PayerIQ
Sun, May 24, 2026
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Tier 2MDFederal
Medicare Part D National Program
Active pursuit — access summits + value dossier
Composite
59.8
Rank
#131
Members
26.9M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
84
+21.0
Lives
20%
84
+16.8
Geography
20%
10
+2.0
Restrictions
15%
10
+1.5
Relationship
10%
85
+8.5
Financials
10%
100
+10.0
Composite Score59.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 21.0 + 16.8 + 2.0 + 1.5 + 8.5 + 10.0 = 59.8
Intelligence
Qualitative intelligence
Members
26.9M
Drug spend
$8.1B
Formulary
4-tier
PA / RA level
None
Biosimilar policy
Mandatory substitution
Avg reimbursement
23 days
Strategic notes
Large covered lives base; formulary team open to outcomes-based contracts
Peer set
Closest peers in Federal
Centers for Medicare & Medicaid Services (CMS) Health Plan
DC · Tier 2
59.8
-0.0
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
-1.0
TRICARE (Defense Health Agency)
DC · Tier 2
58.3
-1.5
Centers for Medicare & Medicaid Services (CMS) Insurance
MD · Tier 2
58.2
-1.6
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
+1.9
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review