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: Stakeholders in a specific state (Minnesota) were interviewed about the potential value -- and obstacles -- of a catastrophic backstop program to handle long term care (LTC) financing needs. The design would entail a payroll deduction which would produce a fund to pay LTC expenses once a deductible period (of 1 to 4 years, depending on income) was reached. This design was believed to encourage enrollees to cover the front end better than done today, whether by private insurance or other means.

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: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits.

Description: PBMs are positioned in the healthcare delivery system as the only entity that is not regulated for profitability. The Commercial Fully Insured Health Insurance Plans are heavily regulated by the State Insurance Commissioner who allows only 2%-3% profit margin. The self-funded Health Plans are regulated by ERISA fiduciary responsibility that prohibits excessive compensation. PBMs are classed as a service provider and are not regulated by either. This allows PBMs to implement large, unreasonable mark ups for profit. PBMs are massive commercial entities, states are trying to sue under antitrust law. PBMs found a sweet spot in the regulation. Large Insurance Carries understood that and either acquired large PBMs or merged with them. It is likely that a combination of measures will be needed to regulate PBMs. The most direct approach would be for Congress to pass a law establishing PBM as a fiduciary under ERISA just like an “investment advisor” providing advice for a fee. Establishing PBM as a fiduciary will help Courts and other Federal Agencies ensure that PBMs do not unfairly retain rebates and inflate the prices of Rx drugs sold to employer health plans, and the US population in general.

Description: Discussion of recent developments in the taxation of noncoordinated benefits such as fixed indemnity, hospital indemnity, and specified disease insurance policies. Developments include a recent Chief Counsel Advice Memorandum and proposed triagency rulemaking that would impact non coordinated benefits.

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: Centers for Medicare & Medicaid Services (CMS) launched the GUIDE model, which represents a significant step forward in improving dementia care nationwide. Those with deep expertise in dementia recognize that family caregivers are the most powerful frontline defense to improve care for people living with dementia. It is thus not surprising that the GUIDE model specifically requires the inclusion of the family caregiver in the care team.

Description: The article describes the sessions that the SIPF section sponsored - Paid Family Leave and Medicare and Medicaid Update. The Paid Family Leave session described what it is and what states it is currently in and how it is being implemented. The Medicare and Medicaid update gave the attendees the most up to date news about what is going on at the Federal level.

Description: Actuary Dave Dillon describes his role volunteering his time as a teacher in higher education, including the rewards and challenges that teaching offers. He discusses the importance of being attentive to his audience’s pre-existing knowledge and adapting his presentations accordingly. His work as a teacher typically encompasses three distinct domains: 1) acquainting young students with the actuarial profession, 2) educating non-actuaries about public policy issues related to health insurance (including the Affordable Care Act), and 3) instructing current actuaries on advanced methodologies and principles within the field. Recently he taught a health insurance course for actuarial science graduate students at Georgia State University and lectured at Boise State University’s master's program in Population & Health Systems Management. In every teaching and mentoring opportunity, actuaries can contribute to the expansion and prosperity of the profession and are encouraged to pursue these endeavors.