Mapping the HCP and patient funnel stage by stage

Two leaks define the pharma funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.View full definition → and have no clean equivalent in consumer marketing. A prescriber writes the script and the patient never picks it up. Or the patient picks it up once and never comes back. Both happen after the point where most campaign dashboards have already declared victory, and both are invisible if you stop counting at the prescription. This lesson walks the stages in order, HCP side and patient side, and marks where the volume actually disappears.

Why pharma has two funnels, not one

In most consumer categories the buyer and the user are the same person. In pharma the HCP prescribes, the patient takes the drug, and the insurer or its Pharmacy Benefit Manager (PBM) decides whether it is covered at all.

So marketing runs two parallel journeys:

• HCP funnel: awareness → detailing (rep visits) and digital engagement → sample or starter request → trial prescription → repeat prescribing.
• Patient funnel: diagnosis → prescription received → benefit check and co-pay card activation → first fill → refill → persistence.

They touch at exactly one point, the written script, then diverge again. A brand can win the HCP funnel outright and still miss forecast, because everything after the pen leaves the prescriber's control.

Stage 1: HCP awareness and consideration

Measured with reachreachThe number of unique people exposed to your message in a given period. Unlike impressions, reach counts each person once, no matter how often they see it.View full definition → and frequency logic familiar from B2B, adapted for a regulated audience:

• Share of voice (SOV): a brand's proportion of total detailing visits or media impressionsimpressionsThe total number of times an ad or piece of content is displayed, regardless of clicks. Each display counts as one impression, even to the same person.View full definition → in a therapeutic class.
• Reached target prescribers: the share of the target list (often the top deciles by class volume, "decile 8-10" physicians) contacted at least once, personally or through non-personal channels.

Non-personal promotion runs largely through professional platforms. Medscape, which sells sponsored content, alerts and eDetail inventory against a verified physician audience, reports engagement back at specialty and sometimes NPI level. Which of those engagement signals actually tracks with new prescribing is the question the engagement lesson settles; at this stage they only tell you the message had a chance to land.

Prescribing is heavily skewed in most classes, a minority of writers producing the bulk of volume, which is why targeting rather than broad reach eats the budget.

Stage 2: sample requests and NBRx

NBRx (new-to-brand prescriptions) counts scripts for patients newly starting on this brand rather than refilling it. It is the earliest hard signal that promotion has turned into prescribing behaviour, tracked weekly from pharmacy claims data (IQVIA, Symphony Health) at physician level, under HIPAA privacy safeguards.

Two things distort the early read, and both bite at launch:

• Free-trial vouchers, samples and bridge programmes mean the patient starts therapy weeks before any paid claim exists. Week-four NBRx on a specialty launch can understate real starts badly.
• Weekly claims feeds get restated for several weeks as slower pharmacies report. Teams that celebrate or panic on a single week's number are reading an incomplete file.

Worked example. A brand runs 10,000 details in month one. If 8% of detailed physicians write at least one new script that month, that is 800 writers; at 1.5 NBRx each, 1,200 NBRx. Useful as a planning ratio, but note it is a correlation between contact and script, not proof the detail caused it.

Stage 3: TRx and the refill signal

TRx (total prescriptions) includes new and refilled scripts. The NBRx to TRx ratio places the brand in its lifecycle:

• High NBRx, low TRx: early launch, plenty of trial, little repeat yet.
• Stable NBRx, rising TRx: patient base compounding, persistence holding.
• Falling NBRx, flat or declining TRx: saturation, or share going to a competitor.

TRx lift estimates the incremental scripts attributable to a specific event: a congress sponsorship, a co-pay change, an ad flight. It is normally derived from geogeoThe practice of making your brand and content visible and citable inside AI-generated answers from tools like ChatGPT, Gemini and Perplexity.View full definition →-tests or matched-market comparison, since clean randomisation is rarely permitted when compliance rules govern who may receive which promotion.

One blind spot: cash-pay fills. When a GoodRx coupon prices a generic or an older branded product below the patient's insurance copay, the patient pays cash and the plan never sees a claim. Dashboards built only on insured claims will miss those dispenses and read a decline that is really a channel shift.

Stage 4: the payer wall, prior authorization and access

Between "physician writes" and "patient fills" sits friction with no consumer analogue: prior authorization (PA), where the plan or PBM (CVS Caremark, Express Scripts and Optum Rx are the three largest in the US) must approve coverage before dispensing.

