FEHBlog

Congress remains on the campaign trail as the national election day draws close.  The Federal Benefits Open Season starts two weeks from tomorrow on November 14 when Congress comes back to town.

The FEHBlog did run across two interesting drug spending articles this weekend; both appeared in the Wall Street Journal.

The first article suggests that

The drug industry is showing signs it is slowing the pace of price increases after years of hefty hikes, alarming shareholders worried that pressure from politicians, consumers and employers will continue to stifle pricing power.  Shares of many drugmakers, wholesale distributors and pharmacy-benefit managers were battered Friday on new evidence in corporate earnings reports that pharmaceutical companies are declining to ratchet up prices as sharply as in previous years. 

Time will tell.

The other article highlights the important role of insurers in controlling prescription drug costs.

[A health plan] was dismayed when her health plan stopped covering her migraine drug Treximet earlier this year. To buy a pack at the pharmacy would cost $750, compared with a $20 copay when the drug was covered.
“Nothing’s worth $750 for nine pills,” she said. “It’s cruel.”
Instead, the 50-year-old stay-at-home mother from Memphis, Tenn., takes Treximet’s two active ingredients—sumatriptan and naproxen—as separate pills. For these two generic drugs, her copay is zero.

The article explains that

Treximet [which is manufactured by Pernix Therapeutic Holdings] is just one of many drugs whose active ingredients are generic drugs that can be purchased separately at a fraction of the cost. Others include acne cream Acanya, Duexis for rheumatoid pain and weight-loss pill Qsymia, according to data compiled for The Wall Street Journal by GoodRx, a group that compares pharmacy prices for prescription drugs. 

No wonder there’s been a backlash. Where is the competition that would help control these pricing practices? Does the government allow a patent in these situations? The process of drug pricing is akin to the process of making sausage.

The fun never stops. Yesterday, the ACA regulators released ACA FAQ 34. FAQ 34 concerns tobacco cessation therapy and mental health parity, which was yesterday’s topic of the day.  The FEHBlog noticed that OPM introduced to the FEHBP in 2011 the tobacco cessation program that is discussed in the FAQ.

Yesterday, the President’s mental health parity task force released its final report.  The report made several recommendations, many of which were contemporaneously implemented as explained on the announcement page. The very last announcement (p. 34) concerns the FEHBP:

Review substance use disorder benefits in FEHBP. Federal Employees Health Benefits Program insurance carriers have made significant strides toward ensuring parity in mental health and substance use disorder benefits. Commenters noted that non-quantitative treatment limits may still need examination and modification to ensure full compliance, and consistent definitions of terms relating to residential treatment would provide greater transparency for consumers. In the coming year, the US Office of Personnel Management will undertake a detailed review of NQTLs [non-quntitative treatment limits] applicable to substance use disorder benefits, and take corrective action as indicated by the findings.

It’s nice to see kind words written about FEHBP carriers.

The International Foundation of Employee Benefit Plans alerts us that the ACA regulators are releasing another final rule addressing

• The definition of short-term, limited-duration insurance for purposes of the exclusion from the definition of individual health insurance coverage;
• The standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits; and
• Amendment of a reference in the final regulations relating to the prohibition on lifetime and annual dollar limits.

The rule will be published in the Federal Register this coming Monday.

The FEHBlog recalls speakers warning about the looming cost of a new class of cholesterol fighting drugs called PCSK9 inhibitors.  Pharmalot reports that these drugs aren’t selling like hotcakes as first expected for a number of reasons. In that regard, Healthcare Dive reports on prescription drug value pricing arrangements created by health plans and PBMs.

Speaking of innovations, the Cleveland Clinic released a list predicting the top ten medical innovations for 2017.

Topping the 11th annual list is the harnessing of the microbiome, the gut bacteria swarming in all of us. Recent discoveries have revealed the power of microbes to prevent, diagnose and treat disease. The healthcare industry will soon be pouring resources into addressing the potential for new therapies, diagnostics, probiotics and other products.

