PayerIQ
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Tier 2KYNational

MetroPlus Health Plan

Active pursuit — access summits + value dossier

Composite
62.0
Rank
#104
Members
28.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
63
+12.6
Geography
20%
67
+13.4
Restrictions
15%
10
+1.5
Relationship
10%
34
+3.4
Financials
10%
61
+6.1
Composite Score62.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 12.6 + 13.4 + 1.5 + 3.4 + 6.1 = 62.0
Intelligence

Qualitative intelligence

Members
28.5M
Drug spend
$10.5B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
45 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in National

Humana
TN · Tier 2
61.9
-0.1
Independence Blue Cross Managed Care
NE · Tier 2
62.1
+0.1
WellCare Health Plans
CO · Tier 2
61.8
-0.3
Dean Health Plan
CA · Tier 2
61.6
-0.4
Humana Insurance
NC · Tier 2
61.1
-0.9
Playbook · Tier 2

Engagement timeline

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