PayerIQ
Production
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Tier 2GANational

Capital BlueCross

Active pursuit — access summits + value dossier

Composite
65.7
Rank
#71
Members
29.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
70
+14.0
Geography
20%
90
+18.0
Restrictions
15%
31
+4.6
Relationship
10%
100
+10.0
Financials
10%
35
+3.5
Composite Score65.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 14.0 + 18.0 + 4.6 + 10.0 + 3.5 = 65.7
Intelligence

Qualitative intelligence

Members
29.1M
Drug spend
$10.2B
Formulary
6-tier
PA / RA level
Moderate
Biosimilar policy
Case-by-case review
Avg reimbursement
86 days
Strategic notes

Competitive payer landscape in state; differentiation via HEOR data essential

Peer set

Closest peers in National

Harvard Pilgrim
NH · Tier 2
65.8
+0.2
Mountain Health
DE · Tier 2
65.4
-0.3
CareFirst
OR · Tier 2
65.3
-0.3
Harvard Pilgrim Health Plan
VT · Tier 2
66.0
+0.4
Inland Empire Health Plan
DE · Tier 2
66.8
+1.1
Playbook · Tier 2

Engagement timeline

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