PayerIQ
Production
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Tier 2VARegional

HarmonyCare of Virginia

Active pursuit — access summits + value dossier

Composite
66.2
Rank
#66
Members
3.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
98
+24.5
Lives
20%
67
+13.4
Geography
20%
47
+9.4
Restrictions
15%
31
+4.6
Relationship
10%
69
+6.9
Financials
10%
73
+7.3
Composite Score66.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.5 + 13.4 + 9.4 + 4.6 + 6.9 + 7.3 = 66.2
Intelligence

Qualitative intelligence

Members
3.9M
Drug spend
$1.4B
Formulary
4-tier
PA / RA level
High
Biosimilar policy
No policy defined
Avg reimbursement
84 days
Strategic notes

PBM-managed rebate structure; volume-based rebate negotiation is primary lever

Peer set

Closest peers in Regional

WPS Health Solutions of California
CA · Tier 2
66.2
+0.0
Crystal Run Health Plan of Illinois
IL · Tier 2
66.0
-0.2
MetroPlus Health Plan of Kansas
KS · Tier 2
66.5
+0.3
SelectCare of Utah
UT · Tier 2
67.0
+0.9
HarmonyCare of California
CA · Tier 2
64.8
-1.4
Playbook · Tier 2

Engagement timeline

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