Osceola school health plan sees 16% jump as pharmacy and large claims rise

The School District of Osceola County (SDOC) heard a detailed update in a July 2025 Plan Board workshop on the district’s self‑funded health plan, where the district’s actuary and benefits advisers said the plan is facing a 16% year‑over‑year increase in per‑member medical and pharmacy claims.

The increase is being driven about half by an unexpected rise in “large claim” cases — members with claims above $100,000 — and the other half by pharmacy spending, which staff said is up about 30% year over year. “In this most recently completed fiscal year, we've had 102 claimants at a $100,000 and above,” actuary Jay Miniati told the board, adding that cancers comprised roughly half of the ultra‑high‑cost cases this year.

Why it matters

The district’s plan runs about $80 million annually, staff said, with roughly $65 million paid in claims; a $6 million per‑year increase in monthly run‑rate (about $500,000 a month) is a material budgeting pressure. Under Florida law the district must hold a reserve (actuary cited Florida Statute 112.08) and the actuary presented projections showing how the plan’s reserve and projected expenses would look if plan design and contributions remain unchanged.

Details of the board briefing

Presenters described several linked drivers and mitigation efforts. Miniati, the actuary engaged for SDOC, broke the $65 million in claims into a large‑claim bucket (about $23 million) and everyday claims (about $42 million). On a per‑member‑per‑month basis the overall claim run was reported at about $586; pharmacy accounted for about $125 of that PMPM and had risen roughly 30% year over year.

Staff described the plan design features that aim to control costs while preserving access: a district health center that functions as a medical home, an on‑site retail pharmacy, mobile screening units (mammography, dermatology,…