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Matthew Hayes

FSA, MAAA
Principal & Consulting Actuary
Tampa, FL, US
Matthew Hayes is a consulting actuary in the Tampa office of Milliman. He joined the firm in 2016.
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Experience

Matthew’s experience includes 15 years in the actuarial field working in both the health and life sectors. Matthew’s expertise lies in all areas of the pharmaceutical space including formulary and rebate analysis, competitive analytics, network analysis, policy research, PBM analysis, benefit design, and Part D pricing. Matthew also has extensive experience in Medicare Advantage pricing, research, experience analysis, and regulatory and compliance review.

Prior to joining Milliman, Matthew spent seven years at a large national insurer, helping to double PDP membership during that time while honing his leadership, management, and technical actuarial skills.

Publications

Read their latest work

Article

Evaluation of Net Cost Guarantee Arrangement calculations: 2021 Review

24 February 2022 - by Alex Cires, Joanna Amend, Matthew Hayes, Sarah Hughes
This report evaluates Abarca Health's 2021 Net Cost Guarantee Arrangement with a health plan.
Article

Is it worth revisiting the Medicare Part D Payment Modernization (PDM) Model?

16 February 2021 - by Adam Feller, Kate Herbig, Kevin Pierce, Matthew Hayes
Is it worth revisiting the Medicare Part D Payment Modernization Model?
Article

November 2020 Medicare drug pricing rules: What do you need to know?

25 November 2020 - by Deana Bell, Matthew Hayes, Michelle (Klein) Robb, Tracy Margiott
The two final rules that were released on November 20 will have sweeping impacts to Medicare Part D and Medicare Part B drug pricing.
Article

Medicare Evaluating the potential out-of-pocket cost impact of the Senior Savings Model on Medicare Part D members who use insulin

01 June 2020 - by Lukas Snyder, David R. Mike, Luke Metz, Matthew Hayes, Derek Cole
This paper explores the impact of the Part D Senior Savings Model on patient out-of-pocket costs.
Article

Reducing insulin costs for seniors: Thoughts for plan sponsors considering participation in the Medicare Part D Senior Savings Model

27 March 2020 - by Samantha D’Anna, Adam Feller, Matthew Hayes, Kate Herbig, Michelle (Klein) Robb
This article provides an overview of the Medicare Part D Senior Savings Model and highlights key considerations for plan sponsors.
Article

A new Part D benefit design? Prescription Drug Pricing Reduction Act proposes major changes to Part D

15 August 2019 - by Joanna Amend, Samantha D’Anna, Dustin Grzeskowiak, Justin Harris, Matthew Hayes
This article provides an overview of the provisions in the Prescription Drug Pricing Reduction Act of 2019 and the effects on Medicare Part D stakeholders.
Article

Impact of offsetting midyear list price and rebate reductions in Medicare Part D

05 April 2019 - by Matthew Hayes, David R. Mike
The structure of the Medicare Part D program produces interesting, and sometimes counterintuitive, financial outcomes when drug list prices are decreased and rebates are eliminated.
Article

What’s in the Part D Payment Modernization Model Request for Application: More questions than answers

08 March 2019 - by Adam Barnhart, Matthew Hayes, Nicholas Johnson, Tracy Margiott
With less than one month to respond, many details unknown, and multiple impending changes to the Part D program, the Part D Payment Modernization Model’s Request for Applications leaves more questions than answers.
Article

An end to manufacturer rebates as we know them today?

15 February 2019 - by Deana Bell, Jennifer Carioto, Matthew Hayes
The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.