OPM: The pandemic cost FEHB about $2 billion (3-4% of 2021 claims) to test and treat COVID-19 patients, pushing up premiums. Image: aldarinho/Shutterstock.com
By: FEDweek StaffAn OPM summary of changes in the FEHB program for 2023 blames the pandemic for much of the average 8.7 percent increase in the enrollee share of premiums while summarizing general changes in coverage ahead.
“COVID-19 has introduced unprecedented volatility in rate setting across the health care industry. The FEHB rates reflect this as a result of the claims experience in late 2021/early 2022, which align with the other large employers. In 2021, the coronavirus pandemic cost the FEHB Program about $2 billion (3-4% of 2021 claims) to test and treat COVID-19 patients, which impacts rates for the 2023 plan year,” said the summary.
“The largest contributors to the 2023 premium increase reported by FEHB carriers are higher than expected utilization in outpatient services and facilities, increase in utilization of professional services, and increased utilization and unit cost in specialty drugs. This is consistent with the larger market and reflects the impact of the COVID pandemic,” it said.
It added: “As the COVID-19 pandemic continues, and new challenges must be met such as Monkeypox, OPM continues to work with the FEHB carriers to ensure our enrollees have access to appropriate benefits and services and to meet and address these challenges. Throughout the COVID-19 pandemic, carriers have provided quick solutions for access to testing, vaccines, mental health benefits, and telehealth, as well as encouraging our enrollees to get vaccinated by offering incentives.”
Specifics of each plan’s coverage terms are to be released ahead of the open season which this year will be November 14-December 12 but the document says that trends in coverage changes include:
* Expanded initiatives for maternal health, including paying more for high-value care than low-value care; increased reimbursement or expanded coverage for certified nurse midwives, birth centers, and perinatal support services such as doulas and nurse home visits; and raising awareness of potentially life-threatening warning signs during and after pregnancy.
* Required coverage for foods specifically formulated and prescribed to treat inborn errors of metabolism regardless of age, mode of administration, specific disease or whether it is the sole source of nutrition for that individual.
* A ban on a general exclusion of services, drugs, or supplies related to the treatment of gender dysphoria.
* A requirement that carriers cover a range of anti-obesity drugs at various cost points.
Also, it said, carriers were required to continue coverage for measures against COVID-19, including over-the-counter tests, booster doses, therapeutics, and pharmacy access to therapeutics; and expansions in telehealth services that arose due to the pandemic. “Additionally, all Carriers cover the full range of contraceptives and contraceptive care for adolescent and adult women as provided in the Women’s Preventive Services Guidelines supported by the Health Resources and Services Administration without cost sharing,” it said.
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