PayerIQ
Sun, May 24, 2026
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Tier 2MDFederal
Centers for Medicare & Medicaid Services (CMS) Insurance
Active pursuit — access summits + value dossier
Composite
58.2
Rank
#154
Members
22.6M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
73
+18.3
Lives
20%
70
+14.0
Geography
20%
36
+7.2
Restrictions
15%
43
+6.5
Relationship
10%
70
+7.0
Financials
10%
53
+5.3
Composite Score58.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.3 + 14.0 + 7.2 + 6.5 + 7.0 + 5.3 = 58.2
Intelligence
Qualitative intelligence
Members
22.6M
Drug spend
$4.1B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Mandatory substitution
Avg reimbursement
31 days
Strategic notes
Competitive payer landscape in state; differentiation via HEOR data essential
Peer set
Closest peers in Federal
TRICARE (Defense Health Agency)
DC · Tier 2
58.3
+0.0
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
+0.5
Centers for Medicare & Medicaid Services (CMS) Health Plan
DC · Tier 2
59.8
+1.5
Medicare Part D National Program
MD · Tier 2
59.8
+1.6
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
+3.4
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review