For 2027, OPM emphasized that FEHB and PSHB plan members should take a \u201cmore active role\u201d in their health. The agency is also encouraging carriers to expand non-pharmaceutical health coverage, which OPM said will \u201cprevent chronic conditions and drive meaningful cost savings.\u201d<\/p>\n
\u201cToday\u2019s health decisions shape outcomes for years to come,\u201d OPM Associate Director for Healthcare and Insurance Shane Stevens said Friday in a press release<\/a>. \u201cBy focusing on prevention and giving individuals the tools to take ownership of their health, our participants have enhanced opportunities to improve their health while ensuring a more sustainable program for federal employees, retirees and taxpayers.\u201d<\/p>\n ]]><\/p>\n Health plan participants have faced significant cost spikes over the last several years. For 2026<\/a>, enrollees in FEHB and PSHB began paying an average of 12.3% and 11.3% more, respectively, toward their health insurance premiums.<\/p>\n Amid the surging expenses, OPM is encouraging carriers to find \u201cinnovative\u201d ways to cut costs while maintaining \u201ccomprehensive\u201d coverage. That can include strategies such as \u201csite of care optimization\u201d\u2014 or in other words, incentivizing plan members to go to lower-cost medical care facilities whenever possible.<\/p>\n \u201cAll carriers must provide sufficient documentation demonstrating that every feasible cost reduction strategy was thoroughly evaluated and incorporated into their benefit and rate proposals to the greatest extent possible,\u201d Stevens said in the OPM letter.<\/p>\n Kevin Moss, a federal benefits expert and senior editor at Consumers\u2019 Checkbook Guide to Health Plans for Federal Employees, said some of the recommended cost-savings strategies, including \u201csite of care optimization,\u201d are already in effect behind the scenes from carriers. But Moss noted that plan members should be on the lookout for additional types of offerings, including what OPM described as \u201cdigital therapeutics,\u201d based on what OPM included in its call letter.<\/p>\n \u201cFEHB members could see new types of benefits show up in their FEHB plan next year, such as digital therapeutics and functional and lifestyle medicine, or an expansion of existing wellness benefits,\u201d Moss told Federal News Network. \u201cYou should also expect to see more member-facing education from carriers on preconception maternal health.\u201d<\/p>\n A different federal benefits expert, speaking anonymously to be able to speak candidly about the call letter, likened OPM\u2019s goals of maintaining benefits while cutting costs to squeezing a balloon from both ends.<\/p>\n \u201cThere are certain factors that have been driving these large increases the last couple of years, and they\u2019re not going away. How can carriers respond to this request of squeezing the balloon and not having it pop?\u201d the benefits expert told Federal News Network. \u201cI don\u2019t know how you can say, \u2018We don\u2019t want to shift more costs to members. We don\u2019t want premium increases. We don\u2019t want any cut in benefits. But we also want to add all these lifestyle benefits.\u2019 From where I\u2019m sitting, the pieces aren\u2019t going to fit together.\u201d<\/p>\n ]]><\/p>\n Notably, OPM\u2019s call letter, published on March 31, also came several weeks behind the usual schedule of releasing the letter in January or February. Carriers now have less than two months to align their benefits and adjust premium rates for the 2027 plan year.<\/p>\n An OPM spokesperson said the agency is \u201cconfident\u201d that carriers will be able to meet the statutory May 31 deadline to finalize their proposals. OPM said it will hold \u201cpre-proposal\u201d meetings with carriers, starting this week, to help address any questions.<\/p>\n \u201cCarriers have been closely monitoring major health care and insurance reforms under President Trump, and they recognize this year\u2019s call letter reflects OPM\u2019s alignment with the administration\u2019s priorities,\u201d the spokesperson said. \u201cWith this proactive approach and the flexibility to make adjustments during contract negotiations, we expect the process to move forward smoothly.\u201d<\/p>\n Weight loss treatments<\/p>\n In its call letter, OPM detailed its expectations across several health-related areas \u2014 including weight loss and obesity management, vaccine-related incentives, maternal health care and gender-affirming care.<\/p>\n For obesity treatment plans next year, OPM is calling on FEHB and PSHB carriers to revise requirements, as needed, for members before they can qualify for coverage of GLP-1 medications prescribed for weight loss.<\/p>\n For plan year 2027, OPM will require carriers to use a rigorous type of obesity management program called \u201cintensive behavioral therapy\u201d (IBT), both before and during getting insurance coverage of \u201canti-obesity medications.