Sunday, June 25, 2017

Weekend update

Congress is in session again this week on Capitol Hill. Here's link to the Week in Congress's account of last week's actions there. The Week in Congress included a link that the FEHBlog has been trying to find - a Senate Budget Committee summary of the Better Care Reconciliation Act.

Tomorrow is the closing day of the U.S. Supreme Court's curent term. Six decisions are anticipated. The Court already gave the FEHBP its victory in the Nevils case earluer this year.

On Friday, plaintiffs' counsel in the massive multi-district class action arising out of Anthem's 2015  data breach, which impacted FEHBP members, announced a proposed settlement of the lawsuits.  (Multi-district means that an assortment of related lawsuits filed across the country were consolidated before one court -- here the U.S. District Court for the Northern District of California.)
The proposed settlement provides [among other things]for Anthem to establish a $115 million settlement fund, which will be used to 1) provide victims of the data breach at least two years of credit monitoring; 2) cover out-of-pocket expenses incurred by consumers as a result of the data breach; and 3) provide cash compensation for those consumers who are already enrolled in credit monitoring.
U.S. District Judge Lucy Koh will hold a hearing on the fairness of the settlement on August 17. More details are available here.

A similar multi-district case arising out of OPM's 2015 data breach is pending in the U.S. District Court for the District of Columbia. The court heard several dispositive motions late last year. Here's a link to the lead plaintiffs' counsel website for that case.

Also last week, the Centers for Medicare and Medicaid Services issued a proposed 2018 rule for the Medicare Part D MACRA quality payment program for clinicians. The fact sheet is available here. Healthcare Dive explains that
MACRA will eliminate the sustainable growth formula and replace it with a .5% annual rate increase through 2019, after which physicians are encouraged to shift to one of two Quality Payment Programs: 1) Merit-Based Incentive Payment System (MIPS) or 2): Alternative Payment Model (APM). It is believed most physicians will enter into the MIPS program in the first year.
The article further notes that
The proposal allows for the exemption of small providers participating in the program by increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or less Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. The agency believes the move will exclude about 134,000 clinicians from MIPS. 

Friday, June 23, 2017


The FEHBlog did read through the Better Care Reconciliation Act. He was pleased to read Avik Roy's assessment of the bill. As the FEHBlog has noted neither the House bill nor the Senate bill would adversely impact the FEHBP or its enrollees. Both bills would repeal the ACA taxes, like the health insurer fee and the medical device tax, that have helped raise premiums.  Employee Benefit News points out that there's good news for FEHBP consumer driven plans:
The bill keeps all the provisions from the House of Representatives’ healthcare bill that increases the benefits of health savings accounts, which is good news for employers and employees. Under the plan, individuals can put $6,550, up from $3,400, and families can put $13,100, up from $6,550, into a tax-free HSA.
It also makes the accounts more flexible by: allowing both spouses to make catch-up contributions to one HSA beginning in 2018, letting people use their HSAs to pay for over-the-counter medications, which was restricted under the ACA and lowering the tax penalty if you use an HSA to pay for unqualified medical expenses to 10%, from 20%.
We may have reached the beginning of the end of this legislative process. (The FEHBlog is not betting the ranch on this statement though.) reports that the President has nominated Michael Rigas to be deputy director at OPM. That's currently a vacant position.
Rigas is chief of staff at the Massachusetts Department of Veterans’ Services. Before joining that agency, he worked in Republican politics and advocacy, at the Massachusetts Republican Party and conservative think tank The Heritage Foundation.
During the George W. Bush administration, he was associate administrator of the General Services Administration, where he worked on efforts to increase the amount of government contracting to woman- and veteran-owned businesses.
The Senate Homeland Security and Governmental Affairs Committee has not yet scheduled a confirmation hearing for George Nesterczuk, the President's nominee for OPM Director.

Healthcare Dive provides its perspective on Cigna, which is a network provider in the FEHBP.

The Washington Post reports that Democrats on the House Oversight and Government Reform Committee sent a letter to OPM  inquiring about the Federal Long Term Care Insurance Program which experienced premium spikes last year. "An agency spokesperson declined to say what, if anything, has been done to stabilize the program since the November hearing [before that Committee]. Even basic questions related to the number of people in the program were deferred."

Thursday, June 22, 2017

Better Care Reconciliation Act

The text of Senate bill which is described as the Better Care Reconciliation Act is available here.

Wednesday, June 21, 2017

Midweek update

The Senate leadership is expected to release its version of the American Health Care Act tomorrow. Stay tuned.

The FEHBlog recently mentioned the HCP/LAN spring forum. HCP/LAN is a public / private partnership to promote alternative payment methods for healthcare.  HCP/LAN has provided a link that allows you to view the forum webcast and the presentations.

Teladoc, one of the large telehealth vendors, announced a deal to acquire a medical consultancy known as Best Doctors.  The Teladoc press release explains that
Teladoc will marry its award-winning technology, industry-leading engagement capabilities, and robust, scalable platform with Best Doctors’ world-renowned network of medical experts, analytics expertise, patient decision-support, and regional expertise on a global scale. The newly combined company offers a highly differentiated suite of virtual care delivery solutions for a broad range of market segments, spanning the full spectrum of employers to health plans and health systems. Furthermore, Teladoc will now develop and deploy global expansion plans, meeting a broader spectrum of care needs outside the U.S.
Healthcare Dive reports that hospitals and other health care providers are filling vacant spaces in shopping malls across the country.  The FEHBlog noted that the Wall Street Journal which first reported the foregoing phenomenon reported today that TJX, the owner of TJ Maxx and Marshalls, is doing well by sticking to the retail store model.
TJX gets almost all its sales from its roughly 3,800 physical locations and plans to open 250 stores this year. Its revenue and profits are climbing and it envisions expanding to 5,600 stores worldwide over time.
The Framingham, Mass., company isn’t shifting business online or using big data to figure out what shoppers want. Instead, it has become one of the country’s fastest-growing retailers by sticking with a playbook from a vanishing era. It relies heavily on the instincts of its merchandise buyers, many of whom have been with the company for decades. TJX stores rapidly turn over limited quantities of products that are all sold at bargain prices. The result is a rarity in retail—a constant treasure hunt.
One size does not fit all.

Sunday, June 18, 2017

Weekend update

Happy Fathers' Day. 

Congress remains in session this week, here's a link to the Week in Congress's report on last week's activities on Capitol Hill.  Note that the House passed three healthcare related bills last week that essentially act as amendments to the American Health Care Act (left column of the link).  The Hill provides us with an outline of the Senate leadership working group's changes to that bill.

Tammy Flanagan discusses and compares FEHB plan prescription drug coverage here.  She advises
To get ready for the 2017 health insurance open season this fall, you may want to spend one of your lazy, hazy days of summer comparing prescription drug benefits between your FEHBP plan options. It could save you some out-of-pocket costs in 2018.
Her article explains how to engage in this exercise.

CMS has created a useful website for its statutorily mandated Social Security Number (SSN) Removal Initiative.  CMS is replacing the SSN with a new eleven character Medicare Beneficiary Indicator (MBI) on Medicare enrollment cards. The card replacement process begins next April and will end in April 2019.  As the FEHBlog understands it, CMS will use both the SSN (a/k/a HCIN) and the MBI in Medicare electronic transactions, such as cross over claims, until January 1, 2020. At that point only the MBI will be used. As there are over 1 million enrollees with Medicare coverage plus dependent spouses in the FEHBP, this is a transition that warrants FEHB carrier and annuitant attention.

Health Data Management reports on a new Advisory Board survey of consumer interest in telehealth services.
According to [that] survey, up to 77 percent of consumers would consider seeing a provider virtually, and 19 percent already have. The results suggest that the healthcare industry has largely underestimated and, to date, failed to meet consumer interest in virtual care. The Virtual Visits Consumer Choice Survey is Advisory Board’s ninth nationwide consumer choice survey designed to better understand the tradeoffs that consumers make when they need different types of care.
The article suggests that health care providers need to get on board the telehealth train.

Friday, June 16, 2017


It's a momentous day. The Trump administration issued its first ACA FAQ which is number 38. The FAQ concerns the mental health parity provisions of the 21 Century Cures Act which Congress passed last December.

Speaking of complicated laws, the OPM Inspector General issued its semi-annual report to Congress for the period ended March 31, 2016, yesterday.  The Inspector General demands that Congress extend the federal health care programs anti-kickback act to the FEHBP. The FEHBlog, as a lawyer, should be jumping up and down for joy over this demand because adding legal complexities mean mean more work for lawyers.

