Milliman Medicare Market Intelligence
An interactive web-based solution for competitive Medicare market insights
Milliman Medicare Market Intelligence
Complete Medicare Intelligence, actionable insights
Proven in unlocking market access potential for leading organizations
100%
Unsampled data – all members, all claims
70M+
Medicare lives
2 weeks
As little as 2 weeks of data lag
7
Specialized modules and more to come
MedIntel combines 100% unsampled CMS claims data with Milliman's actuarial expertise to deliver real-time Medicare market intelligence.
Your critical questions, answered
Select your business to see how MedIntel’s specialized modules solve your most pressing business challenges and inform strategic decisions
Part D Plan Sponsors
How do my pharmacy network reimbursement rates compare to market benchmarks across different pharmacy types and drug categories?
Module: Pharmacy Network Discounts
- Benchmark reimbursement rates against competitors.
- Negotiate better pharmacy network contracts.
- Prepare data-driven RFP responses with market intelligence.
Are emerging utilization trends specific to my plan, or reflective of broader market dynamics I should respond to?
Module: Emerging Part D Claims
- Identify trends and benchmark utilization patterns.
- Inform formulary decisions and benefit design.
- Distinguish plan-specific trends from market-wide shifts.
Which members am I losing to competitors, what is their risk profile, and where are they going?
Module: Member Migration
- Track member movement patterns and risk profiles.
- Understand retention drivers to reduce churn.
- Support competitive positioning in RFP responses.
Which specific prescribers or pharmacies are contributing to adherence gaps that impact my Star ratings?
Module: Adherence
- Improve Star Ratings through targeted interventions.
- Identify prescriber- and pharmacy-level opportunities.
- Demonstrate quality performance in RFP submissions.
Data foundation
Technical section explaining the data sources and Milliman’s analytical enhancements.
Built on CMS’s Research Identifiable Files (RIF), our platform provides 100% unsampled claim- and member-level data covering the entire Medicare population. Part D prescription drug event (PDE) records and traditional Medicare claims are available with as little as two weeks of lag, while Part C encounter data provide comprehensive Medicare Advantage (MA) insights.
Complete claims detail
- Every National Drug Code (NDC) with prescriber National Provider Identifier (NPI), pharmacy National Council for Prescription Drug Programs (NCPDP), and dispensing details
- Complete member demographics by month: age, geography, low-income subsidy (LIS) status, dual eligibility, and disease indicators
- Plan identifiers (contract, plan benefit package), benefit design parameters, and complete financial reconciliation
- Hundreds of additional data elements supporting deep analytical needs
Milliman value added analytics
Our actuarial team enriches the raw CMS data with proprietary methodologies and industry-standard benchmarks to deliver actionable intelligence:
Enhancements:
- Enhanced entity resolution for PBMs, pharmacy chains, and prescriber networks
- Comprehensive drug pricing benchmarks
- CMS-compliant risk adjustment scores and disease hierarchies
- Imputed medical costs for Part C encounters
- CMS Stars measure calculations for adherence and outcomes
- Member attribution logic linking patients to pharmacies and providers
Key Benefits
Outperform competitors with actuarial-grade benchmarks
Compare your plan performance against every market participant using CMS-compliant risk scores and Milliman's proven methodologies. Make confident strategic decisions backed by 75-plus years of actuarial expertise and complete market data.
Drive significant contract savings with complete market intelligence
Negotiate from a position of strength with comprehensive reimbursement benchmarks across all competitors. Identify opportunities for improved contract terms across pharmacy types, drug categories, and 20-plus dimensions—leading to millions in potential annual savings.
Track every member, every claim—know where they go
Monitor real member migration patterns across the entire Medicare landscape. Quantify financial impact of enrollment changes by analyzing prior-year utilization and cost profiles for every cohort, protecting your high-value membership.
Answer complex questions in minutes, not months
Generate custom reports at any level—national trends to individual pharmacy—using 100% unsampled data, not statistical samples. Transform weeks of manual analysis into minutes of data-driven insights.
Platform capabilities
Interactive dashboards & custom reporting
Explore complete claims data through intuitive dashboards tailored to your role. Generate custom reports filtered by plan sponsor, member cohort, therapeutic class, prescriber network, or any combination of many other available dimensions.
Rebate modeling & scenario analysis
Model rebate structures and formulary positioning scenarios using your actual claims data. Evaluate financial impacts of drug placement decisions with confidence, leveraging both plan-specific and market-wide utilization patterns.
