Description: Recently, actuaries have become more involved in formulary decisions due to high and variable pharmacy cost and utilization trends. How can actuaries and pharmaceutical manufacturers work together to better predict the market while covering key drugs? What discussions are currently taking place between manufacturers and payers? Is there value in these discussions that actuaries are missing? This presentation will provide both actuarial and manufacturer perspectives in order to create a mutual understanding that will begin to direct future conversations to benefit both stakeholders.

Description: MACRA not only impact providers, it will impact the entire healthcare market. MACRA published studies and commentary to date have primarily focused on providers, with the majority of the information addressing the impacts to clinicians. However, our investigation indicates MACRA has far reaching impacts to payers as well as providers. MACRA is impacting each geographic market and line of business in a unique way, and health payers will have multiple strategic decisions to consider given the changing market dynamics.

Description: This paper identifies and discusses issues affecting retirees’ abilities to successfully navigate medical insurance choices after their employer retiree medical insurance group benefit plan has been terminated and replaced by an outsourced health reimbursement account (HRA) providing accessibility to a stipend through eligible medical insurance claims submissions.