The Conversation I Keep Having with Pharma Leaders

A patient services VP told me last month: "I know our infrastructure has gaps. I've read every framework. I understand the 90/10 problem. I just haven't done anything about it."

She's not alone.

I've had this same conversation—word for word—with four different pharma leaders this quarter.

Smart people. Senior roles. Real budgets. Genuine commitment to patients.

All of them stuck in the same place: between understanding the problem and acting on it.

So I started asking why.

Here's What They Actually Said

The Commercial VP: "It feels too big. I don't know where 18 months of work starts."

The Patient Services Director: "My hub contract just renewed. I can't tear everything up now."

The Analytics Lead: "I need a business case before I can ask for budget. But I need data to build the business case. It's circular."

The Brand Lead: "Honestly? I'm just overwhelmed. I'm running a launch, fighting payer battles, and managing four vendors. Adding one more initiative feels impossible."

Different roles. Different therapeutic areas. Same underlying message.

They weren't lacking resources. They weren't lacking authority. They weren't lacking conviction that the 90/10 Framework matters.

They were lacking certainty that it would work for them before they tried it.

The Pattern I Couldn't Shake

Every one of these leaders had already made bigger bets with less certainty.

The Commercial VP greenlit a $40M launch based on Phase 2 data.

The Patient Services Director chose vendors based on RFP responses, not proven outcomes.

The Analytics Lead built dashboards based on theoretical user needs.

The Brand Lead positioned a product against competitors who didn't exist yet.

They make uncertain decisions every day. Just not about patient engagement infrastructure.

Why?

Because for everything else, the cost of waiting is obvious. For patient engagement, the cost is invisible.

A delayed launch costs market share. Everyone sees it.

A persistence problem grows slowly. By the time you can prove it's getting worse, the damage is already in the numbers.

What Changed for One of Them

The Patient Services Director called me three weeks later.

"I mapped one patient journey. Just one. Took my analyst two hours. We found a 12-day gap between hub enrollment and specialty pharmacy fill where 23% of our patients drop out."

She paused.

"That's been happening for two years. None of our vendors flagged it because none of them owned that handoff."

She didn't redesign everything. She didn't fire vendors. She didn't ask for a million-dollar budget.

She mapped one journey.

Then she had something to show her board. Then she had something to ask for.

The 90/10 Framework didn't become real to her when she read about it. It became real when she saw her own patients in her own data.

The Question I'd Ask Yourself

Not: "Should I build 90% infrastructure?"

Not: "Do I have budget for this?"

Not: "Where do I even start?"

Instead: "What's one patient journey I could map this week?"

Because here's what I've learned watching pharma leaders navigate this:

You won't decide to invest in infrastructure based on a framework. You'll decide based on what you see when you look at one of your own patients.

The leaders who act aren't more convinced. They just looked first.

If you're stuck between understanding and acting, I'd love to hear what's keeping you there. Reply or message me—I'm collecting these conversations.

Linked Patient Learning helps biopharma teams map their first patient journey and decide what to do with what they find.