But he's not.  In 1996, as part of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Congress extended this anti-kickback act  beyond the  Medicare and Medicaid programs to all federal healthcare programs with the express exception of the FEHBP.  This was not an oversight. The House Ways and Means Committee explained in its contemporaneous report that
the Committee decided that the current anti-kickback statute is not well suited to the Federal Employee Health Benefit Program (FEHBP) which operates more like a private sector program with a wide range of primarily managed care options for federal employees. The fee-for-service and entitlement nature of the Medicare program and other federal health programs give rise to potentially fraudulent or abusive practices that are not present in an environment with managed care coverage.
H. Rep. No. 104-496, at 83 (104th Cong., 2d Sess. 1996).  The Committee’s rationale applies equally if not more strongly over twenty years later as FEHBP carriers have increased their reliance on provider networks. See FEHBA § 8902(n).

On the general health care cost front, the government has come out with two interesting reports:
  • The Labor Department's Bureau of Labor Statistics reports on its "experimental disease-based price indexes, which adjust expenditures on disease for inflation." 
  • The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary released state-level health care spending data for the period 1991-2014.  "David Lassman, the lead author of the report noted that, 'recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal health care expenditure growth; however, during the 2009 to 2014 period, the variation in spending between the lowest and highest states was virtually unchanged.'” 
On the prescription drug cost front
  • The Drug Channels blog muses on CVS Health's recently announced approach to sharing manufacturer rebates with high deductible health plan members.  
  • Med City News reports that Mylans's high priced Epipen product will have market competition later this year. 
On Thursday, San Diego, California-based Adamis Pharmaceuticals received a nod from the FDA to begin marketing its version of the device. Shares of the NASDAQ-listed company spiked 50 percent following the news.
Via phone, Mark Flather, senior director of investor relations and corporate communications for Adamis, said the company won’t release a definitive price until the product launches in the second half of this year. The expectation is, however, that it will meet customers’ demand for a more affordable product. “We expect to be cheaper than the other offerings on the market,” Flather stated.
  • The Hill reports that the Trump Administration is developing an executive order on drug pricing.  
Executive orders can’t change or make laws, but they can be used to direct agencies to pursue certain regulatory actions.
One such policy under discussion could be to direct federal agencies to pursue value-based purchasing contracts for drugs. Value-based contracts require manufacturers and insurers to work together on payment for a drug based on how it performs.
Another policy that is under discussion would instruct agencies to pursue trade policies that would strengthen the intellectual property rights of pharmaceutical companies.
OPM began to encourage FEHB carriers to implement value based purchasing contracts a few years ago.

Tuesday, June 13, 2017

Tuesday Tidbits

The Wall Street Journal reports tonight that
A Republican congressman who helped shepherd the party’s health-care overhaul bill through the House last month predicted Tuesday that a final bill will pass the Senate and land on the president’s desk before August.  House Energy and Commerce Chairman Greg Walden’s estimate, described at The Wall Street Journal’s CFO Network meeting in Washington, suggests he is optimistic that Senate leaders will be able to meet a self-imposed July 4 deadline for passing their health legislation.
The Washington Examiner weighs in with an article about the ongoing Senate deliberations.

The major consulting firm, PwC, came out its Health Research Institutes's annual projection of next year's health care cost trend.
Heading into 2018, the healthcare industry appears to be settling into a “new normal” marked by more moderate fluctuations in a single-digit medical cost trend.  HRI projects 2018’s medical cost trend to be 6.5%—the first uptick in growth in three years.
Following health plan benefit design actions in the next Open Season, PwC expects the net increase to be 5.5%.  PwC describes the mid single digit growth to be unsustainable.  

PwC advises employers to consider the following actions:

  • Target work site health promotion programs to the right people.
  • Evaluate the value of drug spending.
  • Focus more on provider arrangements to tackle price.
PwC advises health plans to consider the following actions:

  • Look for ways to automate processes.
  • Consider alternative therapies.
  • Explore value-based purchasing with biopharmaceutical companies.
  • Take ownership of collaborating with pharmaceutical companies and providers to manage high-risk patients.
  • Be providers' partner in reducing medical costs.
Fierce Healthcare has a useful article summarizing the PwC report.  It also offers a follow up report from AHIP's Institute held last week in Austin, TX, on the observations that "health plan leaders shared some of the innovative ways their organizations are tacking the steep challenge of helping members live healthier lives." Good luck with that. 

Finally, the Hill tells us about a unanimous U.S. Supreme Court decision yesterday that will help speed cost saving biosimilar drugs to market. "The Court in Sandoz v. Amgen ruled 9-0 in favor of generic drugmaker Sandoz in a dispute with rival company Amgen. The court ruled that manufacturers of low-cost biosimilars don't need to wait an extra six months after FDA approval to launch their product." Yeah!

