US Payer Intelligence

Know Every Payer's Rules Before You Walk In

Know every payer's rules before you walk into the room. Comprehensive US payer coverage data with health plan profiles, formulary tracking, and coverage policy monitoring.

40+ Health Plans Real-time Formulary Tracking Coverage Policy Database Payer Archetypes
Payer Formulary Status Tier Prior Auth
Aetna Commercial Preferred Tier 2 No PA
CVS Caremark Covered Tier 3 PA Required
Express Scripts Under Review Pending Step Therapy
UnitedHealthcare Preferred Tier 2 No PA
Cigna Covered Tier 3 PA Required
Capabilities

Comprehensive Payer Intelligence

From health plan profiles to coverage policies, US Payer Intelligence surfaces the data you need for access success.

Health Plan Profiles

40+ major US health plans including Medicare Part B/D, Medicaid, Commercial, PBMs, and IDNs. Coverage details, decision criteria, and key contacts.

Comprehensive plan coverage details
Decision-maker criteria and preferences
Key contact information

Formulary Tracking

Real-time monitoring of formulary status changes, tier positioning, prior authorization requirements, and step therapy protocols.

Real-time formulary change tracking
Tier positioning and step therapy data
Prior authorization requirements

Coverage Policy Database

Searchable database of payer-specific coverage policies, evidence requirements, and decision-making frameworks for faster access success.

Searchable coverage policies
Evidence and clinical requirements
Detailed decision frameworks
Payer Intelligence

Access Payer Intelligence Across All Types

Unified intelligence across all payer types to accelerate access strategies and formulary positioning.

Medicare

Medicare Part B and Part D coverage policies, pricing strategies, and formulary positioning for government programs.

Medicaid

State-specific Medicaid coverage requirements, formulary rules, and access strategies across all 50 states.

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Commercial

Self-insured and fully-insured commercial plan access data, tier positioning, and formulary management strategies.

PBM Strategies

Pharmacy benefit manager formulary positioning, contracting strategies, and network access optimization.

IDN & Specialty

Integrated delivery network and specialty pharmacy coverage policies, contracting terms, and formulary requirements.

Payer Archetypes

Strategic payer archetypes and behavioral profiles to identify key decision-makers and access pathways.

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