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Adams County reviews health-plan claims, eyes pharmacy and TPA changes to curb costs
Summary
At a commissioners meeting, USI Insurance Services reviewed the county's health-plan claims through April and recommended deeper review of pharmacy contracts, third-party administrators and wellness incentives to manage rising fixed costs.
At a meeting of the Adams County Board of Commissioners, Jordan, a USI Insurance Services consultant, presented the county’s health-plan claims through April and urged further review of pharmacy contracts and third-party administrators to control costs.
The presentation showed expected year-to-date claims of $622,585 and a net performance to date of $604,308, which Jordan described as “performing relatively well as it relates to expected claims cost at 97.1%.” The county’s enrollment was 67 employees; USI calculated a per-employee annualized claims cost of $10,888 and a total per-employee-per-year cost including fixed expenses of $17,699 if current trends continue.
The report highlighted three drivers: a small number of large claimants tracked separately from aggregate stop-loss, rising pharmacy spending (about half of current claims), and the impact of network and vendor choices. Jordan said the county has seen pharmacy savings from the county’s Prudent Rx program, “about a 10 to 12% savings,” but recommended pursuing additional pharmacy vendors and a partner that offers transparency and clinical support.
Why this matters: employee health benefits are one of Adams County’s largest nonpayroll expenses and affect budgeting for 2026. Jordan told commissioners he expects to provide a preliminary budget projection after June data is in and to return with stop‑loss and renewal numbers in late summer.
Discussion and next steps included: continued benchmarking of county contributions (no change to employee premium contributions since February 2016), evaluating pharmacy benefit managers (PBMs) and alternative vendors, and a possible request-for-proposal process for third-party administrators (TPAs). Jordan recommended a measured transition if the county changes vendors: “the best approach…is give it, you know, grandfather everything in for the first, you know, quarter or 6 months,” so the county can gather real data before imposing programmatic edits such as mandatory generics or step therapy.
Commissioner Doug asked about leveraging a county hospital pharmacy; Jordan replied that some vendors could include that option in a partnership but that the county would need to see data before changing arrangements. Jody (county staff) and Shannon (county benefits coordinator) were identified during the discussion as staff who will work with USI on benchmarking and vendor reviews.
Commissioners and staff also discussed wellness programs and participation in annual health screenings. Jordan and staff noted prior participation increases after expanding screening services and said financial incentives typically change participation materially. Jordan said USI will return with a benchmarked budget estimate after receiving June data, and the benefits team will present further details on pharmacy and TPA options during renewal discussions in September–October.
Ending: The board did not take formal action beyond accepting the presentation; USI will provide a budget projection and continue vendor review work for the commissioners to consider ahead of renewal.
