PayerIQ
Production
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Tier 4TXRegional

Tufts Health Plan of Texas

Deprioritize — minimal contact + revisit annually

Composite
45.1
Rank
#235
Members
2.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
52
+13.0
Lives
20%
37
+7.4
Geography
20%
52
+10.4
Restrictions
15%
47
+7.0
Relationship
10%
52
+5.2
Financials
10%
21
+2.1
Composite Score45.1
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.0 + 7.4 + 10.4 + 7.0 + 5.2 + 2.1 = 45.1
Intelligence

Qualitative intelligence

Members
2.1M
Drug spend
$0.5B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Case-by-case review
Avg reimbursement
83 days
Strategic notes

PBM-managed rebate structure; volume-based rebate negotiation is primary lever

Peer set

Closest peers in Regional

GuildNet of Virginia
VA · Tier 4
45.9
+0.8
Denver Health Medical Plan of Montana
MT · Tier 3
46.0
+0.9
Priority Health of New York
NY · Tier 3
46.3
+1.1
Group Health of Delaware
DE · Tier 3
46.5
+1.3
Physicians Health Plan of Maryland
MD · Tier 4
43.1
-2.0
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier