Description: This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance exchanges created by the Patient Protection and Affordable Care Act, and product design considerations in light of vast health illiteracy.

Description: This article is a brief overview of what digital health is, how it is regulated, and who some of the big unicorns are.

Description: This is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: The big event of 2023 is the launch of multiple Humira biosimilars, which began in January with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing the specialty drug marketplace in the United States. The expectation of the full impact of this big event is very hopeful, but there is still uncertainty several months after its beginning. Humira is the highest-selling drug in the world and has been since 2013 (Figure 1)—except for when COVID-19 projects temporarily surpassed it. The world is eagerly awaiting the launch of multiple biosimilar drugs to compete with Humira and hopefully bring more competitive pricing to the benefit of payers and patients everywhere.

Description: Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event. Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event.

Description: Read the October 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities. This is the first digital-only issue of the newsletter.