Freedom Claims tells commissioners county's self-funded plan is $44,000 ahead; specialty drugs drive most pharmacy costs

A Freedom Claims representative briefed Cheyenne County commissioners on the county's self-funded health plan performance and urged continued monitoring of high-cost prescription drugs that drive early-year claims.

"You guys have netted 44,000 to date," the Freedom Claims representative said, explaining that the county’s structure (a combination of carrier payments, Freedom Claims fees and a county reserve) had resulted in a net benefit compared with fully insured options. The representative noted that specialty drugs — a small share of prescriptions — account for the vast majority of pharmacy spending: "92% of your drugs are generic drugs. But of that 8% of specialty, they're driving 85% of your cost."

The presenter explained that deductibles restart at the beginning of each plan year and that high-cost prescriptions early in the year often create a spike in paid claims until deductibles are met. The representative described prior-authorizations and formulary management tools as mechanisms to manage specialty-drug spend and offered to continue market checks and periodic reviews for the county.

Commissioners asked clarifying questions about reported trends and employee experience. The representative said the observed higher trend is common and expected to moderate as the plan year progresses. No formal action was taken; the representative offered ongoing support and contact information.