Payer Prioritization

Patient impact vs ease of addressing: where to focus first

Illustrative synthetic dataLive AI

Payer prioritization matrix

Patient impact vs ease of addressing. Dashed lines are the medians.

Ease = 0.6 × evidence confidence for the plan's default evidence + 40 × (1 − restrictions / 5). Illustrative scoring, not a forecast.

Quadrants

  • Commercial Plan C
    Commercial · Prior authorization, Tier placement
    6,300 · ease 54Focus first
  • Large Employer Plan D
    Employer · Step edit, Quantity limit
    4,100 · ease 58Quick win
  • Regional Commercial Plan E
    Commercial · Prior authorization, Specialist-only prescribing
    3,900 · ease 54Quick win
  • Medicaid MCO Plan F
    Medicaid MCO · Step edit, Prior authorization
    2,700 · ease 62Quick win
  • National PBM Plan A
    National PBM · Step edit, Prior authorization, Quantity limit
    14,200 · ease 50Build evidence
  • Regional MA Plan B
    Medicare Advantage · Step edit, Prior authorization, Specialist-only prescribing
    9,800 · ease 50Build evidence

Why focus here?

Live AI rationale per payer, grounded in the matrix and evidence library

Click "Explain the priorities" for a rationale per payer.