PayerIQ
Production
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Tier 2ORNational

CareFirst

Active pursuit — access summits + value dossier

Composite
65.3
Rank
#76
Members
34.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
67
+16.8
Lives
20%
88
+17.6
Geography
20%
61
+12.2
Restrictions
15%
10
+1.5
Relationship
10%
90
+9.0
Financials
10%
83
+8.3
Composite Score65.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.8 + 17.6 + 12.2 + 1.5 + 9.0 + 8.3 = 65.3
Intelligence

Qualitative intelligence

Members
34.5M
Drug spend
$13.7B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
54 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in National

Mountain Health
DE · Tier 2
65.4
+0.1
Capital BlueCross
GA · Tier 2
65.7
+0.3
Harvard Pilgrim
NH · Tier 2
65.8
+0.5
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
+0.7
Highmark Health Insurance
VT · Tier 2
64.0
-1.3
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review