Description: Employers, health plans, stop-loss insurers and reinsurers are all affected by the high cost of treating cancer. In recent years, cutting-edge pharmaceuticals, bone marrow transplants and CAR-T cell therapies have driven very high cost trends for cancer, with more emerging therapies on the horizon. In this session, we will review these new treatments, showcase models that aid in understanding the range of likely financial effects of the current, expanded, and likely-to-be approved indications for cell therapies that will treat certain patients affected by lymphoma, leukemia, and multiple myeloma. This session will explain important considerations for modeling Medicare, Medicaid versus commercial populations, key risk concerns caused by the size of enrollee pools, and important differences between the various therapies that affect modeling. We will also discuss averted cost, health outcomes, pricing levels, and risks caused by provider billing practices.

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

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: Update on Affordable Care Act topics, including Section 1332 waivers, Association Health Plans, silver loading and cost sharing reductions.