PayerIQ
Production
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Tier 2WVMedicaid

Cenpatico West Virginia

Active pursuit — access summits + value dossier

Composite
71.7
Rank
#25
Members
9.4M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
66
+13.2
Geography
20%
83
+16.6
Restrictions
15%
37
+5.5
Relationship
10%
73
+7.3
Financials
10%
40
+4.0
Composite Score71.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 13.2 + 16.6 + 5.5 + 7.3 + 4.0 = 71.7
Intelligence

Qualitative intelligence

Members
9.4M
Drug spend
$1.7B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
No policy defined
Avg reimbursement
63 days
Strategic notes

Competitive payer landscape in state; differentiation via HEOR data essential

Peer set

Closest peers in Medicaid

Community Care Alliance Vermont
VT · Tier 1
76.9
+5.3
WellCare of Alabama
AL · Tier 2
66.1
-5.6
Washington Medicaid Health Plan
WA · Tier 2
64.7
-7.0
Centene Medicaid Wyoming
WY · Tier 2
63.8
-7.9
Idaho Department of Medicaid
ID · Tier 2
60.9
-10.8
Playbook · Tier 2

Engagement timeline

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