Fingers crossed, of course.

Finally Fierce Healthcare reports on a study finding that consumer are willing to price shop for health services if they are given the necessary information. That’s good news.

The FEHBP now the Federal Benefits Open Season always has featured health fairs at federal agencies where employees can gather information and speak with plan representatives.  Congressmen and women with districts that have a large population of federal annuitants, like the FEHBlog’s, offer their own health fairs aimed at the annnuitants.  Benefeds in cooperation with OPM will be holding a virtual benefits fair online.

Can’t attend a health fair this year? No problem!  
For whatever reason—telework, geography, or just being busy—you can’t always make it to an onsite event. But, now you can attend online!
1.  Register for the virtual benefits fair online and confirm your
     email. Be sure to set a secure password.
2.  Log in anytime during the Federal Benefits Open Season, from
     November 14 to December 12, 2016.
3.  Visit individual carrier booths to compete in our nationwide virtual
     scavenger hunt and trivia-style games, watch videos, and get
     answers from the experts!
Live answers to your questions
Visit the virtual benefits fair during any one of our two live carrier chat days:
Monday, November 14, 2016, 10 a.m.–5 p.m. ET
Wednesday, December 7, 2016, 10 a.m.–5 p.m. ET  

Here’s the registration link.

Yesterday the Centers for Medicare and Medicaid Services gave the State of Vermont (pop.  625,000 people, 630,000 cows?) final approval to move forward with a plan to implement a “Vermont All-Payer Accountable Care Organization (ACO) Model. The CMS fact sheet explains that

Vermont will encourage Vermont payers and providers to participate in ACO programs such that by 2022, 70 percent of all Vermont insured residents, including 90 percent of Vermont Medicare beneficiaries, are attributed to an ACO. ACOs will continue to have payer-specific benchmarks and financial settlement calculations, but the ACO design (e.g., quality measures, risk arrangement, payment mechanisms, and beneficiary alignment methodology) will be closely aligned across payers. 

It will be interesting to see how if at all this initiative impacts the FEHBP.  This initiative is Vermont’s Plan B that follows up on a shelved effort to create a single payer system.

Also yesterday, the Internal Revenue Service released its handy dandy summary of 2017 inflation adjustments to tax provisions, several of which relate to health benefits. Many of the adjustments had been previously announced.

Mike Causey had a column yesterday which confirmed the FEHBlog’s understanding that the FEHBP-related provision of the House Oversight and Government Reform Committee’s bipartisan postal reform bill (HR 5714) find general support with most affected organizations.

The FEHBlog is back inside the Beltway following an enjoyable weekend in the Nutmeg State.  Congress remains out on the campaign trail.  Medpage Today makes some predictions about the lame duck session following the election.

The FEHBlog has been waiting for the Congressional Budget Office to score the postal reform legislation that the House Oversight and Government Reform Committee passed last July.  Last Thursday, the CBO released a report on one of those bills (HR 5707) but the report on HR 5714 which bears on the FEHBP remains pending. Perhaps it will be released this coming week. In that regard, a friend pointed out a new website that aggregates Congressional Research Service reports.

Fedsmith summarizes the FEHBP significant changes for 2017 letter which the FEHBlog posted last week. If you didn’t have a chance to download the letter from the FEHBlog, the summary should suffice.

The Federal Times reports on the state of self plus one coverage.

Self-Plus-One has amassed more than 540,000 beneficiaries in its first year, accounting for more than half of the eligible federal employees and retirees.  In a conference call announcing [2017] premium changes for the Federal Employees Health Benefits program, agency officials said that 40 insurance plans in the program still had higher enrollee shares than family coverage plans.  In those cases, OPM Director of Healthcare and Insurance John O’Brien said the agency was actively advising beneficiaries in those cases to remain on their family plans. “While the number of plans is significant, in terms of overall share of the population, it’s relatively modest,” he said. 

On the HIPAA front, HHS’s Office for Civil Rights and the Federal Trade Commission (“FTC”) point out that “if you share health information, it’s not enough to simply consider the HIPAA regulations. You also must make sure your disclosure statements are not deceptive under the FTC Act.”  The agencies provide guidance on the relevant provisions of the FTC Act.  Also last week, OCR took another HIPAA scalp.

St. Joseph Health (SJH) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules following the report that files containing protected health information (PHI) were publicly accessible through internet search engines from 2011 until 2012.  SJH will pay a settlement amount of $2,140,500 and adopt a comprehensive corrective action plan.

Also last week the ACA regulators unveiled ACA FAQ 33.  This FAQ concerns student health coverage which has no relevance to the FEHBP but illustrates the breadth of this law.

The Washington Post today continued its series on the country’s opioid and heroin abuse crisis. Last week, according to this U.S.A. Today report, Cigna and the N.Y. Attorney General announced a settlement under which Cigna will loosen its prior authorization rules for medication assisted treatment (“MAT”) of these unfortunate conditions.

MAT, when prescribed and monitored properly, has been found to be safe, reasonably priced and effective in helping patients recover from opioid use disorder.
Unlike methadone, which must be administered under strict rules in certain clinics, MAT drugs — which usually contain buprenorphine and naloxone  — can be prescribed or dispensed in doctors’ offices for opioid dependency, as long as the doctor is authorized. Mental health therapy and management of medical issues is also recommended.
Cigna’s policy change, which is effective Oct. 15, covers all of Cigna’s commercial insurance plans.

The FEHBlog is visiting Storrs Connecticut for his 40th University of Connecticut reunion. UConn only offers two class reunions 40th and 50th because the classes are so large. 

The Federal Times offers Walt Francis’s observations on the coming Federal Benefits Open Season. Federal News Radio provides an update on the rather tumultuous decisionmaking period for Federal Long Term Care Insurance Program enrollees.

As of Oct. 7, more than 96 percent of enrollees who responded to the
OPM’s enrollee decision period, which ran from July 18 through Sept. 30,
chose to accept the increase or take one of the special benefit
reduction options, an agency spokesperson told Federal News Radio in an
email.

Less than 4 percent of those who responded chose to discontinue their
coverage or take the “paid-up” option, the spokesperson said.

Yesterday the FEHBlog ran across this interesting September 2015 OPM website providing a profile of federal civilian non-postal employees. 

Healthcare Dive reports on a recent Healthgrades report on clinical outcomes at U.S. hospitals.

A total of 22 states, including Delaware, New Mexico and Hawaii, as
well as the District of Columbia did not have any hospitals that
received either a 4- or a 5-star rating, Healthcare IT News reported. The states with the most hospitals in the top 50 list was California with eight hospitals, followed by Illinois and Michigan.
Among the top 50 hospitals were the Mayo Clinic in Phoenix, Saint
Luke’s Hospitals in Cedar Rapids and Baltimore-based Medstar Good
Samaritan Hospital.

Finally, Drug Channels provides his annual analysis of the Kaiser/HRET 2016 Employer Health Benefits Survey. The FEHBlog appreciates Drug Channels insights but he was puzzled by observation that “Patients taking specialty drugs face economically-debilitating
coinsurance—in some cases with no limit on out-of-pocket expenses.”  Currrently, the ACA requires that all in-network coinsurance be subject to an annual limit.  The FEHBlog is not suggesting that Drug Channels has identified a non-issue but rather that the issue may be overstated.

Yesterday, the U.S. Office of Personnel Management released a benefits administration letter containing the annual list of significant FEHB plan changes (there are no significant FEDVIP plan changes for 2017) and Federal Benefits Fast Facts.  The plan changes list shows adds, drops, and geographic region changes principally for HMOs participating in the FEHBP next year.  Occcasionally the list includes nationwide plan changes, but none are reported in the 2017 letter.

