SPEAKERS:
Namita Powers, Principal, ZS
KEY TAKEAWAYS:
• Pharma’s industry overall healthcare provider (HCP) NPS is as low as negative 10% while patient care perception plummets
• On average, 30 % of new prescriptions never get filled, costing billions annually
• Companies have effective plays for less than 50% of identified barriers
• Targeted workflow interventions reduced specialty pharmacy cancellations by 50% within three months in one case study
• Agentic AI enables n=1 barrier identification without requiring organizational transformation
The Philadelphia Eagles' "tush push" works over 90% of the time because every player knows their role, trusts their teammates, and drives toward one clear goal: just one yard. Pharma invests billions in customer engagement with armies of roles and comprehensive digital solutions, yet the scorecard reveals a troubling reality. "Only one third of US patients say they feel cared for by the healthcare system. That is a 10% drop in a year in a system designed for care," Namita Powers explained at Pharma Customer Engagement USA in Philadelphia. The prescription abandonment crisis compounds this failure. "On average, 30% of new prescriptions are never filled. Think about that. We do all of this work to get them to write the script, and one third of them are never filled," Powers stated. Trust metrics paint an even darker picture. "Our HCP net promoter score as an industry is negative 10%. Pharma starts below zero in the relationships that matter most," she noted.
Why Customer Centricity Initiatives Keep Failing
The root cause of engagement failure lies not in strategy vision but in organizational execution. Pharma has pursued behavior-changing, personalized customer engagement at scale for over a decade, yet remains trapped in surface-level approaches focused on channel preferences rather than deep contextual understanding. Account centricity initiatives stumble, digital centricity efforts produce middling results, and patient centricity programs fall flat for the same fundamental reason. "In pharma today, everybody and nobody owns the customer. We are so siloed and approach everything so functional, every function is out there on that field, focused on their own yardage, their own lineup, their own plays that they are running independently," Powers observed.
This fragmentation becomes particularly problematic when organizations overcomplicate the fundamental question of customer definition. In prescription-driven markets, Powers argues for radical simplicity paired with comprehensive context. "The customer is the HCP in context. I’m not overly focused on the HCP. I'm overly focused on the context, on the context of decision making," she emphasized. That context encompasses patient populations with specific clinical profiles, geographic areas with distinct social determinants, regional payers influencing access decisions, health system affiliations with their pathways and protocols, EMR algorithms embedded in workflows, and operational realities that shape every prescribing decision.
Traditional pharma engagement focuses overwhelmingly on clinical, safety, and efficacy profiles while addressing other complexity factors by throwing roles at problems. Organizations deploy field reimbursement managers, nurse educators, and thought leader liaisons without ensuring these roles have the insights, content, and solutions needed to genuinely overcome barriers. Functions operate independently, each measuring their own metrics and running their own plays without coordinating toward shared goals. Until this structural problem gets solved, organizations will continue fumbling opportunities to deliver meaningful customer value.
From Clinical Profiles to Operational Workflow Barriers
The shift from traditional brand planning to barrier-driven engagement requires acknowledging that decision-making complexity extends far beyond product characteristics. Powers and her team have documented this reality systematically. "We have actually codified an industry barriers library now of 188 common industry barriers, and a good chunk of them are about operational and economic issues, not just the clinical ones that we tend to focus on in brand planning," she revealed.
Real-world examples illustrate how operational barriers create massive business impact that clinical messaging cannot address. "One company found that 20 to 30% of their scripts were being cancelled by the specialty pharmacy because patients weren’t answering the phone from an unknown number calling to verify their benefits and confirm therapy status," Powers explained. Another organization believed physicians weren’t triggering enough diagnostic tests to identify biomarkers, but cross-functional workshops revealed the actual problem: test results returned in PDF format with no searchable mechanism for identifying which patients had the relevant biomarkers. A third company discovered their referral site didn't accept the primary insurance carried by most patients in the prescriber’s practice, rendering product efficacy discussions irrelevant.
These operational and economic barriers represent the hurdles pharma consistently fails to clear. Organizations create extensive safety and efficacy materials in every format, tone, and language while leaving field teams without solutions for the workflow challenges that actually prevent patient access. The assessment results prove shocking. "We worked with one company, 28 barriers, they only had good plays for two of them. Another company, 65 barriers, they only had good plays for eight of them," Powers stated. Companies leap hundreds of feet over the first two clinical hurdles while slamming into the remaining operational barriers, leaving field teams as waiters without a kitchen, unable to put meaningful solutions on the table regardless of training quality.
Five Questions That Transform Barriers Into Coordinated Action
Identifying barriers represents only the starting point. Organizations must develop and execute plays that overcome each barrier through coordinated cross-functional effort. Powers introduced a five-question framework that brings clarity to roles, resources, and accountability: What’s our goal with this customer? Which role is best suited to achieve this goal ? What should they know? What can they use? Who can they tell?
