PayerIQ
Production
Back to universe
Tier 2HIBCBS

Blue Shield of California

Active pursuit — access summits + value dossier

Composite
59.8
Rank
#134
Members
6.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
79
+19.8
Lives
20%
64
+12.8
Geography
20%
74
+14.8
Restrictions
15%
28
+4.2
Relationship
10%
49
+4.9
Financials
10%
33
+3.3
Composite Score59.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.8 + 12.8 + 14.8 + 4.2 + 4.9 + 3.3 = 59.8
Intelligence

Qualitative intelligence

Members
6.2M
Drug spend
$1.6B
Formulary
2-tier
PA / RA level
Moderate
Biosimilar policy
Preferred substitution
Avg reimbursement
64 days
Strategic notes

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

Peer set

Closest peers in BCBS

Horizon Blue Cross Blue Shield NJ
OR · 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