Albany County approves contract with Health Insurance Solutions Inc. for employee prescription administration

The Albany County Board of Commissioners voted during a regular meeting to approve a contract with Health Insurance Solutions Incorporated (HISSE) to administer the county's prescription drug program for employees and covered members.

Shannon, a representative of Health Insurance Solutions Incorporated, told the board the county has worked with HISSE since 2020 and that the program "provides outreach to patients for review on potential cost reductions for alternative medications to treat covered members illness and injury while ensuring equal or better outcomes." She said pharmacy costs per covered life fell from about $2,900 in 2020 to roughly $2,600, a 9.9% reduction, and that the county realized about $1.4 million in savings from 2020 to 2021.

The vendor described the work in three phases: a reduction of the 29 most expensive specialty drugs that the presenter said saved about $6.8 million; a pharmacy benefit manager (PBM) contract rebate audit that saved roughly $1.1 million; and further work during 2022'24 accounting for about $8.4 million in savings. Shannon summarized those figures as a grand total of $16.3 million in savings since the partnership began.

Why it matters: county officials said the contract aims to lower prescription costs for Albany County employees while preserving access to needed medications. Commissioners asked about how the program interacts with the county's medical carrier, appeal timelines for denied drugs, and whether co-pay tiers would change.

During questions, a board member who identified himself as Todd Drake asked whether the program could deny coverage when a prescribed medication has no generic alternative and whether that would impede an employee's access to needed medication. Shannon replied that the program uses "peer to peer" reviews between prescribing physicians and the plan's clinical reviewers and that, when medically necessary, drugs can be approved following that review. She also said that when an initial denial occurs the vendor and county typically provide an answer within 24 hours and that a state-level appeal process exists for further review if needed, which requires additional medical documentation from the prescribing physician.

A commissioner asked how the HISSE service works alongside Anthem and Express Scripts; Shannon said HISSE works with the county's prescription administrator and with manufacturers to seek lower out-of-pocket costs for employees and that there is "no gap in coverage" for members on Anthem/Express Scripts. The board was told that the county and HISSE hold weekly standing meetings to review issues and stay ahead of concerns.

On copay structure, a board member noted "nothing's changed there," and the administration confirmed the county's 15/30 copay tiers remain unchanged under the contract. A commissioner also asked whether the RFP process had an evaluation committee; Shannon replied the RFP responses were scored, but no further details about committee composition were provided during the meeting.

Motion and vote: a motion to accept the HISSE contract was made on the floor and was seconded by Ray Joyce. The board chair called for the vote and received unanimous "ayes." The board approved the contract.

Votes at a glance: the board also approved the previous meeting's minutes by unanimous consent earlier in the session. Later in the agenda, a separate item to amend various resolutions revising board compositions was moved to table and was tabled. The meeting concluded after a motion to adjourn passed by voice vote.

What was not specified: the contract length and dollar value were not stated during the discussion; the transcript did not specify which individual moved to accept the HISSE contract by name (the second was recorded as Ray Joyce). The record indicates the county has partnered with HISSE since 2020 but does not provide the contract start or effective dates.