OPM: FEHBP Carriers Should Focus on Rising Prescription Drug Use and Costs

All insurance carriers participating in the Federal Employees Health Benefits Program in 2018 should continue their efforts to effectively manage prescription drug use among beneficiaries while trying to rein in escalating costs, the Office of Personnel Management advised in its annual call letter to FEHBP carriers.

OPM wants carriers to “reexamine” opportunities to reinforce or add to management techniques that help balance those dual goals, since rising drug prices and more prescription drug use in health care are driving up FEHBP premiums. According the agency, 25.5 percent of the FEHBP health care budget was spent on drugs in 2015. “We are particularly interested in proposals that optimize safe use and evidence-based formulary management of drugs for mental health conditions, substance use disorders, immunosuppression, diabetes, HIV, seizure disorders, and cancer,” stated the Jan. 11 letter, obtained by Government Executive.

FEHBP carriers have to submit their 2018 benefit and rate proposals to OPM by May 31. OPM expects to have benefit and rate negotiations for next year finished by mid-August “to ensure a timely open season.”

The agency also encouraged carriers to continue their efforts to be more transparent about drug prices going forward. “OPM appreciates efforts carriers have made to provide drug cost calculators that display up-to-date information about the formulary tier, member cost-share and utilization management requirements for covered prescription drugs,” the letter said. “Effective drug use calculators should be accurate, intuitive, easy to navigate and understand, and be member-friendly.”

OPM is also focusing on several other areas to improve the federal employees’ health care program in 2018, and directed carriers to devise proposals that reflect those priorities. They include limiting “unexpected out-of-network billing for members through various education and outreach efforts;” expanding telehealth services; providing comprehensive diabetes management for beneficiaries and educating FEHBP enrollees about their coverage options related to that disease; and ensuring mental health and substance use disorders receive adequate coverage under FEHBP plans. In particular, OPM emphasized the importance of carriers continuing to expand their access to medication used to treat mental health and substance use disorder.

“Due to the enormous costs SUD has on society, it is essential that FEHB plans recognize the seriousness of this condition and assure access to effective treatments,” the letter stated.