Fedweek

Walmart Pharmacy prescription medicine counter - Peabody, Massachusetts USA - February 12, 2018 Image: QualityHD/Shutterstock.com

Although full details of FEHB plans won’t be released until just before the start of the November 12-December 10 open season, an OPM fact sheet contains several highlights, including some related initiatives designed to control costs that have been under way for years.

One area of particular focus has been prescription drugs, which it says account for 27 percent of costs in the program, and that have been one major driver of premium increases in recent years. That upward pressure slowed in 2017, OPM said, contributing to the average increase in the enrollee share of premiums working out to 1.5 percent, about a quarter of what it had been in prior recent years.

“Medication management programs work collaboratively with members who have multiple drug regimens and chronic conditions to assess their medication regimen, help improve adherence, manage medication costs and avoid adverse safety events to improve health outcomes. Most FEHB carriers have or propose to put in place a medication management program to optimize the medication needs of FEHB members,” it said. “OPM has asked plans to be more transparent and provide effective drug use calculators that are member-friendly and more interactive. 98% of FEHB plans have drug cost calculator available to members and 91% of plans provide a link to the pre-enrollment pharmacy price transparency tool.”

One drug category of particular concern has been opioids. The number of prescriptions dispensed after the initial prescription dropped from above 5 million to 4.4 million over 2015-2017, OPM said, as carriers have responded to OPM’s request that they tighten their standards for dispensing them and promote awareness of opioid risks to enrollees.

Also, “FEHB carriers report diabetes as one of the most common conditions among their enrolled population and as a top driver of medical and pharmacy costs. For the 2019 plan year, 88% of all FEHB plans are referring qualifying adults to intensive behavioral counseling interventions for diabetes prevention.”

Further, more carriers are offering monetary incentives to FEHB enrollees to also enroll in Medicare Part B—either through member cost share waivers or Part B reimbursement, OPM said. For enrollees in both programs, Medicare acts as the first payer and FEHB as a supplement, essentially requiring the former program to bear most of the costs of claims.

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“Now 39 FEHB plans waive copays or coinsurance and waive deductibles for those enrolled in Part B, which provides out-of-pocket savings for Medicare enrollees. More than 90% of FEHB members are enrolled in a plan that provides additional benefits for those who enroll in Medicare,” it said.

OPM also cited expanded use of telehealth, which are less expensive than in-person care for services that don’t require personal contact. “Several plans are expanding telehealth services to cover minor acute medical conditions, behavioral health counseling, substance use disorder counseling and dermatology. Many FEHB plans have also reduced copayments for telehealth visits for the 2019 plan year,” it said.

Also, the amounts that enrollees in high-deductible plans with health savings accounts may use toward certain medical expenses will increase in a third of such plans, and three plans have added high-deductible options.

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