Description: This paper is a primer for actuaries with limited experience in accessing and using public data sets. From Small Talk Newsletter, November 2005, Issue No. 25.

Description: An overview of key considerations for benefit triggers in critical illness products

Description: The coming wave of biosimilars could have a major impact on prescription drug spend in coming years. The big event of Humira biosimilar launches in 2023 will be significant in determining that ultimate impact. Payers are making coverage decisions. The more biosimilars are utilized, the greater the potential savings. How will biosimilar adoption be maximized?

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including health care reform, Medicare, loss ratios, premium review, reinsurance, benefit and eligibility changes, exchanges, and risk based capital.

Description: The Actuary Vol. 22, No. 6. The author provides commentary regarding an interview with Paul Barnhart reported on in The Actuary March 1988 concerning the controversy over health insurance reserves. Specifically the elements of the “Benefit Ratio Reserve” method were analyzed.

Description: Article discusses causes of high charges in relations to reimbursement arrangements and possible actions of insurers & payers. Issue No. 45.

Description: This is an article that highlights recommended reading by the Health Practice area communications committee. The readings cover a broad subject matter from risk assessment, medical technology to uninsured.

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: This is the complete January 2012 issue of Health Watch.