Board reviews health benefits contracts, recommends Prime Therapeutics for pharmacy; explores district wellness clinic

Trustees spent significant time July 29 on employee-benefit procurement and plan design as part of the action agenda and budget discussions.

District staff and a benefits consultant presented results of recent requests for proposals for the pharmacy, stop-loss and dental plans. The board was told that Prime Therapeutics — the district’s current pharmacy benefit manager (PBM) — submitted a proposal that, after negotiations, guarantees higher rebates for the district than other bidders. The consultant said the district secured a roughly 32% increase in guaranteed rebates for the 2026 plan year compared with current guaranteed amounts, which staff estimated improved expected rebates by about $600,000 through contract negotiations.

On stop-loss coverage, staff reported the number of contract “lasers” (specific high-cost claim exclusions) would decrease from five to two under the new proposal and that the district is monitoring a claimant approaching $700,000 in paid claims. The district said it reviews claims regularly and that the proposal’s reduced lasers and premiums would be manageable for next year.

Trustees also approved a new dental carrier chosen after an RFP; the vendor proposed the same rates and plan design the district currently offers, including coverage for nearly 800 retirees who participate in the retiree dental plan. Staff said the new dental agreement carries a three-year rate guarantee and preserves the plan’s current design.

Board members raised access and cost concerns for employees using urgent-care and emergency-room services. One trustee suggested negotiating direct contracts with local urgent-care centers so staff could use those clinics at lower copays instead of visiting ERs. The superintendent and benefits staff said the district already has direct contracts in place for some lab work and that the district has considered a district-operated wellness/urgent-care clinic; they said this option can be explored further in a future insurance workshop.

Several trustees asked that staff improve employee education about plan benefits, particularly diabetes-related coverage that the district said provides $0 copay for certain diabetic supplies and preferred insulin for qualifying members. Staff described an active insurance committee that meets monthly, receives stipends and shares plan information with campuses.

Trustees approved the action items for the health plans by voice vote. Board discussion signaled an interest in exploring a district wellness center or direct urgent-care arrangements to reduce ER utilization and out-of-pocket costs for employees and their families.