“Last-mile risk is actually a patient risk, not just a risk to the business or a monetary risk.” – Tony Pelli, Practice Director of Security and Resilience at BSI Consulting
The last mile is the most volatile and least-controlled segment of the pharmaceutical supply chain.
Whether it's a time-critical oncology treatment, insulin, or a high-demand GLP-1 shipment, the final hours before it reaches the patient are when control slips and risk peaks. As more therapies turn temperature sensitive, high value, and direct to patient, this is the step where failures are most likely and consequences more severe.
So where does risk concentrate in the last mile? And what does it take to control it?
1. Find the risks
Last-mile delivery is fragmented by design. It involves multiple handoffs, limited visibility, and a shifting mix of operators depending on the region.
The US benefits from a small number of primary distributors, reducing transfers and improving control. Across Europe, Asia, and emerging markets, distribution networks are broader and more complex, exposing shipments to more threats.
However, the risk spots are consistent:
- Courier handovers with no verified chain of custody.
- Delays in urban areas that strand shipments outside controlled conditions.
- Direct-to-patient drop-offs with no standardized conditions, especially outside the developed world.
Each of these open the door to theft and diversion. The work starts with mapping end-to-end flows down to the final delivery handoff, covering every third-party touch point and any moment where environmental control can break down.
2. Measure risk by patient impact
Traditional risk models underestimate the last mile. Tony Pelli explains: “Any individual last-mile shipment isn't as valuable as a first or middle-mile shipment, so you can systematically underrate the risk, and those thefts add up. That's where it has the most direct impact on the patient.”
A better approach is to score risk by patient impact, not shipment value.
Build predictive insight into delivery conditions, then tie escalation triggers to how much a failure would harm the patient. For example, a time-critical oncology therapy stuck in local distribution should jump the queue even if every standard protocol cleared it.
Effective risk scoring should combine:
- Product sensitivity to address temperature tolerance and shelf life.
- Patient criticality to capture how much harm a delay or failure causes.
- Real-time disruption signals on the route, not just shipment value or a country's theft rate.
This shifts decision-making from operational efficiency to patient outcomes.
3. Design for control
Many last-mile failures are the result of structural gaps: the wrong delivery model, weak cold chain controls, or insufficient safeguards against theft.
Standard parcel networks are often used for therapies that require specialized handling. At the same time, high-demand drugs like GLP 1 (for weight loss) have become attractive targets valuable enough to resell and easy to move and conceal.
This creates a dual risk:
- Loss through theft or diversion.
- Re-entry of compromised product into the supply chain.
Strengthen control where it matters most:
- Segment delivery models: Match service levels to therapy criticality.
- Implement smart packaging: Enable real-time monitoring and intervention.
- Build redundancy: Diversify carriers and position inventory closer to patients.
- Reinforce chain of custody: Use tamper-evident and trackable controls.
These fixes are well understood; the challenge is applying them consistently across the supply chain.
4. Make it consistent
Consistency is where many organizations fail. One high-risk lane is fixed but is not extended across the network. The effort never scales, the risk reduction fades, and the gaps between regions widen until the next failure exposes them.
The usual culprits are familiar:
- Inconsistent standard operating procedures (SOPs) across regions and partners.
- Fragmented data that limits real-time visibility.
- Weak feedback loops that prevent systemic learning.
Strong performance in one region can mask risk elsewhere, creating a false sense of control. As Tony Pelli puts it: “Visibility without action isn't sufficient. A lot of companies focus heavily on getting as much visibility as possible then forget to plan around what they actually do with it.”
Closing these gaps requires a unified approach:
- Standardize global SOPs for handling, monitoring, and incident response.
- Integrate partners into a single control tower for real-time coordination.
- Align on what’s tracked, how often, and what triggers action.
- Establish corrective and preventive action (CAPA) processes to ensure every incident drives improvement across the network.
Consistency is what turns isolated fixes into sustained risk reduction.
What to hold onto
Three principles should guide last-mile strategy:
- Last-mile risk is patient risk. When a shipment fails here, the patient is who suffers.
- Visibility alone isn't enough. Data with no plan to act on it changes nothing.
- Orchestration is everything. Managing one third-party logistics provider or one country well counts for little without consistency across all of them.
The therapies moving through today’s supply chains—whether life-saving treatments or high-demand GLP 1s—require a last mile built to match their importance. Because when the last mile fails, the patient pays.
