Every pharmaceutical launch is measured against ambitious commercial forecasts. Brand teams spend years preparing for approval, market access, and physician uptake. Pharma invests upwards of $1-2 billion and 10+ years to bring a therapy to market. Yet once approved, the majority of therapies fail to achieve expected real-world performance.
Once a therapy enters the real world, success is no longer determined by clinical efficacy alone. It depends on whether patients can start treatment quickly, remain on therapy, complete monitoring requirements, and receive coordinated support throughout their journey.
Studies show that 50 to 60 percent of patients with chronic illnesses miss doses, take medication incorrectly, or discontinue treatment in the first year. These aren’t just adherence statistics – they’re indicators of commercial, clinical, and operational risk.
These execution challenges rarely make headlines. They’re difficult to measure, spread across multiple vendors and teams, and often emerge months after launch, when commercial expectations have already been set. For Brand Managers, they’re the difference between a successful launch and an underperforming asset.
Approval isn’t the finish line, it’s where execution risk begins.
The Industry Blind Spot
Pharma has built highly optimized systems for clinical development, regulatory approval, and market access. Yet once therapies enter the real world, they rely on an entirely different capability: execution.
Clinical trials operate in controlled environments – but patients, healthcare systems, and care teams don’t.
Real-world success depends on a complex network of patients, healthcare providers (HCPs), specialty pharmacies, laboratories, nurse educators, digital engagement platforms, and commercial teams working together.
The challenge isn’t a lack of investment; it’s that these capabilities often operate independently. While the industry has optimized for proving a therapies efficacy, it has yet to build the connected infrastructure needed to deliver consistent real-world outcomes.
Where Therapies Actually Fail
A. The First Point of Failure: Time-to-Therapy
Failure often begins before treatment even starts. IQVIA reports that delays between prescription and initiation create measurable drop-off, with over half of new prescriptions for novel medicines going unfilled. Prior authorization requirements, access barriers, fragmented communication, and complex onboarding processes all create friction before a patient even begins treatment, increasing the risk of non-adherence.
Time-to-therapy isn’t just an operational metric. It’s a leading indicator of treatment abandonment risk and launch performance.
The good news is that these delays can be addressed. In a global Multiple Sclerosis patient support program, RxPx redesigned the patient onboarding journey by coordinating stakeholders, streamlining workflows, and proactively identifying barriers to treatment initiation.
The result was a 74% reduction in time-to-treatment, reducing the average wait from approximately six weeks to just 11-16 days. By removing friction at the start of the patient journey, more patients were able to begin therapy sooner and remain engaged throughout treatment.
Read the Multiple Sclerosis Case Study
B. Adherence Collapse
Once patients start their treatment, persistence tends to decline rapidly. Research shows that approximately 50% of patients discontinue therapy within 6-12 months. This is largely due to side effects, regimen complexity, and limited clinical support.
This is often described as an adherence problem, but it’s actually an execution problem. Most brands already invest in patient support programs, specialty pharmacies, nurse educators, digital tools, and field teams. The problem is that these services often operate independently. Data isn’t shared in real time, interventions aren’t coordinated, and patients experience multiple disconnected touchpoints instead of one seamless journey.
C. Safety Execution Gaps
In clinical trials, safety monitoring is rigorous.
In the real world:
- Monitoring adherence drops significantly
- Adverse events are underreported or delayed
- Required follow-ups are inconsistently completed
Studies suggest that up to 90% of adverse drug reactions go unreported in real-world settings. The issue isn’t simply compliance – it’s the absence of connected workflows capable of identifying risks early and ensuring the right action reaches the right person at the right time.
D. Fragmented Systems & Outcomes
Behind every therapy is a network of specialty pharmacies, patient support providers, laboratories, nurse educators, digital engagement tools, HCPs, and commercial teams. Individually, these services perform well, but collectively, they operate in silos.
As a result, there is disconnected data, redundant outreach, inconsistent patient experiences, and limited visibility into performance.
