Board hears benefits review: medical claims fell but pharmacy costs rose; rebates partially offset increases

Lincoln Parish School Board members heard April 9 that plan changes implemented for the 2025 plan year reduced net medical-claim costs but that pharmacy spending rose and will continue to require management.

Jason Huffman of Brown & Brown told the board that after several actions taken late in 2024—switching the plan’s primary claims administrator to UMR, realigning employee/retiree contributions, and moving Medicare Advantage retirees to UnitedHealthcare—the district’s calendar-year 2025 medical-claim payments were “a little bit under 7 million,” down from roughly $9.4 million in 2024 (a decrease Huffman described as more than 26%). He said those changes were deliberately adopted to slow an adverse trend in per-member-per-month costs.

Pharmacy presented a contrasting picture: total pharmacy claims rose from about $5 million in 2024 to about $6.5 million in 2025, driven by high-cost specialty categories (oncology, inflammatory conditions) and newer drug classes including GLP‑1 agents. Heather Steel of OptumRx said GLP‑1s and several specialty drugs were among the top plan cost drivers and noted that the top five conditions account for a large share of pharmacy spend. She said plan-paid amounts are not the same as member out-of-pocket payments and clarified that some price differences shown are amounts charged back to the plan.

Brown & Brown and partners said contracting improvements produced higher rebate dollars—reported to have increased from about $1.7 million to more than $2.5 million—so that when rebates are included the net pharmacy trend improved (they estimated net pharmacy increase nearer to 11.5% year‑over‑year rather than the larger top-line increase). Huffman and UMR representatives also highlighted a reduction in the Lincoln Parish Medicare Advantage per-member-per-month cost after moving to UnitedHealthcare, which they said yielded more than $900,000 in first-year savings for the plan.

Presenters cautioned the board that projected 2026 top-line pharmacy expenses may rise again, in part due to broader adoption of GLP‑1 drugs and other novel treatments, and said the district’s pharmacy-management partnerships and rebate contracting would be a primary tool to mitigate those costs.

What’s next: Brown & Brown and the district’s pharmacy partners will continue to monitor trends, report updated rebate realization and cost projections to the board, and work on contracting and utilization strategies to manage high-cost drug categories.