Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Health Insurance topic
No spam. Unsubscribe anytime.
Davis County sees high health‑plan loss ratio, officials flag costly prescriptions as driver
Summary
County insurance consultants reported a medical loss ratio near 43% for part of 2024, prompting an 8% premium increase and committee concern about high‑cost specialty drugs (including Trikafta) that are driving claims.
At the same Jan. 13 meeting the county’s insurance report — prepared by benefits consultant GBS and reviewed by the county’s insurance committee — showed an elevated medical loss ratio and prompted concern that specialty pharmacy costs could push further premium increases.
Presenters reported a loss ratio of about 43% for the relevant quarters (meaning plan payouts have been unusually high relative to premiums collected) and said the county’s pooled plan historically ran much lower ratios (for example, in prior years in the 80–90% range in the consultant’s aggregate reporting). The county received an 8% premium increase for the plan described in the presentation; staff characterized that increase as “surprising” and said it reflected a difficult claim mix for the period shown.
Committee members singled out a very small number of high‑cost prescription cases as a major driver. The report named Trikafta (a cystic‑fibrosis drug) and other specialty medicines as examples. Meeting comments cited individual prescription costs in the tens of thousands of dollars for a 30‑day supply and noted that single shock claims can materially move the plan’s loss ratio and put pressure on premiums and employer/employee contributions.
A committee summary estimate presented during the meeting calculated county per‑member annual costs (current premium divided by number of members) near $13,680. Committee members discussed plan design choices (traditional versus high‑deductible/HSA options), the distribution of premiums between employer and employee (examples in the presentation used both 80/20 and 90/10 splits for illustrative purposes), and the role of the county’s participation in larger risk pools to moderate volatility.
Staff said they will continue to monitor claims, discuss options with the consultant and the pooled plan administrators, and expect ongoing conversations ahead of the annual premium renegotiation window (committee discussion placed those negotiations in an August–September timeframe).