\u201d IBT programs are designed to promote weight loss through nutrition, physical activity and other behavioral changes.<\/p>\n Many carriers already have requirements for enrollees to complete before getting coverage for a GLP-1. It\u2019s not yet clear whether, or by how much, carriers will need to adjust their requirements in response to OPM\u2019s new call letter.<\/p>\n \u201cAttestation statements alone from members or providers of prior weight loss attempts should not bypass these requirements for a comprehensive approach to obesity management,\u201d Stevens said.<\/p>\n GLP-1 prescription drugs have grown in popularity over the last several years as a way for individuals to manage obesity. In 2024, OPM began requiring FEHB carriers to cover at least one GLP-1 drug, as well as at least two oral medications, that can be prescribed for weight loss.<\/p>\n ]]><\/p>\n A recent OPM office of inspector general report<\/a> found that FEHB pharmacy spending on GLP-1 medications increased by more than 500% in just a five-year span \u2014 from 2019 to 2024. Between 2023 and 2024 alone, the spending increased by $900 million. Data on GLP-1 spending during 2025 is not yet publicly available.<\/p>\n Despite a section of OPM\u2019s call letter discussing vaccines, there do not appear to be any changes to vaccination coverage for plan members \u2014 in terms of both the types of vaccines covered and the cost to members.<\/p>\n Carriers will continue to be required to cover all vaccines 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) \u2014 including all vaccines recommended for children, OPM said.<\/p>\n The Trump administration\u2019s CDC has sought to cut the number of\u00a0vaccines<\/a>\u00a0it recommends for every child \u2014 a move that is in the middle of litigation<\/a>. Leading medical groups have said the CDC\u2019s cuts would undermine protections against a half-dozen diseases, according to the Associated Press<\/a>. Regardless, coverage under the FEHB and PSHB is still required for all ACIP-recommended vaccines \u2014 including ones under scrutiny from the CDC.<\/p>\n For plan year 2027, OPM is making one vaccine-related revision: All FEHB and PSHB carriers are being told to remove any existing monetary incentives for enrollees who get pediatric and prenatal vaccinations, to \u201csupport members\u2019 independent judgment with respect to vaccination.\u201d<\/p>\n Some, but not all, federal insurance carriers may offer monetary incentives to enrollees who get certain vaccinations, such as an annual flu shot. Generally, these benefits allow enrollees to receive a limited amount of money that can be put toward other health care expenses \u2014 similar to a Flexible Spending Account. These wellness incentives, however, are mainly limited to plan members who are 18 years and older.<\/p>\n Despite no broad changes to vaccination coverage, OPM\u2019s call letter still leaned in on the idea of personal choice in vaccine decisions and referenced goals of the Trump administration\u2019s larger push toward the \u201cMake America Healthy Again\u201d agenda<\/a>.<\/p>\n \u201cVaccination coverage remains an important public health tool for protecting individuals and communities from preventable disease,\u201d Stevens said. \u201cHowever, the administration has emphasized that decisions regarding vaccination should be grounded in individual medical judgment and informed consent, particularly as it relates to pediatric and prenatal vaccinations.\u201d<\/p>\n Gender-affirming care<\/p>\n OPM\u2019s call letter will also bring further changes for insurance enrollees seeking coverage of gender-affirming care.<\/p>\n Beginning in January 2026, OPM required FEHB and PSHB carriers to largely terminate coverage of gender-affirming care for enrollees, with exceptions made for those midway through treatment. OPM also still allows for coverage of counseling services from licensed mental health providers, including \u201cthose who provide faith-based counseling.\u201d<\/p>\n Starting in 2027, OPM told carriers to additionally end all insurance coverage for plan members who are mid-treatment for gender-affirming care. The only coverage that will still be allowable from carriers relating to gender-affirming care is counseling services.<\/p>\n The Biden administration previously expanded<\/a> carriers\u2019 coverage requirements for gender-affirming care \u2014 a move that has been sharply reversed under the Trump administration.<\/p>\n OPM\u2019s decision to roll back gender-affirming care coverage has come under recent contention. A group of federal employees filed a complaint<\/a>, alleging that the coverage restrictions illegally discriminate against employees based on sex and disability.<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/04\/opm-oig-glp1-graph.png\")
Source: Office of Personnel Management, Office of Inspector General, December 2025.
\nVaccines<\/p>\n