🏛 Elite Medicare Analytics · CY2025
The definitive
Part D intelligence
platform.
Part D intelligence
platform.
Formulary friction scoring, IRA impact modeling, claims pattern analysis, and clinical strategy insights — built for analysts, brokers, and health plan executives.
Part D Plans (CY2025)
3,918
↑8.2% vs CY24 enrollment
CMS Plan Finder · 2025
Specialty Drugs w/ PA
94%
↑6pp year-over-year rise
CMS Formulary PUF · CY2025
IRA OOP Cap (2026)
$2,000
vs $7,400 catastrophic threshold CY24
IRA 2022 · CMS Implementation
Negotiated Drug Prices
10
First batch MFPs effective Jan 2026
CMS Drug Negotiation · 2025
Market Signals
High-impact formulary intelligence
Tier Coverage Distribution
Across top 200 Part D drugs
IRA Savings Preview
Estimated 2026 member benefit
Strategic Notes
This week's consulting insights
FDA openFDA · RxNorm · NDC Directory
Drug & NDC Intelligence Search
Search by brand name, generic name, NDC, or pharmacologic class. Results pull live from FDA and NLM APIs.
Quick access:
Module 1 · Formulary Friction Matrix
Where carriers resist
drug access — and why.
drug access — and why.
Friction Score = f(Prior Auth, Step Therapy, Quantity Limits, Tier Placement). Higher scores indicate greater access barriers for members — and higher rebate capture for the carrier.
Friction Score Scale:
2
Low
4
Moderate
6
High
8
Very High
10
Maximum
Average Friction Score by Carrier
Across top 50 specialty drugs
Module 2 · Part D Claims & Payment Explorer
From list price to
net cost — the full picture.
net cost — the full picture.
Drug Cost Waterfall: List Price → Maximum Fair Price / Negotiated → Estimated Rebate → Plan Net Cost → Member OOP. Overlay geographic prescribing variance by drug class.
⚠
Rebate estimates are proxy calculations based on CMS gross/net drug cost ratios and published Medicare rebate benchmarks. Actual rebates are confidential. CMS PUF · Milliman proxy
Drug Cost Waterfall
30-day supply · Medicare Part D member perspective
Geographic Prescribing Variance
Indexed prescribing intensity vs national average (100 = national avg)
Module 3 · IRA $2,000 Cap Impact Simulator
Quantify the real value
of the IRA benefit redesign.
of the IRA benefit redesign.
Model how the 2026 $2,000 OOP cap and Maximum Fair Price (MFP) negotiations change net drug spending for Medicare beneficiaries across conditions and drug classes.
Configure Scenario
Select condition, drug, and member profile
Condition / Drug Class
Specific Drug
Member Annual Income
Plan Year Comparison
$0
Estimated annual savings vs CY2024
Annual OOP Comparison
CY2024 vs CY2025 vs CY2026 (IRA)
Module 4 · Rx Learning Hub
Strategy behind
every data point.
every data point.
Consulting-grade insights that translate formulary mechanics, carrier strategy, and Part D economics into actionable intelligence for brokers, analysts, and plan executives.
Technical Architecture · PostgreSQL · Python · Next.js App Router
Database Schema & Ingestion Architecture
Production-ready schema for Part D PUF, Formulary PUF, IRA data, and FDA drug data. Python ingestion scripts and Next.js API route structure.
Data Sources · Methodology · Disclaimers
How we source, process,
and present data.
and present data.