Boulder County commissioners on Aug. 28 accepted Benefits Advisory Board (BAB) recommendations for the county's employee benefits lineup in 2026, including a carrier change for medical administration, adjustments to the high-deductible health plan (HDHP) to maintain IRS compliance, and a recommendation to discontinue coverage of GLP-1 medications when used for weight loss.

County financial staff reported the health and dental insurance fund remained in a healthy position but that claims and pharmacy costs had increased in 2024 and again in 2025. "Through June, the plan is running at 104% of budget," said Paige Bilby, credentialed health actuary with MJ Companies. Her team highlighted pharmacy spending as a primary cost driver, noting rapid growth in use and plan payments for the GLP-1 class of weight-loss drugs (brand names cited in staff materials included Wegovy and Zepbound).

The BAB's recommendations reflect an RFP process and months of discussion. The panel recommended moving medical administration from Cigna to Aetna, which MJ's analysts projected would yield lower administrative fees and provider-discount advantages. The advisory board also voted to correct the HDHP design to a non-embedded family deductible (to ensure IRS-compliant HSA eligibility) and to restore a no-cost telehealth visit benefit that federal rules allowed through 2024.

The most consequential recommendation for county premiums was to discontinue coverage of GLP-1 medications when prescribed for weight loss (the board did not recommend restrictions on GLP-1 prescriptions for type 2 diabetes). MJ's analysis showed the county paid roughly $1.3 million for Wegovy and Zepbound in 2024; year-to-date 2025 totals had already approached or exceeded last year's spending. Removing coverage for weight-loss uses of these drugs accounted for about $1.2 million of projected 2026 savings in the consultant's forecast.

"Coverage for these drugs has and continues to be optional for employers," MJ's team told the board. The BAB considered alternatives (higher member cost share, quantity limits, prior program participation requirements, a lifetime maximum) but concluded the savings from restrictions would not approach the savings from exclusion. The board voted to recommend exclusion, citing rapid utilization growth and the effect on premiums for the broader employee population.

On the financial side, MJ Companies presented two forecasts: a status-quo scenario producing a projected 16.4% increase in total plan costs, and a forecast incorporating the BAB's recommendations that reduced the projected increase to about 8.2% for 2026. With the BAB recommendations, the county estimated it would maintain the existing 87% county / 13% employee cost-share on premiums. Commissioners approved the BAB package of recommendations.

Commissioners and staff discussed transition-of-care protections for employees whose providers might be out of network under the new carrier. Aetna and county benefits staff described a process to maintain coverage for members in active treatment and to assist employees in finding in-network providers during the transition, and the county said it will brief employees and hold additional open-enrollment sessions.

The board approved the BAB recommendations and asked staff to continue planning for communication, network transition and stop-loss procurement prior to open enrollment in October.