OPM has issued its annual call letter to FEHB carriers–the start of negotiations over specific coverage terms and premium rates for the succeeding year–continuing and expanding long-running efforts to control prescription drug costs as well as to encourage participation in wellness programs.
“In 2016, 26.2 percent of total FEHB expenditures were on prescription medications. Most FEHB carriers also report an increase in drug costs per member per year,” it said, saying it wants greater emphasis on managing those costs related to chronic conditions. “FEHB carriers cite heart disease, diabetes, breast cancer, cerebrovascular disease, inflammatory conditions, and respiratory conditions as both most prevalent and most costly. Effective medication management programs are critical to achieving optimal member outcomes and keeping benefits affordable.”
It added that carriers “report heart disease and diabetes as the most common conditions among their enrolled population and diabetes as a top driver of medical and pharmacy cost.” However, data collected by OPM show that some carriers are not meeting standards for referring enrollees to programs for cardiovascular disease and diabetes prevention, it said.
OPM added that it is “receiving more member appeals and disputed claims” regarding coverage for genetic testing. “OPM recognizes that effective genetic benefits management can speed time to diagnosis, optimize treatment, improve health outcomes, and avoid costs associated with adverse drug effects. We strongly encourage FEHB carriers to review their current benefits and propose any needed revisions for 2019. All proposals should include a description of the carrier’s genetic testing strategy, scope of included testing, and any applicable vendor partnerships,” it said.