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TwinFyRx 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.

Step 1 of 5

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.

ContractPlanDrugTierPASTQLQL Detail
H0028001semaglutide 1 MG Pen Injector33 mL / 28 days
H0028001atorvastatin 20 MG Oral Tablet1—
H0028001adalimumab 40 MG/0.8 ML Pen Injector52 pens / 28 days
H0028001apixaban 5 MG Oral Tablet360 tabs / 30 days
S5820003semaglutide 1 MG Pen Injector43 mL / 28 days
S5820003atorvastatin 20 MG Oral Tablet1—
S5820003adalimumab 40 MG/0.8 ML Pen Injector5—
S5820003apixaban 5 MG Oral Tablet2—
R4120001semaglutide 1 MG Pen Injector33 mL / 28 days
R4120001atorvastatin 20 MG Oral Tablet1—
R4120001adalimumab 40 MG/0.8 ML Pen Injector42 pens / 28 days
R4120001apixaban 5 MG Oral Tablet360 tabs / 30 days
Prior Auth Step Therapy Quantity Limit
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Notice how adalimumab requires PA in every plan and sits on Tier 4–5. Semaglutide has near-universal PA too, but with step therapy in 2 of 3 plans. Meanwhile atorvastatin sails through — Tier 1, no restrictions. The raw data already tells a story about access difficulty.