This structure delivers something pharma has historically lacked: collaboration to an end rather than collaboration in the abstract. Instead of describing what each role does generally, plays specify exactly who runs point for each barrier-specific goal. "We have been doing collaboration in the abstract. We have one-pager, vague, RACI playbooks. This is what the MSL does, this is what the TLL does, right? But then when it matters on the ground, everyone's not sure who's picking up the ball and we fumble," Powers explained. The framework prevents unnecessary role proliferation by revealing when specialized functions aren’t required. "One company thought they needed a thought leader liaison role. But once we wrote all the plays, there was only one play for a TLL to do. Did we need a whole role for just one play?" Powers asked. By working with compliance to define the specific action required, the organization enabled MSLs to handle the play and avoided creating an entire role for a single task.
The phone play demonstrates how simple, coordinated interventions deliver measurable outcomes. With the goal of getting patients to answer specialty pharmacy verification calls, representatives served as the primary channel, communicating to physicians that patients needed to expect and answer calls from unknown numbers. Field reimbursement managers reinforced this message in the fewer accounts where they had presence. The team provided representatives with insights showing which specialty pharmacies autorejected scripts and which physicians were affected, along with a patient leaflet explaining what to expect. "That phone play, the company just started running it probably the last three months. Cancellation rates are down by half," Powers reported.
The framework also streamlines measurement to two essential questions: How quickly did we execute the play after identifying the barrier, and did the play work in resolving that barrier? This focused approach replaces the overwhelming analytics that bombard field teams with every possible report, instead providing exactly the insights needed to execute each specific play. "We only ever have to measure two things in this world. When we learned there was a barrier, how quickly did we run the play? And did the play work?" Powers stated. When combined with agentic architecture, systems can queue up barrier-specific information and trigger appropriate workflows automatically.
Seizing the Once in Fifteen Year Transformation Window
The convergence of CRM vendor landscape shifts and agentic technology capabilities creates what Powers characterizes as a serendipity moment for fundamentally reimagining customer engagement. "We’re in a serendipity moment right now. Shifts in the CRM vendor landscape and the agentic technology that's available to us creates this serendipity moment, this once in a 15-year opportunity to solve this problem," she explained. Organizations can now move CRM from functioning as a memory tool to operating as a system with a mind, identifying and inferring barriers at an individual customer level using systems of context and intelligence. This technology can trigger workflows, send alerts, and coordinate cross-functional plays within each user’s unique workflow, all managed centrally and compliantly.
The transformation doesn’t require massive organizational restructuring or changing every function. Organizations simply need every function to orient around barriers rather than independent metrics and plays. "We don’t need to change every function. We don't need to do a big org transformation. We just have to get every function to orient to the barriers," Powers noted. This shift enables the kind of coordination that makes the Eagles' tush push successful: every player knows their role, trusts their teammates, and drives toward clear shared goals.
Powers recommends organizations start with an eight- to 10-week sprint documenting all barriers for a priority brand, emphasizing operational challenges rather than only clinical drivers. This requires cross-functional participation since brand teams typically lack visibility into workflow and access barriers. "Get your barriers down on paper for your priority brand. Be specific. Don’t just focus on clinical drivers and barriers. Don’t let your brand team tell you we already do this. It is also operational barriers. Cross-functional information is critical," she advised. Organizations then assess their current state, determining which barriers have effective plays and which represent gaps. The assessment typically reveals that companies have strong coverage for clinical education barriers but lack solutions for the operational and economic challenges that actually prevent patient access.
Closing these gaps requires prioritizing resources strategically and building the content, solutions, and services that enable field teams to genuinely overcome barriers. "A role without solutions is kind of good for nothing. And that's what we have in this industry. We need to give them content and solutions and services to overcome these workflow barriers," Powers stated. The future Powers envisions contrasts sharply with current reality, where congenial conversations about product quality leave physicians frustrated because their patients can't access referral sites that don’t accept their insurance. "The doctor was like, yeah, we talked about how good the product is, but the rep doesn’t realize that the referral site that we have to refer to doesn't take the main insurance that most of my patients have. Who cares if the product is so good if my patients can't get it?" she recounted from field research.
When organizations enable field teams with barrier-specific insights and executable solutions, they can finally move beyond abstract discussions of customer centricity to deliver coordinated plays that genuinely move the ball forward, building the trust and delivering the outcomes that pharma has pursued unsuccessfully for over a decade.
Discover more on this topic at Pharma USA 2026 (March 17-18, 2026, Philadelphia) - North America's largest cross-functional pharma gathering. Visit the website here.
