Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: Established as part of the 1998 Utah State legislative session, the State of Utah's Children's Health Insurance Program CHIP delivers much-needed health insurance to children that are not eligible for Medicaid and who are below certain poverty levels. From Prescription Drugs Monograph, M-HB04-1.

Description: Presented at the Living to 100 Symposium, January 2011. In India, the prevalence of lifestyle diseases such as diabetes and cardiovascular diseases has been increasing tremendously. This spurt of diseases and the resultant morbidity is severely affecting the quality of life of the elderly. The problem is compounded by a medical and health care infrastructure which is inadequate to meet the challenge. This paper analyzes and estimates, using actuarial tools, the effect on the economy with particular focus on the present and future elderly segment of the population, identifies opportunities for insurers to address the situation, and suggests remedial measures to deal with the situation. Medico-actuarial studies in this area will also be covered.

Description: Part one of a two part series explores implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA.

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: Prescribers, payers, and patients must put a higher priority on the comparative cost-effectiveness of competing pharmaceutical products if society is ever going to achieve rational and affordable drug use for all. From Prescription Drugs Monograph, M-HB04-1.

Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

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.