PayerIQ
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Tier 2VTNational

Highmark Health Insurance

Active pursuit — access summits + value dossier

Composite
64.0
Rank
#83
Members
37.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
60
+15.0
Lives
20%
80
+16.0
Geography
20%
44
+8.8
Restrictions
15%
47
+7.0
Relationship
10%
95
+9.5
Financials
10%
77
+7.7
Composite Score64.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.0 + 16.0 + 8.8 + 7.0 + 9.5 + 7.7 = 64.0
Intelligence

Qualitative intelligence

Members
37.3M
Drug spend
$13.9B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
84 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in National

CareFirst
OR · Tier 2
65.3
+1.3
Mountain Health
DE · Tier 2
65.4
+1.4
Capital BlueCross
GA · Tier 2
65.7
+1.6
Harvard Pilgrim
NH · Tier 2
65.8
+1.8
Independence Blue Cross Managed Care
NE · Tier 2
62.1
-1.9
Playbook · Tier 2

Engagement timeline

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