OPM calls on federal insurance carriers to promote ‘well care,’ cut costs

Key Points:

• The Office of Personnel Management (OPM) issued a March 31 call letter outlining new expectations for federal health carriers in the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs for the 2027 plan year, focusing on cost reduction and promoting a "well care" model.
• OPM encourages carriers to expand non-pharmaceutical health coverage, promote prevention, and implement cost-saving strategies such as "site of care optimization," while requiring documentation that all feasible cost reductions have been evaluated and incorporated.
• New requirements include the use of intensive behavioral therapy (IBT) for obesity management before coverage of GLP-1 weight loss medications, reflecting concerns over rapidly increasing spending on these drugs within federal plans.
• OPM mandates the removal of monetary incentives for pediatric and prenatal vaccinations to support individual vaccination decisions, and further restricts gender-affirming care coverage by eliminating insurance coverage for members mid-treatment starting in 2027, allowing only counseling services.
• Carriers are urged to enhance education and support for maternal health, including screening for fertility-impacting conditions and offering discounted rates for assisted reproductive technology, with all plan proposals due by May 31 ahead of the Open Season in late 2026.