AxsPolicy

Formulary Rules & Lives

Attaches plan/formulary rules and covered lives to the same canonical entities mastered by AxsID. Because plans are anchored to payer, sponsor, PBM, and processor relationships, policy analysis can be performed at the correct grain — from parent payer down to a specific plan-year — without breaking joins.

What it does

AxsPolicy provides comprehensive policy data linked to the master relationship graph established by AxsID. This ensures consistent analysis across all levels of the payer hierarchy.

Key Features

Comprehensive formulary and plan data at the right granularity

Rules

Comprehensive coverage of tiering, PA/step edits, exclusions (as available)

  • Tier information (preferred, non-preferred, specialty)
  • Prior authorization requirements
  • Step therapy edits
  • Quantity limits
  • Exclusions and restrictions

Lives

Plan-level covered lives with segmentation where applicable

  • Total covered lives by plan
  • Geographic distribution
  • Demographic segmentation
  • Channel breakdown (commercial, Medicare, Medicaid)
  • Trend analysis over time

Joins

Stable foreign keys to payer, plan, sponsor, PBM, and channel

  • Canonical payer IDs from AxsID
  • Plan sponsor linkages
  • PBM relationships
  • Channel-specific analysis
  • Time-versioned relationships

Seamless Integration with AxsID

AxsPolicy builds on the foundation established by AxsID to provide policy context at every level

1

Canonical Entities

Uses the same master IDs from AxsID for payers, plans, sponsors, and PBMs

2

Policy Attachment

Links formulary rules and covered lives to the appropriate entity level

3

Granular Analysis

Enables policy analysis from parent payer down to specific plan-year

Use Cases

How organizations use AxsPolicy for better decision making

Market Access Analysis

Understand formulary coverage and restrictions across payers and plans to optimize market access strategies.

Coverage Optimization

Identify coverage gaps and opportunities by analyzing formulary rules and covered lives at the plan level.

Competitive Intelligence

Compare formulary positioning and coverage policies across competing products and therapeutic areas.

Access Forecasting

Project patient access based on formulary trends, covered lives, and policy changes over time.