Voice of the Customer in Pharma: Three Ways to Hear, Not One

Pharma needs voice of the customer more than any industry I have worked in, and collects less of it than any of them.

That is not a failure of effort. The structure of your market blocks the front door. What most companies do about it is stop listening and call the survey a listening program. You end up with a dashboard nobody acts on and a patient population you have never heard from.

There is a better answer, and it starts with admitting there are three ways to hear your customer rather than one.

Why does pharma need it most?

Because your customers meet a system you designed and cannot see.

In retail, a bad experience ends in a complaint and a refund. In your market, a bad experience ends in a patient who never starts therapy, and nobody tells you. The science worked. The clinician decided. The value evaporated somewhere between the decision and the dose, in a process your company set up and does not watch.

The scale of that silence is documented. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. Almost none of those people filed a complaint with you.

The gap shows in the numbers. Deloitte's 2025 research found that only 28% of HCPs believe pharma's engagement strategies meet their needs, against 82% of life sciences executives who say they are satisfied with those same strategies. That 54 point spread is the sound of an industry not listening and not knowing it.

Meanwhile your access to the people who could tell you is shrinking. Veeva Pulse data reported by BioSpace put HCP accessibility at 45%, down from 60% eighteen months earlier. The need goes up as the door closes.

So why do you get so little of it?

Three structural blocks, and only one of them is about budget.

You often cannot speak to the patient. In most markets you may not discuss the product with her, which removes the single most informative conversation available to any other industry.

Your customer is three people. A physician chooses, a payer covers, a patient uses. Ask one and you have heard a third of the decision, usually from the party least exposed to what went wrong. I have written separately on why consumer CX does not translate to pharma, and this is the clearest consequence of it.

Your remaining access is expensive. Outside pharma, Gartner found 62% of customer service channel transitions are high effort in industries where the company can watch the transition happen. You usually cannot watch yours, and every survey you send to a physician spends a little of the 45% you have left. A listening program that burns access to produce a slide is worse than no listening program, because it costs you the thing you cannot buy back.

What are the three ways to hear your customer?

Direct, frontline and synthetic. Different fidelity, different cost, different jobs, and the discipline is knowing which one you are standing on.

Direct voice is the customer speaking for herself. Highest fidelity and most constrained. Use it sparingly, on questions nothing else can answer, and never for anything you could have observed instead.

Voice of the frontline is your field force, your hub agents, your medical information line and your patient support team reporting what they witnessed. Lower fidelity on feelings, far higher fidelity on behavior, and almost entirely unused.

Synthetic is a model standing in for a customer you cannot reach. Lowest fidelity, highest reach, and useful in a narrower band than its vendors suggest.

Most companies invest in the first, ignore the second and are being sold the third. The order of value is roughly the reverse.

Why is the frontline the most undervalued signal you own?

Because it reports behavior rather than opinion, and behavior is what you are actually trying to predict.

Your rep does not need to ask a physician how she feels about prior authorization. She watched the office manager give up on an appeal. Your hub agent does not need a survey to know which step loses people, because she has said the same sentence forty times this week. That is observed evidence, collected daily, at no incremental cost, by people you already employ.

It also arrives early. A rep meets a new payer policy weeks before any dashboard registers it. Most companies have nowhere to put that signal, so it dies in a car park between calls.

Treat it properly and it becomes an instrument. Structure what gets captured, route it somewhere a decision can be made, and close the loop back to the person who reported it, or they stop reporting. The discipline for running your field as a sensing system rather than only a delivery channel is set out in our practice note on field excellence operations.

Where does synthetic actually help?

Upstream of research, never downstream of it.

Here is the honest case. At the design stage you are not choosing between a synthetic persona and real data. You are choosing between a synthetic persona and one brand manager's assumption, formed in a meeting, unchallenged. Simulation beats assumption. That is a real gain and worth having.

Here is the honest limit. A model trained on text learns how people explain decisions, not how they make them. Your physician decides on context, habit, trust and the difficult patient she saw on Tuesday, then produces a tidy rationale when asked. The model reproduces the rationale. You get a fluent, confident account of why someone would do something they will not actually do.

That matters more in your market than in most, because predisposition rather than stated preference is what moves prescribing. It matters most of all on patients, where the pitch is strongest and there is no ground truth available to check the simulation against. The audience you most want to simulate is the one you can least validate.

So use it to generate hypotheses, pressure test a design, or reach a segment you cannot survey in time. Do not use it to produce a number you report.

How do you know which signal to trust?

Three tests, and apply them to every input before it reaches a decision.

Provenance. Can this be traced to something a human did, rather than something a human said? An abandoned appeal outranks a satisfaction score.

Predisposition or rationale. Does it capture what moved the person, or the story they told afterwards? Stated reasons are the weakest evidence in your market and the only thing a synthetic respondent can produce.

Predictive hold. Run it against a cohort whose outcome you already know. Compare what it predicted to realized conversion, time to therapy and persistence. Publish the error. Any signal that cannot be scored this way is a focus group with better grammar.

That last test is the one the industry is skipping, and it is the only one that separates a listening system from a listening theatre.

Where does this sit against measurement?

Beside it, doing a different job, and confusing the two is what broke the last generation of CX programs.

Voice of the customer tells you why. Progression measurement tells you whether. You need both, and the error was never listening too much. The error was promoting sentiment to the scorecard, where it could not carry the weight.

Keep your listening rich and your scorecard behavioral, and the whole system holds. The measures that belong on the scorecard are in how to measure customer experience in pharma, and the discipline that connects listening to realized value is Customer Excellence.

Key takeaways

Pharma needs voice of the customer more than other industries and collects less of it, because the front door is closed by law and by structure.
The 54 point gap between how HCPs rate your engagement and how your executives rate it is what not listening looks like from the outside.
You have three routes, not one. Direct voice, voice of the frontline and synthetic, in descending fidelity and ascending reach.
The frontline is the most undervalued signal you own, because it reports observed behavior rather than stated opinion and arrives weeks earlier.
Synthetic simulation beats assumption and loses to evidence, so it belongs upstream of research and never inside a reported number.

Questions to ask your leadership team

When did a patient last tell you something that changed a decision, and how did it reach you?
What happens to what your field force sees, between the observation and the next planning cycle?
Of the customer evidence in your last brand review, how much was something observed and how much was something stated?
If you bought a synthetic audience tomorrow, what cohort would you validate it against, and who would publish the error?
Which numbers on your scorecard are sentiment, and what would replace 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. Related reading: Operationalizing voice of the customer for commercial success, Bespoke, the future of experience measurement and What is value leakage in pharma?

< Older Post

Newer Post >

[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.

Tan building with a hanging sign against a clear blue sky