PayerIQ
Sun, May 24, 2026
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Tier 2PARegional
L.A. Care Health Plan of Pennsylvania
Active pursuit — access summits + value dossier
Composite
68.9
Rank
#41
Members
2.6M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
100
+25.0
Lives
20%
60
+12.0
Geography
20%
60
+12.0
Restrictions
15%
54
+8.1
Relationship
10%
64
+6.4
Financials
10%
54
+5.4
Composite Score68.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 12.0 + 12.0 + 8.1 + 6.4 + 5.4 = 68.9
Intelligence
Qualitative intelligence
Members
2.6M
Drug spend
$1.0B
Formulary
5-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
39 days
Strategic notes
Restrictive formulary; outcomes-based arrangement may unlock Tier 2 placement
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review