PayerIQ
Production
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Tier 2VABCBS

Blue Cross Blue Shield Montana

Active pursuit — access summits + value dossier

Composite
62.4
Rank
#100
Members
5.2M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
62
+15.5
Lives
20%
53
+10.6
Geography
20%
83
+16.6
Restrictions
15%
33
+5.0
Relationship
10%
98
+9.8
Financials
10%
49
+4.9
Composite Score62.4
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 15.5 + 10.6 + 16.6 + 5.0 + 9.8 + 4.9 = 62.4
Intelligence

Qualitative intelligence

Members
5.2M
Drug spend
$1.5B
Formulary
2-tier
PA / RA level
High
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
57 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in BCBS

Blue Cross Blue Shield of Georgia
NH · Tier 2
62.9
+0.5
Anthem Blue Cross Blue Shield of Maine MCO
CT · Tier 2
61.6
-0.7
Blue Cross Blue Shield Wyoming
NJ · Tier 2
61.5
-0.9
Blue Cross Blue Shield of Louisiana
VT · Tier 2
63.4
+1.0
Blue Cross Blue Shield Nebraska HMO
ME · Tier 2
61.1
-1.2
Playbook · Tier 2

Engagement timeline

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