Industry Insights

As a pharmacist, in the past 20-plus years, I’ve owned my own pharmacy, worked for a PBM (pharmacy benefit manager), served as a consultant to health plans and more. Now, I find myself in the operations department of a Stop Loss carrier. As pharmaceutical costs continue to rise and new drugs debut with million-dollar price-tags, the market is seeing greater catastrophic claims expenses – and I’m working to share my industry knowledge and understanding of pharmaceutical costs and use across the client population.

There’s a bit of a change taking place in company circles. After many years of being at the end of a variety of “nerd” jokes, actuaries are gaining some popularity for what we have to offer. The large claims trend is creating a number of challenges in the business, and our knowledge is vital to efforts that can help to minimize the impact. This, dare I say, has caught the attention of those in all segments of the company because actuaries have what everyone needs to make smart decisions in challenging times – the ability to turn data into action.

Large carriers often offer Stop Loss insurance among their many lines of business; it’s one more product to sell if requested by a customer. Our approach is a little different. Stop Loss is what we do – and our focus is on developing strong relationships as we work to deliver the right solutions for the client at hand. Stop Loss is not a commodity, but an integral part of the financing of our policyholders’ health plans.  

Most people in insurance are familiar with Lloyd’s of London, which started in 1686 in London, England, at Lloyd’s Coffee House, a venue popular with sailors, merchants and ship owners. Lloyd’s originally provided shipping news, but it became an ideal place to obtain marine insurance for ship owners interested in pooling their losses so the impact of losing one ship would be spread across the entire group.

I love solving problems. That’s the best part of my job. Lucky for me, we’re in a thought-provoking industry – one that’s become even more challenging with the growth of high-dollar claims. As a reinsurer, paying those claims is the most important thing we do. The challenge lies in creating the right solution for each client, appropriately pricing business to ensure obligations can be fulfilled and finding ways to help contain claim costs for everyone involved.