PayerIQ
Production
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Tier 1ILNational

Optum Rx

Priority engagement — executive meetings + contract acceleration

Composite
76.1
Rank
#13
Members
39.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
98
+24.5
Lives
20%
96
+19.2
Geography
20%
49
+9.8
Restrictions
15%
50
+7.5
Relationship
10%
59
+5.9
Financials
10%
92
+9.2
Composite Score76.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.5 + 19.2 + 9.8 + 7.5 + 5.9 + 9.2 = 76.1
Intelligence

Qualitative intelligence

Members
39.6M
Drug spend
$16.0B
Formulary
3-tier
PA / RA level
Very High
Biosimilar policy
Step therapy required
Avg reimbursement
33 days
Strategic notes

Formulary restructure Q3 creates new placement window; timing is critical

Peer set

Closest peers in National

HealthMarket
VT · Tier 1
77.0
+1.0
Highmark Health
HI · Tier 2
71.3
-4.8
Inland Empire Health Plan
DE · Tier 2
66.8
-9.3
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
-10.0
Harvard Pilgrim
NH · Tier 2
65.8
-10.3
Playbook · Tier 1

Engagement timeline

Week 1
Executive sponsor outreach · contract review
Week 2
Account team alignment · data sharing MoU
Week 4
Strategic roadmap session
Quarterly
C-suite QBR · joint planning