Market Access
Payer Lens — Budget Impact & PMPM
Select a payer segment to see covered lives, high-risk share, flu hospitalization burden, and Investigational Prophylactic preventable savings.
Payer prioritization heuristic
Medicare FFS + Medicare Advantage together cover ~65M lives — 45% of the US high-risk pool. Their flu-related hospitalization cost per member per year (PMPY) is 4–7× commercial books. For Investigational Prophylactic, Medicare Advantage is the anchor tenant.
Covered lives
33.0M
High-risk lives
30.4M
92% share
Hosp/100K
245
Cost/hosp
$12,200
Investigational Prophylactic avert @ 40%
5K
hospitalizations
$ saved @ 40%
$75.7M
Annual
PMPM Impact vs Investigational Prophylactic Uptake
Medicare Advantage — projected medical cost avoided per member per month
Break-even calculation depends on WAC and net price; consult market access for confidential PMPM ceiling.
Budget impact — 1M-life plan
Assumes payer average characteristics of the segment above
| Scenario | Hospitalizations averted (per 1M) | $ saved / yr (per 1M) | PMPM |
|---|---|---|---|
| Uptake 25% | 0 | $0 | $0.000 |
| Uptake 40% (target) | 150 | $2.3M | $0.191 |
| Uptake 70% (aspirational) | 664 | $10.2M | $0.848 |