PayerIQ
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Tier 2VTNational

Harvard Pilgrim Health Plan

Active pursuit — access summits + value dossier

Composite
66.0
Rank
#68
Members
18.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
79
+19.8
Lives
20%
39
+7.8
Geography
20%
100
+20.0
Restrictions
15%
18
+2.7
Relationship
10%
77
+7.7
Financials
10%
81
+8.1
Composite Score66.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.8 + 7.8 + 20.0 + 2.7 + 7.7 + 8.1 = 66.0
Intelligence

Qualitative intelligence

Members
18.7M
Drug spend
$6.8B
Formulary
2-tier
PA / RA level
Very High
Biosimilar policy
Preferred substitution
Avg reimbursement
71 days
Strategic notes

Prior collaboration on REMS program; account trust level high

Peer set

Closest peers in National

Harvard Pilgrim
NH · Tier 2
65.8
-0.2
Capital BlueCross
GA · Tier 2
65.7
-0.4
Mountain Health
DE · Tier 2
65.4
-0.6
CareFirst
OR · Tier 2
65.3
-0.7
Inland Empire Health Plan
DE · Tier 2
66.8
+0.7
Playbook · Tier 2

Engagement timeline

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