Sunday, June 11, 2017

Weekend update

Congress remains in session on Capitol Hill this week. Here's a link to the Week in Congress's report on last week's activities on the Hill.

The Centers for Medicaid and Medicare Services, which includes the HHS agency responsible for ACA implementation, CCIIO, has issued a request in the Federal Register seeking "recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets."  The comment deadline is July 12, 2017. Comments can be submitted on  It's another step in the right direction.

Last Friday, the FEHBlog noted a recently filed putative class action lawsuit against prescription benefit managers over Epipen pricing.  An Epipen is a device that allows a layperson, e.g., a parent, or  patient to self-inject a generic antihistamine drug to control a violent allergic reaction.  Mylan, the Epipen manufacturer, took advantage of an effective monopoly position to crank up prices.  The effective monopoly was on the delivery device which is FDA approved, not on the drug, as explained in this New York Times article.

The lawsuit raises an ERISA challenge to the current PBM pricing methodology which involves negotiation prices and manufacturer rebates.  The plaintiffs, who likely are enrolled in high deductible plans, would prefer to see the rebates converted to lower drug prices, rather than lower health insurance premiums.  This lawsuit, if successful, which the FEHBlog tends to doubt, has wide-ranging ramifications.

Morning Consult discusses some steps that the new FDA Commissioner Scott Gottlieb is contemplating to address drug pricing concerns. Specifically,
Gottlieb, a former deputy FDA commissioner, said he wants to improve the process for approving generic versions of  “complex” drugs such as EpiPens, which consist of an old medication that has a new delivery system. Another step the FDA will take, he said, is to publish a list of drugs that are off-patent and lack generic competition.
The FEHBlog also was impressed by this New York Times article about the innovative efforts undertaken by an  Albany NY regional health plan, the Capital District Physicians' Health Plan, to promote the use of generic drugs by network doctors. (Capital District Physician's Health Plan is an FEHBP carrier.)
As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year.
He’s on a different mission now: When he calls on doctors, he champions generic drugs that frequently cost pennies and work just as well as the kinds of expensive brands he used to push.
Instead of Big Pharma, he works for Capital District Physicians’ Health Plan, an Albany, N.Y., insurer. Instead of maximizing pill profits, his job is to save millions of dollars by educating doctors about expensive prescription drugs and the stratagems used to sell them.
“Having come from Big Pharma, I do really feel my soul has been cleansed,” Courtney said with a laugh. He formerly worked for Pfizer and Johnson & Johnson. “I do feel like I’m more in touch with the physicians” and plan members, he added.
A templatable idea, indeed.

Friday, June 09, 2017


Federal News Radio reports that as anticipated "The House Republican Steering Committee on Thursday recommended [South Carolina Rep. Trey] Gowdy for the chairmanship [of the House Oversight and Government Reform Committee which has FEHBP oversight responsibility], replacing Utah Rep. Jason Chaffetz, who is leaving Congress at the end of the month. Gowdy beat out Oklahoma Rep. Steve Russell. The full House Republican conference is expected to confirm the choice next week."  

A House Energy and Commerce subcommittee yesterday held a hearing to examine HHS's role in healthcare cybersecurity. It's clear that the subcommittee wants HHS to take the lead government role in this effort. HHS's testimony discusses its accelerated efforts to accept this responsibility. Inside Cybersecurity points out that during the hearing
The Department of Health and Human Services announced that it has formed a cybersecurity communications center that is focused on helping the healthcare industry respond to cyber attacks and restructuring department operations to assist those cyber-defensive measures in the wake of the WannaCry ransomware attacks last month.
The Healthcare Cybersecurity Communications Integration Center, or HCCIC, will have “initial operational capabilities” by the end of the month, HHS officials told the House Energy and Commerce oversight subcommittee today.
The new HCCIC -- which is modeled on a similar center at the Department of Homeland Security for sharing cyber-threat intelligence across industry sectors -- was established in response to the WannaCry attack that affected healthcare providers throughout Europe and the United States, and HHS is in the process of getting internal buy-off on the system before its established as a long-term response to evolving cyber threats.
HHS is working with its “legal teams” to ensure the liability protections offered under Cybersecurity Act of 2015 are applied to the sharing of information under the HCCIC, said Leo Scanlon, deputy chief information security officer at HHS, in informing lawmakers of the new HCCIC.
AHIP held its annual institute in Austin, Texas this week. Health Care Finance fills us in on an interesting panel of payer and pharma representatives discussing "the balance between innovation, the affordability of prescription drugs and how both organizations can work together."

