PayerIQ
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Tier 2HINational

Highmark Health

Active pursuit — access summits + value dossier

Composite
71.3
Rank
#27
Members
27.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
65
+16.3
Lives
20%
58
+11.6
Geography
20%
82
+16.4
Restrictions
15%
64
+9.6
Relationship
10%
98
+9.8
Financials
10%
77
+7.7
Composite Score71.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.3 + 11.6 + 16.4 + 9.6 + 9.8 + 7.7 = 71.3
Intelligence

Qualitative intelligence

Members
27.0M
Drug spend
$7.9B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
83 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in National

Inland Empire Health Plan
DE · Tier 2
66.8
-4.6
Optum Rx
IL · Tier 1
76.1
+4.8
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
-5.3
Harvard Pilgrim
NH · Tier 2
65.8
-5.5
Capital BlueCross
GA · Tier 2
65.7
-5.7
Playbook · Tier 2

Engagement timeline

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