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.
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.
Professional Designations
- Fellow, Society of Actuaries
- Member, American Academy of Actuaries
Education
- BS, Mathematics, University of Louisville
Affiliations
- Member, Southeastern Actuaries Conference
Publications
Read their latest work
Video
Evolution in PBM market dynamics: How change impacts pharmacy supply chain
30 October 2024 - by Mark F. Gruenhaupt, RPh, Matthew Hayes, Kristin Niakan
Hear how pharmacy benefit manager profits are shifting amid new rebate credits, legislative trends, and PBMs’ expansion into biosimilars distribution.
Video
2025 Medicare Bid Cycle: Life Sciences Insights
31 July 2024 - by Matthew Hayes, Peter Heinen, Ryan Swenson, Maggie Alston
Milliman’s actuarial experts discuss Part D lessons from the latest bid cycle and the impact on life sciences organizations.
Video
Webinar: Medicare Advantage and Part D Trend Discussion
09 March 2022 - by Brent Jensen, Andy McBeth, Jeremy Hamilton, Matthew Hayes
Join us in a discussion of several areas of trend impacting bids in 2023.
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.
Video
Webinar: Succeeding in the Part D PBM RFP and contracting process
06 October 2021 - by Matthew Hayes, Angela Reed, Michelle N. Angeloni
In this webinar, we dive into key elements for success in the Part D PBM process, including valuing the impact to net plan liability, understanding the pros and cons of network and formulary strategies, and understanding how to evaluate the ability for each PBM to offer the operational expertise needed to compliantly and effectively manage Part D benefits.
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.