PayerIQ
Production
Back to universe
Tier 2AZBCBS

Anthem HealthKeepers Virginia

Active pursuit — access summits + value dossier

Composite
58.9
Rank
#144
Members
6.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
70
+17.5
Lives
20%
61
+12.2
Geography
20%
67
+13.4
Restrictions
15%
10
+1.5
Relationship
10%
81
+8.1
Financials
10%
62
+6.2
Composite Score58.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.5 + 12.2 + 13.4 + 1.5 + 8.1 + 6.2 = 58.9
Intelligence

Qualitative intelligence

Members
6.3M
Drug spend
$2.3B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
48 days
Strategic notes

Restrictive formulary; outcomes-based arrangement may unlock Tier 2 placement

Peer set

Closest peers in BCBS

Blue Cross Blue Shield North Dakota
MA · Tier 2
58.5
-0.4
Horizon Blue Cross Blue Shield NJ
OR · Tier 2
59.8
+0.9
Blue Shield of California
HI · Tier 2
59.8
+0.9
Regence BlueCross BlueShield Oregon HMO
GA · Tier 2
60.0
+1.1
CareFirst BlueCross BlueShield
MO · Tier 3
57.6
-1.3
Playbook · Tier 2

Engagement timeline

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