Kootenai County directs staff to budget Payor Matrix pharmacy program to reduce FY26 health costs

Kootenai County commissioners on July 9 directed staff to incorporate projected savings from a Payor Matrix pharmacy "bolt-on" program into the county's FY26 health insurance budget and asked human resources to prepare premium-adjustment scenarios for the next budget meeting.

Alliant consultant David Smith told the Board that specialty pharmacy costs have risen sharply across the county's plan and that Payor Matrix could reduce the county's pharmacy spend by sourcing expensive medications outside the existing Prime Therapeutics/Regence contract through patient-assistance programs, manufacturer "bridge" programs, international sourcing and biosimilars. "A lot of these drugs are game changers and they're really really helping people. They're also very very expensive," Smith said during the presentation.

The recommendation came during a single-agenda meeting on Alliant's FY26 health insurance options. Smith and other Alliant representatives outlined how Payor Matrix would exclude a small list of very high-cost drugs from the county's current PBM contract and attempt to secure the same drugs at lower cost through alternate channels. If a member qualifies for a patient-assistance program (PAP), Alliant said that drug could be provided at no cost to…