PayerIQ
Production
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Tier 2MABCBS

CareFirst BlueCross BlueShield Managed Care

Active pursuit — access summits + value dossier

Composite
68.7
Rank
#43
Members
5.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
93
+23.3
Lives
20%
64
+12.8
Geography
20%
81
+16.2
Restrictions
15%
63
+9.4
Relationship
10%
44
+4.4
Financials
10%
26
+2.6
Composite Score68.7
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 23.3 + 12.8 + 16.2 + 9.4 + 4.4 + 2.6 = 68.7
Intelligence

Qualitative intelligence

Members
5.5M
Drug spend
$1.5B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Mandatory substitution
Avg reimbursement
79 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in BCBS

Anthem Blue Cross Blue Shield of Maine HMO
IA · Tier 2
69.0
+0.3
Blue Cross Blue Shield of Alabama
ID · Tier 2
69.3
+0.6
Florida Blue
ME · Tier 2
68.1
-0.6
Blue Cross Blue Shield of Massachusetts Insurance
GA · Tier 2
68.0
-0.8
Blue Cross Blue Shield of Rhode Island Managed Care
KS · Tier 2
69.6
+0.9
Playbook · Tier 2

Engagement timeline

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