The ~1% Problem: $500,000 on Pharma Search with only $6,000 Reaching HCPs. Does the System Work?

I recently audited a pharma brand’s marketing program. The objective was to reach healthcare professionals through paid search, and the budget was meaningful at roughly $500,000.

When we analyzed the program using UTMs and pixel-level data, the outcome was startling but not surprising: only about $6,000 of that spend reached verified prescribers.

What’s more surprising than the sheer numbers is that the brand never knew. Our conversations were exclusively with the agency. 

Website-level identity resolution is still not widely adopted in pharma, and while I raised the issue, it is the kind of topic that can feel risky to elevate directly to senior client leadership. To their credit, the agency did shift toward audience targeting afterward, but the brand itself never saw the disconnect.

Unfortunately, the issue is systemic.

Why keyword-only search falls apart in pharma

Brands allocate roughly 32% of their media budgets to search. Until July of last year, Google did not allow pharmaceutical advertisers to use HCP audiences at all, resulting in an entire market built around keyword-only targeting, even when the stated goal is to reach prescribers.

The brand believed that since they were targeting HCP keywords (clinical terms, drug names, and indications), they were targeting HCPs.

However, patients also search those same terms. If you are only targeting keywords, you are not targeting prescribers. In reality, you are targeting anyone with a keyboard.

What makes this especially frustrating is how much work goes into these programs. Pharma teams and agencies meticulously review and approve every keyword, lists are debated line by line, and changes happen quarterly, if they happen at all.

The system is slow, rigid, and manual. By the time anything is updated, the money is already gone.

The unintentional result is that budgets meant for HCPs quietly turn into DTC spend. Brands think they are reaching prescribers, but most dollars never get anywhere near a prescribing decision.

Search requires a different audience model

So, this is really an audience problem.

HCPs represent roughly 2% of the U.S. population. Reaching an audience that small at scale requires audience-based targeting. There is no practical way to do it using keywords alone without some form of email- or device-level identity.

Even when brands do use audience targeting, they often import the wrong mental model, defaulting to NPI-based lists designed for programmatic or paid social, which often narrows reach to a highly curated group of ten thousand or so prescribers.

That approach makes sense in interruptive environments, where the goal is to capture attention, but search is different.

In search, intent is present. Even if an HCP is not on a brand’s high-value NPI list, they are still a prescriber. When they are actively researching, the priority should be recognition.

The compelling opportunity in pharma search is identifying whether the user is a prescriber and routing them to content that reflects their role: physician, nurse, pharmacist, or physician assistant. 

A better world starts with a simpler question. Is this user a prescriber or not?

Rethinking what success looks like in search

With that foundation, brands can broaden their keyword universe for prescriber-targeted campaigns and focus on accelerating the research journey. The goal is to help HCPs find the most relevant information faster, so they can get what they need and get back to their already demanding day.

Until pharma marketing makes this shift, search budgets will continue to be optimized for activity instead of outcomes. Campaigns will look busy while missing the people who matter most.

For brands that want to remedy this approach, there are a few practical steps to start with:

1. Audit your website traffic. Use a solution that can resolve visitors into two clear cohorts: prescribers and everyone else. If you cannot see the split, you cannot manage it.
2. Apply audience targeting deliberately. Search already includes an in-market signal through keywords, which means it requires a different structure than programmatic or paid social. Do not assume the same targeting strategy applies across channels.
3. Set explicit resolution benchmarks.  Define success in measurable terms. For example, if you are running an HCP-targeted search campaign, you might expect 60% of visitors to resolve to prescribers. If they do not, something is wrong.

Most brands will not realize how large this gap is until they look more closely. When they do, the essential question will be why the industry accepted proxies for so long when outcomes were the goal all along — and how to fix it.