The Jefferson County Health & Human Services and Finance & Rules Committee convened on September 30, 2025, to discuss significant developments in health insurance and prescription benefit management. The meeting featured a presentation by Insurance Director Matthew Roy, who outlined the results of the recent Request for Proposals (RFP) process for the county's health insurance services.

Roy emphasized the importance of evaluating four key criteria when selecting a Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM): the ability to administer benefits, pricing, network adequacy, and experience with self-funded benefits. The county's consultant played a crucial role in guiding the RFP process, which began in January and involved extensive evaluations.

The committee recommended continuing its partnership with UMR as the TPA for the next three years. UMR has been serving the county since 2018 and has consistently provided satisfactory service, with minimal claim issues. The competitive bidding process resulted in a reduction of administrative fees by approximately $20,000 annually, a positive outcome for the county's budget.

In terms of pharmacy benefits, the county has worked with ProAct since 2012 and has been pleased with their service. After evaluating proposals from seven PBMs, the committee unanimously approved a new contract with ProAct. This decision is expected to yield substantial savings of around $2 million per year, attributed to lower administrative fees, improved drug pricing, and increased rebates from ProAct.

The breakdown of the anticipated savings includes a $70,000 reduction in administrative fees, a $625,000 improvement in drug pricing, and an increase of $1.35 million in rebates. These financial benefits are significant, especially considering the county's annual claims range between $11 million and $12 million.

Overall, the meeting highlighted the county's commitment to maintaining quality health benefits while achieving cost savings for taxpayers. The successful negotiations with both UMR and ProAct reflect a strategic approach to managing health care costs effectively. As the county moves forward, these decisions are expected to enhance the financial sustainability of its health insurance programs.