PayerIQ
Production
Back to universe
Tier 2NHNational

Harvard Pilgrim

Active pursuit — access summits + value dossier

Composite
65.8
Rank
#70
Members
38.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
55
+13.8
Lives
20%
99
+19.8
Geography
20%
86
+17.2
Restrictions
15%
38
+5.7
Relationship
10%
34
+3.4
Financials
10%
60
+6.0
Composite Score65.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.8 + 19.8 + 17.2 + 5.7 + 3.4 + 6.0 = 65.8
Intelligence

Qualitative intelligence

Members
38.1M
Drug spend
$12.0B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
91 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in National

Capital BlueCross
GA · Tier 2
65.7
-0.2
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
+0.2
Mountain Health
DE · Tier 2
65.4
-0.4
CareFirst
OR · Tier 2
65.3
-0.5
Inland Empire Health Plan
DE · Tier 2
66.8
+0.9
Playbook · Tier 2

Engagement timeline

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