SPEAKER: Maria Whitman, Managing Partner, Global Commercialization Strategy and Solutions, ZS
KEY TAKEAWAYS:
• 35% of prescriptions go unfilled despite decades of friction-reduction investment, signaling a strategy ceiling, not an execution gap
• Pharma's identity as a science innovator: rational when systems worked, now limits how it engages in redesigning care when the system itself becomes a barrier
• System-level redesign can significantly improve speed to care and outcomes by redesigning how care flows; Baylor Scott & White cut care fulfillment from eight weeks to one
• AI deployed into unchanged decision workflows generates reporting quality, not decision velocity — a form of institutionalized waste
• The practical test for zero distance isn't conceptual alignment; it's whether organizations can act across teams to remove barriers and move the patient forward
The number that indicts the strategy
"Even with all of the frictions that we're helping to change, 35% of prescriptions are still not filled. And I know for many of you — I work with many of you — it's much higher for some brands."
Maria Whitman opened her Reuters Events: Pharma USA keynote with that figure not as a confession but as a diagnostic, and the distinction matters. Confession implies the industry tried and fell short. The diagnostic she was building toward is harder: that the industry has been addressing many of these frictions, and that the 35% non-fill rate persists despite those efforts.
The question she posed — implicitly, then explicitly — is not why execution has failed. It is whether addressing individual frictions is enough to change what patients actually experience.
Her answer is structural. The goal, as she framed it, has been mis-specified from the start. "The goal is not more touchpoints. The goal is not more engagement. The goal is not more tools. Please, God, no more tools. The goal is shrinking the friction. The goal is getting to those outcomes faster. The goal is shrinking the distance and the time between a patient experiencing a need and actually getting it fulfilled." That reframe — from activity metrics to reducing distance between need and fulfillment — becomes the lens through which the rest of her argument unfolds. If a program cannot demonstrate that it reduced the time between need and fulfillment, it is, by this logic, a cost.
What follows is not an argument about tactics. It is about whether pharma's organizational identity is now the primary barrier between its science and the patients that science is designed to reach.
The identity that became a liability
Every strategic assumption has an expiration date. Pharma's foundational self-conception — that the industry's job is to produce the molecule, and the healthcare system's job is to deliver it — was not irrational. For decades, the system was functional enough that the handoff worked. The assumption became load-bearing infrastructure for an entire operating model: commercial strategy, field force design, hub architecture, patient support programs. All of it built on the premise that pharma's domain ends at the prescription pad.
Whitman named the assumption plainly: "We are innovators in science but not architects of care. This assumption worked when the system reliably carried forward our innovation. This assumption breaks when the system itself becomes a barrier and the patient is lost."
The identity isn't wrong historically. It's expired. The healthcare delivery system that once reliably carried the molecule forward has degraded into the primary obstacle between patients and outcomes, and pharma's operating model has not updated to reflect that shift. What was once a rational division of labor is no longer sufficient to address the barriers patients face today.
The scale of the disengagement problem makes this concrete. Whitman's unpublished ZS/Harris Poll data shows 44% of patients saying "this is too hard, too costly, too challenging, and it's not worth it" — giving the healthcare system what she called "the Heisman" before any brand-level journey even begins. That figure deserves more weight than it typically receives in commercial planning conversations. Patient support programs, adherence tools, and hub services are designed for patients who have decided to engage. They are structurally irrelevant to the 44% who have already decided the system isn't worth the effort. The same data shows 24% avoiding care because they feel ignored by their providers, 30% of Americans living in pharmacy deserts, and 60% of specialty patients seeing more than two physicians before reaching appropriate care. These are not edge cases in a functioning system. They are the system's default operating state.
The burden this creates falls on the least-empowered actor in the care chain. "In this system, patients have to be their own project manager. They have to coordinate the care across the facets of the healthcare system, and they have to find their own journey to getting their needs fulfilled." Designing patient support programs that help patients navigate a system pharma has accepted as fixed is a different strategic posture than redesigning the system itself. The first is service delivery within an existing architecture. The second is architecture.
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What Whitman does not fully address — and what any executive evaluating this argument must grapple with — is that health systems have their own reasons to be skeptical of pharma as a care architect. Regulatory frameworks constrain pharma's role in clinical decision-making. Health system administrators are wary of commercially motivated pathway design. The identity shift she proposes requires not just internal organizational change but external credibility that the industry has not uniformly earned. The first move, therefore, is not declaring an architect identity. It is auditing where current investments implicitly accept the old one.
What system-level redesign actually produces
The argument for system-level intervention is only as strong as its evidence, and Whitman offered two cases worth examining carefully — not because they are flawless but because the magnitude of their outcomes exposes how much value point-optimization has been leaving on the table.
The Baylor Scott & White case is the more arresting. The health system built a digital front door with chatbot-and-human triage designed to route patients to the appropriate site of care before they entered the system. The results were not incremental. "In a very short period of time, 60% of patients that they triaged would have ended up in the wrong site of care. What took eight to ten weeks in several of their use cases is now down to one week — need to fulfillment of care." A 60% mis-triage rate in the legacy model means the system's default state was failure. The one-week fulfillment against an eight-to-ten-week baseline is evidence that the process itself was the problem, and that architectural intervention produces step-change results that no amount of friction reduction at individual nodes could have approached.
