Patient Impact
Label-eligible patients blocked or delayed
Illustrative synthetic dataData source: Optum RWD cohort (simulated)
Label-eligible patients
96,000
Blocked or delayed
41,000
% of eligible affected
42.7%
Abandoned at pharmacy
12,500
30.5% of affected
Treatment cascade
Adults with T2D and CKD · stages are overlapping cohort cuts, not a strict funnel
Affected patients by payer
Selected payer highlighted · click to select
| Payer | Patients affected | Share of total | Abandonment rate |
|---|---|---|---|
| National PBM Plan A | 14,200 | 34.6% | 27% |
| Regional MA Plan B | 9,800 | 23.9% | 30% |
| Commercial Plan C | 6,300 | 15.4% | 16% |
| Large Employer Plan D | 4,100 | 10.0% | 10% |
| Regional Commercial Plan E | 3,900 | 9.5% | 20% |
| Medicaid MCO Plan F | 2,700 | 6.6% | 18% |
| Total | 41,000 | 100% |
Region split
- Northeast6,30015.4%
- South12,50030.5%
- Midwest14,20034.6%
- West8,00019.5%
Outcomes by time-to-therapy
Events per 100 patient-years
Simulated Optum HEOR outcomes. Illustrative only; replace with Optum data in a pilot.
Cohort logic (simulated claims algorithm)
- Adults aged 18+
- T2D with CKD: ICD-10 E11.22 with N18.3 to N18.4
- ≥12 months continuous enrollment
- UACR and eGFR testing flags from lab claims
- Therapy history windows for ACEi/ARB and SGLT2 inhibitor
- Access barrier: rejected claim, PA pend or step edit before first fill