PayerIQ
Sun, May 24, 2026
Back to universe
Tier 2DCFederal
Centers for Medicare & Medicaid Services (CMS) Health Plan
Active pursuit — access summits + value dossier
Composite
59.8
Rank
#132
Members
19.4M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
100
+25.0
Lives
20%
58
+11.6
Geography
20%
35
+7.0
Restrictions
15%
13
+1.9
Relationship
10%
78
+7.8
Financials
10%
64
+6.4
Composite Score59.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 11.6 + 7.0 + 1.9 + 7.8 + 6.4 = 59.8
Intelligence
Qualitative intelligence
Members
19.4M
Drug spend
$5.2B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Preferred substitution
Avg reimbursement
27 days
Strategic notes
Patient advocacy partnerships in market; leverage for formulary narrative
Peer set
Closest peers in Federal
Medicare Part D National Program
MD · Tier 2
59.8
+0.0
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
-1.0
TRICARE (Defense Health Agency)
DC · Tier 2
58.3
-1.5
Centers for Medicare & Medicaid Services (CMS) Insurance
MD · Tier 2
58.2
-1.5
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
+1.9
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review