Five Percent of the Budget, Half the Incremental Refills
A rare disease Rx DTC campaign measured four audience ad groups against three other data partners and retargeting tactics inside one integrated outcomes study. The partner holding 5.3% of measured investment returned 31% of verified patients and 51% of all incremental refills. The partner holding more than ten times that spend returned none. Here is what that comparison supports, and the two places it stops.
The short answer
In an integrated rare disease Rx DTC study measuring several audience partners on one methodology, HealthVerity segments carried 5.3% of measured media investment and returned 31% of all verified patients reached and 51% of all incremental Rx refills, with refill incrementality significant at a 95% confidence interval on all four ad groups. The largest single-partner investment in the same study, more than ten times the HealthVerity spend, registered no measurable incremental refills. New patient starts stayed below the reporting threshold, so this is a refill and persistence story, not a new-starts story.
The question worth answering
Rare disease DTC has a structural problem: the addressable patient population is small enough that most audience partners cannot prove they found it. Reach numbers look fine, frequency looks fine, and then the outcomes study comes back with everything sitting under a reporting threshold. When that happens repeatedly, budget defaults to whichever partner can absorb the most spend, which is not the same as whichever partner works.
This campaign was set up to answer the question properly. Four HealthVerity CPM ad groups, split across patient and caregiver segments over two flights, were measured head to head against three other syndicated and custom data partners plus retargeting tactics, all inside a single integrated Rx outcomes study running from 1 January to 17 July 2026. One methodology, one window, one definition of a verified patient.
What the data showed
Indexed against every other tactic in the study blended together, the HealthVerity ad groups returned roughly 7.8x on verified patients reached, 7.9x on TRx, and 18.4x on both incremental refills and attributed doctor visits. The refill figure is the one that carries weight, because it is the only metric in the set that reached statistical significance, and it did so on all four ad groups.
The comparison that reframes the whole study is a negative result rather than a positive one. The single largest partner investment in the campaign, more than ten times the HealthVerity spend level, registered zero measurable incremental refills in the same window against the same methodology. Absolute spend and absolute outcomes had come apart completely.
| Ad group | Share of HV investment | Verified patients | Audience quality index | Incremental refills |
|---|---|---|---|---|
| Caregiver segment, flight 2 | 60% | 528 | 95x | 83 |
| Patient segment, flight 2 | 30% | 443 | 381x | 86 |
| Caregiver segment, flight 1 | 4% | 195 | 396x | 27 |
| Patient segment, flight 1 | 6% | 175 | 383x | 26 |
| Total | 100% | 1,341 | — | 222 |
Audience quality index measures concentration against a random-reach baseline of 1x. Three of the four ad groups landed between 381x and 396x, against a next-best partner peak of 51x elsewhere in the study. The two flight 1 ad groups are the striking ones: together they carried 10% of the HealthVerity investment and produced 370 verified patients and 53 incremental refills. Small money, precisely spent.
The number that should worry you
The flight 2 caregiver segment took 60% of the HealthVerity investment and delivered a 95x audience quality index, against 381x to 396x on the other three ad groups. It still produced the most verified patients and the most incremental refills in absolute terms, because it had the most money behind it. But the quality index fell by roughly three quarters as that segment scaled.
That is the shape of an audience running out of precision as it grows, and it is the single most useful signal in the study for planning the next flight. It says the efficiency demonstrated at 5.3% of investment is not automatically portable to 20%. It also says the flight 1 structure, not the flight 2 structure, is the one to scale from.
How to read this honestly
New patient starts fell below the platform's minimum reporting threshold on every HealthVerity ad group, so no new-starts claim is made here. One other partner in the study registered the only reportable new patient start count, and that is a genuine point in its favor. This is a refill and persistence result. The efficiency was also demonstrated at 5.3% of measured investment, and results at meaningfully higher spend are not guaranteed, which the declining quality index on the scaled caregiver segment already hints at. The right next move is an incremental budget test with the quality index watched weekly, not a wholesale reallocation. Brand, spend levels, and competing partner identities are withheld.
What I would take to the next plan
Judge audience partners on share of outcomes against share of investment. A partner holding 5% of spend and 51% of the significant outcome is making an argument that raw volume metrics will never surface. The inverse case in this same study, ten times the spend and no measurable refills, is the reason the comparison has to be run in both directions.
Insist on one study, one methodology. The only reason these partners can be ranked against each other is that they were measured inside a single integrated study on the same verified-patient definition over the same window. Partner scorecards stitched together from separate vendor reports quietly reward whoever had the longest measurement window.
Track audience quality index as a scaling diagnostic, not a scorecard metric. Its absolute value is interesting once. Its trajectory as a segment absorbs more budget is what tells you when to stop adding money, and it is the metric that would have flagged the flight 2 caregiver dilution in-flight rather than in the readout.
Say plainly what a study cannot measure. Below-threshold new patient starts are not a soft negative to be buried; they define what the result is about. A refill efficiency finding that survives its own footnotes is what earns the larger test. The measurement scaffolding behind this kind of read is covered in the Pharma Programmatic Measurement Framework, and the DTC activation context is in DTC Programmatic Activation in Pharma.
Key takeaways
- HealthVerity segments held 5.3% of measured investment and returned 31% of verified patients and 51% of incremental refills, significant at 95% CI on all four ad groups.
- The largest single-partner investment in the study, over ten times the spend, produced no measurable incremental refills in the same window.
- Peak audience quality index reached 396x against a random-reach baseline, with a next-best partner peak of 51x.
- New patient starts stayed below the reporting threshold on every HealthVerity ad group, so the finding is about refills and persistence only.
- The scaled caregiver segment's quality index fell to 95x, which is the signal that this efficiency needs an incremental budget test before any large reallocation.
Frequently asked questions
Does this prove the audience partner would perform at ten times the budget?
No, and the study contains the reason to doubt it. The efficiency was demonstrated at 5.3% of measured investment, and the one ad group that did scale, the flight 2 caregiver segment at 60% of the partner's spend, saw its audience quality index fall to 95x against 381x to 396x on the smaller ad groups. That is dilution as the segment grows. The right next step is an incremental budget test with the quality index monitored weekly.
Why are there no new patient start results?
New patient starts fell below the measurement platform's minimum reporting threshold on all four ad groups, which happens routinely in rare disease where the addressable population is small. Making a new-starts claim from suppressed data would be dishonest, so the case study is scoped to incremental refills and verified patient reach, where the data reached significance.
What does an audience quality index of 396x actually mean?
It measures how concentrated an audience is against a random-reach baseline of 1x, so 396x means impressions landed on identified patients at roughly 396 times the rate random delivery would produce. It is a concentration measure, not an outcome measure, which is why it is most useful as an early warning when it falls during scaling rather than as a headline result on its own.
About the author
Christian Guerrero is an Associate Director of Programmatic Media at Havas Media Network in New York, where he leads programmatic strategy and activation for pharmaceutical brands across HCP and DTC channels. He holds an MS in Marketing from Baruch College's Zicklin School of Business and writes about connecting media investment to verified Rx outcomes. Connect on LinkedIn or get in touch.
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I structure DTC audience tests so every partner sits inside one study, one window, and one outcome definition, which is the only way a partner ranking means anything. Happy to walk a recruiter or brand lead through how this applies to a specific category or partner roster.