PayerIQ
Production
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Tier 2IABCBS

Anthem Blue Cross Blue Shield of Maine HMO

Active pursuit — access summits + value dossier

Composite
69.0
Rank
#39
Members
4.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
58
+11.6
Geography
20%
69
+13.8
Restrictions
15%
61
+9.2
Relationship
10%
21
+2.1
Financials
10%
73
+7.3
Composite Score69.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 11.6 + 13.8 + 9.2 + 2.1 + 7.3 = 69.0
Intelligence

Qualitative intelligence

Members
4.8M
Drug spend
$1.7B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
No policy defined
Avg reimbursement
30 days
Strategic notes

Medicare Part D plan with stable formulary; step edit removal is key ask

Peer set

Closest peers in BCBS

CareFirst BlueCross BlueShield Managed Care
MA · Tier 2
68.7
-0.3
Blue Cross Blue Shield of Alabama
ID · Tier 2
69.3
+0.3
Blue Cross Blue Shield of Rhode Island Managed Care
KS · Tier 2
69.6
+0.6
Florida Blue
ME · Tier 2
68.1
-0.9
Blue Cross Blue Shield of Massachusetts Insurance
GA · Tier 2
68.0
-1.0
Playbook · Tier 2

Engagement timeline

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