PayerIQ
Production
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Tier 2CONational

WellCare Health Plans

Active pursuit — access summits + value dossier

Composite
61.8
Rank
#107
Members
40.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
42
+10.5
Lives
20%
99
+19.8
Geography
20%
74
+14.8
Restrictions
15%
29
+4.3
Relationship
10%
41
+4.1
Financials
10%
82
+8.2
Composite Score61.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.5 + 19.8 + 14.8 + 4.3 + 4.1 + 8.2 = 61.8
Intelligence

Qualitative intelligence

Members
40.6M
Drug spend
$13.8B
Formulary
3-tier
PA / RA level
High
Biosimilar policy
Preferred substitution
Avg reimbursement
81 days
Strategic notes

Recent merger with regional system creates expanded formulary committee access

Peer set

Closest peers in National

Humana
TN · Tier 2
61.9
+0.1
Dean Health Plan
CA · Tier 2
61.6
-0.1
MetroPlus Health Plan
KY · Tier 2
62.0
+0.3
Independence Blue Cross Managed Care
NE · Tier 2
62.1
+0.4
Humana Insurance
NC · Tier 2
61.1
-0.6
Playbook · Tier 2

Engagement timeline

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