Insurance companies participating in the health care program for federal employees have been told to continue to try to hold down premium costs through wellness initiatives and controls on prescription drug spending.
The instruction came in the annual “call letter” issued Thursday by the Office of Personnel Management, which runs the Federal Employees Health Benefits Program. The letter starts the process of negotiating coverage and premium terms for the following calendar year.
Almost all federal employees and retirees and their spouses and children up to age 26 are eligible to participate in the program, which has about 200 participating plans. Several plans are national in scope, while the large majority are regional health maintenance organizations. Wellness programs and prescription drug cost controls have been part of the FEHBP for years but the new call letter reemphasizes and expands those initiatives.
“The health and wellness of FEHB Program members continues to be one of our most important priorities. Overweight and obesity continue to be widespread problems with strong implications for health care costs, chronic illness and disease management,” OPM said in the letter.
Plans that have obesity-reduction programs in place are to report the results, while those that don’t have such programs are expected to craft them.
OPM also said it expects carriers to offer incentives for enrollees to participate in such programs and stick with them in the long-term. “This includes incentives for enrollees who complete health risk assessments, who adhere to disease management programs, or who participate in wellness activities or treatment plans aimed at managing and improving health status,” the letter said.
Another major focus will be on prescription drug costs, which now account for almost a third of the costs in the program, OPM director for healthcare and insurance John O’Brien told a meeting of insurance companies Thursday. OPM wants the share of generic drugs to increase from 70 to 75 percent of all prescriptions dispensed, and wants to hold down cost growth in especially expensive specialty drugs.
The letter also instructed the health carriers to comply with several provisions of the Affordable Care Act that affect the program. These include eliminating annual limits on essential health benefits, ending limits on eligibility to participate in certain clinical trials, and covering certain preventive care and screenings for women under policy set by the Health and Human Services Department.
The FEHBP is the largest employer-sponsored health benefits program in the country, according to OPM, with about 8 million participants and $43 billion annually in premiums. Enrollees pay about 30 percent of the total premium cost, with the government paying the rest.
O’Brien said that 10 new carriers are expected to join the program in 2013, more new entries than the last five years combined.