Also yesterday, the federal government announced that changes in the CPI-W will produce small 0.03% cost of living adjustments for federal annuitants and Social Security beneficiaries.  The Washington Post offers a good perspective on these announcements here. The Wall Street Journal adds

The hold-harmless provision of the Social Security Act says Medicare can pass along only up to the dollar increase in the cost-of-living adjustment to the estimated 70% of all beneficiaries who will qualify for hold-harmless treatment in 2017.
Because a 0.3% increase in the cost-of-living adjustment would translate into a $4 raise in the average Social Security payment, this would effectively cap the average Medicare Part B increase at $4, said Dan Adcock, policy director at the nonprofit National Committee to Preserve Social Security & Medicare. Medicare Part B covers doctor visits and other types of outpatient care.
This means that Medicare must spread much of the projected increase in its costs across the remaining 30% of beneficiaries who aren’t covered under hold harmless. This group includes not only high earners, but also those who receive Medicare, but have deferred or aren’t eligible for Social Security benefits, and those who are new to Medicare in 2017.

NARFE explains that federal annuitants in the legacy CSRS retirement program also fall outside the group protected by the hold harmless clause because their Medicare premiums are withheld from the federal annuities, not from Social Security benefits.  Federal annuitants participating in the current FERS program do have hold harmless protection unless they fall in the “high earner” subgroup.

CMS will not announce Medicare Part B premiums until next month probably around the time that Congress returns from campaigning.  Congress added a band-aid to the hold harmless clause last year and it likely will do so again this year.

We are four weeks away from the beginning of the Federal Benefits Open Season.  The National Academy of Medicine is holding its annual meeting this week. Their focus is on the twin problems of obesity and diabetes.  In a similar vein, the Washington Post continued its series on health problems faced by rural America.  This article mau maus the prescription drug industry for creating drugs to control the side effects of opioids.  It’s not an either replace opioids with other painkillers or treat side effects proposition in the FEHBlog’s view.

Becker’s Hospital Review offers six observations on the current state of the government’s anti-trust litgitation with two sets of large health insurers seeking to merge.  “The proceedings will play out over the next few months, as the Anthem-Cigna trial is slated for Nov. 21 and the Aetna-Humana trial is set for Dec. 5.”

The FEHBlog didn’t make it home until 2:30 am this morning following attendance at the Washington National’s 4-3 loss to the LA Dodgers. (Go Cubs!).  And the FEHBlog had to be up as usual at 6:30 am so the FEHBlog my friends is weary.

Contrast that with HHS which today issued a nearly 3,000 page final rule implementing the new MACRA law for reimbursing doctors and allied health providers under Medicare Part B beginning as early as January 1, 2017.  The FEHBlog is skeptical of these massive rulemakings.  Becker’s Hospital Review posts 10 things to know about the rule. HHS has created a snazzy new website to help doctors with MACRA implementation.

How does this impact the FEHBP you ask? The large number of annuitants with primary Medicare Parts A and B coverage help moderate premiums for everyone due to the FEHBA’s sensible approach of using a single risk pool for each plan option.  OPM has been trying to encourage new annuitants to pick up Medicare Part B for that reason. The MACRA rule on top of the PHSA Section 1557 rule and other ACA innovations may be the straw that breaks the camel’s back by causing more and more doctors and annuitants to leave Medicare Part B. Time will tell.  HHS indicates that it plans to continue tweaking the rule.

In this regard, the FEHBlog took note of this Fierce Healthcare article about a study concluding that commercial accountable care organizations are larger and more efficient than Medicare ACOs. That makes sense to me because commercial carriers tend to be more flexible than CMS in developing these new networks. Also the commercial ACOs are based on voluntary contracts rather than imposed laws.

The press continues to hammer on drug prices.  Kaiser Health News reports that drug price increases hurt the bottom line of hospitals and the Wall Street Journal reports that those increases hurt the bottom line of consumers with high deductible health plans.  The FEHBlog would not be surprised to see Congress eviscerate the current drug pricing system which raises prices on the front end but allows for a volume rebate to third party payers on the back end. Bear in mind that this model is based on Medicaid’s drug program.  Whether Congress would apply such a solution to Medicaid is another question.

