TwinFyRxTwinFyRx Labs
From plan restrictions to
access friction intelligence
Walk through five transformations that turn raw CMS Part D formulary data into composite access friction scores. See how prior auth, step therapy, and quantity limit signals combine to reveal payer access barriers.
Plan-Level Restrictions
Raw Part D formulary data
Every Part D plan publishes which drugs it covers and what restrictions apply. CMS aggregates these into quarterly public-use files. Each row is a plan × drug combination with tier placement and access control flags.
| Contract | Plan | Drug | Tier | PA | ST | QL | QL Detail |
|---|---|---|---|---|---|---|---|
| H0028 | 007 | 5 | 6 per 28 days | ||||
| H0028 | 007 | 3 | 3 per 28 days | ||||
| H0028 | 007 | 3 | 74 per 30 days | ||||
| H0028 | 007 | 1 | — | ||||
| S2893 | 001 | 5 | 6 per 28 days | ||||
| S2893 | 001 | 3 | 3 per 28 days | ||||
| S2893 | 001 | 3 | 74 per 30 days | ||||
| S2893 | 001 | 1 | 30 per 30 days | ||||
| R0110 | 003 | 5 | 6 per 28 days | ||||
| R0110 | 003 | 3 | 3 per 28 days | ||||
| R0110 | 003 | 3 | 74 per 30 days | ||||
| R0110 | 003 | 1 | — |
Real 2026 plans, one of each type (MA-PD, PDP, Regional PDP): Humira 40 mg pen (Tier 5) needs prior auth in every plan; Ozempic 1 mg pen (Tier 3) needs prior auth in every plan; Eliquis 5 mg tablet (Tier 3) needs no prior auth; atorvastatin 20 mg (Tier 1) needs no prior auth. The raw data already tells a story about access difficulty.