PayerIQ
Production
Back to universe
Tier 3NMMedicaid

New Mexico Medicaid Health Plan

Monitor & nurture — quarterly touchpoints + data sharing

Composite
55.9
Rank
#180
Members
11.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
61
+15.3
Lives
20%
86
+17.2
Geography
20%
25
+5.0
Restrictions
15%
73
+10.9
Relationship
10%
26
+2.6
Financials
10%
49
+4.9
Composite Score55.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.3 + 17.2 + 5.0 + 10.9 + 2.6 + 4.9 = 55.9
Intelligence

Qualitative intelligence

Members
11.7M
Drug spend
$2.5B
Formulary
2-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
84 days
Strategic notes

Medicare Part D plan with stable formulary; step edit removal is key ask

Peer set

Closest peers in Medicaid

Community Care Alliance Vermont Health Plan
VT · Tier 3
55.8
-0.1
Meridian Health Plan of Louisiana
LA · Tier 3
56.0
+0.1
Medicaid Managed Care Hawaii
HI · Tier 3
56.4
+0.5
Molina Medicaid Iowa
IA · Tier 3
56.5
+0.6
Cenpatico California
CA · Tier 3
57.5
+1.6
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report