PayerIQ
Production
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Tier 2VAFederal

Medicare Part D National Program HMO

Active pursuit — access summits + value dossier

Composite
71.3
Rank
#28
Members
34.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
75
+18.8
Lives
20%
100
+20.0
Geography
20%
57
+11.4
Restrictions
15%
30
+4.5
Relationship
10%
97
+9.7
Financials
10%
69
+6.9
Composite Score71.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.8 + 20.0 + 11.4 + 4.5 + 9.7 + 6.9 = 71.3
Intelligence

Qualitative intelligence

Members
34.2M
Drug spend
$8.1B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
83 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in Federal

Indian Health Service
MD · Tier 2
68.8
-2.5
Medicaid Federal Match Program
VA · Tier 2
68.3
-2.9
Medicare Advantage National
DC · Tier 2
67.2
-4.1
CHAMPVA (Civilian Health and Medical Program of VA)
MD · Tier 1
75.5
+4.3
Medicare Advantage National HMO
DC · Tier 2
62.0
-9.3
Playbook · Tier 2

Engagement timeline

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