“It’s not the prescription that changes lives—it’s the fill.”

In pharma, NBRx (new-to-brand prescriptions) is the metric everyone chases. But what happens after the prescription is written often gets far less attention. That’s a mistake—because in many categories, the biggest leaks in the funnel happen after the NBRx is recorded.

It’s a quiet killer of brand growth: a high NBRx count with a low fill rate.

Why It Matters

Here’s the brutal truth: a prescription isn’t a win—it’s a hypothesis. It only becomes a win when it’s filled, picked up, and used.

Yet so many brands celebrate NBRx spikes without asking the harder question: Did those patients ever get on therapy?

Common Drop-Off Drivers (and What Data Can Reveal)

Using real-world data platforms like Symphony, IQVIA, or Surescripts, brands can track where the patient journey breaks down—and more importantly, why.

Here’s what the data can surface:

• Reversals: Was the script denied by the payer? Reversed by the pharmacy? If so, was it followed up with a PA?
• Abandonment: Did the patient never pick it up? Often a signal of cost concern, lack of education, or unclear next steps.
• Switches: Was the prescription changed to a competitor with better formulary positioning?

Each of these outcomes leaves a trail—and if you know what to look for, you can build interventions that matter.

How Brands Can Respond

1. Targeted Copay Messaging at Time of Reversal

Use reversal data to trigger a real-time affordability message to the provider (via EHR) or patient (via SMS or email).

Timing is everything: within 24–48 hours can make or break conversion.

2. Field Deployment Based on Claim Activity

Don’t just call on the highest prescribers. Call on physicians with high NBRx-to-fill drop-off rates.

These are often treaters who want to use your brand but are hitting friction.

3. Prior Auth Streamlining

Real-world data can highlight which plans are denying access.

Integrate PA help directly into EHRs or offer provider-specific guidance for submissions. Don’t just react—prevent.

4. Segmented Adherence Interventions

Identify cohorts who filled but never refilled.

Tailor your patient support programs to address day 30 and day 60 churn with personalized content.

The 609 View

At 609 Health, we help life sciences teams move from counting scripts to closing the loop.