Becker’s Healthcare tells us about the growing practice of doctors de-prescribing medicines for older patients.  Becker’s identifies the following five things to know:

1. Of patients in their 60s, almost 40 percent are taking more than five medications.
2. To lower this figure, physicians conduct comprehensive medication reviews to determine which drugs they can decrease the dosage or de-prescribe if they do not benefit a patient’s overall health.
3. Alongside pharmacist Barbara Farrell, Cara Tannenbaum, MD, created the website, deprescribing.org, which allows physicians in the Untied States and Canada to obtain information to help them assess if a patient should cease taking certain medications that are unnecessary or even harmful. Canadian Deprescribing Network maintains the site.
4. In 2015, The American Geriatric Society updated its Beers Criteria, which features a list of 40 medications or classes of drugs that the society deems as possibly inappropriate for older adults. The American Geriatric Society added three new drugs and two new classes of medications to its warning lists for older adults or people with certain health concerns last year. Currently, an expert panel is working on an update for that list for 2018.
5. Physicians have issued warnings about using sedatives in older adults and recently, there have been warnings about proton pump inhibitors. WSJ reports new studies show an association between these pumps and a higher risk for bone loss, fractures and serious bacterial infections.

Here’s a cost reduction effort that health plans should support.

In a bit of good news for the human team,  Healthcare Dive reports on a study finding that human doctors perform signficantly better than computerized algorithms when making initial diagnoses.

Researchers from Harvard Medical School, Brigham & Women’s Hospital and The Human Diagnosis Project used 45 clinical vignettes to compare the diagnostic accuracy of 23 online or app-based symptom checkers with that of 234 physicians.  The results show 72.1% of doctors listed the right diagnosis first, versus 34% of the algorithms. 

One of the many tortured ACA provisions is the requirement to cover with no enrollee cost sharing preventives services with A or B reecommendations from the National Preventive Services Task Force when provided in-network. The basic problem is that the NPSTF recommendations provide medical not insurance coverage advice. Moreover, NPR reports that “The former chairmen of the U.S. Preventive Services Task Force say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people’s health care decisions.”  If you build it, they will come.

Health IT Security reinforces the burning need for HIPAA patient identifiers in order to get the full bang for the buck out of the $32 billion that the federal government has spend on electronic medical records.

Finally, OPM last week “released the detailed government-wide Federal Employee Viewpoint Survey (FEVS) results for 2016. The complete governmentwide results for 2016 contain scores from indices such as Employee Engagement, Global Satisfaction, and the New IQ. Also included are promising practices on employee engagement, very practical advice on what works to help improve engagement and performance. The 2016 FEVS provides government employees with the opportunity to candidly share their perceptions of their workplace, their agencies, and their leaders. This year, 407,789 employees responded to the survey out of the 889,590 to whom it was sent, for a response rate of 45.8%.”

It’s a long weekend for federal employees.  Medicare’s open enrollment period for Medicare Advantage and Part D plans starts on Saturday and runs through December 7. Hopefully before then we’ll know what’s up with Medicare cost sharing for 2017.

The Federal Benefits Open Season starts on November 14 and runs through December 12. By now plans typically have posted 2017 benefits info on their websites.  In the next week or two, OPM will release the handy benefits administration letter on significant FEHBP and FEDVIP changes for 2017. The FEHBlog will be sure to link to it once it’s posted.

The FEHBlog has been expecting Congress to consider the House Oversight and Government Reform Committee’s bipartisan Postal reform bill in the lame duck session following the national election on November 8.  A National Association of Postal Supervisors legislative representative opines in the Postal Times that this viewpoint is a “long shot”. The FEHBlog is not suprised to possibly have made an incorrect educated guess. He is suprised that nearly two months after the House committee cleared the bill, the Congressional Budget Office has not scored it.  That was the next step according to Committee leadership.