Board hears how new prescription payment process and GLP-1 drugs complicate rebates and costs

John and board members discussed prescription drug trends and rebate mechanics, focusing on recently expanded indications for GLP-1 drugs used for diabetes and weight loss. John said some high-cost drugs are increasing plan costs and that the countyaces a complex trade-off: narrowing the formulary might reduce direct spending on a particular drug but could also reduce overall manufacturer rebates and leave net costs unchanged. "If you start removing drugs from a formulary, it impacts other rebates on other drugs as well, not just the drugs that you remove," John said.

Board members asked whether generics or PBM (pharmacy benefit manager) restructuring could mitigate costs. John said some generics and pricing changes could help but warned the rebate structure and PBM negotiations mean no simple fix exists; he said staff and vendors will analyze options and report back next meeting.