many as half of written prescriptions never become initiated therapy. The Path to Adhere runs from first dose through persistence and outcome. It leaks slowly and it compounds, because every missed refill or unresolved barrier cuts the value of every month of therapy that follows.

Within each path the leak is rarely inside a function. Access, brand, field, medical and patient support can each meet their own internal standard while the patient does not progress. The failure lives between the steps, at the handoffs, where ownership is fuzzy and your measurement confirms that tasks got done rather than that the patient moved forward.

Why does it stay invisible?

Three reasons. First, accounting convention. You count commercial success at prescribing, so whatever happens afterward is nobody's number. Second, organizational design. The functions that touch the patient after the script are managed separately, so the human cost and the financial cost land in different reports and the operating failure lands in neither. Third, heroics. Your most resourceful people compensate for system gaps with extra calls, personal contacts and informal escalations. That keeps a flawed model running and hides what it really costs. Every one of those escalations is intelligence about where your system is broken, and most organizations never collect it.

Is every stopped therapy a leak?

No. A clinical reconsideration, an informed patient decision and a legitimate coverage determination are not failures of your commercial system. The discipline is to separate those from avoidable friction in access, coordination, communication and support, and to separate what you control from what you can only influence. A value leakage diagnostic that cannot make that distinction overstates the problem and loses the trust of the clinical and access teams you need on your side.

How do you measure value leakage?

By progression, not activity. The core measures are script to start conversion, time to therapy, the stall points where patients wait, persistence over time, barrier resolution rates and realized value per unit of demand you created. Two summary measures sit on top. Realization Rate is realized value divided by earned value. Customer Value at Risk, or CVaR, is earned value multiplied by one minus the Realization Rate. It is the commercial exposure created by friction, fragmentation and failed handoffs, estimated barrier by barrier as a probability weighted revenue figure you can act on.

Both fit inside a single statement of how value is realized in pharma. Realized Value equals Brand times Product times Experience, raised to the power of Culture, times one minus CVaR. Brand creates belief. Product creates clinical possibility. Experience moves intent toward impact. Culture decides whether that repeats. CVaR is the share you lose on the way. Value leakage is the name for everything CVaR counts.

Why is this a commercial system problem rather than a sales problem?

Because in pharma your commercial system is part of the therapeutic value chain. Its job is to put the state of the art in front of the clinical decision before it is made, and then to see that decision through to the patient. A commercial system that stops at the prescription is doing half its job and getting measured on the half it does. You do not have a sales problem. You have a systemic value realization problem, and value leakage is how it shows up in your numbers.

This is also why digital and AI programs so rarely close the leak. They make the demand creation half of your system faster and more scalable. On their own they do not assign an owner to a handoff, define how an exception gets handled, or turn a frontline observation into a classified, assigned and resolved fix. Those are design decisions. They are the work of Customer Excellence.

What does closing the leak look like?

Four changes, in order. Put explicit accountability on every handoff between prescription and sustained therapy. Define what happens with exceptions, so a stalled patient triggers a process instead of a heroic act. Measure progression: where barriers occur, how long they take to resolve and whether the fix held. Run a formal loop that captures frontline signal, classifies the barrier, assigns an owner, intervenes, measures progression and learns. Where competing therapies offer similar clinical benefit, the company that does this reliably converts more of its earned value than the company that does not. That is the commercial advantage that begins after the prescription.

Key takeaways

Value leakage is earned therapeutic and commercial value lost between prescription and patient.
It concentrates in the Path to Fulfill and compounds in the Path to Adhere, at handoffs rather than inside functions.
It stays invisible because you count success at prescribing, your functions report separately and heroics hide the cost.
You measure it by progression, summarized as Realization Rate and Customer Value at Risk.
Closing it is a design and governance job for your whole commercial system, not a sales or technology fix.

Questions to ask your leadership team

How much appropriate prescribing in your portfolio fails to become treatment, and how much of that loss is preventable?
Who owns progression from prescription to initiation, and can they act across organizational lines?
If every hub, pharmacy and field dashboard were green tomorrow, could you show that patients started treatment faster?
Would treatment initiation hold up if your most resourceful people were out for a month?
When the frontline spots a recurring barrier, how long does it take you to change the process, and who decides?

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. Related definitions: Consumer-Grade Pharma and Customer Excellence in pharma.

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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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