PayerIQ
Production
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Tier 2CTPBM

OptumRx

Active pursuit — access summits + value dossier

Composite
58.3
Rank
#151
Members
27.0M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
61
+15.3
Lives
20%
65
+13.0
Geography
20%
52
+10.4
Restrictions
15%
36
+5.4
Relationship
10%
68
+6.8
Financials
10%
74
+7.4
Composite Score58.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.3 + 13.0 + 10.4 + 5.4 + 6.8 + 7.4 = 58.3
Intelligence

Qualitative intelligence

Members
27.0M
Drug spend
$11.6B
Formulary
2-tier
PA / RA level
High
Biosimilar policy
Step therapy required
Avg reimbursement
29 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in PBM

BioScrip
MN · Tier 2
59.3
+1.0
WellDyneRx
KS · Tier 2
59.4
+1.1
OptumRx MCO
MD · Tier 3
56.9
-1.4
Zinc Health Services HMO
WA · Tier 3
56.9
-1.4
AllianceRx Walgreens Prime Health Plan
HI · Tier 3
56.2
-2.0
Playbook · Tier 2

Engagement timeline

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