PayerIQ
Production
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Tier 2NCNational

Humana Insurance

Active pursuit — access summits + value dossier

Composite
61.1
Rank
#116
Members
30.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
82
+20.5
Lives
20%
62
+12.4
Geography
20%
81
+16.2
Restrictions
15%
14
+2.1
Relationship
10%
39
+3.9
Financials
10%
60
+6.0
Composite Score61.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 20.5 + 12.4 + 16.2 + 2.1 + 3.9 + 6.0 = 61.1
Intelligence

Qualitative intelligence

Members
30.6M
Drug spend
$12.6B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
No policy defined
Avg reimbursement
19 days
Strategic notes

PBM-managed rebate structure; volume-based rebate negotiation is primary lever

Peer set

Closest peers in National

Dean Health Plan
CA · Tier 2
61.6
+0.5
CVS Caremark
MO · Tier 2
60.5
-0.6
WellCare Health Plans
CO · Tier 2
61.8
+0.6
Humana
TN · Tier 2
61.9
+0.8
MetroPlus Health Plan
KY · Tier 2
62.0
+0.9
Playbook · Tier 2

Engagement timeline

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