Prescription drug costs drive spike in St. Mary Parish school health claims, district staff warn

Mister Perez, a district staff member, told the St. Mary Parish School Board on July 10 that the district paid $1,100,000 in health insurance premiums and $1,448,000 in claims through June 2025, with June recording the largest single-month prescription drug spend at $608,000.

Perez said two drugs account for most of the increase: a GLP-1 medication (referred to in the presentation as Mangero) and a new specialty biologic advertised as "SKYRIZI On Body Injectable." "Mangero accounts for an increase of 201,000 dollars," Perez said, and the new specialty drug "represents a cost of a $155,000." He added that together those two drugs produced "over $350,000 of an increase this year compared to last year."

Perez told board members the district is approaching the reference period insurers use to set 2026 renewal rates (September 2024 through August 2025) and urged caution: "We can't continue to see an increase like this in prescription drugs. Hopefully, this was an exception." He said the district will consider options including a tighter formulary or, if the board chooses to go self-funded, different program controls: "If the board decides to go self funded, you have more flexibility, you have more options."

Board members asked whether plan design changes are possible on a fully insured plan. Perez said he has discussed options with Blue Cross but that some design changes (for example, raising specialty cost-share caps) may not be permitted on a fully insured platform. He described a "tighter formulary" approach that could limit availability of some drugs and require additional clinical justification from prescribers. "That is a requirement now," Perez said, describing prior steps for utilization management and prior authorization.

Board member Miss Brent asked whether the two costly drugs are listed on the plan formulary; Perez confirmed they are. Perez said one of the new specialty drug prescriptions represented seven prescriptions at roughly $21,000 per month each and cautioned that a small number of members taking high-cost specialty therapies can materially change renewal experience. "All it takes with these specialty medications is just for a few people to take a few of these medications," he said.

Perez compared U.S. and European prices for GLP-1 drugs and said the district may need to be "creative and get aggressive with the prescription drug program" when renewal discussions begin. No board action was taken during the presentation; it was presented for information as part of the business affairs report.