Congress is considering risky changes to the popular Federal Employees Health Benefits Program that would disrupt prescription benefits for 8 million federal employees and retirees, reduce their choices and eliminate tools used by the program to save federal workers money.
The FEHBP Prescription Drug Integrity, Transparency and Cost Savings Act sounds promising at first blush. It promises more accountability, transparency and lower drug costs. However good its intentions, though, the bill uses an approach that would seriously undermine the ability of one of the nations best health benefits programs to continue preserving choice, quality, and overall affordability of prescription drug benefits. It would make FEHBP less able to accomplish its original goal of helping the federal government recruit and retain employees who might otherwise choose private-sector jobs with better benefits.
By any measure, FEHBP is a huge success. It has been routinely touted in the health reform debate as a national model for high-quality health care programs. A recent survey by the Office of Personnel Management, the agency administering FEHBP, found that federal employees are overwhelmingly satisfied with their current health benefits by a 7-1 margin. This is significant, since pharmacy benefits are the most often used part of the program. The bottom line is that FEHBP offers prescription-drug benefit programs that are as good as or better than those offered by many Fortune 500 companies.
Nonetheless, the goal of this legislation is to force OPM to take FEHBP in an entirely different direction. It wants the programs prescription drug benefits to operate less like those of savvy large employers and more like those of the Medicaid program for the poor. Currently, FEHBP relies on the same, sophisticated pharmacy benefit managers used by blue chip companies, Medicare Part D, and other successful programs to improve affordability. This bill would drive many well-regarded PBMs out of the program altogether and rely instead upon government price controls and micromanagement to do the job.
Practically speaking, this bill presents a number of challenges that could result in higher costs and fewer choices for federal workers:
It eliminates many of the tools that are successfully used by FEHBP plans and PBMs to reduce drug costs and increase drug safety. It forbids PBMs from informing doctors and pharmacists when safer, more affordable drugs are available.
It handcuffs PBMs ability to drive deeper drug discounts from drug companies and drugstores. By requiring plans to send FEHBP enrollees for each and every prescription the price paid to manufacturers for drugs and to pharmacies for dispensing them, the bill would effectively require PBMs to publicly disclose how they negotiate discounts from drug companies and drugstores throughout America. While the average consumer has little use for such information, drug makers and drugstores would find it immensely useful in their efforts to raise drug prices, according to the Federal Trade Commission, Congressional Budget Office, and numerous economists.