LaSalle County’s self‑insured health plan is running above expected costs for 2025, county insurance consultants told the LaSalle County Insurance Committee on Oct. 24, as a small group of very large claims and specialty pharmacy drugs pushed employer spending higher.

At the committee’s monthly meeting, Beth (Horton Group consultant) said the plan was “running at a 109% of expected, 109.2%,” and that large‑claim activity — not enrollment change — is the principal driver. She said enrollment was “very little change,” with two additional employees and four members year‑over‑year for the plan.

Committee members were told the plan has had 12 large claims that exceed 50% of the plan’s specific deductible (the transcript references “75,000”). Beth said the number of large claimants matched last year’s total but that this year’s claims are generally less severe than the single very large claim that drove 2024 costs. She described employer responsibility as higher in 2025 while carrier responsibility declined compared with the same period last year, and said the county’s net year‑to‑date costs were up about 8% (about $630,000) versus the prior year.

Why it matters: large claims can quickly push a self‑insured plan above budgeted expectations and affect future renewal pricing. Committee members heard that the county’s pharmacy mix — particularly specialty medications and J‑code (provider‑administered) drugs — is a key cost area.

Consultants highlighted two pharmacy trends the county should watch. First, specialty drugs remain a significant share of pharmacy spend but have declined from 42% in 2024 to roughly 30% year‑to‑date in 2025; consultants said that will improve further when the plan requires biosimilar options for biologic medications such as Humira and Stelara, with exceptions allowed for documented clinical need. Second, GLP‑1 class medications (commonly discussed in consumer media as weight‑loss drugs) are appearing on plan utilization lists; the Horton Group consultant said the county’s plan covers GLP‑1 drugs only for type‑2 diabetes diagnoses and not for weight‑loss indications.

Beth also reviewed J‑code spend, saying the plan had paid roughly $500,000 for provider‑administered medications through September; she said the committee and consultants continue to watch site‑of‑care use (hospital versus outpatient/office/home) because higher‑cost settings drive greater plan expense.

The committee heard that the county’s generic dispensing rate is strong at about 90% year‑to‑date and that the plan’s specialty share has been trending down. Consultants said the plan’s HealthJoy benefit had 356 eligible members and 146 activated users (about a 40% activation rate) and encouraged renewed engagement during open enrollment to drive care‑navigation and cost‑savings activity.

Votes at a glance: the committee approved minutes and the insurance bills earlier in the meeting by roll call. It later voted to accept and place on file the monthly health insurance reports as presented.

Ending: Committee members were told consultants will continue monitoring large claims, specialty drug trends, biosimilar uptake and site‑of‑care patterns; consultants also said they expect additional cost relief next year when biosimilars are required for specified biologic drugs.