With more sophisticated treatments becoming available on an almost daily basis, health plans are challenged with managing the coverage of emerging therapies while maintaining their pharmacy budget. As a result, pharmacists and actuaries are tasked with working together closely to determine the best combination of coverage to keep pharmacy benefits comprehensive while keeping overall costs low. Given the distinct differences in their educational backgrounds, terminology, culture, methods, and value-drivers, what can be done to enhance the pharmacist-actuary relationship and maximize the accuracy of data provided?
This session will discuss common interactions between pharmacists and actuaries at health plans and reveal best practices to make these interactions as valuable as possible. In addition, the session will highlight the key coverage decisions that are influenced by actuaries, along with the key information that pharmacy teams can provide to support the actuary’s analysis.
Learning Objectives: :
At the completion of this activity, participants should be able to:
Differentiate the culture, language, methods, and value-drivers between actuaries and the pharmacy team.
Identify at least two strategies that can enhance the pharmacist-actuary relationship.
List at least three types of data from the pharmacy team that actuaries can use to make more accurate estimations.
Summarize how actuarial decisions affect management of the pharmacy benefit and associated drug spend.