PayerIQ
Production
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Tier 2ILRegional

FirstChoice of Illinois

Active pursuit — access summits + value dossier

Composite
68.5
Rank
#46
Members
3.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
99
+24.8
Lives
20%
76
+15.2
Geography
20%
53
+10.6
Restrictions
15%
47
+7.0
Relationship
10%
45
+4.5
Financials
10%
64
+6.4
Composite Score68.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 24.8 + 15.2 + 10.6 + 7.0 + 4.5 + 6.4 = 68.5
Intelligence

Qualitative intelligence

Members
3.3M
Drug spend
$1.1B
Formulary
5-tier
PA / RA level
High
Biosimilar policy
Preferred biosimilar policy
Avg reimbursement
49 days
Strategic notes

Restrictive formulary; outcomes-based arrangement may unlock Tier 2 placement

Peer set

Closest peers in Regional

L.A. Care Health Plan of Pennsylvania
PA · Tier 2
68.9
+0.4
Scott and White Health Plan of West Virginia
WV · Tier 2
67.7
-0.8
MedStar Health of Washington DC
DC · Tier 2
67.7
-0.8
UCare of Alaska
AK · Tier 2
67.6
-0.9
Dean Health Plan of Mississippi
MS · Tier 2
69.8
+1.3
Playbook · Tier 2

Engagement timeline

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