The Federal Employees Health Benefits (FEHB) Program offers a variety of health plans to federal employees and retirees. Some of these plans have recently introduced a new benefit for members who are also enrolled in Medicare Part A and/or Part B: the Medicare Prescription Drug Program (MPDP). MPDP is a Medicare Part D plan that coordinates with FEHB to provide prescription drug coverage. MPDP is available as a standalone Prescription Drug Plan (PDP) or as part of a Medicare Advantage Prescription Drug plan (MA-PD).
MPDP aims to lower out-of-pocket costs for prescription drugs and provide additional approved drugs in some tiers than the traditional FEHB pharmacy benefit. MPDP also has a cap on the amount that members pay out-of-pocket on prescriptions annually. MPDP is offered at no extra premium for eligible FEHB members.
However, MPDP is not mandatory for FEHB members who have Medicare. They can choose to keep their existing FEHB pharmacy benefit, which is considered creditable coverage, meaning it meets or exceeds Medicare’s minimum standards. They can also enroll in a different Part D plan outside of FEHB, but they may lose some of their FEHB benefits if they do so.
To help FEHB members decide whether to enroll in MPDP or not, here are some examples of how MPDP compares to the traditional FEHB pharmacy benefit for three different FEHB plans: FEP Blue Focus, Basic Option, and Standard Option. The examples are based on the 2024 plan year benefits and assume that the members have Medicare Part A and/or Part B as their primary payer.
| FEHB Plan | Traditional Pharmacy Benefit | MPDP Pharmacy Benefit |
|---|---|---|
| FEP Blue Focus | – Tier 1: $5 copay <br> – Tier 2: 40% of our allowance ($350 max) <br> – No mail service or specialty pharmacy benefit <br> – No annual pharmacy out-of-pocket maximum | – Tier 1: $5 copay <br> – Tier 2: 40% of our allowance ($350 max) <br> – Tier 3: 40% of our allowance ($350 max) <br> – Tier 4: 40% of our allowance ($350 max) <br> – Mail service and specialty pharmacy benefit available <br> – Annual pharmacy out-of-pocket maximum of $3,250 per member |
| Basic Option | – Tier 1: $10 copay <br> – Tier 2: $50 copay <br> – Tier 3: 50% of our allowance ($60 min) <br> – Tier 4: $80 copay <br> – Tier 5: $100 copay <br> – Mail service and specialty pharmacy benefit available <br> – Annual pharmacy out-of-pocket maximum of $6,000 per member | – Tier 1: $10 copay <br> – Tier 2: $50 copay <br> – Tier 3: 50% of our allowance ($60 min) <br> – Tier 4: $80 copay <br> – Tier 5: $100 copay <br> – Mail service and specialty pharmacy benefit available <br> – Annual pharmacy out-of-pocket maximum of $2,000 per member |
| Standard Option | – Tier 1: $10 copay <br> – Tier 2: $35 copay <br> – Tier 3: 50% of our allowance ($60 min) <br> – Tier 4: $80 copay <br> – Tier 5: $100 copay <br> – Mail service and specialty pharmacy benefit available <br> – Annual pharmacy out-of-pocket maximum of $6,000 per member | – Tier 1: $10 copay <br> – Tier 2: $35 copay <br> – Tier 3: 50% of our allowance ($60 min) <br> – Tier 4: $80 copay <br> – Tier 5: $100 copay <br> – Mail service and specialty pharmacy benefit available <br> – Annual pharmacy out-of-pocket maximum of $2,000 per member |
As the table shows, MPDP offers lower out-of-pocket maximums and more drug tiers than the traditional FEHB pharmacy benefit for all three plans. However, the copays and coinsurance for each tier may vary depending on the plan and the drug. Therefore, FEHB members should compare their current and expected drug costs under both options before making a decision.
MPDP is one of the changes that resulted from the Inflation Reduction Act (IRA), which was enacted in 2023 to lower prescription drug costs for Medicare beneficiaries and the federal government. The IRA also included other provisions that affect Part D plans, such as capping insulin prices at $35 per month, eliminating the 5% enrollee share in the catastrophic coverage phase, and limiting Part D premium growth to no more than 6% per year. These provisions will be implemented gradually from 2023 to 2025.
FEHB members who are interested in enrolling in MPDP should contact their FEHB plan or visit their plan’s website for more information. They can also find more details about MPDP and how it coordinates with Medicare on the FEP Blue website. MPDP is a voluntary benefit that FEHB members can choose to enroll in or opt out of during the annual open season or when they have a qualifying life event. MPDP is not available for all FEHB plans, so FEHB members should check their plan’s brochure or website to see if it is offered. MPDP is a Medicare Part D plan, so FEHB members who enroll in MPDP will receive a Part D card and a Part D Explanation of Benefits in addition to their FEHB card and FEHB Explanation of Benefits.
MPDP is a new option that may benefit some FEHB members who have Medicare, especially those who have high prescription drug costs. However, MPDP is not a one-size-fits-all solution, and FEHB members should weigh the pros and cons of MPDP and the traditional FEHB pharmacy benefit based on their individual needs and preferences. MPDP is not mandatory for FEHB members who have Medicare, and they can keep their existing FEHB pharmacy benefit if they are satisfied with it. FEHB members who have Medicare should also consider other factors, such as whether to enroll in Medicare Part B and whether to choose a Medicare Advantage plan, when making their health care decisions. FEHB members who have Medicare should review their options carefully and consult with their FEHB plan, Medicare, or a trusted advisor before making any changes to their health care coverage.
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