2025–2034 horizon (10y)
Module 3
Drivers & Scenarios
Market drivers with bounded future states and leading indicators. Scenarios are combinations of driver states — used by the forecast engine and strategy simulator.
PolicyAffects: medicare_pdp, medicare_ma
Medicare obesity coverage
Likelihood of change
55%
Disruption magnitude
85%
conservative30%
Status quo — no Part D coverage
base50%
Limited coverage for high-risk subgroups
disruptive20%
Broad Part D coverage post-CMS reinterpretation
Leading indicators: CMS RFI outcomes · TROA congressional movement · Part D formulary signaling
CompetitiveAffects: commercial, employer_carveout
Oral GLP-1 entry
Likelihood of change
78%
Disruption magnitude
72%
conservative25%
Orforglipron delayed past 2027
base55%
Oral GLP-1 launches 2026, ~15% share by Y3
disruptive20%
Multiple orals by 2026, rapid share shift
Leading indicators: Ph3 readouts · FDA submission timing · Manufacturing capacity
ChannelAffects: employer_carveout, commercial
Employer coverage expansion
Likelihood of change
62%
Disruption magnitude
48%
conservative35%
Carve-outs accelerate, coverage drops
base45%
Selective coverage with strict PA
disruptive20%
Outcomes-based coverage becomes standard
Leading indicators: Mercer/Willis Towers surveys · Carve-out RFP volume · ICER review outcomes
PayerAffects: commercial, employer_carveout, medicare_ma
PBM utilization management
Likelihood of change
82%
Disruption magnitude
66%
conservative20%
Stable PA criteria
base55%
Tightening PA, step edits, BMI floors
disruptive25%
Quantity limits + outcomes contracting required
Leading indicators: PBM formulary publications · PA criteria changes · Reject rate trends
EvidenceAffects: commercial, medicare_ma, medicare_pdp
CV outcomes label uptake
Likelihood of change
70%
Disruption magnitude
38%
conservative20%
Limited cardiology uptake
base55%
Cardiology guidelines incorporate by 2026
disruptive25%
Standard of care for secondary prevention
Leading indicators: ACC/AHA guideline updates · Cardiology Rx trends · RWE publications