On a related note, the Washington Post reports that "A group of prominent cancer doctors is planning a novel assault on high drug costs, using clinical trials to show that many oncology medications could be taken at lower doses or for shorter periods without hurting their effectiveness."  They formed a nonprofit called the Value in Cancer Care Consortium for this purpose. Bravo.

The FEHBlog's curiosity was piqued by this BNA article about a putative class action lawsuit contending large prescription benefit managers are responsible for high Epipen pricing. By downloading the complaint, the FEHBlog learned that the complaint alleges that the PBM defendants violated the federal law governing private sector benefit plans known as ERISA by negotiating higher rebates with drug manufacturers instead of lower prices. The FEHBlog will keep an eye on this case.

Fierce Healthcare tells us about a Robert Wood Johnson survey which finds that healthcare provider sponsored health insurers, another progeny of the ACA, are finding the row tough to hoe.
[O]f the 42 insurance companies created or acquired by provider systems since 2010, only four had reached profitability by 2015. Two more of the plans are currently up for sale, and five have gone out of business entirely, suggesting the current insurance environment “is not conducive to profitability for new provider-sponsored plans,” according to the report’s author, Allan Baumgarten. 
It's further evidence, assuming further evidence is necessary, that the ACA overreached in meddling with the U.S economy.

Tuesday, June 06, 2017

Tuesday Tidbits

Following up on Sunday's post about high dollar claims, a large health claims stop loss insurer Sun Life Financial reported that multi-million dollar health claims have increase 68% over the past four years. 
 * Cancer dominates the top 10 - Based on dollar amount and percentage of total stop-loss claims, malignant neoplasms and leukemia/lymphoma/multiple myeloma (cancers) took spots 1 and 2 on the top-ten catastrophic claims list, representing more than a quarter (26.7%) of total stop-loss reimbursements from 2013-2016;
* Breast cancer prevalence - Breast cancer is the most common form of cancer in the U.S., with an estimated 247,000 new cases reported in 2016, and an average paid claim amount of $147,100;
* Transplants costs are high - Bone marrow/stem cell transplants are the costliest transplant procedures, with an average paid claim cost of about $400,000. Transplants were the most common high-dollar claim condition among 20 to 39 year-olds;
* Highest individual claim - Of the top-10 conditions, the highest claim was $3.2 million, for malignant neoplasm (cancer). The attached chart details the highest claims in each top-10 condition;
* The top three highest-cost conditions - Leukemia, lymphoma and/or multiple myeloma (cancers); congenital anomalies (conditions present at birth); and malignant neoplasm (cancers) are more likely to result in million-dollar claimants due to their frequency; and
* IV medications tracked in the study pushed up costs - When looking at data on intravenous drugs, the report showed they accounted for 48% of total paid charges on the top five highest-dollar claimants. Of the 562 claimants exceeding $1 million between 2013 and 2016, 45 generated more than $1 million in high-cost intravenous medications.
The American Medical Association issued its annual physician practice benchmark survey.
Previous research has documented the long term trend away from physicians being practice owners and toward being employees as well as toward larger practice sizes (Kane, 2015). The new Benchmark data show that this trend continued through 2016. In fact, 2016 marked the first year in which less than half of practicing physicians owned their own practice—47.1 percent. This was about 6 percentage points lower than in 2012.
This is a clear consequence of the ACA.

The Wall Street Journal today reported on another interesting physician practice survey.
It is something nine out of 10 primary-care practices have said to at least one patient in the past two years, albeit more politely. According to research published last month in the journal JAMA Internal Medicine, 67% of nearly 800 practices reported dismissing one to 20 patients over two years while 15% reported dismissing 21 to 50 patients. About 10% reported dismissing no patients over the course of two years and 8% said they dismissed 51 or more patients.
The study was inspired by worries that patient dismissals may rise because some insurers are starting to reimburse doctors for health outcomes rather than services provided. That shift has been in the works, before the Affordable Care Act became law in 2010.
“The good news is in our study we found that no, it did not have an impact,” said Ann O’Malley, the first author on the study and a senior fellow at Mathematica Policy Research, a Princeton, N.J., policy-research organization. “The providers stuck with their patients. They did not seem to be worried that just because they were in this initiative and being measured on some sort of quality metric that they needed to cherry-pick their patients.”
Finally, the FEHBlog ran across this Health Data Management article about a successful initiative to increase the number of skilled practitioners to treat autism.   Here's a Science Daily article about the Project ECHO autism program which is based at the University of Missouri.
Launched in March 2015, ECHO Autism is a partnership between the MU Thompson Center for Autism and Neurodevelopmental Disorders, MU Health, and the Missouri Telehealth Network Show-Me ECHO program. ECHO Autism clinics are conducted using high-quality, secure video conferencing technology to connect participating primary care clinics to a panel of experts.
Initial studies of the program have found that participating primary care providers demonstrated significant improvements in confidence across all sectors of health care for children with autism, including screening and identification, assessment and treatment of medical and psychiatric conditions, and knowledge of and referral to available resources.
The project is being expanded to Alabama and Alaska among other geographic areas.

