$1 billion in earned commercial value. ~$450 million realized.

The rest leaked through prior authorization, affordability barriers, and handoffs no one owns.

Wayne Simmons spent over two decades inside pharma commercial operations at Pfizer and Bayer, watching the same structural failure repeat itself. The commercial model is highly optimized to generate prescribing intent. What it was never designed to do is govern what happens next.

Between a written prescription and a patient starting therapy sits a system that was never built to own: reimbursement variability, prior authorization, specialty pharmacy coordination, affordability barriers, fragmented handoffs across field, hub, and patient services. Each stage leaks value. Compounded across fulfillment, initiation, and adherence, up to half of clinically appropriate prescriptions never convert into initiated therapy.

This is a structural problem. More coaching, better messaging, and CX frameworks borrowed from retail all operate within the same broken architecture. The gap doesn't close because no one owns the downstream system as a system.

This whitepaper introduces journey operations: the discipline for governing progression across the path to prescribe, fulfill, and adhere. Co-authored by Wayne Simmons, creator of the FieldOS methodology and former Global Head of Customer Excellence at Pfizer, and TheyDo, it lays out what it actually takes to close the gap between intent and impact.

What you'll take from this paper

• The Value Leakage Ladder: how compounding drop-off reduces $1B earned to ~$450M realized, and where in the system it happens

• Why the commercial model leaks value by design, and why the usual responses don't change that

• The FieldOS Three-Path Framework: governing the path to prescribe, path to fulfill, path to adhere simultaneously

• What changes when progression becomes observable and measurable: for field teams, management, and forecasting

• Diagnostic questions to identify where your commercial architecture is leaking value today

About the author

Wayne Simmons brings more than two decades of pharma commercial leadership, including global roles at Pfizer and Bayer. TheyDo is trusted by enterprise commercial teams at Lufthansa, Shell, and leading life sciences organizations worldwide.

From script to treatment: Closing pharma’s intent-to-impact gap with journey operations is a co-authored paper by Wayne Simmons, The Customer Excellence Agency, and TheyDo.