County health plan ran slightly above expectations; consultants propose PBM review and network changes

Beth, the county's underwriter/analyst, reviewed 2025 year-end plan performance and market context, saying the county's active plan finished the year at about 106.3% of expected and reporting a per-capita cost of $25,091 on the Blue Cross plan. "You ended the year at a per cap of 25,091 on the Blue Cross plan," Beth told the committee.

Beth and the consulting team traced much of the recent volatility to large claimants and market changes in Medicare Advantage and specialty drugs. She noted the county's pharmacy share is lower than national benchmarks because inpatient and outpatient costs make up a larger portion of the county's spend. Beth highlighted that some recent market shifts (including coverage changes for GLP-1 medications and the introduction of biosimilars for certain autoimmune therapies) affect future pharmacy costs and rebate dynamics.

To reduce future cost pressure the consultants recommended multiple strategies: an RFP and contract review of the county's pharmacy-benefit manager and PBM-related arrangements (the Marsh McLennan MMA Rx Solutions team will present an analysis at the June meeting), consideration of a higher-performance provider network (Blue Choice Options) to capture deeper discounts where feasible, and additional contract and rebate negotiations. Beth said switching certain specialty biologic medications to biosimilars could yield considerable savings (the presentation projected approximately a 50% reduction in cost for the drugs identified where biosimilars are available).

Beth also reviewed member-engagement metrics: about 62 people participated in the most recent on-site health screening out of 459 eligible (about 13.5%), and the HealthJoy app has roughly a 40% partial activation rate with measured savings just under $30,000, which the consultant said does not yet offset the service cost.

Chair Nancy Yerrick asked for a motion to accept and place on file the health insurance report; Doug Stockley moved, James Bailey seconded, and the committee voted all ayes to accept the report. The consultants noted they will return with more detailed PBM and contract recommendations at the June midyear meeting to prepare for the 2027 renewal.

Why it matters: Finishing the year above expected levels affects future premiums and stop-loss pricing. The committee approved placing the report on file and directed consultants to pursue contract analysis and cost-containment strategies ahead of future renewals.