PayerIQ
Sun, May 24, 2026
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Tier 2NYMedicare Advantage
Clover Health
Active pursuit — access summits + value dossier
Composite
71.0
Rank
#29
Members
3.9M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
94
+23.5
Lives
20%
86
+17.2
Geography
20%
64
+12.8
Restrictions
15%
33
+5.0
Relationship
10%
53
+5.3
Financials
10%
73
+7.3
Composite Score71.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 23.5 + 17.2 + 12.8 + 5.0 + 5.3 + 7.3 = 71.0
Intelligence
Qualitative intelligence
Members
3.9M
Drug spend
$2.0B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
Step therapy required
Avg reimbursement
58 days
Strategic notes
PBM-managed rebate structure; volume-based rebate negotiation is primary lever
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review