The UCB myasthenia gravis program is Whitman's strongest evidence that pharma can be the architect rather than the molecule supplier. "Rare disease, 7.3 years average time to diagnosis, many, many doctors seen. In six months, the program spoke for itself. Six months, 20 confirmed diagnoses. This is zero distance." A company willing to design the diagnostic pathway, not just support it, can compress a 7.3-year average to a six-month proof case. The program's logic was not patient support; it was system redesign at the point where the barrier actually lives.
Both cases are real. Both are significant. But they occupy structurally different positions, and the distinction most useful to executives evaluating whether "zero distance" applies to their portfolio is one Whitman leaves implicit. Baylor Scott & White redesigned its own infrastructure — pharma was not the architect; it was, at most, a beneficiary. UCB's program targets a rare condition where patient identification is the primary barrier and the pathway from confirmed diagnosis to appropriate specialist is relatively linear. The harder question — whether pharma can architect care pathways for chronic conditions with multiple competing stakeholders, sustained behavioral change requirements, and diffuse clinical accountability — remains genuinely unanswered by either case.
Organizations evaluating the zero distance thesis should be precise about where the barrier actually lives. Where the barrier is finding the patient, the evidence for pharma-led system redesign is strong. Where the barrier is sustaining the patient across years of therapy in a fragmented delivery system, the evidence is thinner and the path to pharma as architect is correspondingly harder. That is not an argument against the ambition. It is an argument for calibrating where to start.
Where organizational design defeats technology
"AI isn't the problem; design is the problem. Tech is powerful, but it's the same concept as our patient journey. If we're not rewriting the decisions, if we're not rewriting the workflow, then all we're doing is cataloging yesterday."
That observation lands with particular force given current industry AI investment levels. Most pharma organizations are in the middle of multi-year AI capability buildouts. The risk Whitman is identifying is not that AI fails to deliver — it is that AI delivers exactly what it is asked for, which is better information flowing into unchanged decision structures. When boards review AI spend in 18 to 24 months and find that reporting quality improved but decision-making did not change, the impact will remain limited.
A specialty pharmacy case makes the organizational design failure concrete in a way that abstract AI arguments cannot. "30% of the prescriptions from their specialty pharmacy were being canceled. When they dug into it, they found out that it was because the specialty pharmacy was calling from an unknown number to patients to verify. Of course they were not verifying. Of course they were hanging up on them." The insight was not clinically complex. It was invisible to every individual stakeholder because no single function owned the cross-system view. The fix — field reps carrying cards with the specialty pharmacy's number, patients primed to expect the call — cost almost nothing. The impact of not identifying the issue earlier was significant.
A budget impasse Whitman described is the organizational design failure in its purest form. A cross-silo solution existed. It would have cost nothing net. Marketing had exhausted its budget. The vacancy existed in the field. No governance mechanism existed to connect them. "If we thought cross-silo, then we'd say, 'Hey, you know what? A rep cost $200,000. Don't fill one vacancy. Put the effort at the point of zero waste and move forward to zero distance.'" The money was there. The organizational architecture to deploy it was not.
These three failures — AI generating dashboards instead of decisions, a 30% cancellation rate invisible to every silo, and a budget impasse that blocked a zero-net-cost solution — are not separate problems. They are the same problem expressed in three different functional languages. Pharma organizations optimize within silos and then attribute the resulting system-level failure to execution, market complexity, or patient behavior. This can lead to misattribution of the underlying issue.
The diagnostic whitman left implicit
Whitman's framework is directionally correct. The evidence is real. The provocation is warranted. One implication of her argument is that "zero distance" depends on how quickly organizations can act across the system, not just on patient engagement.
The waste she describes across every example shares the same underlying structure. As she framed it, "if AI generates new insights but we haven't changed who or what can act on it and how fast, that is waste. The power move here is zero distance is about how fast and wise we can move decisions, not dashboards." The patient is at the end of that logic, but the many of the barriers sit within how organizations operate internally.
This reframe has a specific implication that Whitman's consulting context prevented her from stating directly. The evidence across her presentation suggests that pharma companies' strategic investments — AI, patient journey optimization, hub services, patient support programs — are consistently deployed in ways that reinforce the existing operating model rather than challenge it. The 35% non-fill rate, the 30% specialty pharmacy cancellation rate, and the $200K budget impasse are not failures of individual programs. They are outputs of an organizational identity that has not been examined.
The practical test is not whether "zero distance" resonates as a concept in a strategy session. It is whether your organization's ways of working, including budget allocation and cross-functional coordination, would enable these types of solutions to be implemented. If the answer is no — and for most organizations it is — the distance is not only between the company and the patient. It is between the company and its own stated ambition.
That gap does not close through additional investment in the current operating model. It requires changes in how decisions are made and executed across the organization. "Zero distance to the patient is not a vision. It is a design choice. And I think it's the only one leaders in this room can make." The choice is available. Whether the organizational structures that would need to change are ones any given leadership team is actually prepared to change — not in a keynote, but in a budget cycle — is the question the 35% non-fill rate has been asking for years.
To get you highlights of Pharma USA 2026 faster, we are using generative AI technology to summarise the transcripts of the sessions. If you have any feedback about the summary, please contact lucy.fisher@thomsonreuters.com.
Discover more on this topic at Pharma Customer Engagement USA 2026 (October 27-28, Philadelphia) - where commercial, marketing, medical, data and AI pioneers converge. Explore the agenda here
