Brown & Brown: Flagler Schools— medical and pharmacy costs rose; district exploring AdventHealth, narrow networks and pharmacy RFP

Brown & Brown presented Flagler County School Board members Oct. 28 with a year-end review of health-plan performance and pharmacy procurement options, saying early reforecasting shows the plan may run above budget and identifying pharmacy cost drivers and possible network strategies.

The consultant, Danielle Boyle of Brown & Brown, told the board the district—s plan year (Sept. 2024–Aug. 2025) had roughly $9.4 million in net medical claims and just under $4 million in pharmacy spend. Pharmacy rebates were material and appear on the district—s accounting as negative fixed costs; the broker reported large rebate payments historically for the district. High-cost claimants were concentrated but not unusually numerous: 16 members had more than $100,000 in claims during the plan year, and four of those were new in the final month of the year.

Pharmacy details: Brown & Brown identified GLP-1 class medications (injectable agents used for diabetes and weight-management indications) as a significant contributor to pharmacy cost growth. The broker said GLP-1 prescriptions amounted to a notable share of pharmacy spend (broker materials showed GLP-1s as a large portion of recent pharmacy dollars and called out a ~24% contribution of certain GLP-1 use within a plan sub-group). The board discussed options ranging from tighter prior authorization and lifestyle-management participation requirements to removing coverage for weight-loss indications, a step Brown & Brown warned would be disruptive to employees.

Network strategies under consideration: brokerage staff outlined several approaches to blunt hospital and specialty cost inflation: - Direct contracting: pursue a direct arrangement with AdventHealth for preferred hospital pricing; the broker said AdventHealth could be paid quickly under some models but that securing exclusive or preferred pricing requires negotiation. - Tiered networks: evaluate vendors such as Nomi Help that offer a tiered-network approach to reduce out-of-pocket costs when members use preferred providers. - Narrow networks: consider options like Cigna—s SureFit narrow network, which can cut costs but would exclude some local hospitals except for emergency care.

Pharmacy procurement: staff said the district—s pharmacy consulting and RFP work is active. The district currently uses RxBenefits, a purchasing group that aggregates leverage across PBMs; Brown & Brown—s pharmacy consultants have recently helped other clients realize savings by moving to different PBM arrangements and will present detailed RFP results back to the board.

Financial outlook and next steps: Brown & Brown presented several forecast scenarios, including a status-quo projection that would put the district well above its budget (the broker—s conservative underwriting scenario included a margin that moved the projection toward ~18% over budget). Staff said stop-loss premiums were being shopped to multiple carriers and that the 30% placeholder sometimes used in underwriting does not represent the final stop-loss renewal. Trustees asked for deeper claims-drilldown work and a population-health review; the broker said a data-warehouse review and a population-health briefing are scheduled.

What the board asked for: more granular data on high-cost claimants, a deeper analysis of the medical versus pharmacy trend drivers, the output from the pharmacy RFP and vendor negotiations (including AdventHealth discussions), and a return presentation in November or December with refined projections and recommended plan changes.

Source attribution: the summary above is based on presentation and Q&A led by Brown & Brown staff and district benefits staff during the Oct. 28 workshop.