PayerIQ
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Tier 3CAMedicaid

Cenpatico California

Monitor & nurture — quarterly touchpoints + data sharing

Composite
57.5
Rank
#161
Members
4.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
72
+18.0
Lives
20%
42
+8.4
Geography
20%
72
+14.4
Restrictions
15%
66
+9.9
Relationship
10%
47
+4.7
Financials
10%
21
+2.1
Composite Score57.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 18.0 + 8.4 + 14.4 + 9.9 + 4.7 + 2.1 = 57.5
Intelligence

Qualitative intelligence

Members
4.9M
Drug spend
$1.1B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
76 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Medicaid

Meridian Health Plan of Kentucky
KY · Tier 3
58.0
+0.5
Molina Medicaid Iowa
IA · Tier 3
56.5
-1.0
Medicaid Managed Care Hawaii
HI · Tier 3
56.4
-1.1
Medicaid Managed Care Delaware
DE · Tier 2
58.9
+1.4
WellCare of Alaska
AK · Tier 2
59.0
+1.5
Playbook · Tier 3

Engagement timeline

Week 2
Account manager check-in
Bi-annually
Formulary monitoring report