Building Defensible Assumptions in a Volatile Policy Era

Pharmaceutical forecasting has always been difficult, but today’s volatile market requires a new approach. You can no longer rely on historical data or assume that policies will stay the same; you must plan for multiple scenarios and quick adaptation.

At Triangle Insights Group (TIG), we anticipate changes rather than reacting to them. We use our Policy Reporter database to track legislation and payer trends in real-time, allowing us to build forecasts based on where the market is going, not where it has been.

Shifts in Pricing, Coverage, and Sales

Four major structural shifts in the access environment are driving this volatility:

• Distribution Shifts: New distribution models and alternative purchasing channels directly impact net revenue. Because these shift how patients buy and how payers react, we model multiple scenarios to pinpoint where revenue is at risk.
• Inflation Reduction Act (IRA): While we know the IRA’s timeline, the negotiation results remain unpredictable. Instead of relying on a single fixed assumption, we use historical data and competitive factors to build a range of likely outcomes.
• Tariffs and Trade Policy: Tariffs and international pricing models affect list prices and margins. We track these policies to determine the most probable pricing paths. 

Payer Behavior: Payer consolidation and changes to Medicaid/340B are making access more difficult. We analyze these trends to understand how they will increase restrictions and impact patient adherence.

TIG’s Methodology: Translating Policy Signals into Forecast Inputs

TIG pairs real-time policy monitoring, through our proprietary Policy Reporter database, with structured forecasting methods to reflect access realities, not just hypothetical landscapes. Using Policy Reporter, we base our analysis on current behavior of payers and regulators. Today’s forecasts need to be flexible and built for uncertainty with deep policy fluency.

TIG focuses on the following four access levers that are most likely to influence performance: 

• Coverage & Restrictions
• Channel Utilization
• Patient Affordability
• Rebate & Discount Pressure

We model baseline and alternative scenarios (tightening Medicaid rules, increased channel steering, or affordability mandates) to show how different policy trajectories shift uptake, adherence, and net revenue. This methodology produces a forecast that is analytically rigorous and grounded in real-time policy intelligence.

Case Example: Using Payer Management Archetyping to Strengthen Forecast Assumptions 

A top-20 pharmaceutical company sought to understand how a novel, new-to-market asset would be managed in a highly competitive therapy area. TIG helped identify analog products with parallel pricing strategies, evidence profiles, and competitive pressures using Payer Management Archetyping (PMA) and our Policy Reporter data.

By integrating PMA findings into the forecasting workstream, the client was able to: 

• Re-segment accounts based on real behavior rather than broad payer categories 
• Adjust access and gross-to-net assumptions for high-risk archetypes 
• Refine early uptake curves to reflect likely utilization management intensity 
• Align pricing, value, and pre-approval information exchange strategies prior to launch 

The result was a far more defensible forecast, with access assumptions grounded in historical behavior rather than generic expectations.

To learn more about our analysis process for this case study, as well as a more in-depth look at our forecasting capabilities, read our full Whitepaper on access environments.