PayerIQ
Production
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Tier 2NVBCBS

Blue Cross Blue Shield of Kansas

Active pursuit — access summits + value dossier

Composite
60.5
Rank
#122
Members
8.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
93
+18.6
Geography
20%
66
+13.2
Restrictions
15%
19
+2.9
Relationship
10%
46
+4.6
Financials
10%
58
+5.8
Composite Score60.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 18.6 + 13.2 + 2.9 + 4.6 + 5.8 = 60.5
Intelligence

Qualitative intelligence

Members
8.3M
Drug spend
$3.2B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
31 days
Strategic notes

Patient advocacy partnerships in market; leverage for formulary narrative

Peer set

Closest peers in BCBS

Regence BlueCross BlueShield Oregon HMO
GA · Tier 2
60.0
-0.5
Blue Cross Blue Shield Nebraska HMO
ME · Tier 2
61.1
+0.6
Horizon Blue Cross Blue Shield NJ
OR · Tier 2
59.8
-0.8
Blue Shield of California
HI · Tier 2
59.8
-0.8
Blue Cross Blue Shield Wyoming
NJ · Tier 2
61.5
+0.9
Playbook · Tier 2

Engagement timeline

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