Weekend update

We are one week away from the Federal Benefits Open Season which begins next Monday November 11.

OPM announced last week that beginning next year the children of same sex domestic partners will be eligible for self and family FEHBP (and FEDVIP) coverage as stepchildren provided that the federal employee and domestic partner register their relationship with the employee’s agency and they don’t live in a state that permits same sex marriage. In states that recognize same sex marriage OPM expects the same sex couple to marry in order to cover the partner’s children (just like an opposite sex couple).

The Senate, but not the House, is in session this coming week according to the Hill’s Floor Action blog.

Following up on Friday’s note about HHS’s decision not to apply the federal program’s anti-kickback act to qualified health plans in the ACA exchanges, the Wall Street Journal reports tonight that prescription drug manufacturers are enthused by the fact that the decision allows them to offer subsidies, e.g., co-pay cards, to cover QHP co-payments on their brand name prescription drugs. The article notes that

[D]rug makers have been concerned that high copayments and deductibles on plans sold on the exchanges could deter newly insured people from filling their prescriptions, said Dan Mendelson, president of consulting firm Avalere Health LLC. He said the average “silver” health plan offered through the exchanges has a $2,500 deductible, while the average “bronze” plan’s deductible is $5,000.

FEHB plans expressly are not subject to this complicated anti-kickback law. The PBM trade association plans to fight the HHS decision because the co-pay cards interfere with their formulary arrangements.

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