Mid-week update

Last week must have been employee wellness guidance week for the federal government. Fedweek reports that last Thursday OPM issued a memorandum to federal government employers urging support for employee wellness programs by explaining the business case for them. Both federal employing agencies and FEHB plans offer employee wellness programs.

The HHS Office for Civil Rights explained in a set of FAQs last Thursday that HIPAA privacy rights apply to health plan sponsored wellness programs but not to employer sponsored wellness programs. But there are other privacy laws that apply to the employment relationship. As the FEHBlog mentioned last week, there is crazy quilt of laws that apply to these wellness programs.

As employers, the internet, the media etc., are encouraging people to take an interest in their healthcare, Labcorp, a major laboratory test company, is making available a service by which people can self order laboratory tests. According to Bloomberg News,

Laboratory Corp. of America Holdings will let customers go online to pay for tests, visit a service center to get blood drawn, then view the results on the Web. The company has already been doing back-office lab work for a number of Internet firms that let people order up tests without a doctor.

Rapid and at-home diagnostics are a growing corner of the health-care market, with businesses like WellnessFX Inc. and Direct Laboratory Services LLC tapping into demand from patients who want to get sensitive results in private or seek to monitor their health outside of the traditional doctor’s office. Companies like LabCorp are tapping into demand from consumers who want to measure their bodies to monitor the effects of exercise and healthy living and to learn about their potential risks of disease.

“We need to retake that territory for ourselves,” LabCorp Chief Executive Officer David King said in a telephone interview. “It’s a growth opportunity for us. It’s something consumers increasingly want to have access to, and it’s something we’re doing already and our capabilities are being utilized without us getting the benefit from a branding perspective.”

This may in the words of Newman from the Seinfeld show create quite a conundrum for health plans which need health plan test claim information for many of the government mandated HEDIS quality measures. In this regard, the FEHBlog notes that because plans typically do not cover charges for “self-ordered” over the counter drugs, it’s likely that plans will not cover charges for self ordered lab tests. The FEHBlog doubts that a flexible spending account would reimburse such charges without a doctor’s prescription which may defeat the purpose of these new services, but then again who knows?

Employee Benefit News features an helpful article about how employers and health plans are addressing rising prescription drug costs.  The article was spurred by this Aon Hewitt report on the prospect of double digit prescription drug benefit increases. As OPM has recommended to Congress that the agency be allowed to administer prescription drug benefits for the FEHBP, it’s worth calling everyone’s attention to this AHIP ordered study prepared by the Menges Group which finds that

In the 28 states and the District of Columbia where Medicaid plans include (or carve in) prescription drug benefits in the coverage, they saved $2.06 billion in state and federal expenditures in 2014 alone, according to a new report by The Menges Group. The report attributes the significant savings to greater use of generics and lower-cost medications.
Meanwhile, the seven states that carve out prescription drugs forfeited $307 million in total savings last year by not integrating pharmacy and medical benefits. Those states also saw net costs per prescription jump 20 percent from fiscal year 2011 to 2014.

This is only the latest study supporting integration of these benefits.  Maintaining the current integration of these benefits in the FEHBP simply makes sense.