PayerIQ
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Tier 3MDPBM

OptumRx MCO

Monitor & nurture — quarterly touchpoints + data sharing

Composite
56.9
Rank
#166
Members
33.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
66
+16.5
Lives
20%
88
+17.6
Geography
20%
30
+6.0
Restrictions
15%
28
+4.2
Relationship
10%
43
+4.3
Financials
10%
83
+8.3
Composite Score56.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.5 + 17.6 + 6.0 + 4.2 + 4.3 + 8.3 = 56.9
Intelligence

Qualitative intelligence

Members
33.6M
Drug spend
$16.1B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
83 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in PBM

Zinc Health Services HMO
WA · Tier 3
56.9
-0.0
AllianceRx Walgreens Prime Health Plan
HI · Tier 3
56.2
-0.7
Elixir Industries
OR · Tier 3
56.1
-0.8
OptumRx
CT · Tier 2
58.3
+1.4
BioScrip
MN · Tier 2
59.3
+2.4
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report