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SJVIA hears 22% jump in pharmacy costs; board presses PBM performance on GLP‑1s and specialty drugs
Summary
Consultants for the San Joaquin Valley Insurance Authority reported a 22% year‑over‑year rise in total pharmacy plan costs driven by higher prescription counts and specialty drugs, prompting board members to ask for a formal comparison of PBM performance vs. RFP promises.
Consultants for the San Joaquin Valley Insurance Authority told the board that total pharmacy plan costs rose about 22% when comparing fourth quarter 2024 to fourth quarter 2023, and that increased prescription counts and specialty drugs were major drivers.
Eddie Barfield of Keenan, presenting the Keenan pharmacy utilization update, said “overall total plan costs in comparing the two periods has increased by about 22%” and highlighted growth in specialty drug fills and costs. He reported about a 12% increase in overall RX counts year over year and noted that specialty scripts and costs were a meaningful subset of that change.
The report identified GLP‑1 weight‑loss and diabetes drugs (brand examples shown in the packet) among the top cost drivers. Barfield described clinical‑program savings and manufacturer rebates, and noted patient‑assistance savings from a program formerly called VCAP: “Total savings, May through December was just over $330,000,” he said. He also said biosimilars for certain biologics are arriving and could reduce future costs.
Directors pressed Keenan and the PBM contractor on whether prior vendor commitments in the RFP had been fulfilled. Supervisor Magsig said the PBM had promised to move members toward generics and reduce specialty utilization during the RFP process and asked for a formal “true up” comparing vendor promises to outcomes: “When we select vendors and they submit RFPs to us, their feet need to be held to the fire,” Magsig said. Later she added, “For me, even though financially the SJVIA is in a healthy position… costs have gone up 22% in this category, that is concerning.”
Board members also questioned how the report categorized different doses of the same drug. A discussion focused on Ozempic being listed in multiple dose lines; County Fresno staff member Davani Amblet said dose tiers reflect how patients are titrated on therapy: “When you are first put on Ozempic, they put you on the lower dosage to kind of build up your system…and then up the dosage,” Amblet said.
Keenan said the board would be given further information during renewal season and that proposals under review for 2026 renewal will include consideration of utilization controls such as required mail order for 90‑day maintenance drugs and step therapy for GLP‑1s.
The discussion was informational; no formal policy change or formulary action was taken at the meeting. Board members requested follow‑up detail comparing actual PBM performance against commitments made in the PBM RFP and additional breakdowns for specialty drug reporting.
Looking forward, staff and Keenan said they plan to include pharmacy strategies in the 2026 renewal timeline and to provide a vendor performance “true up” to the board ahead of final renewal decisions.
