The Abandonment Rate is Getting Worse. Here’s Why.
*By Bob Miglani, CEO of Hoot | Former Pfizer Leader, 23 Years*
Watch video clip here:
—
I spent 23 years at Pfizer watching something that should have been unacceptable become normalized.
A drug gets approved. Clinical trials prove it works. Physicians prescribe it. And then somewhere between the exam room and the pharmacy counter — or between the first fill and the third month — the patient disappears.
We called it “abandonment.” We tracked it. We built patient support programs to fight it. We hired hub vendors and invested in copay assistance and printed education brochures.
And still, 40 to 50 percent of patients walked away before the therapy had a real chance to help them.
That was a decade ago. The forces driving abandonment today are stronger, more complex, and more dangerous than ever. I’ve been speaking with some of the sharpest minds in the industry about this on *The Patient Experience Podcast* — including Dan Seewald, former Pfizer marketing leader and innovation executive, whose conversation with me cut right to the heart of where this is all going.
Here is what I believe is actually happening.
—
## Force One: The Doctor Has Seven Minutes
The physician has always been the most trusted voice in a patient’s life. Nothing has changed about that.
What has changed is the clock.
The average specialist appointment in a complex therapy area runs seven to twelve minutes. In that window, the physician has to confirm a diagnosis, explain a condition the patient has never heard of before, navigate prior authorization, discuss side effects, review injection or infusion protocols, and still leave time for the patient to ask questions.
They can not do all of that. Nobody can.
So something gets cut. And what gets cut — every time — is the deep education. The nuanced explanation of why this therapy works, what the patient will feel in the first few weeks, why they need to stay on it even when it seems like nothing is happening, and what to do when fear creeps in at 11pm on a Tuesday.
The patient leaves the office with a prescription and a glossy brochure. They understood maybe forty percent of what was said. They felt too intimidated to ask the questions they really had. And now they are on their own.
This is not a failure of physicians. They are running as hard as they can inside a system that was never designed for the complexity of modern specialty medicine. But the gap it creates — between what patients are told and what they need to understand to actually stay on therapy — is where abandonment is born.
—
## Force Two: They Go Home and Ask ChatGPT
Here is where it gets genuinely dangerous.
The patient gets home. The fear sets in. The complexity feels overwhelming. Their family has opinions. And so they do what people do in 2026: they pick up their phone and start searching.
What they find is not what their doctor said.
They find forums where patients describe terrible side effects. They find TikTok videos where influencers question whether the drug even works. They find ChatGPT responses that are medically plausible-sounding but stripped of the clinical context that makes them accurate for *that patient’s* situation. They find social media communities that validate stopping therapy far more enthusiastically than they validate staying on it.
As Dan Seewald discussed on *The Patient Experience Podcast*, AI is reshaping how patients encounter information about their therapies — and not always in ways that build trust. The same tools that could theoretically guide patients toward clarity are, in their current form, often amplifying confusion. AI answers feel authoritative. They feel personalized. But they are not coming from the physician who knows this patient’s history. They are not calibrated to the emotional reality of being newly diagnosed and scared.
Social media compounds this. The loudest voices in any patient community are usually the people who had the worst experiences. The patient who stayed on their biologic for three years and went into remission does not post about it every week. The patient who quit after month two because of nausea shares that story everywhere.
The patient who was already uncertain is now more uncertain. The patient who was borderline ready to abandon has now found a community that confirms their hesitation.
And pharma’s patient support materials — built on regulatory-reviewed PDFs and 1-800 numbers — are simply not competing with this.
—
## Force Three: The Therapies Themselves Have Become Enormously Complex
This is the force I believe is most underappreciated, and it is the one that Dan Seewald and I kept returning to in our conversation.
The entire industry has pivoted to specialty.
Look at any major pharma company’s pipeline and you will see it. Biologics. Gene therapies. CAR-T. Bispecifics. Rare disease programs. Immunology. Oncology. The era of blockbuster primary care drugs prescribed to millions of patients with relatively simple regimens is giving way to highly targeted therapies prescribed to smaller patient populations navigating significantly more complex treatment journeys.
This is a triumph of science. These therapies are genuinely miraculous.
But they are asking something of patients that primary care never did.
A patient prescribed a biologic for a rare autoimmune condition might need to understand the mechanism of the disease, why the therapy modulates a specific immune pathway, how to self-inject, what a flare means versus a side effect, how to monitor for serious adverse events, what the prior authorization process looks like, and how a specialty pharmacy differs from their corner drugstore — all before they ever take their first dose.
That is not a brochure problem. That is not a copay card problem. That is a sustained, ongoing, physician-led education problem.
And the industry built its patient support infrastructure for a simpler world. Hub services were designed when the primary barrier to adherence was access and cost. They were not designed for a world in which the primary barrier is patient understanding — a world in which confusion about mechanism of action, fear of side effects, and misinformation from social media are doing more damage to adherence rates than any benefit verification delay.
The math is brutal. Take ten thousand prescribed patients. Four thousand hesitate after the appointment. Two thousand never fill. Another two thousand abandon in the first ninety days. That is forty million to eighty million dollars in annual revenue that never materializes — not because the drug failed, but because the patient’s understanding failed.
—
## What Has to Change
I am not pessimistic about this. I have spent the last several years building a solution to it. But I am clear-eyed about why the traditional approaches are losing ground.
PDFs do not follow patients home. Hub nurses handle access and enrollment, not the fear that hits at midnight. Copay cards solve cost. They do not solve confusion.
What actually works — what the research and our own data consistently shows — is the physician’s voice, delivered to the patient at the exact moment they need it. Not a generic video. Not a pharma brand spokesperson. The *prescribing physician*, speaking directly to the patient about their specific therapy, at the moments when doubt and confusion are highest: right after the prescription is written, before the first dose, after the first side effect, when the patient is wondering whether any of this is actually working.
Dan Seewald put it well when we spoke: the question pharma has to answer is not how to produce more content. It is how to deliver the right guidance, from the right voice, to the right patient, at the right moment. That requires rethinking the entire patient education infrastructure — not incrementally improving what exists, but building something designed for the complexity of specialty medicine in 2026.
The abandonment rate is a symptom. The disease is a growing gap between what specialty therapies require of patients and what the system currently gives them.
That gap is getting wider. The forces driving it are not going away.
The question for every patient services leader, every brand team, and every commercial organization is simple: what are you doing about it that is actually new?
—
*Bob Miglani is the CEO of Hoot, a physician-led patient education and adherence platform. He spent 23 years at Pfizer across sales, marketing, medical affairs, and patient access. He is the host of The Patient Experience Podcast, where he speaks with pharma leaders, patient services executives, and innovation leaders about what is actually breaking in patient engagement — and what to do about it. Connect with Bob on LinkedIn.*
*Listen to the episode featuring Dan Seewald, former Pfizer marketing and innovation leader, on The Patient Experience Podcast at [gethoot.com/patient-experience-podcast](https://gethoot.com/patient-experience-podcast).*