PayerIQ
Production
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Tier 2GABCBS

Blue Cross Blue Shield of Massachusetts Insurance

Active pursuit — access summits + value dossier

Composite
68.0
Rank
#49
Members
8.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
69
+17.3
Lives
20%
100
+20.0
Geography
20%
73
+14.6
Restrictions
15%
42
+6.3
Relationship
10%
42
+4.2
Financials
10%
56
+5.6
Composite Score68.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.3 + 20.0 + 14.6 + 6.3 + 4.2 + 5.6 = 68.0
Intelligence

Qualitative intelligence

Members
8.2M
Drug spend
$2.1B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Preferred substitution
Avg reimbursement
37 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in BCBS

Florida Blue
ME · Tier 2
68.1
+0.1
Anthem Blue Cross Blue Shield of Colorado
AK · Tier 2
67.8
-0.2
Blue Cross Blue Shield of Rhode Island Health Plan
TN · Tier 2
67.7
-0.3
Hawaii Medical Service Association
SC · Tier 2
67.5
-0.4
CareFirst BlueCross BlueShield Managed Care
MA · Tier 2
68.7
+0.8
Playbook · Tier 2

Engagement timeline

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