OPM: Carriers also are to offer “multi-faceted educational initiatives to members and providers on how to access their contraception benefits.” Image: Calek/Shutterstock.com
By: FEDweek StaffOPM has issued a series of instructions to FEHB carriers on coverage for contraceptives and on several other issues in the program, saying “there are reports of continued barriers to contraceptive coverage, which make it difficult for individuals to access the coverage without cost sharing.”
The letters come in advance of the annual “call letter” that kicks off the negotiation over terms and premium rates for the following calendar year.
In one, OPM said it “strongly encourages”—putting the words in boldface type—carriers to cover all contraceptive drugs and drug-led devices approved by the FDA without cost sharing, other than those for which there is a covered therapeutic equivalent, consistent with guidelines issued recently by Treasury and HHS regarding Affordable Care Act coverage.
“Access to affordable contraception is a Biden-Harris administration priority, and FEHB carriers should continue their focus on this important initiative. OPM intends to further address contraceptive coverage requirements, including the therapeutic equivalence approach, in the future and will continue to monitor access to contraceptive services closely,” it says.
Carriers also are to offer “multi-faceted educational initiatives to members and providers on how to access their contraception benefits.”
A second letter addresses the issue of pharmacy benefits managers, companies that act as middlemen between drug manufacturers and carriers and whose fees have come under criticism from both parties on Capitol Hill. The House Oversight and Accountability Committee for example recently approved HR-6283, to require those companies to only charge a flat fee for drug placement versus letting them continue to charge a percentage of the drug.
The OPM letter reiterates previously issued standards on transparency “due to the added layers of complexity related to PBMs’ business practices over the years.” Those standards stress oversight by the carriers and fuller disclosure of costs across the various transactions involved.
A third letter addresses reporting requirements on medical treatment claims, pharmacy claims, drug rebates and more.
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