PayerIQ
Sun, May 24, 2026
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Tier 2DCFederal
TRICARE (Defense Health Agency)
Active pursuit — access summits + value dossier
Composite
58.3
Rank
#152
Members
29.6M
Scoring profile
Six-criterion radar
Breakdown
Weighted score contribution
Claims
25%
48
+12.0
Lives
20%
91
+18.2
Geography
20%
71
+14.2
Restrictions
15%
21
+3.1
Relationship
10%
42
+4.2
Financials
10%
65
+6.5
Composite Score58.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 12.0 + 18.2 + 14.2 + 3.1 + 4.2 + 6.5 = 58.3
Intelligence
Qualitative intelligence
Members
29.6M
Drug spend
$8.5B
Formulary
5-tier
PA / RA level
Low
Biosimilar policy
Mandatory substitution
Avg reimbursement
26 days
Strategic notes
CMS Star Rating above 4.0; quality bonus payments create room for contract flexibility
Peer set
Closest peers in Federal
Centers for Medicare & Medicaid Services (CMS) Insurance
MD · Tier 2
58.2
-0.0
Centers for Medicare & Medicaid Services (CMS)
VA · Tier 2
58.8
+0.5
Centers for Medicare & Medicaid Services (CMS) Health Plan
DC · Tier 2
59.8
+1.5
Medicare Part D National Program
MD · Tier 2
59.8
+1.5
Centers for Medicare & Medicaid Services (CMS) HMO
VA · Tier 2
61.6
+3.4
Playbook · Tier 2
Engagement timeline
Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review