A benefits broker update to commissioners July 28 said Montgomery County’s self‑funded health plan continued to get strong PPO discounts through Aetna, but pharmacy spending has risen sharply this year and now accounts for about 40% of paid claims year‑to‑date.

Representatives from the county’s broker reviewed 2024 plan performance (total plan cost about $2.89 million in 2024) and three months of 2025 data. The county’s aggregate attachment point usage was 68% for the 2024 plan year and about 47% so far in 2025; the broker noted that low aggregate attachment rates are good for the county but that monitoring high‑cost claims remains important.

Pharmacy costs rose from 23% of total spend last year to roughly 40% year‑to‑date, driven in part by high‑cost diabetes and GLP‑1 therapies (Monjaro, Ozempic and similar products) and some ADHD medications. The broker noted the county’s plan excludes anti‑obesity coverage absent a diabetes diagnosis but that diabetes‑indicated products can still drive pharmacy spend when used for metabolic conditions.

The broker described a script‑sourcing program the county began in mid‑2022 that has generated roughly $120,000 in documented savings to date and reported an outstanding opportunity list of about $230,000 in potential additional savings if members migrate to script‑sourcing; the firm keeps a 20% fee on demonstrated savings. Broker staff recommended evaluating a diabetes‑focused member support program (coaching, monitoring supplies, adherence supports) as a 2026 “bolt‑on” to lower high‑cost chronic therapy usage and said they will continue to monitor high‑cost claimants who approach the specific deductible.

Commissioners asked about coverage for weight‑loss drugs. Broker staff said anti‑obesity drugs are not covered absent the qualifying diabetes diagnosis; when a diabetic diagnosis is present, drugs such as Ozempic or Monjaro can be covered and are expensive (typical per‑fill plan costs in the thousands of dollars). The broker reported no reimbursement yet for 2025 aggregate stop‑loss (reimbursements totaled $367,000 in 2024) but said top claimants this year may produce a reimbursement later if they exceed the specific deductible.