PayerIQ
Production
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Tier 4PAMedicaid

Pennsylvania Department of Medicaid

Deprioritize — minimal contact + revisit annually

Composite
43.4
Rank
#239
Members
9.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
48
+12.0
Lives
20%
67
+13.4
Geography
20%
28
+5.6
Restrictions
15%
28
+4.2
Relationship
10%
50
+5.0
Financials
10%
32
+3.2
Composite Score43.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.0 + 13.4 + 5.6 + 4.2 + 5.0 + 3.2 = 43.4
Intelligence

Qualitative intelligence

Members
9.1M
Drug spend
$1.2B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
71 days
Strategic notes

Formulary restructure Q3 creates new placement window; timing is critical

Peer set

Closest peers in Medicaid

Sunshine State Health Alaska
AK · Tier 4
44.4
+1.0
WellCare of Florida
FL · Tier 4
45.4
+2.0
Molina Medicaid New York
NY · Tier 4
41.1
-2.3
Molina Medicaid Louisiana
LA · Tier 4
45.7
+2.3
Minnesota Medicaid Health Plan
MN · Tier 3
46.1
+2.7
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier