Weekend update

The FEHBlog is on vacation this week on the Outer Banks of North Carolina. But Congress is in session, and the Supreme Court has 11 more decisions to issue before it can go on its summer vacation. Decision days are today, Wednesday and Thursday this week according to the Scotusblog.

The FEHBlog was disappointed to conclude that the Hill has stopped publishing its next week in Congress report on the Floor Action blog. The FEHBlog did some online research and found this helpful The Week in Congress website as a replacement. There’s a lot of attention to appropriations right now.

The New York Times had an article Saturday on how big PBMs like CVS Caremark and Express Scripts are pressing prescription drug manufacturers to bargain over prices or “be banned” from their formularies.   As you can tell from the examples of banned and approved drugs, the PBMs can attempt to excercise this leverage when there is more than one prescription drug available to treat a particular condition. In the most recent call letter for benefit and rate proposals, OPM gave FEHB plan carriers the green light to use such managed formularies in their plans beginning in 2016.

The ACA regulators have been pushing health plans to include more information on their explanations of benefits, e.g., diagnoses. Here’s a link to a story about such disclosure backfiring on the plan.