Commissioners direct staff to include option removing weight‑loss drugs and switching telemedicine in draft budget

County benefits staff presented renewal offers from multiple carriers and four package options for the county’s employee health plan, and commissioners gave direction on two near‑term changes to include in the draft budget.

Swede Sullivan, joined by HR Director Lori Blattman and benefits staff, said the county solicited bids from eight medical carriers and found Cigna remained the most competitive. Cigna proposed an 11.4% renewal after negotiation; plan design changes could reduce the increase to 9.3%. Removing employer coverage of certain weight‑loss medications would reduce the renewal to about 6.7%. Combining plan changes and removing weight‑loss coverage would bring the renewal down further, to about 4.6%.

Sullivan told commissioners that the county currently covers roughly 83 employees for weight‑loss drugs at an estimated annual cost to the plan of about $700,000; the county insures approximately 560 employee subscribers and 990 total covered members (employees plus dependents). Staff noted 95% of private employers and many governments do not cover these medications and that usage and cost have grown rapidly since the benefit was added about three years ago. Benefits staff also listed known side effects reported with some of the newer weight‑loss drugs.

On telemedicine, Sullivan said the county currently pays roughly $28,000 a year to an external telemedicine vendor (Clever Health) and that Cigna will provide an integrated telemedicine product at no additional monthly fee. Commissioners expressed broad support for switching telemedicine enrollment to the insurer’s product to save the county about $28,000 while maintaining telemedicine access; staff said they will market the benefit internally to raise utilization.

After discussion about potential health impacts of removing coverage for weight‑loss drugs — including questions about whether patients requiring those medications for comorbidities would retain access — commissioners asked staff to explore options such as lower‑cost compounded alternatives, possible grandfathering or transition approaches, and whether a member opt‑in premium could be offered. Benefits staff said some lower‑cost compounded alternatives exist and that employees could purchase medications directly if the county did not cover them.

Chairman Morgan said he would place the budget with Option 3 (remove weight‑loss drugs and adopt Cigna telemedicine) into the draft FY budget for the board to vote at the regular meeting; he said commissioners could change the budget item during the meeting. Staff committed to follow up with detailed cost impacts and any transitional options to minimize abrupt disruption for members who rely on these medications.