Troy M. Filipek

Troy’s areas of expertise include pharmacy, managed care, and Medicare Advantage. He supports clients with pricing, reserving, and other analysis for medical and pharmacy benefit plans, both in the Commercial and Medicare markets.

In the pharmacy space, Troy works extensively with pharmacy benefit managers, pharmaceutical companies, payers, retail pharmacies, and pharmacy trade groups / industry organizations with particular emphasis on Medicare Part D.

Specific to the Medicare market, Troy has vast experience with carriers and employers. Troy assists Medicare Advantage plans, Part D plans, and employers with strategic planning, Medicare bid preparation, benefit design evaluation, contract negotiations, and various other analyses. He has been a key contributor to Milliman’s Part D research efforts since the benefit was passed by Congress in 2003, and later adjusted through the Affordable Care Act and Inflation Reduction Act.

More generally, Troy has experience at all levels for managed care plans and other healthcare organizations. He reviews underwriting and rating processes, assists with regulatory filings, develops pricing and reserving models, analyzes historical experience, and provides expert witness testimony related to, among other things, insurance company premium rates and provider reimbursement levels. He also works on mergers and acquisitions and provides strategic consulting on a host of other items.

Troy has published numerous articles for the Society of Actuaries, Milliman, and other publications. He regularly presents on various healthcare subjects at industry conferences and actuarial meetings. He is also a co-author of a chapter in several editions of 'Essentials of Managed Care' titled "Underwriting and Rating."

Troy has been a member of several American Academy of Actuaries and other professional society workgroups, most recently serving on the Academy’s Medicare Steering Committee. Troy also served on Milliman’s Health Steering Committee that sets priorities for the Health Practice and manages budgets across the firm.