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Missoula County approves 10% increase to employee medical premiums for FY2026
Summary
Commissioners approved a 10% across-the-board increase to the countys medical premium rates, citing sharp rises in specialty pharmacy costs and hospital facility charges; plan amendments to out-of-network coinsurance and pharmacy program participation were also approved.
The Missoula County Board of Commissioners approved a 10% increase to employee medical premium rates across plan tiers, effective July 1 for fiscal year 2026.
County benefits staff told the board the increase responds primarily to rapidly rising pharmacy costs and growing facility claims. "The primary driver, again, remains pharmacy benefit spend," a county benefits administrator said during the meeting, adding that specialty pharmaceuticals have become more common and "its not uncommon for our plan and other employer funded plans to see a fair number of members receiving drugs that are in the 5 to $10,000 a month range."
Officials also cited rising hospital and personnel costs. The benefits presenter said local facilities reported substantially higher nursing costs and that the county has begun to see facility contract rates that are multiple hundreds of percent of Medicare: "When we say a percentage, these are in the hundreds of percents ... between a 200% and a 300% of Medicare ... in some spaces, we're seeing our line costs reach up to 500 to 600% of Medicare costs," the presenter said on the record.
To address cost pressures, the board approved two plan amendments included with the rate change: - Change out-of-network coinsurance from the current 70/30 split to a 50/50 split to give the plan negotiating leverage with local facilities. - Require members who would benefit from third-party pharmacy assistance programs to engage with those programs so savings can pass through to the county plan; staff said foundations often will pay a large share of specialty drug costs but members must apply directly.
The benefits presenter said the countys plan has seen pharmacy spending rise from roughly $1 million a year to similar amounts in a single month in recent years; weekly pharmacy invoices were described on the record as between about $80,000 and $200,000. The presenter also noted that roughly eight years of plan experience informed discussions about other options (for example, assessing whether employees with other government health coverage might reduce county costs), but staff emphasized the need to maintain benefits for affected employees.
A commissioner moved to approve item 6 (the premium increase and plan amendments); the motion was seconded and approved by voice vote. The transcript does not include a roll-call tally.
The record did not specify projected premium revenue, actuarial analyses, or the number of employees affected beyond a general reference to the county plan population. The presenter described the county as a self-funded employer plan serving roughly 2,500 lives, but a precise headcount on the record was not provided.
