PayerIQ
Production
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Tier 2NCRegional

ConnectiCare of North Carolina

Active pursuit — access summits + value dossier

Composite
70.9
Rank
#30
Members
4.3M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
64
+16.0
Lives
20%
90
+18.0
Geography
20%
60
+12.0
Restrictions
15%
60
+9.0
Relationship
10%
71
+7.1
Financials
10%
88
+8.8
Composite Score70.9
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 16.0 + 18.0 + 12.0 + 9.0 + 7.1 + 8.8 = 70.9
Intelligence

Qualitative intelligence

Members
4.3M
Drug spend
$1.4B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
67 days
Strategic notes

Large dual-eligible population; PA/RA process requires clinical evidence package

Peer set

Closest peers in Regional

Dean Health Plan of Mississippi
MS · Tier 2
69.8
-1.1
Providence Health of Connecticut
CT · Tier 1
72.7
+1.8
L.A. Care Health Plan of Pennsylvania
PA · Tier 2
68.9
-2.0
FirstChoice of Illinois
IL · Tier 2
68.5
-2.4
Scott and White Health Plan of West Virginia
WV · Tier 2
67.7
-3.3
Playbook · Tier 2

Engagement timeline

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