Hierarchical Issue Map

Stakeholder → Key Business Question → Sub-question. The structural backbone the rest of the model and AI layer reason against.

Why this exists

The issue map is the structural backbone for the rest of the platform — not a Q&A surface. Every KBQ ties to (a) the drivers on Scenarios that resolve it, (b) the levers on Strategy that respond to it, and (c) the evidence grounding the answer. It forces analysts and reviewers to agree on what we need to know before debating numbers. AI narrative belongs downstream (Overview, Strategy fit, What-changed) where it can ground in quantified scenarios — not here, where answers should still come from analyst-curated evidence.

Coverage gap: 1 of 6 KBQs have no linked evidence yet. These are flagged below — ground them before they hit a deck.

Need a new question? Add custom KBQs from the Market Foundation page. Add a KBQ

Sub-questions (3)

Will CMS reinterpret the Part D obesity exclusion?
CMS RFI Response, 2024: CMS exploring obesity coverage under Part D via reinterpretation
kbq1.1
What congressional action on TROA is realistic by 2026?
kbq1.2
Which high-risk subgroups would be prioritized first?
kbq1.3

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Sub-questions (3)

When does orforglipron reach the US market?
Lilly Q3 2024 Earnings: Orforglipron Ph3 readout expected Q2 2025
kbq2.1
What is the efficacy gap vs injectable GLP-1s?
kbq2.2
Will PBMs prefer oral for cost/adherence?
kbq2.3

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Sub-questions (3)

What BMI floors are PBMs adopting?
IQVIA LAAD Claims, 2024 Q3: Commercial PA approval rates fell from 71% to 58% YoY for GLP-1 obesity
kbq3.1
Are step edits to phentermine/orlistat becoming standard?
kbq3.2
What quantity limits are being enforced?
kbq3.3

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Sub-questions (2)

What is the elasticity of access to rebate depth?
kbq4.1
Which top 3 PBMs require outcomes contracting?
kbq4.2

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Sub-questions (3)

What ROI threshold do employers require?
Mercer Employer Survey 2024: 44% of large employers cover GLP-1s for obesity, up from 26%
kbq5.1
Will carve-out vendors expand or restrict coverage?
kbq5.2
How does CV outcomes data change benefit design?
SELECT Trial NEJM 2023: 20% MACE reduction in established CVD without diabetes
kbq5.3

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Sub-questions (2)

What is 12-month persistence by OOP band?
Symphony Health Rx Claims 2024: 1-year persistence 32% at >$50 OOP vs 58% at <$25 OOP
kbq6.1
Does copay assistance meaningfully shift persistence?
kbq6.2

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Linked from Market Foundation. Drop new sources into the Evidence Library to ground KBQs before they hit a deck.