20252034 horizon (10y)
Module 2

Forecast Engine

Deterministic patient-flow model. HCP demand and demand→filled conversion are separate levers, access can be tuned per segment, and rebate↔access coupling lets you simulate a guided curve.

Scenario
Combined access multiplier · 1.00×
Annual price escalator · 3.0%
HCP demand × 1.00
Intent to prescribe — independent of payer friction.
Demand → filled × 1.00
PA, copay, abandonment — what closes the demand-to-fill gap.
Patient support program (PAP)
Free goods / bridge / copay assist. Lifts conversion in Y1–Y4.
Peak net revenue
$19.64B
0.0%
Year 2034 · vs Base
Filled pts at peak
1.73M
938K new · 797K continuing
Access cut at peak
57.8%
HCP demand → filled gap
10-yr cumulative net
$132.08B
2025–2034

Patient flow & revenue by year

YearHCP demandNew ptsContinuingFilled totalAccess cutGrossNetGTN
2025471K199K0199K57.8%$3.21B$1.98B38.5%
2026969K375K80K455K57.8%$7.57B$4.60B39.2%
20271.55M574K192K766K57.8%$13.10B$7.86B40.0%
20282.11M750K331K1.08M57.8%$18.99B$11.27B40.7%
20292.51M860K474K1.33M57.8%$24.10B$14.12B41.4%
20302.79M927K594K1.52M57.8%$28.22B$16.32B42.2%
20312.96M960K684K1.64M57.8%$31.35B$17.89B42.9%
20323.05M971K745K1.72M57.8%$33.64B$18.93B43.7%
20333.06M960K782K1.74M57.8%$35.10B$19.47B44.5%
20343.02M938K797K1.73M57.8%$35.94B$19.64B45.3%

Net revenue trajectory

2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Gross revenue Net revenue

Rebate ↔ access coupling

Brief lever: "for a given rebate, here's the access you unlock." When on, rebate depth on commercial + employer carve-out drives the access tier via a guided curve, replacing channel baselines. Persisted on Base Case.

Rebate depth · 42%
20%70%
Commercial
Baseline access
62%
Unlocked access
68%
Baseline rebate
38%
Concession
42%
Employer carve-out
Baseline access
34%
Unlocked access
54%
Baseline rebate
28%
Concession
42%

Curve: each +1pp of rebate above baseline unlocks ~1.4pp of access, capped at 95%. Calibration is illustrative — replace with payer-research-backed curve before going live.

Continuing-patient access protection (grandfathering)

Brief lever: "access can hit new vs continuing patients differently." 100% = refills are fully grandfathered against a coverage cut (today's default). 0% = continuing patients feel the same access shock as new starts. Persisted on Base Case.

Current
Fully grandfathered
100%
0% · refills exposed100% · fully grandfathered

Math: continuing patients are scaled by protection + (1 − protection) × min(1, accessMultiplier) each year. Only bites when scenario access < 1.0 (e.g. Downside).

Rebate sweep · break-even concession depth

With coupling forced ON, peak net revenue across rebate depths 20%–70% on Base Case. All other levers held at current settings. The blue dot marks the optimum; the dashed line is the current concession.

Optimum @
20% rebate
$24.72B peak
Current
42% rebate
coupling off — preview
20%30%40%50%60%70%$24.72B$12.48B

Read: where the curve flattens or turns down is the point where additional concession stops buying enough access to pay for itself. Use this to anchor pricing-committee conversations.

Recommended rebate depth — AI callout

Sweep optimum is 20% rebate → $24.72B peak net on Base Case. Current concession is 42%. Generate a pricing-committee callout grounded in these numbers.

Click Generate for a grounded AI narrative. The model receives only the structured numbers and selections shown on this page.

Sensitivity tornado · ±20%

10-yr cumulative net · ranked by swing

Which single assumption moves the answer most? Each bar shows how cumulative net revenue changes when one input is flexed ±20% off the Base Case baseline, with everything else held constant.

Access multiplier
$-47.48B+$55.24B
Competitive pressure
$-22.01B+$33.02B
HCP demand (intent to prescribe)
$-26.42B+$26.42B
Demand → fill conversion
$-26.33B+$24.02B
Annual WAC growth
$0M+$0M
Top of the list = highest priority to nail down with evidence or contracting. Bottom = noise.

Goal-seek · reverse-solver

"What would have to be true?"

Pick a target net revenue and a year. The model binary-searches for the lever value on Base Case that hits it.

Solve for
Target year
Target net revenue ($M)
Required access multiplier
0.33×
Year 2028 net achieved
$1.20B
vs. target $1.20B
Solver runs against the live engine — same math as every other view. Only one lever moves; everything else holds at the Base Case baseline.

Per-segment access posture

Payers treat segments differently. These modifiers stack on top of channel-level access (1.0 = neutral). Edits persist on the Base Case scenario and flow into every view.

BMI ≥30 w/ comorbidity
Obesity with T2D, HTN, dyslipidemia
1.00×
New persist.
58%
Cont. persist.
72%
BMI ≥30 uncomplicated
Obesity without qualifying comorbidity
0.78×
New persist.
46%
Cont. persist.
62%
BMI 27–29.9 w/ comorbidity
Overweight with qualifying comorbidity
0.62×
New persist.
42%
Cont. persist.
58%
Established CVD (SELECT)
Secondary CV risk reduction label
1.05×
New persist.
64%
Cont. persist.
78%
Adolescent obesity
Ages 12–17 with BMI ≥95th %ile
0.55×
New persist.
48%
Cont. persist.
66%

Channel-level access & GTN

Commercial
46% mix
Eff. access
62%
GTN
38%
PBM keeps
22%
Self-insured / carve-out
12% mix
Eff. access
34%
GTN
28%
PBM keeps
10%
Medicare Part D
14% mix
Eff. access
18%
GTN
22%
PBM keeps
18%
Medicare Advantage
8% mix
Eff. access
22%
GTN
30%
PBM keeps
15%
Medicaid (FFS+MCO)
16% mix
Eff. access
41%
GTN
62%
PBM keeps
5%
Cash / 340B
4% mix
Eff. access
95%
GTN
5%
PBM keeps
0%