PayerIQ
Production
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Tier 2LANational

Blue Cross Blue Shield Association

Active pursuit — access summits + value dossier

Composite
58.2
Rank
#153
Members
31.7M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
72
+14.4
Geography
20%
32
+6.4
Restrictions
15%
34
+5.1
Relationship
10%
38
+3.8
Financials
10%
35
+3.5
Composite Score58.2
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 14.4 + 6.4 + 5.1 + 3.8 + 3.5 = 58.2
Intelligence

Qualitative intelligence

Members
31.7M
Drug spend
$11.6B
Formulary
4-tier
PA / RA level
Very High
Biosimilar policy
Mandatory substitution
Avg reimbursement
51 days
Strategic notes

Active Medicaid contract renewal cycle; incumbent advantage can be leveraged

Peer set

Closest peers in National

Regence BlueCross BlueShield
MN · Tier 3
57.5
-0.8
Kaiser Permanente Insurance
MT · Tier 3
57.1
-1.1
Centene Corporation
GA · Tier 3
56.8
-1.4
CVS Caremark
MO · Tier 2
60.5
+2.3
Humana Insurance
NC · Tier 2
61.1
+2.9
Playbook · Tier 2

Engagement timeline

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