OPM is seeking to expand some FEHB benefits while again emphasizing cost-reduction steps such as wellness programs, controls over prescription medicine costs, and better coordination with Medicare for enrollees also in that program. The annual “call letter” in which OPM outlines the coverage features it wants for the following year tells carriers: to cover applied behavior analysis for treatment of Autism Spectrum Disorder; to reduce the use of out-of-network services within network hospitals at increased costs; to continue to focus on financial and other incentives for enrollees to participate in wellness programs; and to propose changes for enrollees with both FEHB and Medicare coverage such as reduced cost sharing and improved coordination of pharmacy benefits. It also encourages them to begin or increase access to “telemedicine” virtual visits and to hospice and advance care planning for those critically ill. Carriers will need to have in place strategies to manage high-cost prescription drugs and they were strongly encouraged to exclude drugs “that do not provide additional clinical value, or are less safe than other drugs for the same indication.” However, they also are to assure that those with chronic conditions “will have access to safe, clinically appropriate, and affordable prescription drug choices.” OPM meanwhile encouraged carriers to improve access to drugs used to manage addictions. Several broader changes in the program that the administration raised in its recent budget plan would require legislation; there has been no movement on those ideas since they were first raised several years ago. These include allowing additional plan designs, purchasing of prescription drugs government-wide rather than by individual plan, and allowing plans to charge higher premiums to those who use tobacco or who don’t participate in wellness programs deemed appropriate for them.
|TSP||G Fund||F Fund||C Fund||S Fund||I Fund|