ヘルスケア業界が進化を続ける中、支払者によるカバレッジ決定に基づいて処方薬や医療機器などのヘルスケア製品への患者アクセスを確保することはますます困難になっています。ライフサイエンス企業は、アクチュアリーと提携することで、ステークホルダーの戦略に関する貴重な知見を得て、自社製品を成功に導く最適なポジショニングが可能となります。

アクチュアリーは、高度な分析手法をリアルワールドの医療データに適用し、ライフサイエンス企業が医療や報酬体系政策の変化による影響を予測し、変化する支払者の優先事項を理解できるようにします。アクチュアリーと協働することで、ライフサイエンス企業はエビデンスベースの戦略を展開し（健康面のアウトカム改善や有効性研究を通じた）商品価値を示し、市場アクセスを強化し、競争上の優位性を獲得することができます。

アクチュアリーとは？

アクチュアリーは、ライフサイエンス企業をはじめとする様々な組織が分析スキルを活用してリスクを軽減し将来の機会を獲得するお手伝いをします。アクチュアリーは、数学、統計学、データサイエンス、経済学などのバックグラウンドを持つことが多く、データ分析を戦略的情報に変換して意思決定を支援するスキルを有しています。

How can actuaries support life sciences companies?

Below are five important ways actuaries support and add value to the success of life sciences companies.

1. Drive insights from healthcare claim data assets

Actuaries excel at transforming vast, complex datasets into actionable insights. Access to broad datasets can be especially valuable for gaining competitive insights, as well as for launching new-to-market products where the experience of similar, existing products in the market can inform strategy. Actuaries frequently partner with clinicians or pharmacists using market-wide claim datasets, combining both the clinical and actuarial perspectives to navigate and get the most out of data analytics.¹ This data-driven approach supports a wide range of strategic initiatives outlined below, from drug development to go-to-market strategy.

2. Assess the impact of new healthcare policies and regulations

The healthcare policy landscape continues to evolve amid new federal and state proposals and regulations, and new policies raise questions for life sciences companies. What impact might new policies have on an organization’s market share and revenue? How might competitors and other supply-chain stakeholders be affected? How might patients be impacted? Actuaries are uniquely skilled at answering these questions and analyzing the financial impacts of regulatory changes. In assessing these impacts, there are often many unknowns, such as how a new policy might be implemented or how the market might react. Actuaries are trained to consider a range of assumptions and scenarios to drive toward actionable strategies.

3. Support market access strategy for new prescription drugs and other life sciences products

As life sciences companies develop and launch new products in the market, effective market access strategies are essential to ensuring their success. Actuaries are deeply involved in the intricacies of the healthcare system, using data analytics to support market access strategies through analyses such as the following:³

• Payer mix: Actuaries perform claims-based analyses to identify patients with disease-specific diagnostic codes (or analogs of related conditions) in the commercial, Medicare, and Medicaid populations. These analyses include examining these patients’ underlying demographics, such as age and gender, and analyzing the overall medical and pharmacy spend, including patient out-of-pocket exposure, within each market.
• Pull-through: Actuaries assist with quantifying actual product uptake and forecasting expected product utilization under various scenarios (e.g., changes in formulary coverage, launch of new generics, expanded indications). Their analyses can also inform provider outreach initiatives and guide re-engagement with payers in cases where a high number of formulary exceptions arise.

These analyses can help life sciences companies demonstrate value to payers and other stakeholders. This value can be essential to successful product launches and reimbursement negotiations.

4. Support treatment effectiveness studies and HEOR

Health economics and outcomes research (HEOR) is key to demonstrating the value of therapies in real-world settings. HEOR focuses both on a treatment’s impact on health outcomes as well as its cost-effectiveness. Actuaries bring statistical rigor and methodological expertise to effectiveness studies, ensuring sound design and robust evaluation of clinical and economic outcomes.⁴ They are also skilled at interpreting existing study literature, which can inform future study designs and provide additional perspectives. Their involvement can strengthen the credibility of product value propositions, supporting regulatory submissions and payer discussions. Given their experience in the insurance industry, actuaries are well-positioned to frame HEOR results in a way that resonates with payers.

5. Leverage payer expertise to better understand health plan strategies

Actuaries are uniquely positioned to bridge the perspectives of key stakeholders (such as payers, providers, pharmacy benefit managers, and pharmacies) with life sciences companies. They support numerous payers with formulary coverage decisions, utilization management practices, and pricing strategies for Medicare Advantage bids and commercial rate filings. Actuarial insights into pricing strategy that are valuable to life sciences companies include, but are not limited to, changes in plan benefit designs and offerings and changes in member premiums that can have a downstream impact on drug utilization. With this expertise, actuaries can help life sciences companies align their strategies and goals with evolving market dynamics.

Conclusion: Why actuaries are vital to life sciences companies

Actuaries are essential partners for life sciences companies, offering expert analysis, data-driven insights, and the development of robust economic models tailored to the organization’s goals and objectives. Their unique skill set and direct experience working with key stakeholders in the healthcare sector provide a comprehensive perspective on the factors that influence a life sciences company’s success. By working closely with actuaries, life sciences companies can monitor and strengthen their financial position, expand market access, and deliver valuable products to patients and other stakeholders.

¹ Data assets. Milliman. Retrieved September 8, 2025, from https://www.milliman.com/en/health/life-sciences/data-assets .

² Naber, J., Pierce, K., & Smith, R. (2025, January 29). Using Milliman's data assets to unlock value for life science companies. Milliman. Retrieved September 9, 2025, from https://www.milliman.com/en/video/using-millimans-data-assets-value-life-science-companies.

³ Market access strategy. Milliman. Retrieved September 9, 2025, from https://www.milliman.com/en/health/life-sciences/market-access-strategy.

⁴ Health economics and outcomes research. Milliman. Retrieved September 9, 2025, from https://www.milliman.com/en/health/life-sciences/health-economics-and-research.