Prescription Abandonment: A Research-Driven Playbook for Pharma to Tackle a Major (Yet Often Hidden) Growth Barrier

A Common Frustration We Don’t Talk About Enough

If you’ve worked in biopharma long enough, you know the feeling: your team has perfected the science, the story, and the sales force. The launch deck is watertight. The messaging is succinct. The field force is energized. And then, despite all of that effort, a certain portion of patients never even start the therapy.

This is prescription abandonment in action: when a prescription is written but never picked up. It’s one of the most infuriating realities in our industry, because it’s the point where assiduous commercial planning collides with the realities of human behavior. And it’s bigger than most people think: roughly a quarter of new prescriptions are never filled (and this % varies by category). That’s millions of missed opportunities every year -- for better outcomes, and for the brands designed to deliver them.

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What Exactly Is Abandonment?

In marketing research, precision matters. When we talk about “abandonment,” we’re usually referring to primary non-adherence: the patient leaves the office or clinic with a prescription in hand (or sent electronically), but it never gets filled at the pharmacy.

It’s worth distinguishing this from early discontinuation, which is when a patient does pick up their medication but discontinues within the first few weeks or months. Both are serious issues, but if we’re going to measure, diagnose, and solve abandonment, we need to align around this working definition: prescription written, never picked up, typically measured within 10 to 30 days of the initial Rx.

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The Scope of the Problem

The numbers paint a sobering picture. Studies show that when out-of-pocket (OOP) costs exceed $250, nearly 70% of patients walk away. When the OOP is under $30, only about 11% do. Sticker shock is real, and it’s one of the most reliable predictors of abandonment.

But cost isn’t the only factor. Patients in medically underserved areas abandon at higher rates than those in better-resourced communities. Those without insurance, or with high-deductible plans, face steeper drop-offs. And even patients with coverage may find themselves caught in prior authorization limbo, confused by specialty pharmacy channels, or overwhelmed by side-effect warnings they don’t fully understand.

The impact is immense. Non-adherence in all its forms contributes to an estimated 125,000 avoidable deaths each year in the U.S. and more than $500 billion in downstream costs to the healthcare system. But let’s keep it human: behind every data point is someone who left the pharmacy empty-handed, worried about the bill, or too confused to move forward.

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Why Patients Walk Away

Based upon years of marketing research, we know there are multiple drivers of abandonment:

• Cost shocks: Discovering at the counter that an out of pocket cost is much more than expected.
• Access friction: Prior authorization hurdles, delays in benefit verification, specialty channels that feel foreign to patients.
• Confusion and fear: Patients who don’t understand why they need the medicine, or who second guess whether to take it based upon concerns, e.g., side effects.
• Practical barriers: Transportation, childcare, pharmacy hours -- the small things that become magnified amidst a real, busy life.
• Behavioral dynamics: Particularly in chronic or asymptomatic conditions, patients may simply not feel urgency to start.

Each of these reasons reflects what we hear about from patients and caregivers in marketing research studies, and often they stack together. A patient who is already anxious about a new diagnosis, or overly concerned about a side effect profile, is much more likely to walk away if they hit cost and access roadblocks too.

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What Research Can Reveal That Data Alone Can’t

Claims data and prescription fill records help inform us about leakage: the scope of it. They can highlight patterns: higher drop-off in certain payers, geographies, or therapeutic classes. That’s essential, but it only gets us so far.

To design effective solutions, we need to go deeper. This is where primary marketing research can play a critical role:

• Quantitative surveys can size the drivers, test cost thresholds, and simulate uptake if assistance, co-pay mitigation, or delivery options are offered.
• Qualitative research, including interviews with patients, caregivers, pharmacists, gives commercial teams the “why” behind the data. These conversations surface the lived experience: “I didn’t know who to call when the pharmacy said prior auth wasn’t approved.”

Combined, these approaches let us move from simply knowing that 25% abandon to understanding exactly what might impact that behavior.

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A Systematic Approach for Brand Teams

Here’s what we've done when clients have come to us with data in hand showing Rx leakage, a step by step heuristic to approach the problem:

1. Map the funnel with secondary data: e-prescription → approval → pickup. Measure time-to-fill, OOP cost bands, PA cycle time, and coupon/PAP usage.
2. Layer in quant research to measure the relative weight of abandonment drivers and test solution concepts (affordability bundles, SMS nudges, delivery options).
3. Add qual depth to capture the emotional and practical realities of the patient and caregiver journey.
4. Evaluate interventions such as messages, tools, support programs, and test them with real patients in controlled ways.
5. Pilot, measure, scale: track first-fill conversion as a key performance indicator, alongside persistence and patient satisfaction.

This is a process we've used with clients that transforms a challenge into an insight, and an insight into a game plan.

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Case Study: Metastatic Prostate Cancer

At ThinkGen, we recently explored prescription abandonment in metastatic prostate cancer, a setting where you wouldn’t expect it to be an issue. After all, a potentially life-threatening diagnosis usually motivates patients to act; and caregivers also are motivated to take care of their spouses. So why were some men not filling their prescriptions?

Our secondary analysis pointed us toward economics. Patients with higher out-of-pocket costs were far more likely to abandon their first fill. But when we dug deeper through interviews with patients, caregivers, and office staff, we uncovered another critical piece of the story: the patient assistance program designed to offset costs wasn’t being used as often as it could be.

Why? Many of the patients were older and unfamiliar with how to navigate the process. More importantly, office staff -- often the linchpin in connecting patients to assistance -- weren’t always knowledgeable about the program details or didn’t have the bandwidth to communicate it effectively and walk patients through enrollment. The result was that men facing steep pharmacy bills quietly opted out, even in the face of a serious cancer diagnosis.

The research pointed to a surprisingly simple but powerful solution: better education and training for office staff. By equipping them with clear information about patient assistance resources and how to guide patients step-by-step, the brand could dramatically reduce abandonment without overhauling the entire support infrastructure.

This case was a reminder that sometimes the barriers are not where you expect them to be. Abandonment isn’t always about motivation or even disease severity. Often, it’s about the everyday systems and people patients rely on, and whether those touchpoints are ready to connect them to the help they need.

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Practical Recommendations for Brand Teams

Based on our work, here’s a checklist for commercial teams worth pondering:

• Define abandonment KPIs clearly and track them like you would a funnel metric (first-fill conversion, time-to-fill, early persistence).
• Pre-screen every new start for affordability programs; don’t wait for patients to raise the issue.
• Surface OOP costs before patients leave the clinic, not at the pharmacy counter, so there are no surprises.
• Educate and equip office staff and HCPs to proactively connect patients with patient assistance programs (PAPs) and explain how to access them. In many cases, this is the single most important touchpoint for preventing abandonment.
• Use provider-branded nudges (SMS, email, portal messages) at the moments that matter most: prescription, PA approval, pickup, and the critical first two weeks.
• Run small pilots, measure rigorously, and scale what works, always closing the loop with both commercial KPIs and patient experience feedback.

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Closing: From Missed Moments to Meaningful Impact

Prescription abandonment is one of our industry’s biggest hidden barriers. It robs patients of timely care and brands of their full potential. But it’s not inevitable.

By blending the power of secondary analytics with the nuance of primary marketing research, we can understand not just where abandonment happens, but why. And when we know why, we can engineer solutions that meet patients in the moments that matter.

Every script tells a story. With the right insights, we can help make sure that story ends not at the pharmacy counter, but in successful treatment — where it belongs.