Description: The document is a research call for proposals seeking researchers to produce a report on the uses of synthetic medical claims data for actuaries. It outlines the background, purpose, research objectives, proposal requirements, selection process, and conditions for submission.

Description: There are many ways to actively utilize BE approaches – and implementing these important tools can help insurers in many ways.

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: Session 2A: Navigating Medicaid Single Preferred Drug Lists (PDLs) - A Deep Dive

Description: It's your first full day of productive learning! Start it off right with a delicious breakfast and warm welcome.

Description: Source: This document is a whitepaper sourced from a health insurance industry analysis. It provides a detailed overview of the evolution and strategic importance of voluntary benefits within employer-sponsored health plans in the United States. Intent: The paper aims to inform healthcare stakeholders—particularly employers, insurers, and HR professionals—about the role of voluntary benefits in filling coverage gaps left by major medical plans. It outlines the historical development, market drivers, regulatory context (especially post-ACA), and future trends, with a focus on personalization, digital integration, and financial protection. Value: This resource offers practical insights and strategic guidance for enhancing benefits design and employee engagement.

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: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care

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: Description of the design and purpose of the military health system and Veterans Health Administration's programs. Covers the types of benefits offered and how these programs differ from typical commercial health systems.