The problem isn’t that pharma needs another vendor. Most brands already have vendors. The problem is that they lack a connected execution infrastructure bringing strategy, technology, data, and human expertise together into one coordinated system.
The Cost of Doing Nothing
Doing nothing doesn’t mean abandoning patient support. It means continuing to rely on fragmented delivery models, disconnected technology, manual workflows, and siloed vendors that struggle to coordinate the patient journey.
The consequences extend far beyond patient adherence:
Commercial:
- Billions in lost revenue due to delayed treatment initiation, non-initiation, and early discontinuation.
- Reduced return on launch investment as therapies fail to achieve expected real-world performance.
Clinical:
- Reduced real-world effectiveness despite strong clinical trial results.
- Increased hospitalizations, adverse events, and downstream healthcare costs due to poor persistence and inconsistent monitoring.
Reputational:
- Perception that therapy is underperforming in the real world.
- Strained relationships with healthcare providers, payers, and other stakeholders when patient outcomes fall short of expectations.
The greatest cost isn’t a lack of investment – it’s failing to connect the people, processes, and technology needed to help patients successfully start and stay on therapy.
The Shift: From Patient Support to Execution Infrastructure
For years, the industry has focused on patient engagement, but engagement alone doesn’t solve fragmented execution.
What’s needed is a coordinated execution ecosystem that connects every stakeholder involved in therapy delivery – from strategy and onboarding through to adherence, monitoring, and long-term optimization.
Because therapies succeed through connected infrastructure.
What “Good” Looks Like
High-performing therapies are supported by one coordinated execution ecosystem that connects patients, HCPs, specialty pharmacies, laboratories, support teams, and digital platforms into a single, continuously optimized model.
Rather than competing for data, every component contributes to a shared view of the patient journey, ensuring no critical signal is lost during a handoff.
This enables 4 essential capabilities:
1. Real-Time Visibility
Continuous monitoring of patient progress, adherence, safety, and emerging risks.
Through RxPx’s laboratory monitoring solution, more than 1.2 million laboratory tests have been monitored, enabling proactive intervention, earlier identification of missed testing, and real-time safety oversight.
2. Coordinated Workflows
Connected systems integrating pharmacies, laboratories, patient support, and healthcare teams.
In RxPx’s Multiple Sclerosis (MS) program, this coordinated approach reduced time to treatment by 74%, eliminating barriers before they could lead to treatment abandonment.
3. Where AI Flags Risk, Humans Close the Gap
Technology identifies patterns and AI predicts risk. Human clinical teams translate those insights into timely, personalized interventions and empathetic support.
In the same MS program, this approach achieved 90% treatment adherence and 92% patient satisfaction, demonstrating the value of combining intelligent automation with human support.
4. Continuous Optimization
Every patient interaction strengthens the system. Feedback loops continuously refine interventions, improve workflows, and optimize patient support, ensuring programs become more effective over time rather than remaining static.
Programs built on connected infrastructure consistently reduce time-to-therapy, improve persistence, strengthen safety execution, and deliver better commercial outcomes.
The pharmaceutical industry has spent decades optimizing for approval, but approval is no longer the bottleneck – execution is. The therapies that outperform in the real world won’t simply be the most innovative. They will be the ones that remove barriers, coordinates care, and helps patients successfully start and stay on treatment.
The Risk Doesn’t Begin at Launch. Neither Do We.
Everything in this article points to the same conclusion: the greatest risks to a therapy’s success don’t begin after launch – they begin long before the first prescription is filled.
Time-to-therapy delays, fragmented patient support, disconnected safety monitoring, and siloed technology are all predictable risks. The challenge is that they’re rarely identified until they begin impacting commercial performance.
That’s why RxPx works with pharmaceutical brands long before launch and continues supporting therapies throughout the patient journey. By combining strategic consulting, connected technology, AI-driven insights, and human expertise into one coordinated execution ecosystem, we help identify and reduce execution risk before it becomes launch failure.
How prepared is your therapy for real-world execution?
Book a Therapy Risk Assessment to uncover hidden execution risks and discover how connected execution infrastructure can improve launch performance from day one.
