Mapping the HCP and patient funnel stage by stage

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 (or payer) pays and takes the drug, and often a third party, the Pharmacy Benefit Manager (PBM), decides whether insurance covers it at all.

That means marketing has to run two parallel journeys:

• HCP funnel: awareness → detailing (rep visits) → sample request → trial prescription → repeat prescription.
• Patient funnel: diagnosis/awareness → prescription received → co-pay card activation → first fill → refill (adherence).

They intersect at the point of prescription, but each has its own drop-off points and its own metrics.

Stage 1: HCP awareness and consideration

This is 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.Voir la définition complète → and frequency metrics familiar from any B2B funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète →, adapted for a regulated environment:

• Share of voice (SOV): a brand's proportion of total detailing (sales rep) 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.Voir la définition complète → in a therapeutic class.
• Message recall: tracked via post-call surveys or panel data (e.g., from Veeva or IQVIA physician panels).
• NRx-eligible reach: the percentage of target prescribers (often the top 20% by volume, sometimes called "decile 8-10" physicians) who have been reached at least once.

Pharma companies concentrate spend on high-decile prescribers because prescribing is famously skewed: a small share of physicians often account for a large share of volume in a given class. This is why HCP segmentationsegmentationDividing a market into distinct groups of customers who share similar needs, characteristics or behaviours, so each group can be served with a tailored approach.Voir la définition complète → and targeting, not broad 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.Voir la définition complète →, dominate pharma marketing budgets.

Stage 2: sample requests and nbrx

NBRx (New-to-Brand prescriptions) is the single most watched number in a pharma launch. It counts prescriptions for patients newly starting therapy on this brand, as opposed to refills. It is the earliest signal that detailing and awareness are converting into actual prescribing behavior.

NBRx is tracked weekly using prescription claims data from vendors like IQVIA or Symphony Health, often at the individual physician level (with privacy safeguards under HIPAAHIPAAHealth Insurance Portability and Accountability Act, loi américaine imposant la protection des données de santé (PHI). Violations : amendes jusqu'à 1,9M$ par catégorie de violation., the US Health Insurance Portability and Accountability Act).

Worked example:

A brand runs 10,000 HCP details in month one. If 8% of detailed physicians write at least one new prescription that month, that's 800 NBRx-generating physicians. If each writes an average of 1.5 NBRx, that's 1,200 NBRx for the month. Marketing teams track this "conversion-per-detail" ratio to judge rep and campaign effectiveness, and it typically improves over a launch's first two to three quarters as awareness builds.

Stage 3: TRx and the refill signal

TRx (Total prescriptions) includes both new and refilled prescriptions. The ratio of NBRx to TRx tells you where a brand sits in its lifecycle:

• High NBRx, low TRx: early launch, lots of trial, not much repeat yet.
• Stable NBRx, rising TRx: healthy, growing patient base with good persistence.
• Falling NBRx, flat/declining TRx: saturation or share loss to a competitor.

TRx lift measures the incremental increase in total prescriptions attributable to a specific campaign or event (a conference sponsorship, a new co-pay program, an ad flight). It is usually estimated via geo-testing or matched-market comparisons, since a controlled experiment (like an A/B testA/B testA/B testing is a controlled experiment that compares two versions of something (A and B) by splitting traffic randomly to learn which performs better on a chosen metric.Voir la définition complète →) is rarely feasible when compliance rules constrain who receives what promotion.

Stage 4: The payer wall, prior authorization and access

Between "physician writes prescription" and "patient fills it" sits a friction point unique to healthcare: prior authorization (PA), where the insurer or PBM (CVS Caremark, Express Scripts, Optum Rx are the three largest in the US) must approve coverage before the drug is dispensed.

