Health Solutions

Prescription drugs

We help navigate pharmacy benefit challenges

Dramatic advances in prescription drugs have the potential to improve and save lives—but these improvements come at a cost. Milliman can help you address the full spectrum of pharmacy benefit challenges, from pharmacy benefit manager (PBM) selection to plan design to Medicare Part D consulting, our experienced experts and smart technology are here for you.

Overview

Milliman prescription drugs solutions

PBM contracting and management

Get favorable contracts and better pricing by leveraging our expertise and understanding of the pharmacy benefits market. We assist with the entire PBM lifecycle, including RFPs, implementation oversight, ongoing support, and audits.

Pharmacy plan design

Gain flexibility for your organization and your members with an effective pharmacy benefits plan model. Our rich data and powerful analytic tools help identify the best strategy for your goals.

Medicare Part D

Building effective Medicare Part D offerings requires a thorough understanding of your options and the complex regulations involved. From plan design to formulary review, compliance planning to star rating improvement, Milliman has market-leading expertise in all things Medicare and can help you with any challenge.

Insight

Milliman prescription drugs insight

Article

Beyond FDA approval: 5 factors in clinical trial design that influence health insurance coverage decisions

We detail factors in Phase-3 clinical trial design that influence health insurance coverage decisions.

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Report

The impact of medication adherence on total healthcare costs for commercially insured patients

A current perspective for patients with diabetes, hypertension, and hyperlipidemia

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White paper

Emerging Medicare Advantage and Part D trends from 2024 financial statements

Medicare Advantage (MA) and Part D insurers are citing significant financial headwinds in earnings calls and the press. Statutory financial statements provide insights into emerging trends through year-end 2024.

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White paper

Demonstrations and consolidations: A first view of the 2025 PDP market

This article highlights the key changes to premiums and plan offerings in the prescription drug plan (PDP) market.

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Research report

Patterns in psychotropic and other select nervous system prescription utilization

Emerging trends in pharmacy shopping and related overdoses

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Article

Manage pharmacy spending with precision medicine via uplift modeling

This white paper focuses on one approach for improving drug utilization management: precision medicine through a method known as uplift modeling.

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White paper

The evolution of biosimilars in the United States

Biosimilars recently have made significant strides toward greater acceptance and utilization since their first U.S. approval in 2015, although challenges persist.

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White paper

Commercial drug trends: 2024 release

This report provides insights into pharmacy cost and utilization trends based on our analysis of the Milliman Consolidated Health Cost Guidelines Sources Database.

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White paper

The shifting Medicare landscape: Results from 2024 open enrollment

2024 brings significant changes to the Part D program, resulting in larger than average shifts in member enrollment

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White paper

CMS Cell and Gene Therapy Access Model

Exploring the benefits, limitations, and considerations for expansion.

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Milliman prescription drug products

Procurement management

Milliman Payer Network Check

Make high-quality financial comparisons of provider medical reimbursement rates across large insurance carriers.

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Pharmaceutical claims analytics

MyRxConsultant

Compare contracted discount rates and savings with real-time pharmaceutical claims experience reporting.

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Insurance risk assessment

IntelliScript

IntelliScript combines industry-leading data and analysis to provide insurers the knowledge, tools, and insight to confidently assess risk.

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Medicare plan selection solution

Medicare Suggest

Deliver detailed, personalized Medicare plan price comparisons through a simple, web or API experience.

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Cost-saving analysis

Milliman Specialty Pharmacy Insights

Identify opportunities to manage specialty pharmacy costs for existing and new drug therapies.

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Price transparency analytics

Milliman Price Transparency Solutions for Payers and Providers

Demystify payer and provider contract pricing data for better transparency across the industry.

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Healthcare market analysis

Milliman DNA Gene and Cell Therapy Forecasting

Analyze the emerging market to support underwriting, pricing, and product development.

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Prescription drugs