Mid-week Miscellany

David Ermer–Uncategorized–

The U.S. Office of Personnel Management’s (“OPM”) legislative proposal to carve out prescription drug benefits to a single prescription benefit manager (PBM) under contract with OPM has attracted the attention of the prescription drug industry.  AIS Health reports that

Elan Rubinstein, Pharm.D., founder and principal of consulting firm EB Rubinstein Associates, maintains that there is another proposal in the [President’s] deficit-reduction plan, one that involves the Federal Employees Health Benefits (FEHB) Program, that is an “important issue” for not only the specialty pharmacy industry but also the broader pharmacy benefits industry. The proposal, says the plan, would allow the Office of Personnel Management (OPM) to “contract directly for pharmacy benefit management services on behalf of all FEHB enrollees and their dependents.” Currently, health plans in the program contract with PBMs on behalf of FEHB enrollees.
 According to the plan, “This will allow the FEHB program to more efficiently leverage its purchasing power to obtain a better deal for enrollees and taxpayers.” Its 10-year estimated savings are $1.6 billion.

Changing from “health plan-managed to an OPM-contracted pharmacy carve-out is an important issue,” Rubinstein says, “because while evidently not on the table now, a next step could be to apply Medicaid rebates as has been proposed for Medicare Part D, leveraging the federal government’s purchasing power very significantly.”

OPM has announced, according to Gov Exec, that a larger number of HMOs participating in the FEHBP will be offering affinity health insurance plans for same sex domestic partners of federal employees.  “According to OPM, the coverage offered is generally at the individual as
opposed to a group rate [which the insured must pay in full], and the terms and conditions of enrollment are
not subject to OPM review” Gov Exec advises that the following plans will offer such affinity benefits in 2012:
  • Aetna
  • Altius (Idaho, Utah, Wyo.)
  • Dean Health Plan (Wis.)
  • Health Net of Arizona
  • HealthPartners (Iowa, Minn., N.D., S.D., Wis.)
  • Kaiser
  • KPS Health Plan (Wash.)
  • PacifiCare of California
  • PacifiCare of Texas
  • Piedmont Community Healthcare (Va.)
  • United Healthcare of the Midwest (Ill., Mo.)
  • United Healthcare of the River Valley (Ill., Iowa)
Affinity benefits typcially are described on a dedicated page in the plan’s OPM approved brochure. 
The Medicare annual open season starts on Saturday, and the FEHBP Open Season starts in 32 days. The Centers for Medicare and Medicaid Services today announced the Open Season planning resources available to Medicare beneficiaries. For example”using Medicare’s Plan Finder – available at www.medicare.gov/find-a-plan
– people will see the enhanced star ratings for 2012.  In addition to
the enhanced star ratings for 2012 and new “gold star” icon, Plan Finder
users will see an icon showing which plans received a low overall
quality rating for the past three years.”  FEHB plans have begun to describe their 2012 benefit and premium changes on their websites.