Michael T. Hunter
PharmD
Principal and Pharmacy Management Consultant
Chicago, IL, US
Michael Hunter is a principal and pharmacy management consultant with the Chicago office of Milliman. He joined the firm in 2014.
Experience
Michael has over 20 years of experience in the pharmaceutical industry, including consulting services to pharmaceutical manufacturers, Medicare Part D plan sponsors, health plans, PBMs, pharmacy purchasing coalitions, drug wholesalers, retail and specialty pharmacies, and state Medicaid agencies. Michael supports his clients with payer-perspective insights regarding formulary access and payer-provider contracting.
Publications and Presentations
- Specialty Pharmacy – Three Perspectives: Medicare, Medicaid, and Commercial. Society of Actuaries Health Meeting. June 2015.
- PBM Contracts: Delve into Innovative Strategies to Improve Your Plan’s Bottom Line. CBI: PBM & Contracting Strategies conference. August 2015.
- Medicare Part D member profitability by pharmacy channel. Milliman Insight. December 2015.
- Understanding Biosimilars and Projecting Cost Savings to Employers. PGE: Biosimilars and Follow-on Biologics conference. March 2016.
- Beyond Hepatitis C: Perspective on current and pipeline therapies that can impact the reinsurance and stop-loss markets. Hanover RE Experience. April 2016.
- The Oncology Pipeline: Who’s paying for it? Asembia Specialty Summit. May 2016.
- The “Rxisk” of adjustments in 2018 ACA risk adjustment. Milliman Insight. August 2017.
- Equipping Employers and Health Plans to Managed Prescription Drug Costs. Pharmacy Benefit Management Institute National Conference. March 2018.
- Commercial payers spend more on hospital outpatient drugs at 340B participating hospitals. Milliman website. March 2018.
- Taking on Medicare Part D risk: Provider perspective. Milliman website. April 2019.
- Estimating the impact of pharmacy costs on total health plan costs. Milliman website. June 2019.
- Analysis of 340B hospitals’ outpatient department acquisition cost and commercial reimbursement for physician-administered brand medicines. Milliman website. December 2019.
Professional Designations
- Member, Academy of Managed Care Pharmacy
Education
- PharmD, Ohio Northern University
Publications
Read their latest work
Article
Analysis of 2020 commercial outpatient drug spend at 340B participating hospitals
13 September 2022 - by Michael T. Hunter, Katherine M. Holcomb, Carol J. Kim
The 340B program allows participating hospitals to obtain certain outpatient medications for reduced costs.
Article
Analysis of 340B hospitals' outpatient department acquisition cost and commercial reimbursement for physician-administered brand medicines
16 December 2019 - by Anna Bunger, Michael T. Hunter, Carol J. Kim
Article
Estimating the impact of pharmacy costs on total health plan costs
03 June 2019 - by Anna Bunger, Katherine M. Holcomb, Michael T. Hunter
Failing to account for rebates overstates the net impact of pharmacy costs to a payer’s total costs.
Article
Taking on Medicare Part D risk: Provider perspective
12 April 2019 - by Michael T. Hunter, Emma Kramer, Simon Moody
This article summarizes the key issues providers need to consider before taking on Part D risk, an increasingly common ask from Medicare Advantage organizations, and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.
Article
Commercial payers spend more on hospital outpatient drugs at 340B participating hospitals
13 March 2018 - by Jason Gomberg, Michael T. Hunter, Carol J. Kim
This report replicates portions of the 2015 U.S. Government Accountability Office 340B report (a comparison of the per Medicare beneficiary hospital pharmacy outpatient drug spending at 340B hospitals and non-340B hospitals) on a commercially insured population to determine if the relationships found in the Medicare population existed in the commercial markets.
Article
The “Rxisk” of adjustments in 2018 ACA risk adjustment
18 August 2017 - by Michael T. Hunter, Michelle (Klein) Robb, Jason J. Petroske, Alan Vandagriff
The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model, and this paper approximates the likely CMS mapping based on the publicly available information to date.
Article
Medicare Part D member profitability by pharmacy channel
24 December 2015 - by Jason Gomberg, Michael T. Hunter
An analysis of 2014 Part D plan profitability to determine if specific pharmacy channels are associated with members that may be more or less profitable for a Medicare Part D carrier.