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Aetna/CVS presents self-funded health plan proposal to Hillsborough County evaluation committee
Summary
Aetna, part of CVS Health, presented a proposal in response to RFP ARMP2424 912 to administer Hillsborough County's self-funded group health plan, highlighting pharmacy pass-through rebates, on-site clinic enhancements, care management and projected savings; committee asked implementation and compliance questions but took no formal action.
Aetna, a CVS Health company, presented a proposal on RFP ARMP2424 912 to the Hillsborough County Bid Presentations and Evaluation Committee on a virtual meeting held via communications media technology; the presentation outlined pharmacy pricing and pass-through rebate terms, proposed on-site clinic staffing and wellness services, and a three-year fee guarantee with implementation funding.
The proposal emphasized pharmacy integration through a National Association of Counties (NACo) coalition pharmacy agreement and a pass-through rebate model. "We are passing through 100% of rebates," Andrew Conroy, who leads Aetna's pharmacy team, said during the question-and-answer session; Conroy also answered "Yes" when asked whether Aetna is fully compliant with Florida's PBM law, SB 1550.
Why it matters: the county's choice of an administrator for a self-funded plan affects employee access to providers, out-of-pocket costs, and the county's health benefit expenditure. Aetna told the committee its proposal aims to lower specialty pharmacy spend and increase provider access while offering targeted clinical programs for high-cost members.
Aetna outlined core features and claimed network access and care integration as selling points. Kathy Aguirre, market head for the Public and Labor Division for the Southeast, said the proposal would provide a 99.5% local provider match and access to 13 CVS HealthHUB or MinuteClinic locations across Hillsborough County. Aetna proposed an on-site clinic model staffed by an advanced practitioner (physician assistant or ARNP) and a medical assistant, with the option to substitute roles such as a nutritionist or wellness coach during implementation.
On pharmacy, Aetna described a NACo coalition PBM arrangement it said delivers "best-in-market pricing," with guaranteed dispensing fees, rebates and transparency provisions. Conroy said specialty drugs account for about 50% of the county's pharmacy spend and noted biosimilars as a near-term savings opportunity: Aetna removed Humira from its preferred formulary on April 1, 2024, in favor of a biosimilar and reported a roughly 96% conversion rate among Humira users in that change. Aetna identified Stelara as a top medication for the county with nearly $2,000,000 in current spend.
Aetna described clinical and member-support programs included in the proposal: a nurse-led care management program for multiple conditions, one-on-one lifestyle coaching, a peer-support program targeted to first responders, virtual primary care with an assigned care team, and on-site customer service representatives. Presenters said the proposal includes implementation support, an initial "fee holiday" for year one and a dedicated fund for wellness audits and clinic resources.
Committee members asked for specifics on prior authorization, narrow networks, specialty pharmacy options and rebate mechanics. Conroy said plan sponsors can choose levels of clinical review, including enhanced prior authorization for high-tech imaging, and that Aetna's standard clinical policy bulletins are publicly available. On rebate mechanics, presenters described quarterly rebate payments with an annual true-up and stated the model is full pass-through for self-insured clients.
Aetna provided an illustrative cost-savings estimate: "For every percentage point that we are better based on your claims, we would save you $1,140,000 based on the data that was provided in the RFP," Kathy Aguirre said. Presenters repeatedly framed many elements as configurable during contract negotiations and implementation and noted they would work with existing vendors the county uses for COBRA and FSA administration.
No formal motions, votes or contract awards occurred during the session. The committee opened the floor for questions after the 30-minute presentation and 15-minute Q&A window; discussion focused on implementation details, plan design options, and clinical programs rather than a selection decision. The committee adjourned and indicated the procurement process would continue later the same day.
Next steps: the presentation will be part of the vendor record for RFP ARMP2424 912 as the county continues evaluation; no award or direction to staff was recorded during the meeting.
