The Pull-through Hygiene Gauge Framework and Assessment

The assessment consists of 10 binary (yes/no) questions spanning three domains:

1. Gap Awareness

Measure Non-Dispensed Rx
Reason Code Breakdowns
Track Payer/Pharmacy/Specialty
Speed to Therapy & Rejections

2. Gap Quantification & Analysis

Quantify Financial Value Lost
Benchmark vs Competitors

3. Loss Resolution Support

Structured Recovery Systems
Workflow Tech Integration
Measurable Performance Goals
Real-time Monitoring
Demonstrate ROI

Pull-through Hygiene Gauge

A unified framework for organizations to assess their ability in identifying and recovering lost prescriptions

Executive Summary

A substantial percentage of written prescriptions never get dispensed, creating avoidable clinical, operational, and commercial loss across the healthcare system. Data from the QC-Health Network demonstrate that, across therapeutic areas, 40%–60% of prescriptions are never dispensed, often due to process breakdowns involving prior authorization, payer restrictions, administrative friction, or pharmacy workflow issues. Moreover, 25%-40% of patients do not fill their initial prescription.

The Pull-through Hygiene Gauge is a structured assessment framework designed to help organizations:

Identify hidden prescription losses
Quantify their operational and financial impact
Qualify the patient care experience
Deploy solutions that recover prescriptions and improve therapy access

By evaluating visibility, analytical readiness, and intervention systems, the Pull-through Hygiene Gauge offers a practical method for improving patient access and brand performance.

Introduction

The journey from prescription writing to medication dispensing is increasingly complex and prone to disruption. In fact, NDC blocks have grown from 30 to 40 in 2015 to over 700 in 2024. Prior authorization requirements, payer utilization controls, incomplete documentation, and pharmacy workflow bottlenecks frequently obstruct the prescription pathway. These breakdowns create systemic loss across three major stakeholder groups:

Patients who face delayed or missed therapy
Providers who experience administrative burden and care interruptions
Pharmaceutical brands which lose prescriptions despite achieving prescriber preference

Traditional analytics rarely capture where or why these losses occur.

Organizations need timely and structured methods to measure prescription leakage and identify operational gaps.

The Hygiene gauge provides such a framework, enabling manufacturers and access teams to evaluate their readiness to support effective prescription fulfillment.

Conceptual Framework: Pull-through Hygiene Gauge

Pull-through Hygiene Gauge refers to the degree to which a brand and its support ecosystem are operationally prepared to ensure prescriptions progress through prior authorization, payer review, and dispensing processes effectively.

The Pull-through Hygiene Gauge operationalizes these components into a measurable assessment of effective brand support to optimize dispense rates.

Strategic Implications

Organizations applying the Pull-through Hygiene Gauge often identify one of the most significant hidden performance gaps in their commercial strategy: prescription loss after the writing of the script.

Key benefits of improving Pull-through Hygiene Gauge score:

Faster speed to therapy
Reduced administrative burden for providers
Improved patient access and satisfaction
Increased prescription capture and brand growth
Ability to direct resources toward the most impactful barriers

Targeted, technology‑enabled solutions—particularly those integrated within provider workflows—have demonstrated the ability to identify prescriptions at risk of abandonment and recover them before they are lost.

Reported outcomes from early adopters include:

Higher dispensing rates
Improved operational efficiency
Return‑on‑investment ratios approaching 10:1

Conclusion

The prescription journey does not end at the point of prescribing any more. Significant barriers occur, and these are growing, during prior authorization, payer review, and dispensing, leading to high rates of prescription abandonment and ultimately patient leakage. The Pull-through Hygiene Gauge offers a practical, structured assessment for:

Identifying dispensing gaps
Quantifying their clinical and economic impact
Implementing solutions that accelerate therapy access

By improving Pull-through Hygiene Gauge scores, organizations can strengthen patient care, enhance provider experience, and optimize brand performance.

Correspondence

For additional information or assistance applying the Pull-through Hygiene Gauge framework:

David Dierk
Aventria Health Group
Email: dwdierk@aventriahealth.com

HYGIENE SCORE (0-10)

1-3: Significant Gaps

4-6: Moderate Gaps

7-10: Strong/High-Performing

Scoring Interpretation

1–3: Significant operational gaps; substantial opportunity for quick improvements
4–6: Moderate gaps impacting performance; targeted interventions recommended
7–10: Strong operational infrastructure supporting prescription fulfillment