Why Consumer CX Does Not Translate to Pharma

Pharma is different is the most overused sentence in this industry, and it is usually an excuse. On this one question it happens to be correct.

The customer experience discipline that arrived here was built somewhere else, for markets that work differently in four specific ways. It underperformed. The industry watched that happen and concluded that experience does not drive commercial outcomes in pharma. The right conclusion was narrower. The imported version did not fit, and nobody had yet built the version that would.

I say that as someone who taught the imported version. Before pharma I led delivery at the Ritz-Carlton Leadership Center, where service is an engineered system and the Credo is a working document rather than a wall poster. That model is superb. It also assumes four things about your market that are not true.

What did pharma actually import?

Three things, and none of them were adapted on the way in.

An instrument, built on surveys and an advocacy score, which Fred Reichheld set out in the Harvard Business Review in 2003 for industries where customers choose freely and buy repeatedly. An organizational shape, the CX function, sitting beside commercial rather than inside it. A logic, which says a satisfied customer buys again.

The results were visible early. Bain's pharma work noted that the industry rated among the least customer friendly in a 2011 Harris poll, down 43% from a similar poll in 1997. That reading is old now, and the direction has not reversed. In 2025, a DHC Group survey reported by eMarketer found just 16% of respondents view the pharma industry as patient centric.

Why does a three person market break the instruments?

Because your customer is not one person.

A physician chooses. A payer decides whether to cover. A patient uses the therapy and pays part of the cost. Three people, three sets of interests, and none of them holds the whole relationship with you.

Every consumer instrument assumes those three are the same person. Loyalty assumes the chooser can come back. Repeat purchase assumes the user controls the next transaction. Advocacy assumes the person recommending you is the person who paid. Take that unity away and the arithmetic stops working.

Here is what it looks like in practice. A physician who thinks highly of your company writes a prescription that a payer refuses and a patient abandons at the counter. Your survey score holds steady. Your realized value does not. The instrument cannot see the failure because the failure happened to someone it never asked.

Why can you not close the loop the way retail can?

A retailer hears a complaint and fixes it with the customer directly. That loop is the engine of the whole discipline. Yours is partly closed by law and partly invisible by structure.

You often cannot contact the patient. In most markets you cannot discuss the product with them. You frequently cannot see what happened at the pharmacy counter, inside the payer's adjudication, or in the thirty seconds when the office staff decided the appeal was not worth filing.

Consumer service has its own version of this problem and it is instructive. Gartner found that 62% of customer service channel transitions are high effort for customers, in industries where the company can watch the transition happen. You often cannot watch yours at all. An instrument designed around a loop you do not have will report that things are fine right up until they are not.

Why does the value event sit outside your control?

In retail the value event is the purchase, and it happens in front of you. In pharma the value event is sustained therapy, months later, handled by payers, pharmacies, hubs, specialty distributors and office staff you do not employ.

The numbers on that interval are not subtle. A 2026 study in JAMA, summarized by Johns Hopkins, found insurer rejections of brand name prescriptions reached 40.7% of initial attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days. IQVIA data reported by Managed Healthcare Executive puts abandonment at 61% once a prescription costs the patient more than $250.

The imported model counts the transaction. Your transaction is a prescription, and a prescription is intent. Everything that determines whether intent becomes value happens after the point where your commercial system stops counting. We call the difference value leakage.

Does regulation really prevent better experience?

Ask most commercial leaders why the experience is what it is and regulation comes up inside a minute. It is the industry's standing answer, and it is mostly wrong.

Regulation governs claims. It constrains what you may say about efficacy and safety, to whom, through which channel, in which market. Those constraints are real and they are not going away.

Regulation says almost nothing about operational burden. It does not require a prior authorization to take three calls. It does not require a hub to ask for the same information twice. It does not require anyone to leave a physician's office guessing about whether a case stalled. In the American Medical Association's latest survey, 93% of physicians said prior authorization delays care and 82% said it at least sometimes leads patients to abandon treatment. Almost none of that delay is a regulatory requirement.

That is the most commercially useful distinction in this argument. Most of the friction your customers meet is not required of you. It is unowned, which is a very different problem and a much more solvable one.

What had to be rebuilt

Four substitutions, each replacing something that came in the imported box.

Measurement moved from sentiment to progression. Not how your customers feel, but whether they advanced: script to start conversion, time to therapy, stall points, persistence, barrier resolution speed, realized value against earned value.

Accountability moved from functions to handoffs. Access, brand, field, medical and patient support can each hit their internal standard while the patient stops moving, because the failure lives between them. Somebody has to own the seam.

The field moved from a delivery channel to a sensing system. Your reps and MSLs meet a new payer policy weeks before any dashboard registers it, and most companies have nowhere to put that signal.

Experience moved from a downstream consequence to a design variable, sitting beside brand and product rather than inheriting whatever those two leave behind. That is the discipline we now call Customer Excellence, and the bar it is built to clear is Consumer-Grade.

Where does it have to live?

Inside the commercial system, not beside it.

A program has its own budget line, its own team and its own dashboard, which is exactly why it can be cut in a bad quarter without anything else changing. What replaced it has to be carried on commercial numbers, owned by commercial leaders, and visible in how brands are run and reviewed. If your experience work disappears when the CX team does, you built the wrong thing.

The industry is arriving at the same place from a different direction. When Eli Lilly launched LillyDirect, David Ricks framed it around how the healthcare system "adds to the burdens patients face". Novartis launched its Cosentyx platform because, in its US president's words, the company needs "new ways to reach patients more directly by removing barriers in the system." Neither of those is a CX program. Both are commercial system changes aimed at burden.

Meanwhile the gap the imported model left behind is still open. 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.

Key takeaways

  • Consumer CX arrived in pharma with its instrument, its org shape and its logic unchanged, and all three assume a market you do not operate in.
  • Your chooser, payer and user are three different people, which breaks loyalty, repeat purchase and advocacy as measures.
  • The feedback loop the discipline depends on is partly closed to you by law and partly invisible by structure.
  • Your value event is sustained therapy, months after the transaction your system counts.
  • Regulation governs claims, not burden, so most of the friction your customers meet is unowned rather than required.

Questions to ask your leadership team

  1. Which of your experience measures would still mean something if the chooser, the payer and the user were three different people, because they are?
  2. When a patient stalls, how do you find out, and how long does it take?
  3. Name three sources of friction your customers meet that you have attributed to regulation. How many are actually required?
  4. Who owns the seam between access and patient support, by name?
  5. If your CX team were dissolved tomorrow, which commercial numbers would change?

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 learned service delivery at the Ritz-Carlton Leadership Center before leading global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Why pharma CX programs fail, Pharma customer experience, why it stalls and what replaces it and What is Customer Excellence in pharma?

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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