A county consultant told the Cameron County Commissioners Court on Nov. 4 that the county's health plan posted an estimated total annual cost of $22,128,779.68 for the most recent plan year, an increase of $1,734,785.68 — a 9.16% rise from the prior year.

"The medical finished at 13,610,794. Your pharmacy was at 6,274,879.74," said Javier Lial, analytical and medical network developer for Valley Risk Consulting, briefing the court during the annual plan review. He said the county received $1,460,000 in pharmacy (RX) rebates credited back from Aetna.

Lial said high‑cost claimants and a sharp rise in use of GLP‑1 drugs were the principal cost drivers. "These five drugs make up 47% of your overall pharmacy costs," he said, naming the commonly used GLP‑1 products referenced in the presentation. He reported 26 high‑cost claimants in the plan year; 14 were below the $250,000 specific deductible (paid fully by the county), and 12 exceeded the $250,000 threshold, with the county's exposure up to the deductible totaling about $3,000,000.

The consultants and staff detailed possible ways to reduce drug spending without cutting core benefits. Presenters said some local public employers have implemented one or more of the following: establishing a specialty pharmacy tier or fourth coinsurance tier; adopting step‑therapy protocols; and outsourcing or personal importation programs that source certain brand drugs from tier‑1 countries such as Canada, New Zealand and Australia at substantial discounts.

"What they've done the past two years is they've outsourced some of these drugs from tier‑1 countries ... for anywhere between 45 to 65% of the cost," Lial said, describing a strategy already used by other regional employers. Staff noted Mexico is not considered a tier‑1 sourcing option under those programs and that outsourcing must meet regulatory and contractual requirements.

Commissioners asked about program timing and implementation. Efren (staff) said county administration would review options and that some changes would require a 60‑day material change notice to employees. Lial suggested the county could issue a solicitation to qualify vendors for international sourcing and bring proposals back to the court within a matter of weeks to months.

Commissioner Garza and others pressed staff to move quickly. Commissioner Garza said the county should not "reinvent the wheel" given neighboring entities already using these programs; staff agreed to prepare recommendations for administration and the court.

The court voted to acknowledge the presentation. "We have a motion to acknowledge the presentation," a commissioner said; the motion carried.

Clarifying details from the presentation: the consultant listed the plan components as medical ($13,610,794), pharmacy ($6,274,879.74), and stop‑loss ($2,243,520), with RX rebates of roughly $1.46 million credited back; he calculated an estimated annual cost of $22,128,779.68 and reported an increase of $1,734,785.68 (9.16%) over the prior year.

The court did not adopt a specific procurement or plan design at the Nov. 4 meeting; staff were directed to develop options and return with formal proposals for possible action.