PA/NP Payer Claims Reveal a Key Gap - Act Now
Pharma marketing and payer access teams rarely work from the same data. The AAPA and POCN Group joint analysis changes that, with a payer mix breakdown that provides new insight into the access realities surrounding PA and NP care.
Within their attributed patient panels, PAs and NPs have a higher share of Medicare and Medicaid covered patients than physicians, consistent with their concentration in primary care and underserved settings.
Prescription Payer Mix - NPs & PAs vs. Physicians (2024):
• Commercial: NPs/PAs 33.1% | Physicians 29.0%
• Medicare: NPs/PAs 26.5% | Physicians 25.4%
• Medicaid: NPs/PAs 11.0% | Physicians 8.3%
Commercial: NPs/PAs 33.1% vs. Physicians 29.0% | Medicare: 26.5% vs. 25.4% | Medicaid: 11.0% vs. 8.3%
This payer distribution has direct implications for formulary strategy, Medicare Part D preferred tier planning, patient assistance programs, and access initiative design. These findings reinforce the important role PAs and NPs play in helping patients navigate coverage requirements, affordability challenges, and access barriers across a wide range of care settings.
These data provide important context for understanding the patient populations PAs and NPs serve and the access realities that can influence treatment journeys. Better understanding those realities can help inform education, support resources, and engagement strategies.
