FEHB to increase prescription drug cost review


The new OPM rules will require FEHB carriers to produce additional details regarding the costs of prescription drugs, which account for around 30% of all program spending and whose annual cost increases are cited as the main driver. increase in premiums.

Under Federal Register Nov. 18 notices from the OPM, HHS and several other agencies, plans will be required to submit annual data on prescription drug price trends, as well as their impact on premiums and costs. refundable. This should include information such as the most frequently distributed brand-name prescription drugs, the most expensive drugs, and those showing the largest increases in spending.

This data is to start with the plan year 2020, but insurers will have until the end of 2022 to submit the first reports – covering 2020 and 2021 – meaning the results are unlikely to be used in the FEHB until 2023. in view of the plan year 2024.

The notice follows OPM’s interim rules on implementing other aspects of a law enacted last year affecting the FEHB among other healthcare programs. These included protections against “surprise billing” – unforeseen charges for care in settings such as hospitals by providers outside of a plan’s network – taking effect with plan year 2022.

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