Industry estimates (as of recent years, treat as approximate) suggest that abandonment at the pharmacy counter, patients who get a prescription but never pick it up, can run 10-20% for specialty drugs, higher when out-of-pocket costs are high. This is why manufacturers invest heavily in:

• Co-pay cards / savings cards: reduce out-of-pocket cost for commercially insured patients (not usable with government insurance like Medicare or Medicaid due to anti-kickback rules under US federal law).
• Hub services: third-party programs that help with PA paperwork, benefits verification, and patient reminders.

Co-pay card activation rate (the share of eligible patients who actually register and use the card) is a key patient-funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → KPIKPIKey Performance Indicator, a measurable value that shows how effectively you're achieving a specific objective, tracked over time against a target.Voir la définition complète →, since an unused card is a wasted subsidy and a lost patient.

Stage 5: First fill and adherence

First fill is the patient-funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → equivalent of NBRx: the prescription actually gets dispensed. From there, marketing shifts to retention:

• Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC): standard adherence metrics estimating what share of the time a patient has drug on hand, based on refill timing. A PDC above 80% is a commonly used industry threshold for "adherent."
• Persistence: how long a patient stays on therapy before discontinuing, often reported at 6 and 12 months.

For chronic therapies (statins, biologics for autoimmune disease), the CDC's resources on medication adherence are a good primer on why non-adherence is a major cost and outcomes issue that marketing-run adherence programs (text reminders, nurse support lines) are explicitly designed to address.

Putting the funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → together: a simplified view

| Stage | FunnelFunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → | Key metric | What it tells you |

|---|---|---|---|

| Awareness | HCP | Share of voiceShare of voiceYour brand's share of total advertising or conversation volume in your category, measured against competitors over a defined period.Voir la définition complète →, 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.Voir la définition complète → | Are the right doctors seeing/hearing about the brand |

| Trial | HCP | NBRx | Are doctors starting new patients on it |

| Volume | HCP | TRx, TRx lift | Is total demand growing, and is a campaign working |

| Access | Patient | PA approval rate, co-pay activation | Is the prescription actually reaching the patient |

| Fill | Patient | First-fill rate | Did the patient get the drug |

| Retention | Patient | PDC, persistence | Is the patient staying on therapy |

The funnels are sequential but not identical in speed: an HCP can generate NBRx within days of a detail, but a patient's path from prescription to first fill can take weeks depending on insurance friction. Marketing teams stitch these together into launch dashboards that overlay claims data (NBRx/TRx) with co-pay card and hub data, usually refreshed weekly.

A simple conversion snippet

Analysts often model funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → efficiency with a straightforward multiplication of stage conversion rates:

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

NBRx = detailed_physicians * pct_writing_NBRx * avg_NBRx_per_writer
filled_prescriptions = NBRx * PA_approval_rate * first_fill_rate

print(NBRx, filled_prescriptions)
# 1200.0  765.0

This kind of back-of-envelope model, however crude, is exactly what brand teams use to spot where the biggest leak is: often it's PA approval and first-fill, not HCP awareness, that quietly kills volume.

Key Takeaways

• Pharma marketing runs two linked funnels: HCP (awareness to prescribing) and patient (prescription to adherence). Metrics differ at each stage and must be read together.
• NBRx (new prescriptions) is the earliest, most-watched launch signal; TRx (total prescriptions) shows overall brand health; the NBRx/TRx ratio indicates lifecycle stage.
• The biggest hidden leak is often not awareness but access: prior authorization and pharmacy abandonment can silently cut converted prescriptions by 20% or more (estimate), which is why co-pay cards and hub services are core marketing tools, not side programs.
• Adherence metrics (PDC, persistence) extend the funnelfunnelThe customer journey from awareness to purchase, typically Awareness, Interest, Consideration, Decision, Action, with prospects narrowing at each stage.Voir la définition complète → past the "sale," reflecting pharma's focus on lifetime valuelifetime valueLifetime Value: the total revenue (or profit) a customer generates throughout their entire relationship with your business.Voir la définition complète → through sustained therapy, not one-time conversion.