Patient Support Services Modeling, Made Actionable
Turn affordability uncertainty into structured, scenario-based planning
Manufacturers don’t need another spreadsheet or “back-of-the-envelope” calculation—they need real data to understand their patient population and make informed decisions about program access, affordability, and financial impact.
Why Now
Policy and coverage are shifting rapidly. With millions of patients expected to lose Medicaid coverage under HR1, and political uncertainty regarding extending and making permanent the expanded ACA premium subsidies, manufacturers may face a surge in patients needing financial support for their medications.
Demand for financial support and navigation may rise as payers restrict benefit designs. Rather than waiting for coverage to stabilize, now is the time for manufacturers to evaluate their options and move forward with confidence.
What the Model Is
Magnolia Market Access’s PAP 2.0 model is a configurable forecasting and scenario tool designed to optimize patient support programs, not just estimate cost. It enables manufacturers to assess how program design choices (e.g., copay maximums, PAP eligibility, enrollment changes, bridge duration) and external factors, like payer mix shifts or Medicare Part D redesign, impact utilization, affordability, and total program cost over time. The model can be used pre-launch, during annual planning, or in response to policy and payer changes, ensuring support strategy stays aligned with the payers and patients who actually drive access.
How It Works
Inputs
The process starts with the whole picture; anchoring the model on the payer mix (e.g., commercial, Medicare, Medicaid, and “other”). First, the model aims to understand which payers control access and coverage, which is foundational to every decision that follows.
From there, we layer in variables such as patient population assumptions, product details, benefit design, and program policies and costs. For products operating in Medicare, expected Part D and IRA-related dynamics are incorporated, so scenarios reflect coverage on the ground, not just a best guess.
Methods & approach
The model helps determine what truly “moves the needle” versus what is simply a “nice to have”. Magnolia can test individual levers (e.g., copay amount) or a full program re-design and immediately see downstream effects. The model typically provides a forecast over three years, and remains transparent and editable, so brand, patient services, and HEOR can adapt quickly as evidence or policy evolves.
Outputs
The model delivers decision-ready insights of demand and cost by program (e.g., copay, PAP, bridge/quick start), by payer type, and by time period. Core outputs include enrollment and utilization projections, per-patient and total program cost, budget impact, and directional ROI to rank scenarios.
Client Value
Utilizing Magnolia’s PAP 2.0 model enables faster, more informed decision-making grounded in a shared, data-driven view of payer and benefit dynamics. Manufacturers can evaluate program changes before implementation, maintain budget discipline, and optimize support strategies to maximize impact. By aligning decisions with real-world access trends, such as Part D formulary and UM, manufacturers can reduce uncertainty and improve pull-through.
Getting Started
Manufacturers seeing signs of shifts in their payer mix or policies that could affect their patient population can partner with Magnolia Market Access to build a model that enables proactive, data-driven decision-making and confident planning for the year ahead.