瑞信美股保险行业2018健康保险研讨会回顾15专家讨论该行业的热门话题201810125页

DISCLOSUREAPPENDIXATTHEBACKOFTHISREPORTCONTAINSIMPORTANTDISCLOSURES,ANALYSTCERTIFICATIONS,LEGALENTITYDISCLOSUREANDTHESTATUSOFNON-USANALYSTS.USDisclosure:CreditSuissedoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethattheFirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.1October2018Americas/UnitedStatesEquityResearchManage[e-mail]@[e-mail],[e-mail]2018HealthInsuranceSymposiumRecap–15ExpertsDiscusstheSector’sHotTopicsLastweek,15industryexperts,executives,andconsultantspresentedatour2018HealthInsuranceSymposiuminNewYork.Thesymposiumcoveredavarietyoftopicsandwaswell-attendedbyinvestors.■“DCPolicyUpdate&Mid-TermElectionsPreview”Highlights.OurDCexpertseesDemocratstakingcontroloftheHousebyamodestmarginduringthemidterms.ThissameexpertalsoseesRepublicansslightlyincreasingtheircurrent51/49majorityintheSenate.Ourexpertdoesnotbelievesinglepayeror“MedicareforAll”legislationcouldgarnerenoughsupporttopass,evenifDemocratscontrolbothchambers.Hedoes,however,believeifthereisasplitincontrolofCongress,HouseDemocratscouldpassa“MedicareforAll”billforsymbolicpurposes(thatwouldnotgoforward),muchlikeHouseRepublicansdidwhentheywereinthemajority,butPresidentObamawasintheWhiteHouse.Withrespecttolegislationtolowerdrugcosts,ourexpertthinksDemocrats,whilesupportingsomeproposalsintheHHSblueprint,maynotstrikeadealwiththeAdministrationbeforethe2020presidentialelection.Finally,iftheRepsretainbothchambersinCongress,theyareexpectedtofocusonfurthertaxcuts,deregulation,andagainpursue“ACArepealandreplace.”■Highlightsfromthe“DiscussionwithaLeadingHealthBenefitManager.”In2017,Thelargeemployerhealthbenefitsmanager,whopresentedatourconference,seesitsgrossmedicalcosttrendof7.5%,whichislowerthanwhatwasexpectedheadingintothisyear.For2018,thecompanyexpectsgrossmedicalcosttrendstobearound8%(1Htrendshavecomeinslightlyhigher).For2019,thegrossmedicalcosttrendisexpectedtobebelowwhatitwasin2017orisexpectedtobein2018.Finally,ourpresenterexpectstheiremployer’spharmacytrendtoberoughly12%for2018and10%for2019.HDHPpenetrationisprojectedtoincreaseto60%for2019vs50%in2018.■Highlightsfromthe“AntitrustandM&AEnvironmentforHealthcare”Session.Ourantitrustexpertsbelievethatthecurrentadministration’sviewtowardverticaldealsismorefavorablethantheprioradministration’s.However,horizontaldealsarelikelytocontinuetogetclosescrutiny.Withrespecttostateinvolvementinthereviewprocess,theexpertsagreethatstateAGsandInsDept.Directorshavearolecanslowadownadeal,butseldomultimatelyblockatransactionthatsuccessfullyclearstheDOJ.Stateauthoritiesoftenreviewadealusingthemoresubjectivecriteriaof“publicinterest”andendupseekingremediesinMCOdealsthatmaintaincoverageforunderservedpopulationsormaintainingemploymentlevels.■Highlightsfromthe“Pharmacy/PBMLandscapeUpdate”.Ourexpertsenvisionamoremodestchangeratherthanacompleteeliminationofthe1October2018ManagedCare2PBMrebates.OurexpertsunequivocallyagreedthatdisclosuresfromCVS&ESRX)aroundthepercentageofrebatesbeingpassedontoclientsiscredible.OnthependingMCO-PBMmergers,ourexpertsbelievethatputtingaPBMtogetherwithahealthplancarriermakesstrategicsense(justasincaseofCI-ESRX).Ourexpertswerelessenthusiasticaboutthenear-termstrategicimplicationsoftheCVS/AETmerger.■Highlightsfromthe“MedicareMarketUpdate”.OurexpertexpressedtheviewthatStarratingsarebecomingmorevolatileovertime.Bywayofbackground,Starratingsfor2020areexpectedtobereleasedinthesecondweekofOctober.CMSisaddingafewexistingregulationstoenablemoreflexibilitywithrespecttothebenefitsMAplanscanoffertotheirmembers.Ourexperthighlightedtwoaspectstothisgreaterflexibility:a)CMSallowingabroadersuiteofbenefits;b)CMSenablingplanstospecificallytargetdiseasestates&conditions.Ourexpertalsohighlightedsomeemergingenhanceddrugbenefitflexibility.Forexample,effective2019,MAplansareabletoimplementPartBsteptherapyfornewprescriptions.Additionally,for2019,PartDsponsorscanemployindication-basedutilizationmanagementusingpriorauthorization.For2020,PartDsponsorswillbeabletospecifycoveredindicationsforeachformularydrug,ratherthanhavetocoverallFDA-approvedindications.■Highlightsfromthe“MedicaidMarketUpdate”.For2018,ourexpertsseetotalMedicaidenrollmentbeingdownslightlyY/Yfrom74.8mlnin2017.TheY/Ydeclineistheresultofanimprovingeconomy(lesspeoplequalifyforMedicaid)andthelackofanyMedicaidexpansion.OurexpertsbelievethatMedicaidenrollmenthasnormalizedandisprobablynearaceilingat80-85million(excludinganyexogenouseventslikeaspateofMedicaidexpansions).ManagedcarepenetrationamongMedicaidenrolleesisexpectedtoincreaseto74%in2018and76-77%in2019from73%in2017and59%in2013.2018isalightprocurementyear.RFPactivityistoincreasesignificantlyin2019(mostlyre-procurements).■Highlightsfromthe“BluesPersp