PayerIQ
Sun, May 24, 2026
Back to universe
Tier 2DCFederal
Medicare Advantage National HMO
Active pursuit — access summits + value dossier
Composite
62.0
Rank
#105
Members
30.5M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
32
+8.0
Lives
20%
83
+16.6
Geography
20%
63
+12.6
Restrictions
15%
63
+9.4
Relationship
10%
85
+8.5
Financials
10%
68
+6.8
Composite Score62.0
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 8.0 + 16.6 + 12.6 + 9.4 + 8.5 + 6.8 = 62.0
Intelligence
Qualitative intelligence
Members
30.5M
Drug spend
$5.0B
Formulary
2-tier
PA / RA level
Moderate
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
86 days
Strategic notes
Data-sharing agreement pending legal review; delay contracting until finalized
Peer set
Closest peers in Federal
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
-0.3
Medicare Part D National Program
MD · Tier 2
59.8
-2.2
Centers for Medicare & Medicaid Services (CMS) Health Plan
DC · Tier 2
59.8
-2.2
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
-3.2
TRICARE (Defense Health Agency)
DC · Tier 2
58.3
-3.7
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review