PayerIQ
Sun, May 24, 2026
Live model
Scoring configurator
Adjust the six scoring weights — all 250 composite scores and rankings recalculate instantly.
Weights
Total · 100.0%
Claimsdefault 25%
25%Direct proxy for drug spend & formulary influence — calibrated to 2024 actuals
Livesdefault 20%
20%Coverage breadth — calibrated to 2024 CMS enrollment data
Geographydefault 20%
20%Regional footprint vs. product launch territory
Restrictionsdefault 15%
15%PA requirements / step therapy (RA) edits, quantity limits, exclusion status
Relationshipdefault 10%
10%Measures the depth, history and receptivity of manufacturer engagement and account management relationship with the payer
Financialsdefault 10%
10%Rebate structure, patient support programs and outcome-based payment arrangements that modern market access contracts often require
Tier shift
Default model vs. live weights
Tier 1
23
25
+2
Tier 2
132
125
-7
Tier 3
75
80
+5
Tier 4
20
20
0
Before / after
Largest rank changes
| Payer | Type | Old rank | New rank | Δ | New score |
|---|---|---|---|---|---|
| Blue Cross Blue Shield Association LA | National | #153 | #155 | 2 | 58.2 |
| Optum Rx IL | National | #13 | #12 | 1 | 76.1 |
| Rightway Healthcare HI | PBM | #12 | #13 | 1 | 76.1 |
| Magellan Rx Management AZ | PBM | #18 | #17 | 1 | 75.0 |
| Sharp Health Plan ND | Commercial | #17 | #18 | 1 | 74.9 |
| Blue Cross Blue Shield of Rhode Island Health Plan TN | BCBS | #52 | #51 | 1 | 67.7 |
| Scott and White Health Plan of West Virginia WV | Regional | #51 | #52 | 1 | 67.6 |
| AllianceRx Walgreens Prime TX | PBM | #94 | #93 | 1 | 63.0 |
| Arkansas Blue Cross OK | Commercial | #93 | #94 | 1 | 62.9 |
| Johns Hopkins Health Plans of Oregon OR | Regional | #117 | #116 | 1 | 61.1 |
Top 10 under live weights
Live priority list
#1
Blue Cross Blue Shield Wyoming Insurance
BCBS · UT
83.6
· 0
#2
Rocky Mountain Health Plans Insurance
Commercial · VT
82.3
· 0
#3
Denver Health Medical Plan of Minnesota
Regional · MN
79.1
· 0
#4
Blue Cross Blue Shield of Oklahoma
BCBS · ME
77.9
· 0
#5
Anthem Blue Cross Blue Shield Nevada
BCBS · WA
77.8
· 0
#6
CareFirst of Massachusetts
Regional · MA
77.1
· 0
#7
HealthMarket
National · VT
77.0
· 0
#8
Blue Cross Blue Shield Wyoming HMO
BCBS · SD
77.0
· 0
#9
Community Care Alliance Vermont
Medicaid · VT
76.9
· 0
#10
Rocky Mountain Health Plans
Commercial · IL
76.9
· 0