Friday, March 28, 2014


OPM and AHIP held an interesting FEHBP carrier conference over the past few days. Federal News Radio,, and the Federal Times all covered the OPM Director's keynote speech.  The FEHBlog did learn a few things:

  1. OPM willl be implementing the ACA;s employer shared responsibility mandate for 2015 which in the FEHBlog's view is good news. OPM is collecting data necessary to estimate the impact of expanding FEHBP coverage to all federal employees who work on average 30 hours or more as calculated under the IRS's rules. 
  2. There are a few specialty drugs (injectables that require special handling, e.g. Gleevec) which are small molecule and therefore can be converted to generic upon patent expiration under the existing FDA approved regulatory pathway. A speaker from CVS/Caremark estimated that when the FDA creates the regulatory pathway for biosimilar drugs (large molecule drugs), the discounts will range from 10% to 40% in line with discounts for multibrand brand name drugs but not small molecule generics (75% discount or more for those).  He pointed out that the costs of developing biosimilar drugs will be much higher than the costs of developing small molecule generics. 
  3. There are 700 or so manufacturer sponsored specialty drug copay assistance programs which are disrupting health plan designs. 
  4. Blood pressure can be brought under control by prescription drugs alone. The Million Hearts campaign is promoting ABCS -- aspirin for those who need it, blood pressure control, cholesterol management, and smoking cessation.  Other lifestyle changes improve health but aren’t critical to controlling blood pressure. That's why it's so important for people with hypertension -- which affects one out of three adult Americans according to the CDC  -- to see a doctor. The FEHBlog had hypertension a few years ago, but he lost weight and takes hypertension, medication, statins for cholesterol management, and aspirin. His blood pressure is perfect now. The trick, of course, is maintenance. So the FEHBlog understands why OPM is promoting blood pressure control in the call letter. 
The House did pass another temporary / one year Medicare Part B payment fix yesterday that the Senate plans to take up on Monday. The American Medical Association, according to fierce,  is furious about this development which surprises the FEHBlog because the House bill extends the ICD-10 coding compliance date to at least October 1, 2015. We shall see. 

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