Abandonment at the counter, where a claim is adjudicated and then reversed because the patient walks away, commonly runs in the low tens of percent for specialty products and climbs steeply with out-of-pocket cost. Note the mechanic: abandonment is measured from reversed claims, so a feed that counts adjudications rather than net dispenses will overstate fills.

Hence the access toolkit:

• Co-pay and savings cards, which cut out-of-pocket cost for commercially insured patients only. Federal anti-kickback rules bar their use with Medicare and Medicaid.
• Hub services, third parties handling benefit verification, PA paperwork, appeals and reminders.

The Medicare exclusion has a consequence brand teams underestimate. For an indication skewed to patients over 65, the main abandonment lever simply does not exist, so plan on formulary position, independent foundation support and hub-driven appeals instead of a copay buydown, and expect the fill curve to look worse than the commercial book at identical promotional spend.

Stage 5: first fill, second fill and adherence

First fill is the patient-side equivalent of NBRx: the drug is actually dispensed. Primary non-adherence, scripts written and never filled at all, is large in chronic care; published US work on electronic prescriptions puts it in the region of a fifth to a quarter of new starts. That leak sits entirely outside the reach of any HCP campaign.

The second leak is the first-to-second-fill step, usually the single steepest decline in the whole mapmapUsing software to automate repetitive marketing tasks and campaigns, enabling personalisation at scale across channels like email, web, and social.View full definition →. After that, retention metrics take over:

• Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC), refill-timing estimates of how much of the period the patient had drug on hand. PDC above 80% is the conventional adherence threshold.
• Persistence: time on therapy before discontinuation, reported at 6 and 12 months. How far that number swings between therapeutic areas is the benchmarking lesson's territory.

The CDC's resources on medication adherence explain why non-adherence is a cost and outcomes problem, which is the ground marketing-run adherence programmes stand on.

Putting the funnel together: a simplified view

The two funnels move at different speeds. NBRx can appear within days of a detail; a patient's path from script to first fill runs weeks when a PA is involved. Launch dashboards overlay claims with hub and co-pay data weekly to keep both in view.

Stitching them is where teams overreach. A customer data platformcustomer data platformSoftware that unifies customer data from every source into one persistent profile that marketing, sales and service teams can act on.View full definition → like Segment (which sells exactly this identity plumbing) can unify consented patient-support interactions, but it cannot join a de-identified claim to a known patient record. The join happens on de-identified tokenstokensA token is the basic unit of text that language models process, often a word fragment, whole word, or punctuation mark rather than a single character.View full definition → or at geography level, and a team that plans a single patient-level view of the whole funnel will spend two quarters discovering that.

A simple conversion snippet

detailed_physicians = 10000
pct_writing_NBRx = 0.08
avg_NBRx_per_writer = 1.5
PA_approval_rate = 0.75
first_fill_rate = 0.85
second_fill_rate = 0.70

NBRx = detailed_physicians * pct_writing_NBRx * avg_NBRx_per_writer
filled = NBRx * PA_approval_rate * first_fill_rate
on_second_fill = filled * second_fill_rate

print(NBRx, filled, on_second_fill)
# 1200.0  765.0  535.5

Twelve hundred scripts written, 536 patients still on drug at the second fill. Doubling detailing effort moves the first line; it does nothing to the 55% lost below it. That is the arithmetic that pushes access and adherence money out of the "support programme" column.

The counter-example is worth holding in mind: Hims & Hers, which sells the telehealth visit, the prescription and the shipment as one subscription, has collapsed most of these stages. Payment precedes dispensing, so counter abandonment more or less vanishes and the retention metric becomes subscription churn. The leaks did not disappear; they moved to a place the company controls.

Key takeaways

• Two funnels, one intersection: HCP awareness through prescribing, patient prescription through persistence. They meet only at the written script.
• NBRx is the earliest launch signal, TRx shows total demand, and their ratio locates the brand in its lifecycle. Early NBRx is understated when samples, vouchers or bridge programmes are running, and weekly feeds get restated.
• The largest leaks sit below the prescription: a fifth or more of new chronic scripts are never filled, specialty abandonment runs into the low tens of percent, and the first-to-second-fill step is usually the steepest drop of all.
• Access tooling is funnel machinery, not a support line item, and its availability is asymmetric: no co-pay card exists for Medicare patients.
• Retention metrics belong on the map because value accrues over sustained therapy, in the way the LTV lesson models it; a filled first script on its own is close to worthless.