Medicare Part D Bids: How Do Actuaries Get to the Answers?

Session Description:

Each year on the first Monday in June, Medicare Part D plan sponsors submit actuarially prepared bids to CMS for the following coverage year. The bid preparation process starts several months in advance of the submission and involves numerous departments, including but not limited to pharmacy, medical, finance, sales, and compliance.

Pharmacists assist actuaries as the bid preparation begins, however, insight into what actuaries do can often be limited. In this session, actuaries will describe what and how they iteratively prepare the bids. The faculty will address key input considerations such as risk adjustment, the mathematical dynamics between inputs, and the key metrics used to guide alignment with business strategy.

Learning Objectives:

At the completion of this activity, participants should be able to:
  • Describe the metrics to determine the success of a Medicare Part D bid.
  • Identify the key actuarial methods for preparing Medicare Part D bids.
  • Discuss key actuarial “math” dynamics between Medicare Part D bid variables.
  • Describe Risk Adjustment essentials and how Risk Adjustment impacts Medicare Part D bids.
  • Name at least three questions pharmacy directors should ask of their actuaries prior to and during preparation of Medicare Part D bids.
  • Identify at least three types of information a managed care pharmacist can provide to actuaries to assist in the preparation of Medicare Part D bids.

Faculty:

Karl J. Gregor, PharmD, MS
Vice President
Optum
Fishers, IN

Sanjit Puri, MD, MBA, ASA, MAAA
Senior Director
Optum
Herndon, VA

Gregory Warren, FSA, MAAA, FCA
Chief Actuary
Optum Advisory Services
Englewood, CO

Schedule of Educational Activity:


This activity consists of an audio recording, pre-test assessment questions (not required to pass or continue), post-test questions (required to pass with a score of 70% or higher) and a specific activity evaluation.

Accreditation:

The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

ACPE UAN:0233-0000-21-011-H04-P • Activity Type: Knowledge-Based
Contact Hours: 1
Release Date: May 26, 2021 •  Expiration Date: December 31, 2022
Activity Fee: $15 for Members and $30 for Non-Members

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP 2021 Virtual.CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor. Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements:

System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating websites. View the minimum technical and system requirements for continuing education online learning activities.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-21-011-H04-P 1 Contact Hour April 14, 2021 - December 31, 2022