Mercedes ISD reviews health plan performance and rising prescription costs

Texas Health Benefits Pool and district consultants reviewed Mercedes ISD’s employee medical claims and benefit utilization, noting a lower total medical spend for the 2023–24 plan year compared with 2022 but higher early‑year costs for the district’s 2024–25 plan.

In a presentation to the Mercedes Independent School District Board of Trustees, Keisha Rollins Contreras, account manager with Texas Health Benefits Pool, said the full reporting year for comparison ran Sept. 1, 2023, through Aug. 31, 2024, and the district’s current utilization figures covered Sept. 1–Dec. 2024. Rollins Contreras said the district’s medical payments for the 2022 plan year under UnitedHealthcare were about $4,325,037.90; for the 2023–24 year under Texas Health Benefits the medical spend was $3,476,261.78. For the first three months of the 2024–25 plan year, the pool reported $1,354,484.29 in paid medical claims and an early-period per‑employee‑per‑month (PEPM) of about $492.72.

The presentation highlighted service‑use patterns: 737 emergency‑room visits in the reporting year, which the presenter said represented roughly 15% of the district’s medical claim costs; about 220 COVID‑related claims (about $36,802.45, roughly 1% of claim spend); and the highest outpatient groupings including abdominal disorders and pregnancy complications. Telehealth registration stood near 14% of members; the presenter said telehealth produced an estimated cost avoidance of $24,487 over the measured period.

A large portion of the discussion focused on high‑cost specialty drugs. Consultants reported increasing utilization of GLP‑1 drugs (referred to repeatedly in the presentation by the brand class and by “Manjaro”/similar spellings in the transcript). The presenters said some of those drugs are not available through international personal‑importation and that domestic spending on a leading GLP‑1 and several other high‑cost scripts accounted for a substantial share of Rx costs year‑to‑date. The plan’s domestic payments for one high‑use GLP‑1 were reported at about $118,000 year‑to‑date; consultants said that category represented roughly 23% of total Rx cost during the period cited. The district’s consultants reported that the voluntary personal importation program saved roughly $35,000 from June–December 2024 and that the district will make the international program mandatory with a restart date of Jan. 15, 2025, to seek additional savings.

The consultants also told trustees the plan expects Rx rebate payments scheduled for April and June 2025 (the presenters identified pending rebates totaling about $228,000). They noted stop‑loss reimbursements and Rx rebates helped the plan’s prior‑year deficit position; as of the December YTD figures consultants said no member had yet exceeded the stop‑loss threshold for the 2024–25 plan year but cautioned that a small number of high‑cost members accounted for a large share of costs.

Board members asked operational questions about telehealth scope (the presenter confirmed telehealth clinicians include doctors and nurse practitioners, can provide prescriptions and work‑notes, and are available 24/7). Trustees also asked for more detail on rebates and the PBM; consultants said Araya, the district’s PBM, would present in a later meeting and that they would supply the exact rebate numbers to administration in the next days.

The presenters recommended several cost‑containment steps under active consideration, including: (1) negotiations and direct contracts with local urgent‑care providers, (2) aggressive management of high‑cost drug utilization (including mandatory international importation where safe and allowable), and (3) wellness and chronic‑disease management programs to target hypertension, hyperlipidemia and diabetes.

Ending: The board did not take immediate action on the presentation; trustees asked staff to return with PBM rebate detail and to continue developing contract and wellness options for follow up.