PayerIQ
Production
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Tier 4INNational

Kaiser Permanente

Deprioritize — minimal contact + revisit annually

Composite
44.3
Rank
#238
Members
21.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
55
+13.8
Lives
20%
48
+9.6
Geography
20%
28
+5.6
Restrictions
15%
15
+2.3
Relationship
10%
75
+7.5
Financials
10%
56
+5.6
Composite Score44.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 13.8 + 9.6 + 5.6 + 2.3 + 7.5 + 5.6 = 44.3
Intelligence

Qualitative intelligence

Members
21.3M
Drug spend
$7.8B
Formulary
3-tier
PA / RA level
Low
Biosimilar policy
Mandatory substitution
Avg reimbursement
76 days
Strategic notes

PBM-managed rebate structure; volume-based rebate negotiation is primary lever

Peer set

Closest peers in National

Northeast Health
HI · Tier 3
50.4
+6.1
HealthSpring
AR · Tier 3
54.0
+9.8
AmeriHealth
UT · Tier 3
54.1
+9.8
Independence Blue Cross
KS · Tier 3
54.3
+10.0
Centene Corporation
GA · Tier 3
56.8
+12.5
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier