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Harlingen CISD benefits staff: GLP-1 drugs were miscoded by carrier; $800,000 credit and a 2022 claim reimbursement will improve projections
Summary
Benefits staff told Harlingen CISD’s benefits committee that a carrier coding error led to GLP-1 (weight-management) prescriptions being included in pharmacy claims, and that Blue Cross has fixed the error and is expected to return roughly $800,000; staff also expects a reimbursement of about $625,000 on a 2022 claim related to stop-loss limits.
District benefits staff told the Harlingen CISD benefits committee that recent pharmacy-cost growth reflected two accounting issues that will materially improve the district’s near-term fund projections once corrected.
Scott Gibbs, a benefits consultant, reported that Blue Cross had misapplied benefit configuration for GLP-1 medications (weight-management exclusion settings), which caused the district’s pharmacy claims to include prescriptions intended to be excluded. “They checked the wrong box,” Gibbs said. Staff said Blue Cross fixed the…
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