Commissioners Discuss Employee Health Benefit Changes; Consider ER Copays, Specialty Drugs, Clinic Options

DuBois County commissioners on Monday reviewed options to control rising employee health-plan costs, including adding an emergency-room copay, evaluating specialty-drug coverage, moving case-management services to a different vendor and exploring a county clinic contract.

Rising specialty-drug spending was a focal point. A commissioner said county plan spending for specialty pharmaceuticals rose from about $80,000 in 2018 to roughly $675,000 in the prior plan year, a more-than-sevenfold increase. Staff noted specialty drugs are often groundbreaking therapies but are a growing driver of total drug spend.

Possible changes discussed: - Emergency-room copay: Commissioners discussed adding a copay — suggested amounts ranged around $200–$250 — aimed at discouraging nonemergency ER use and encouraging lower-cost care options such as urgent care or telemedicine. Commissioners noted standard exceptions could apply, including waiving the copay if the visit results in inpatient admission. - Specialty drugs: Commissioners explored the option of removing specialty-drug coverage from the employer plan to reduce costs; staff cautioned this could shift substantial financial burden to employees who rely on those medications. No decision was made. - Vendor change: County staff recommended moving high-cost-claim management from Hines to Care Connect based on cost and perceived service differences; commissioners signaled support for that vendor change and asked staff to proceed with evaluation. - Clinic/Wellness: Commissioners discussed a potential contract with Blue Mind Clinic for on-site or near-site wellness and primary-care services that could be open to employees and spouses. The county’s HR director said a clinic model has produced cost savings elsewhere and could supplement one-day wellness events that currently cost the county about $14,000.

Why this matters: Rapid growth in specialty-drug spending and high-cost emergency-room use are increasing plan expenditures and taxpayer-funded premiums. The board emphasized protecting a quality benefit for employees while exploring ways to control taxpayer costs.

Next steps: Commissioners asked staff and their benefits vendor to model the financial impacts of adding an ER copay, removing specialty-drug coverage, switching vendors for high-cost-claim management and contracting with Blue Mind Clinic. No formal policy changes were adopted at Monday’s meeting.