Pharmacy risks (and costs) are significant considerations for health actuaries. Pricing, formularies, and rebates may immediately come to mind when managing pharmacy costs, but these are only the starting points. In the increasingly complex pharmacy landscape, additional tools must be utilized to manage this risk effectively. In this session, we will provide an overview of traditional and innovative ways of managing pharmacy costs and risks. We will focus on:
Pricing considerations with traditional benefit, formulary, and rebate management;
Programs to reduce utilization of certain drugs through healthy alternatives;
Pools including public and private reinsurance schemes;
Performance guarantees and pay-for-performance options and considerations, including their best price implications.
Attendees will learn about:
Basic pricing considerations including formulary selections, trend drivers, rebate practices and cost impacts
Alternative treatments to pharmaceuticals, options and trends, including federal government policies
Reinsurance treatment of high-cost therapies, including GCTs, both public and private pooling options
Performance guarantees used in market and their impacts on costs and risks, including outcome based programs and warranties.