2024 Health Meeting - Session 10C: Navigating Actuarial Challenges in an Ever-changing Pharmacy Landscape 6.26.24 Recording

Pharmacy continues to be one of, if not the, fastest growing services in both public and private health plans. Between new blockbuster drugs and gene therapies coming to the market at a record pace expanded indications for drugs already on the market, and rapid cost inflation across numerous therapeutic categories, plan sponsors are constantly looking for new and innovative ways to keep pharmacy costs under control. To complicate matters further, lawmakers at the state and Federal levels are constantly exploring policy options aimed at controlling pharmacy costs. More often than not, it is also exceedingly difficult to predict which policy options will become law, whether they will have the desired effect, and where there might be conflicting provisions between new state and Federal laws and regulations. All of this uncertainty notwithstanding, actuaries need to provide savings estimates for new initiatives and programmatic changes, establish plan premiums, and recommend appropriate risk mitigation strategies for the products that they support. This session will begin with an overview of the latest legislative and regulatory developments related to pharmacy costs and administration, as well as a discussion of how these developments are expected to impact pharmacy costs in public and private health plans. We will also examine the latest trends in cost control measures being explored by public and private plan sponsors and how lessons learned in each market segment provide useful insight for plan sponsors and policymakers in other segments. Finally, we will discuss what data, information, and other resources are available to actuaries facing these challenges. We will also discuss the value of collaborating with non-actuary subject matter experts when devising strategies and methodologies for solving actuarial problems related to pharmacy services. The panel for this session will include: A Medicaid actuary with 10+ years of experience consulting with state Medicaid programs on capitation rate development and pharmacy issues A commercial actuary with 10+ years of experience consulting for employer plans regarding pharmacy issues A pharmacist who is a former State Pharmacy Director and consults both employer plans and state Medicaid programs We are also looking to include an actuary with Medicare experience to round out our panel >