PayerIQ
Production
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Tier 1MDFederal

CHAMPVA (Civilian Health and Medical Program of VA)

Priority engagement — executive meetings + contract acceleration

Composite
75.5
Rank
#16
Members
21.1M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
74
+14.8
Geography
20%
93
+18.6
Restrictions
15%
32
+4.8
Relationship
10%
42
+4.2
Financials
10%
81
+8.1
Composite Score75.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 14.8 + 18.6 + 4.8 + 4.2 + 8.1 = 75.5
Intelligence

Qualitative intelligence

Members
21.1M
Drug spend
$6.5B
Formulary
3-tier
PA / RA level
Moderate
Biosimilar policy
Step therapy required
Avg reimbursement
39 days
Strategic notes

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

Peer set

Closest peers in Federal

Medicare Part D National Program HMO
VA · Tier 2
71.3
-4.3
Indian Health Service
MD · Tier 2
68.8
-6.8
Medicaid Federal Match Program
VA · Tier 2
68.3
-7.2
Medicare Advantage National
DC · Tier 2
67.2
-8.3
Medicare Advantage National HMO
DC · Tier 2
62.0
-13.5
Playbook · Tier 1

Engagement timeline

Week 1
Executive sponsor outreach · contract review
Week 2
Account team alignment · data sharing MoU
Week 4
Strategic roadmap session
Quarterly
C-suite QBR · joint planning