PayerIQ
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Tier 2MEBCBS

Blue Cross Blue Shield Nebraska HMO

Active pursuit — access summits + value dossier

Composite
61.1
Rank
#115
Members
7.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
50
+12.5
Lives
20%
100
+20.0
Geography
20%
56
+11.2
Restrictions
15%
21
+3.1
Relationship
10%
65
+6.5
Financials
10%
78
+7.8
Composite Score61.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.5 + 20.0 + 11.2 + 3.1 + 6.5 + 7.8 = 61.1
Intelligence

Qualitative intelligence

Members
7.7M
Drug spend
$2.4B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
Case-by-case review
Avg reimbursement
65 days
Strategic notes

Medicare Part D plan with stable formulary; step edit removal is key ask

Peer set

Closest peers in BCBS

Blue Cross Blue Shield Wyoming
NJ · Tier 2
61.5
+0.3
Anthem Blue Cross Blue Shield of Maine MCO
CT · Tier 2
61.6
+0.5
Blue Cross Blue Shield of Kansas
NV · Tier 2
60.5
-0.6
Regence BlueCross BlueShield Oregon HMO
GA · Tier 2
60.0
-1.1
Blue Cross Blue Shield Montana
VA · Tier 2
62.4
+1.2
Playbook · Tier 2

Engagement timeline

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