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Weslaco hears quarterly health plan report as medical and pharmacy costs jump
Summary
City consultant reported a nearly 89% year‑over‑year increase in Oct–Dec health plan spending, flagged high‑cost weight‑loss/diabetes drugs and recommended requesting proposals and considering self‑funding and employee wellness measures.
Consultants told the Weslaco City Commission on Feb. 4 that the city’s health insurance plan is seeing a sharp cost increase and recommended seeking bids and boosting wellness offerings.
Roger Garza of Valley Risk Consulting told Mayor Adrian Gonzalez and the commission the city’s combined medical and pharmacy spending rose to $709,854 for October–December 2024, up about 89 percent from $375,682 in the same quarter the prior year. Garza said the plan’s 12‑month loss ratio reached about 124 percent and that high‑cost medications used for diabetes and off‑label weight loss — including Ozempic and related drugs — are a major driver of pharmacy spending.
The consultant said the increase reflected “behavior” in which elective surgeries and higher utilization clustered late in the year and that the city should seek competitive proposals, consider a self‑funded plan to gain more control of benefits and pharmacy costs, and explore on‑site clinic options and an expanded wellness program to reduce reliance on high‑cost drugs.
City staff told the commission that the current wellness program (a Blue Cross Blue Shield product called Well on Target) had only three active participants. Commissioners and staff discussed low enrollment, the enrollment process length (about 25 minutes, according to staff), and steps to boost participation including targeted outreach and offering in‑person help to enroll.
Commissioners asked whether alternatives to Ozempic exist and whether changing plan rules to cover supervised weight‑loss programs rather than high‑cost drugs could reduce costs. Garza said other FDA‑approved drugs exist but are typically approved for diabetes rather than weight loss, and that plan design changes and earlier, supervised weight‑management options could materially lower pharmacy spending.
Garza recommended issuing a request for proposals in the next three months and said a self‑funded structure would give the city more control over pharmacy management, clinic integration and wellness incentives. The commission did not take final action on the report but directed staff to bring more information at the next meeting on property and casualty insurance and on implementation options for wellness outreach.
Looking ahead, commissioners asked staff to increase employee outreach on the existing wellness program, examine incentives that could boost enrollment, and include property/casualty insurance updates at the next meeting.
