PayerIQ
Production
Back to universe
Tier 2NJMedicaid

Medicaid Managed Care New Jersey

Active pursuit — access summits + value dossier

Composite
60.8
Rank
#119
Members
9.9M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
41
+10.3
Lives
20%
68
+13.6
Geography
20%
70
+14.0
Restrictions
15%
61
+9.2
Relationship
10%
62
+6.2
Financials
10%
76
+7.6
Composite Score60.8
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 10.3 + 13.6 + 14.0 + 9.2 + 6.2 + 7.6 = 60.8
Intelligence

Qualitative intelligence

Members
9.9M
Drug spend
$1.9B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Preferred substitution
Avg reimbursement
82 days
Strategic notes

BCBS plan with regional flexibility; negotiation via BlueCard network possible

Peer set

Closest peers in Medicaid

Idaho Department of Medicaid
ID · Tier 2
60.9
+0.1
WellCare of Alaska
AK · Tier 2
59.0
-1.8
Medicaid Managed Care Delaware
DE · Tier 2
58.9
-1.9
Meridian Health Plan of Kentucky
KY · Tier 3
58.0
-2.8
Centene Medicaid Wyoming
WY · Tier 2
63.8
+3.0
Playbook · Tier 2

Engagement timeline

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