Council hears detailed Aetna plan review as consultants recommend pharmacy audit

Robinson Bush/1Digital benefits consultants briefed the Titusville City Council on March 11 on the city's Aetna contracts and plan-management history, urging the council to renegotiate upcoming terms and consider an independent pharmacy claims audit.

The presentation, given by benefits consultant Gina Lucchini, recapped procurement history going back to 2011 and explained why Aetna was selected for the city's administrative services-only medical plan in 2019 and for dental and COBRA services more recently. "Hello. Good evening. My name is Gina Lucchini and I am your benefits consultant with 1Digital Robinson Bush," Lucchini told the council as she outlined RFP work, contract term dates and the consultant team's role.

Why it matters: consultants said recent legal and market changes — notably Florida's Senate Bill 1550 requiring greater PBM transparency and a pass-through of rebates — affect the structure of pharmacy rebates and administrative fees. Lucchini recommended negotiating the 10/1/2025 medical/pharmacy renewal, seeking a revised EAP renewal proposal and commissioning a comprehensive pharmacy claims audit to verify rebate guarantees and ensure the city is receiving all pass-through funds.

Key points from the presentation: - Contract history and scope: Robinson Bush/1Digital has supported Titusville's benefits procurement since 2011 and advised on multiple RFPs; Aetna now provides ASO medical/pharmacy, dental and EAP services, while some benefits (FSA, vision, Medicare Advantage) are with other carriers. - Pharmacy changes and compliance: because Aetna is owned by CVS, consultants flagged potential PBM conflicts of interest and noted that SB 1550 changes (effective for renewals on/after 10/1/2024) require removal of spread pricing, full pass-through of rebates and nonexclusive specialty networks. - Financials and guarantees: Lucchini said guaranteed pharmacy pricing and improved rebates were part of the 2019 award to Aetna and that the city's ASO administrative fees rose in the 2024 renewal (a $9.43 PEPY base increase plus a $5 pharmacy administrative fee), in part to reflect rebate pass-throughs to the city. - Rising pharmacy spend: consultants told the council pharmacy costs have increased in the double digits recently and cited growing GLP-1 utilization (weight-loss/diabetes specialty drugs) as a principal driver.

Discussion and follow-up: Council members asked for details on consultant fees and whether the firm acts as agent of record; Lucchini said the consultant engagement is project- or hourly-based and that Robinson Bush/1Digital does not accept commissions on these products. Council members and the mayor pressed on the size of rebates and whether the city had been underpaid; Lucchini said industry benchmarking suggested the city might have received roughly $400,000 in rebates while market benchmarks pointed toward a larger market value (she relayed an estimate near $526,000 earlier in the packet materials).

Lucchini reiterated three near-term actions she recommends to council and staff: request a revised EAP renewal proposal, negotiate the upcoming 10/1/2025 medical/pharmacy renewal now, and commission a comprehensive pharmacy claims audit and, if appropriate, an on-site rebate audit. She said her firm has added pharmacy consulting capacity since joining 1Digital and can assist with audits.

What council members said: Member Nelson framed the trade-off between budget constraints and employee retention, noting the city is a service employer; other members asked about alternative PBM/ASO options, whether the city could split pharmacy from medical contracts, and how much the consulting work costs (Lucchini estimated project fees or an hourly rate around $200 for some work).

Ending: The council did not take formal action on the Aetna contracts at the meeting but directed staff to continue contract reviews; consultants said they would provide written reports and on-site audit options for council consideration.