The Horton Group told the LaSalle County Insurance Committee that the county’s self-insured health plan is running above the underwriter’s expectation through August, at 108.6% of projected cost and a per-capita spend of about $25,005.33 compared with an expected $23,005.00.

The difference is driven largely by a small number of very large claims and increased pharmacy costs, Horton Group representative Beth said. “We still have a quarter left, so with the next four months we could see this taper off if there aren’t any new situations because your plan does have protection on large claims over a $150,000 stop‑loss deductible,” Beth said.

Why it matters: committee members must weigh higher renewal pricing and stop‑loss terms against plan design and enrollee impacts ahead of the full‑board renewal decision. Horton Group said carriers and actuaries are still adjusting to new clinical and pharmaceutical risks, including gene therapies and high‑cost specialty medications.

Horton Group presented specific drivers: the plan has experienced a similar number of large claimants year‑over‑year but higher employer responsibility because carrier reimbursements under stop‑loss were lower this year. The consultant reported 12 claimants who exceeded 50% of the stop‑loss deductible in both years and five claimants this year above the $150,000 deductible (six last year); those claimants are materially affecting employer cost.

Pharmacy trends were highlighted as a major cost driver. Horton Group said the plan’s generic dispensing rate is strong (about 91%), and specialty drugs represent roughly 30% of pharmacy spend on the county plan. Newer GLP‑1 class drugs (marketed for diabetes and weight loss) have appeared in the plan’s top‑spend list; those drugs are covered on the county plan when used for type‑2 diabetes per clinical criteria, Beth said.

Horton Group noted biosimilars will likely reduce costs for some biologic drugs (for example, Humira and Stelara) beginning in 2026 as plans move to biosimilar preferred lists. “There will be only exceptionary situations where they’ll be able to take Humira,” Beth said, describing dose‑level and clinical exceptions that will preserve branded biologics in limited cases.

Committee members asked about non‑pharmacy approaches to reduce high‑cost conditions. An unnamed committee member asked whether the plan or providers offer counseling or lifestyle programs for conditions such as diabetes. Beth said Blue Cross provides nurse case managers who outreach to members after events that trigger notices, and the consultant described individual examples of case management calls and 45‑minute nurse conversations to coordinate care and benefits.

The committee also heard an update on HealthJoy, the benefit navigation app the county offers. Horton Group reported 352 eligible employees, 142 activated users and roughly $23,000 in documented near‑term savings from HealthJoy searches and referrals (about a 0.8 return on investment so far). Horton Group recommended continued member outreach and education before open enrollment to increase activation and use of telehealth, Rx searches and virtual behavioral health options in the app.

What was not decided: committee members received the monthly performance report for information and discussion; no plan design changes or final renewals were adopted at the meeting. Horton Group warned that final pricing for renewals will depend on stop‑loss market responses to ongoing large‑claim volatility.

Ending: Horton Group and staff will provide additional, itemized drug‑level detail on a few high‑cost specialty medications and will continue to monitor large‑claim activity before the next committee meeting.