🏛 Elite Medicare Analytics · CY2026
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 (CY2026)
3,918
↑8.2% vs CY24 enrollment
CMS Plan Finder · 2026
Specialty Drugs w/ PA
94%
↑6pp year-over-year rise
CMS Formulary PUF · CY2026
IRA OOP Cap (2026)
$2,100
up from $2,000 in CY25 · IRA-indexed
IRA 2022 · CMS Implementation
Negotiated Drug Prices
10
10 MFPs in effect · 15 more selected for 2027
CMS Drug Negotiation · 2026
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:
Multi-Drug · State · Plan Comparison
Formulary Coverage Search
Search one or more drugs by name, RXCUI, or NDC. Compare Tier, QL, PA, and ST across Medicare Advantage plans by state — with the source and effective date on every row.
⚠Loading formulary data source…
Add as many drugs as you like. Names are pulled live from the NLM RxNorm/RxTerms directory.
Status legend:
Confirmed from a CMS file or official plan doc ·
Inferred filled gap, not official ·
Representative sample for this demo ·
Conflict sources disagree ·
Stale past the refresh window.
Educational use only — verify against official carrier formulary documents before any decision.
Coverage areas: PA, WV, DE, NY, and the Kansas City metro (MO). Note: Blue KC exited Medicare Advantage on 1/1/2025, so it is not a current MA-PD carrier — KC-metro rows show the carriers that do serve that area.
Educational use only — verify against official carrier formulary documents before any decision.
Coverage areas: PA, WV, DE, NY, and the Kansas City metro (MO). Note: Blue KC exited Medicare Advantage on 1/1/2025, so it is not a current MA-PD carrier — KC-metro rows show the carriers that do serve that area.
Strategy Suite · MA & DSNP Formulary Intelligence
Design, benchmark & optimize
your formulary strategy.
your formulary strategy.
Every number on this page is computed live from the loaded CMS Formulary PUF records for MA/DSNP plans in your service areas. Compare any plan against the market, find restrictive drug classes, and plan next year's changes with evidence.
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Restriction intensity vs market
Tier distribution vs market
Class-by-class benchmark (this plan vs market average)
Drug class strategy board — click a class to drill into its drugs
Enter a drug or class above to compare how every MA/DSNP plan covers it.
Access & restriction balance by plan
Plotted from formulary structure: restriction burden (PA + ST + QL + specialty tiering) vs breadth of coverage (distinct drugs on formulary). Lower-right = generous & broad; upper-left = restrictive & narrow.
⚠Cost dimension: Dollar copay/coinsurance amounts come from the CMS Beneficiary Cost PUF file (a separate file in the same download). Once that file is added to the pipeline, this view will plot true member cost against access. Today it uses tier placement as the cost proxy and labels it as such.
Year-over-year change tracker
Plans out of alignment with market
Plans whose restriction intensity sits more than one standard deviation from the market mean — candidates for review.
Specialty Suite · Tier 5 Access-Barrier Analysis
How hard is it to get
a specialty drug covered?
a specialty drug covered?
Every Tier 5 specialty drug, scored on the policy friction each carrier applies — prior auth, step therapy, quantity limits, and specialty-pharmacy restrictions. Computed live from the loaded CMS PUF. Search by drug, RXCUI, or condition; compare carriers; export to Excel.
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Disclaimer. This module is for educational and informational purposes only. It is not clinical, legal, or regulatory advice. Specialty drug coverage, prior-authorization criteria, step-therapy rules, quantity limits, and diagnosis-based restrictions change frequently and vary by plan, segment, and effective date. Friction scores are computed from public CMS Prescription Drug Plan Formulary PUF fields; diagnosis/indication is shown only where the source provides it and is otherwise marked "Not in source" — no policy is inferred or presented as confirmed. Always verify against the official carrier formulary and utilization-management documents before any coverage, clinical, or business decision. ManageFormulary is not responsible for omissions or errors.
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 $2,100 Cap Impact Simulator
Quantify the real value
of the IRA benefit redesign.
of the IRA benefit redesign.
Model how the CY2026 $2,100 OOP cap and Maximum Fair Price (MFP) negotiations change net drug spending for Medicare beneficiaries. 10 negotiated drugs now in effect, 15 more selected for 2027.
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.