PayerIQ
Production
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Tier 2CTBCBS

Anthem Blue Cross Blue Shield of Maine MCO

Active pursuit — access summits + value dossier

Composite
61.6
Rank
#110
Members
5.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
84
+21.0
Lives
20%
59
+11.8
Geography
20%
51
+10.2
Restrictions
15%
17
+2.5
Relationship
10%
90
+9.0
Financials
10%
71
+7.1
Composite Score61.6
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 21.0 + 11.8 + 10.2 + 2.5 + 9.0 + 7.1 = 61.6
Intelligence

Qualitative intelligence

Members
5.0M
Drug spend
$1.9B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
61 days
Strategic notes

High claims volume but federal formulary restrictions require CMS waiver pathway

Peer set

Closest peers in BCBS

Blue Cross Blue Shield Wyoming
NJ · Tier 2
61.5
-0.2
Blue Cross Blue Shield Nebraska HMO
ME · Tier 2
61.1
-0.5
Blue Cross Blue Shield Montana
VA · Tier 2
62.4
+0.7
Blue Cross Blue Shield of Kansas
NV · Tier 2
60.5
-1.1
Blue Cross Blue Shield of Georgia
NH · Tier 2
62.9
+1.3
Playbook · Tier 2

Engagement timeline

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