First fill rates have become one of the industry’s favorite metrics. It’s easy to see why. A prescription gets written, a claim goes through, and the patient starts therapy. On paper, that looks like success. But that moment (the first fill) is where risk begins. And if we stop measuring there, we’re missing what matters most.

The drop-off after the “win”
Starting therapy doesn’t guarantee staying on it. Recent data shows that adherence declines quickly after initiation, particularly for specialty medications. A 2023 analysis in the Journal of Managed Care & Specialty Pharmacy found that a significant portion of patients discontinue therapy within the first 90 days.[1]

IQVIA reporting from the past year reinforces the same pattern: early-stage abandonment and non-adherence remain high, largely driven by affordability challenges and access complexity.[2] So while first fill rates may look strong, they don’t tell us whether patients make it through the most critical stretch of treatment.

Months 2 to 4 are where things break down
The first few weeks are structured. There’s coordination, onboarding, and often some level of support. Then reality sets in. Between months two and four, patients start to feel the friction:

  • Out-of-pocket costs that are higher than expected
  • Coverage changes or prior authorization renewals
  • Side effects without enough follow-up
  • Fewer touchpoints with support programs

This is when drop-off tends to peak. And in many cases, there’s no clear system in place to catch it.

The real gap is continuity
Most support models are designed around a moment, getting the patient started. But adherence isn’t a one-time event. It’s something that must be sustained.

When financial assistance, provider workflows, and patient outreach are disconnected, patients are left navigating the hardest part of the journey on their own. Small issues compound. Delays turn into missed doses. Missed doses turn into abandonment.

What’s changing
There’s growing recognition that timing and continuity matter as much as access itself. A 2023 McKinsey analysis found that patient support programs that extend beyond onboarding and stay engaged throughout treatment are more effective at improving persistence.[3] The takeaway is simple: support has to show up after the first fill, not just before it.

Where a connected approach makes the difference
This is where the model starts to shift. Instead of treating affordability, access, and adherence as separate problems, they need to be addressed as part of the same, ongoing process. That’s the role TailorMed plays. By connecting providers, pharmacies, life sciences organizations, and financial assistance programs into a single network, TailorMed helps ensure patients aren’t just supported at the start, but throughout their therapy journey.

That means:

  • Identifying affordability risks before they lead to drop-off
  • Continuously matching patients to relevant assistance as their situation changes
  • Giving care teams visibility into where patients may be struggling, in real time

Instead of a one-time intervention, it’s a sustained support that adapts as the patient moves through treatment.

Rethinking what success looks like
If first fill is the benchmark, we’re optimizing for the easiest part of the journey. A better measure is whether patients stay on therapy long enough to benefit from it, and whether the system is built to support them when challenges arise. Because getting a patient to start therapy is important. Making sure they can continue it is what changes outcomes.

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[1] Source: https://www.jmcp.org/doi/10.18553/jmcp.2023.29.5.XXX
[2] Source: https://www.iqvia.com/insights/the-iqvia-institute/reports
[3] https://www.mckinsey.com/industries/life-sciences/our-insights