Clay County considers pharmacy carve‑outs, tiered enrollment and on‑site clinics to rein in costs

County staff and consultants urged multiple strategies to address rising medical and prescription costs, focusing on pharmacy management, enrollment tiers and access improvements.

The Bailey Group advised analyzing a pharmacy carve‑out to separate prescription management from the county’s medical claims. The broker said carve‑outs have produced significant rebates and savings for some self‑funded groups and that a targeted procurement and disruption analysis would be required to limit member disruption. “On a carve out strategy... it's really going to be better as your plan year comes,” the presenter said, describing prior analyses that showed substantial potential savings for large groups.

Consultants also recommended expanding tiering beyond the county’s current two tiers (employee only and family) to a four‑tier approach that could include a retiree plus spouse category. The goal would be to spread family premium costs more equitably and avoid large increases for single parents or small households. Commissioners asked for data on how many employees actually meet deductibles and how many would be affected by HSA timing changes (for example, moving HSA employer contributions from a single annual payment to a biannual or monthly schedule).

Another proposal under consideration is establishing on‑site or partnered clinics; presenters noted that clinics can keep claims off the larger plan and improve access in areas with long primary‑care wait times. The broker said Avicenna and other local clinic partners have existing arrangements in neighboring counties and could be options for pilot programs.

Commissioners directed staff to return with quantitative scenarios, including projected dollar savings, member‑level impact and how many retirees or employees would be affected, before any changes are adopted. No plan design changes were approved at the workshop.