HITRUST-Certified Security + Dedicated Actuarial Support
Enterprise security meeting the highest compliance standards, plus dedicated actuarial consultants to extract maximum value from day one. Unlike with commodity analytics tools, you get Milliman expertise built into every implementation—with 2–4-week deployment and ongoing consultation from Medicare actuaries.
Purpose-built for Medicare stakeholders
Whether you’re a Part D plan sponsor, PBM, retail pharmacy chain, specialty pharmacy, or life sciences company, our modules are designed specifically for your analytical needs and business objectives within the Medicare marketplace.
Pharmacy Network Discounts
Compare your rates against every competitor PBM and chain using complete Part D data. Analyze by network status, dispensing channel, drug category, and 20+ dimensions to identify immediate savings opportunities and strengthen your negotiating position.
Key Insights You'll Gain:
- Benchmark by preferred/standard/out-of-network status
- Compare across retail, mail order, and specialty channels
- Filter by drug attributes, formulary tier, and plan type
- Identify rate outliers for immediate contract renegotiation
- Track reimbursement trends month-over-month to spot market shifts
Pharmacy market share
Monitor competitive positioning and capture growth opportunities
Track prescription volume trends and market share across pharmacy chains, PBMs, and plan sponsors with complete data. Segment by geography, individual drugs, and channel to identify competitive threats and expansion opportunities.
Key insights you’ll gain:
- Track market share trends by pharmacy chain, PBM, and plan sponsor.
- Segment by LIS enrollment, geography, and drug name.
- Monitor brand, generic, and specialty channel performance.
- Identify plan type opportunities.
- Spot competitive threats before they impact your business.
Emerging Part D Claims
Benchmark utilization and spot trends in near-real-time
Identify whether your experience diverges from market norms with near-real-time Part D data. Drill from organization to plan to NDC level with comprehensive cost metrics to inform strategic decisions.
Key Insights You'll Gain:
- Benchmark drug-specific and plan-level utilization against market
- Drill from parent organization to individual plan and NDC
- Access total allowed cost, scripts, member cost-sharing, CGDP/MDP, and other metrics
- View results in absolute terms or PMPM basis
- Identify emerging trends within 2 weeks of claim adjudication
Emerging medical benefit claims
Optimize MA plan costs with comprehensive encounter data
Analyze medical utilization trends using complete Parts A, B, and C data categorized by Milliman’s Health Cost Guidelines™ (HCG). Benchmark your MA plan against competitors and traditional Medicare to identify significant cost management opportunities.
Key insights you'll gain:
- Track spending patterns across all service categories (inpatient, outpatient, professional).
- Benchmark medical costs against competitors and traditional Medicare.
- Analyze utilization using Milliman’s HCG framework.
- Identify cost outliers and management opportunities.
- Inform benefit design and provider contracting strategies.
Member Migration
Track member movement and quantify financial impact
Identify which members you gained, retained, or lost—nd where they came from or went to. Quantify enrollment changes by analyzing prior-year utilization and cost profiles to protect your high-value member segments.
Key Insights You'll Gain:
- Track member movement patterns across the entire Medicare landscape
- Identify exactly where members came from or went to
- Analyze prior-year drug utilization and cost profiles by cohort
- Quantify financial impact of enrollment changes
- Understand competitor vulnerabilities and protect high-value segments
Adherence
Improve Star ratings with targeted intervention opportunities
Optimize CMS Stars performance with actionable adherence intelligence. Identify intervention opportunities at contract, prescriber, and pharmacy levels using near-real-time data to improve MPR for the three key Stars measures.
Key Insights You'll Gain:
- Benchmark adherence rates against market leaders
- Pinpoint specific prescribers or pharmacies contributing to gaps
- Identify intervention opportunities for diabetes, hypertension, and cholesterol meds
- Deploy targeted interventions using near-real-time claims data
- Track improvement over time to protect and enhance Star ratings
Pharmacy Share of Customer
Maximize prescription capture rates and customer loyalty
Identify which customers fill at your locations and where their remaining scripts go. Benchmark share-of-wallet against competitors to develop targeted strategies that increase loyalty and capture additional prescriptions.
Key insights you'll gain:
- See which customers fill prescriptions at your locations.
- Identify where remaining scripts go to competing pharmacies.
- Benchmark share-of-wallet by store, market, and drug category.
- Segment by LIS status, geography, and therapeutic category.
- Develop targeted strategies to increase customer capture rates.
See MedIntel in action
Join leading Medicare organizations using MedIntel to make data-driven decisions every day. Ready to transform your Medicare market insights?