Sunday, June 04, 2017

Weekend update

Congress is back in town this week.  On Thursday morning, the Oversight subcommittee of the House Energy and Commerce Committee will hold a hearing on the Health and Human Services Department's role in healthcare cybersecurity.

In a bit of good news, Modern Healthcare reports
As hospitals begin to control costs more consciously in a value-based environment, they are asking staffers to be more frugal.  "There's a paradigm shift that's happening across the country in terms of cost of care," said Dr. Jay Bhatt, chief medical officer for the American Hospital Association, adding that clinicians are taking an increasingly active role in fiscal responsibility—mostly as a result of uncertainties in the industry. 
Uncertainty is a common sense reason for cost control. In contrast, Business Insider discusses the case of patient who costs his ACA health exchange plan $1 million per month.   The article which interviews a Kaiser Health Foundation leader explains  
The community rating, a provision of Obamacare, obligates insurers to price premiums the same for people of the same age in the same area. This prevented people with preexisting conditions from being charged more than healthy people and getting priced out of the market.
Without that provision, an insurance company could raise premiums for a sick patient substantially to offset some of their costs, but the price could be so high that it would be financially crippling for the patient's family.
Additionally, the ACA eliminated lifetime limits for insurance plans. Before the ACA, insurers could set a cap on how much they would pay out to a patient over the course of their life.
The FEHBlog does wonder if the cost of care significantly increased because of the certainty of third party payment.  In any event, these types of consumer protections have existed in the FEHBP since well before ACA enactment in 2010.  The article does note that the proposed American Health Care Act would include an invisible risk pool that would help individual health insurers with these outliers cases.    

AHIP writes about health insurer efforts to integrate mental health and other medical care.  That's encouraging.

Friday, June 02, 2017

Supplement to Postal Reform Update

A reader expressed concern to the FEHBlog that the Postal Reform Act would be a bad deal for Postal annuitants. The FEHBlog wishes to dissuade readers from this viewpoint. The Postal Service is pushing for this aspect of the bill because it expects that fully integrating the new Postal Service Health Benefit plans with Medicare will lower FEHB premiums for all PSHB enrollees.  That's the FEHBlog's expectation too.

Postal reform update

Yesterday, the Congressional Budget Office issued its report on the House Oversight and Government Reform Committee's bipartisan postal reform bill.  "CBO estimates that enacting H.R. 756 would reduce direct spending by about $6 billion over the 2017-2027 period; therefore, pay-as-you-go procedures apply. Enacting H.R. 756 would not affect revenues."  This appears to the FEHBlog to be the green light for Congress to continue pursuing enactment of this law which would create a separate Postal Service Health Benefits Program within the FEHBP.

Thursday, June 01, 2017

Midweek update

Today FEHBP carriers can breathe a sigh of relief as the 2018 benefit and rate proposal submission deadline now has passed.

Drug manufacturers can't as NPR reports the Ohio Attorney General has filed a lawsuit seeking to hold five prescription drug manufacturers financially liable for the opioid crisis in that State.  The Wall Street Journal understandably sees parallels to, and distinctions with, the State Attorneys General lawsuit against the tobacco companies which was settled in 1998.  This no doubt will be an   intensively litigated lawsuit that will prompt more.  Medicaid has spend a ton of money on this problem which still exists.

Speaking of prescription drugs, Healthcare Dive discusses new value based reimbursement models used in a recent contract between Optum and Merck.

Closing the loop, Healthcare Dive reports that the Texas Governor has signed into law the State legislatures bill that allows telehealth vendors to operate in that large, populous State.  "The relaxed restrictions allow direct-to-consumer telehealth vendors like Teladoc, American Well and Doctor On Demand to establish videoconferencing operations nationwide."

Fierce Healthcare reports on a study showing that every reason still exists for health plans to use benefit designs that avoid unnecessary emergency room utilization.

Finally, CMS introduced on Tuesday a new Medicare enrollment card that uses "a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019."