New rules from OPM will require FEHB carriers to produce additional details regarding prescription drug costs, which account for about 30 percent of all program outlays and whose cost increases annually are cited as a main driver of premium hikes.
Under November 18 Federal Register notices by OPM, HHS and several other agencies, plans will have to submit annual data on prescription drug pricing trends, as well as their impact on premiums and out-of-pocket costs. That is to include information such as the most frequently dispensed brand name prescription drugs, the costliest drugs, and those showing the greatest increases in spending.
That data is to begin with the 2020 plan year but insurers will have until late 2022 to submit the first reports—covering 2020 and 2021—meaning that the results likely will not be used in the FEHB until 2023 in preparation for the 2024 plan year.
The notice follows interim rules from OPM on carrying out other aspects of a law enacted last year affecting the FEHB among other health-care programs. Those included protections against “surprise billing”—unexpected out of pocket costs for care in setting such as hospitals by providers outside a plan’s network—taking effect with the 2022 plan year.