PayerIQ
Production
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Tier 2MERegional

Gateway Health Plan of Maine

Active pursuit — access summits + value dossier

Composite
60.4
Rank
#127
Members
4.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
63
+15.8
Lives
20%
78
+15.6
Geography
20%
31
+6.2
Restrictions
15%
71
+10.7
Relationship
10%
73
+7.3
Financials
10%
49
+4.9
Composite Score60.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.8 + 15.6 + 6.2 + 10.7 + 7.3 + 4.9 = 60.4
Intelligence

Qualitative intelligence

Members
4.0M
Drug spend
$1.1B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
79 days
Strategic notes

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

Peer set

Closest peers in Regional

Florida Blue of South Dakota
SD · Tier 2
60.5
+0.1
SCAN Health Plan of South Carolina
SC · Tier 2
60.3
-0.1
Martin's Point Health Care of Oklahoma
OK · Tier 2
60.5
+0.1
Hennepin Health of Colorado
CO · Tier 2
60.8
+0.4
EmblemHealth of Connecticut
CT · Tier 2
60.0
-0.4
Playbook · Tier 2

Engagement timeline

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