If you’re thinking of enrolling in The Federal Employees Health Benefits Program (FEHB), there’s good news for you! The program has comprehensive prescription coverage for medications rolled into the program.
What’s more, the various plans participating in the program are quite generous about their drug benefits. The companies administering each plan offer competitively priced bids when designing their coverage to outdo their competition. This means better choices for you.
What is FEHB?
FEHB is a voluntary group health insurance program sponsored by the federal government. It encompasses the most extensive group health insurance program in the U.S.
Individuals covered under the plan include current employees, former workers, retirees, and their families. The monthly premiums are paid by the federal employment and the federal workers who choose to participate in FEHB.
How Good is the Prescription Coverage for Federal Workers?
A considerable advantage of the FEHB Program is that it drives competition and allows the consumer to choose the plan he or she feels is best. For example, you can apply for coverage through a federal employee prescription benefits provider like Blue Cross.
Pharmacy Benefit Managers, or PBMs, work on your behalf with various insurance companies to offer some fairly significant savings to you.
Pharmacy Benefit Managers and insurance companies strive to ensure that enrollees have access to the prescription medications they need. They do this by getting local and nationwide pharmacies near the plan’s participants to be part of their network. This is how most health plans work to get local providers to be part of the network.
The representatives for both sides, PBM and the insurance agency negotiate discounts from both pharmacies and manufacturers of medications to offer lower prices to covered employees.
Most health plans have a formulary of pre-approved medications for various health conditions. The formulary usually has received approval from specialists in various fields of medicine.
The majority of plans will stipulate that your physician prescribe your medication from the formulary’s list of recommendations to be covered under the plan. Often, this means that a generic prescription will be tried before being placed on a brand medication. Most plans will pay for a brand medication once a generic drug has been tried without receiving the desired result.
How Do I Choose the Best Plan for Prescription Coverage?
If you’re currently on any medications, you should consider reviewing the health plan’s formulary list of covered medicines before enrolling or choosing coverage.
You should also know that generic medications are much less expensive than brand name medications.
Typically, a health plan’s copay will be minimal with generic medications. On the other hand, copays for a brand medication can really add up, and there are times a health plan won’t pay for brand-name prescriptions without your doctor arguing the point of why you need to be on one.
For more information on what type of prescription coverage you can expect with the plan you choose, visit the Office of Personnel Management’s website on plan information.
Once there, you’ll be prompted to click on the state where you live. You’ll then be provided with a downloadable e-brochure with information on each health plan and its prescription coverage. It pays to review all of the information given to make an informed decision about which plan has the best prescription coverage.
When making a final decision, however, you’ll want to look at the big picture and consider the entire plan’s benefits. That includes its basic health benefits. You’ll want to assess each plan and factor in the cost of each plan.
A final word for retirees. Many former retired federal workers become eligible for Medicare when they turn 65. While it’s recommended in most cases that retirees take advantage of Medicare’s health plan enrollment, the OPM feels that coverage between FEHB and Medicare Part D, Medicare’s prescription plan, is comparable.
There are also disadvantages to dropping your FEHB coverage for Part D drug coverage, and OPM explains it in full detail.