PayerIQ
Production
Back to universe
Tier 4NYMedicaid

Molina Medicaid New York

Deprioritize — minimal contact + revisit annually

Composite
41.1
Rank
#245
Members
6.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
10
+2.5
Lives
20%
42
+8.4
Geography
20%
42
+8.4
Restrictions
15%
44
+6.6
Relationship
10%
76
+7.6
Financials
10%
76
+7.6
Composite Score41.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 2.5 + 8.4 + 8.4 + 6.6 + 7.6 + 7.6 = 41.1
Intelligence

Qualitative intelligence

Members
6.1M
Drug spend
$0.8B
Formulary
2-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
67 days
Strategic notes

Large dual-eligible population; PA/RA process requires clinical evidence package

Peer set

Closest peers in Medicaid

Centene Medicaid California
CA · Tier 4
40.3
-0.8
Pennsylvania Department of Medicaid
PA · Tier 4
43.4
+2.3
Sunshine State Health Alaska
AK · Tier 4
44.4
+3.3
WellCare of Florida
FL · Tier 4
45.4
+4.3
Molina Medicaid Louisiana
LA · Tier 4
45.7
+4.6
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier