PayerIQ
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Tier 2DEMedicaid

Medicaid Managed Care Delaware

Active pursuit — access summits + value dossier

Composite
58.9
Rank
#143
Members
8.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
69
+17.3
Lives
20%
53
+10.6
Geography
20%
82
+16.4
Restrictions
15%
33
+5.0
Relationship
10%
56
+5.6
Financials
10%
41
+4.1
Composite Score58.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.3 + 10.6 + 16.4 + 5.0 + 5.6 + 4.1 = 58.9
Intelligence

Qualitative intelligence

Members
8.9M
Drug spend
$1.9B
Formulary
6-tier
PA / RA level
Low
Biosimilar policy
Case-by-case review
Avg reimbursement
35 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Medicaid

WellCare of Alaska
AK · Tier 2
59.0
+0.1
Meridian Health Plan of Kentucky
KY · Tier 3
58.0
-0.9
Cenpatico California
CA · Tier 3
57.5
-1.4
Medicaid Managed Care New Jersey
NJ · Tier 2
60.8
+1.9
Idaho Department of Medicaid
ID · Tier 2
60.9
+2.0
Playbook · Tier 2

Engagement timeline

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