PayerIQ
Production
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Tier 2ORBCBS

Horizon Blue Cross Blue Shield NJ

Active pursuit — access summits + value dossier

Composite
59.8
Rank
#133
Members
6.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
57
+14.3
Lives
20%
76
+15.2
Geography
20%
43
+8.6
Restrictions
15%
58
+8.7
Relationship
10%
60
+6.0
Financials
10%
70
+7.0
Composite Score59.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 14.3 + 15.2 + 8.6 + 8.7 + 6.0 + 7.0 = 59.8
Intelligence

Qualitative intelligence

Members
6.2M
Drug spend
$1.8B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Preferred substitution
Avg reimbursement
44 days
Strategic notes

Executive sponsor identified at VP of Pharmacy level; schedule quarterly touchpoint

Peer set

Closest peers in BCBS

Blue Shield of California
HI · Tier 2
59.8
0.0
Regence BlueCross BlueShield Oregon HMO
GA · Tier 2
60.0
+0.3
Blue Cross Blue Shield of Kansas
NV · Tier 2
60.5
+0.8
Anthem HealthKeepers Virginia
AZ · Tier 2
58.9
-0.9
Blue Cross Blue Shield North Dakota
MA · Tier 2
58.5
-1.2
Playbook · Tier 2

Engagement timeline

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