PayerIQ
Production
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Tier 2MONational

CVS Caremark

Active pursuit — access summits + value dossier

Composite
60.5
Rank
#125
Members
26.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
79
+19.8
Lives
20%
64
+12.8
Geography
20%
64
+12.8
Restrictions
15%
35
+5.3
Relationship
10%
48
+4.8
Financials
10%
51
+5.1
Composite Score60.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 19.8 + 12.8 + 12.8 + 5.3 + 4.8 + 5.1 = 60.5
Intelligence

Qualitative intelligence

Members
26.1M
Drug spend
$9.2B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
53 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in National

Humana Insurance
NC · Tier 2
61.1
+0.6
Dean Health Plan
CA · Tier 2
61.6
+1.1
WellCare Health Plans
CO · Tier 2
61.8
+1.3
Humana
TN · Tier 2
61.9
+1.4
MetroPlus Health Plan
KY · Tier 2
62.0
+1.5
Playbook · Tier 2

Engagement timeline

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