PayerIQ
Production
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Tier 2DCFederal

Medicare Advantage National

Active pursuit — access summits + value dossier

Composite
67.2
Rank
#60
Members
23.6M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
67
+16.8
Lives
20%
75
+15.0
Geography
20%
90
+18.0
Restrictions
15%
20
+3.0
Relationship
10%
74
+7.4
Financials
10%
70
+7.0
Composite Score67.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.8 + 15.0 + 18.0 + 3.0 + 7.4 + 7.0 = 67.2
Intelligence

Qualitative intelligence

Members
23.6M
Drug spend
$3.9B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
85 days
Strategic notes

Geographic advantage in target region; growing Medicare Advantage enrollment

Peer set

Closest peers in Federal

Medicaid Federal Match Program
VA · Tier 2
68.3
+1.2
Indian Health Service
MD · Tier 2
68.8
+1.6
Medicare Part D National Program HMO
VA · Tier 2
71.3
+4.1
Medicare Advantage National HMO
DC · Tier 2
62.0
-5.2
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
-5.5
Playbook · Tier 2

Engagement timeline

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