Steve, a USI consultant, told the Dickinson County Board of Commissioners on July 24 that the county could reduce health‑plan costs by adopting alternative funding and prescription‑drug strategies, including partial self‑funding and pursuing biosimilar purchasing programs.

Steve said USI used a working estimate of roughly 150 covered employees at an annual average cost of about $14,000 per employee, producing a plan cost “about $2,000,000” annually; he also said the county’s employee‑only plan runs about $643,000 a year. He told commissioners prescription drugs — especially specialty medications such as Humira — are a central driver of plan cost and described rebate and manufacturer coupon mechanics that can yield large savings under a self‑funded model.

The presentation focused on two points that USI said matter for local governments: (1) how changes to funding (fully insured versus self‑funded) affect county cash flow and underwriting risk; and (2) how prescription‑drug contracting and pharmacy benefit design can materially reduce net costs to the county and to covered employees. USI showed a Monte Carlo‑based analysis USI uses across clients that, in its view, indicates a 72% probability after one year and about a 90% probability after five years that a self‑funded model will cost less than being fully insured, with most of the modeled savings coming from pharmacy strategies.

In examples, Steve cited the impact of biosimilars and manufacturer programs on specialty drugs. He said Humira (manufacturer AbbVie) averaged roughly $7,500–$8,000 per month before biosimilars, that several biosimilars now exist, and that some newer supply‑chain models can reduce cost markedly (he cited industry examples in which a similar medication could be available at about $700 per month). He explained that fully insured carriers commonly retain manufacturer rebates rather than passing them through to the employer; under a partially self‑funded arrangement the employer can receive rebate benefit directly or capture manufacturer coupon savings in alternative ways.

Commissioners and staff raised practical questions about disruption, member access and vendor service. Commissioner Kenny and others asked whether service levels decline when employers move away from Blue Cross; Steve replied that disruption is likely whenever vendors change but that third‑party administrators vary in flexibility (he contrasted an Aetna “mothership” product with Meritaine, a third‑party administrator using the Aetna network). Marsha (HR director) asked whether some drugs would be excluded; Steve said clients do not eliminate coverage for specialty drugs outright but may change plan design, prior‑authorization rules, or use manufacturer assistance programs.

USI offered case studies — City of McPherson and USD 465 (Winfield) — and volunteered to provide commissioner staff with contacts at those entities for reference. Steve urged ongoing communication with employees and benefit committees to reduce disruption if design changes are adopted.

The discussion was informational; commissioners did not take formal action on USI’s recommendations during the meeting. USI agreed to provide follow‑up materials to county HR and administration.