Lives data updates and trends
Trusted insights with Managed Market Surveyor (MMS) & Pharmacy Benefit Evaluator
Build your market access strategy using accurate U.S. managed care enrollment data
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Pharmacy Benefit Evaluator (PBE)
& Managed Market Surveyor (MMS)
The dynamic and rapidly changing U.S. payer landscape makes it crucial for pharma, biotech, and med tech companies to have the most up-to-date and accurate enrollment and pharmacy benefit data. Our trusted and rigorously validated enrolled lives and pharmacy benefit management data delivers a comprehensive dataset curated through a survey conducted twice a year of payers and government agencies by our expert analyst team.
Key highlights from the latest July 2025 data release:
HIX:
Health Insurance Exchange enrollment decreased by 1% as of July 2025 over the previous six months, with much of the attrition due to unpaid premiums resulting in loss of healthcare coverage. Aetna also announced earlier this year its plan to leave the exchange marketplace in 2026, which has caused enrollment declines in multiple states, while Cigna is reporting a decrease in exchange enrollment due to taking a more conservative approach to the marketplace that the company will continue into 2026.
Commercial:
Enrollment in the commercial sector has decreased slightly, including for large national carriers Kaiser and Cigna. Several payers are also winding down business and reducing their market presence due to factors like financial losses, rising costs, and strategic shifts in other lines of business. Fully Insured enrollment decreased slightly, while self-insured enrollment increased slightly.
Medicaid:
Enrollment decreased by nearly 2% or 1.4 million lives as of July 2025 over the previous six months, bringing total Medicaid enrollment to 83.5 million nationally. This decrease reflects states continuing to unwind continuous enrollment provisions implemented during the COVID-19 pandemic for Medicaid. Most states have completed their eligibility redetermination process, and all states must complete the process by end of 2025.
Medicare:
Medicare Advantage enrollment increased by more than 1% over the first half of 2025, continuing a multi-year trend of the Medicare population shifting away from traditional fee-for-service coverage to managed care plans.
Each data purchase comes with the support and insights of our subject matter experts
- Our analyst team goes above and beyond to identify key trends and insights from the latest data. With a deep understanding of the market, they provide analysis with insights you can rely on.
- We want you to get the most out of your purchase. That’s why we provide complimentary training sessions to help you understand the data and its applications. Our subject matter experts will be available to guide you through the insights and help you make informed decisions.
How our enrollment and PBM data informs customer strategies and decision making
- Inform your payer contracting strategy. With accurate and up-to-date information on payer market share, you can make strategic decisions to optimize your market access.
- Stay ahead of the competition. Analyze the shifts and trends in enrollment to identify opportunities and grow the accessibility of your therapies or maintain your market position.
- Navigate benefit design using influence. Understand the influencers of benefit design for key accounts and markets and navigate benefit design strategies more effectively.
Don’t miss out on the opportunity to equip yourself with essential enrollment data and insights. Complete the form to start leveraging the power of MMS Enrolled Lives data and trends reports to drive your market access strategy forward. Also consider purchasing Pharmacy Benefit Evaluator (PBE), which complements MMS and provides pharmacy benefit manager to health plan affiliations data with details on relationship and contract design showing control of formulary decision making and access.
The MMS Enrolled Lives data release occurs twice each year—July data point is released in December followed by the January data point released in June. Stay tuned for future updates.
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