The asthma treatment landscape is continually evolving, bringing new options to the millions of individuals affected by this chronic condition. As novel treatments, such as new triple-therapy inhalers, prepare to enter the market, payers are faced with critical evaluation challenges.
When assessing new pharmacy therapies, payers must answer two fundamental questions: what formulary position and utilization management criteria are clinically appropriate, and what is the incremental near-term budget impact of those decisions?
Actuarial budget impact models (BIMs) serve as an essential tool in this process. These models allow health plans to compare a “current world” treatment mix to one or more “future world” mixes over a decision-relevant horizon, taking into account alternative formulary and adoption scenarios.
In a recently published article for the Society of Actuaries (SOA) Health Community Newsletter, AHP Consulting Actuary Nathan Stokes explores the mechanics of payer decision-making. The article details how an actuarial BIM can estimate the incremental payer budget impact associated with the introduction of new triple therapies under various formulary placement and adoption scenarios.
By examining different access conditions, from soft launches to active formulary steering, the analysis highlights how tier placement and contracting terms translate gross drug costs into payer net costs.
Discover how actuarial modeling can help health plans optimize formulary decisions, improve patient outcomes, and manage the total cost of care.
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