OPM leans into 'well care' as it reshapes federal health plans for 2027

In late March, OPM released its annual call letter, including 2027 policy goals and initiatives for FEHB and PSHB carriers. The theme for next year will be “well care,” defined as “expanding [OPM’s] vision for benefits with a stronger emphasis on the physical and mental wellness of the whole person.”

While specific details depend on how carriers implement these initiatives, we’ve identified several items you’ll want to keep track of for next year.

Vaccine Access
Carriers must continue covering all vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS), including those for children and for shared clinical decision-making. All FEHB plans will continue making these recommended vaccines available without any additional cost.

Reproductive Services and Maternal Health
OPM is encouraging carriers to use screening bundles and outreach programs for women interested in becoming pregnant. They emphasize access to treatments for conditions that adversely impact fertility, including obesity, prediabetes and hypertension, to enhance the likelihood of conceiving naturally and completing a healthy pregnancy.

OPM also strongly encourages carriers to provide discounted rates for assisted reproductive technology (ART) procedures, like in vitro fertilization (IVF), if they are not covered by the plan.

Carriers are permitted to cover certified midwives, certified professional midwives and certified nurse midwives and must list these providers in their online provider directories.

Prevention and Treatment of Obesity
OPM continues to require that all FEHB plans provide at least one GLP-1 weight-loss medication and at least two additional oral anti-obesity medications (AOM). Carriers must use intensive behavioral therapy (IBT) prior to and while covering an AOM. IBT for obesity consists of:

• Obesity screening for adults using body mass index (BMI)

• Dietary assessment

• Intensive behavioral counseling and therapy to promote weight loss through diet and exercise

From the letter: “Prior authorization for any AOM must ensure the member has demonstrated and will continue participation in lifestyle interventions meeting the rigor of IBT before initiating treatment and while on an AOM.”

Carriers must also cover IBT programs for children aged 6 or older who have a BMI higher than the 95th percentile for their age and sex. These programs can be conducted at a primary care office or at a community-centered organization.

Gender-Affirming Care
While gender-affirming care for new patients ended this year, patients who were mid-treatment were allowed to continue in 2026. Next year, all treatment for gender-affirming care will end while still allowing for mental health services with licensed mental health providers.

TrumpRx
OPM mentions the TrumpRx initiative in the call letter and “encourages carriers to educate members” on price transparency. Currently, TrumpRx offers a limited selection of brand-name prescription drugs.

Federal employees can take advantage of the offers available on TrumpRx, but consider the following before you do so:

• Any drugs purchased through TrumpRx will be paid in cash outside your FEHB plan, and those expenses will not go toward your deductible or catastrophic limit.

• You may not always find a lower price on TrumpRx compared to your FEHB prescription drug coverage, so use your carrier’s price tool to see what you are currently paying to determine if there are savings.

• When comparing, make sure you use your medication’s correct form, dosage and quantity to ensure an apples-to-apples price comparison.

• Federal employees who can’t get GLP-1 weight-loss drugs approved in their FEHB plan can use TrumpRx for access to some of those medications.

Site of Care Optimization
To reduce costs, OPM is encouraging carriers to optimize the site of care where clinically appropriate. This includes reviewing their claims to identify strategies that ensure members receive their medically necessary services in the most efficient and cost-effective settings. OPM provides examples of freestanding, home-based and physician office-based infusion centers offering savings compared to outpatient hospital departments.

Digital Therapeutics
OPM encourages carriers to offer proven and cost-effective digital therapeutics as a complement to traditional treatments that may offer ways to manage or improve health conditions through software or other digital health technologies.

The Final Word
Besides these initiatives, federal employees may also see increased wellness incentives from their FEHB plans next year. OPM is strongly encouraging carriers to review their current programs and expand offerings.

Open Season gives federal employees and annuitants the opportunity to reassess whether their current plan still meets their needs. In addition to any new wellness offerings, be sure to review how the premium and benefits are changing in your current plan, as well as prescription drug coverage and access to providers. Carefully reviewing Section 2 of the official FEHB plan brochure, along with information on the carrier’s website, can help you make a more informed choice during Open Season this fall.

Kevin Moss is a senior editor with the Guide to Health Plans for Federal Employees provided by Consumers’ Checkbook. Watch more of his free advice and check here if the Guide is available for free from your agency. You can also purchase the Guide and save 20% with promo code GOVEXEC.