This session starts with a general review of the value of the actuarial principles that undergird our profession and our obligation to the public. We help ensure integrity, sustainability and fairness of health insurance, Medicare and Medicaid; this promotes accountability and informed decision-making, thereby serving the public interest. In particular, actuaries must anticipate how people may change their behavior when they have choice about coverage and care.
We touch on the role of the actuarial profession in relation to social insurance programs like Medicaid and Medicare, which requires us to consider many stakeholders (program beneficiaries, pharmaceutical companies, healthcare providers, federal and state taxpayers, and federal and state policymakers and regulators).
We consider changes to Medicare Part D in the 2022 Inflation Reduction Act (IRA) and their effects on stakeholder behavior and Rx spending
· Changes to benefit structure and how they impact manufacturers, plans, and beneficiaries
· Key changes to cost sharing for non-low income beneficiaries
· Emerging specialty Rx spending trends
· Future changes to the prospective risk score model
Discussion of the role of actuaries and actuarial principles in monitoring and adjustment of policy changes that result in unexpectedly large effects.
(Learning Objectives) Participants will be able to:
Articulate the key role played by actuarial principles in our ability to fulfill our professional obligation to the public regarding health insurance and social insurance programs related to health care
Discuss actuarial principles relevant to Pharmacy program design and their role in mitigating unintended consequences
Articulate (at a high level) effects of the Inflation Reduction Act on Medicare specialty Rx spending and its impact on the sustainability of the SMI trust fund