County hears detailed health-plan briefing; consultants propose PBM/formulary changes and optional KanaRx program to curb pharmacy spending

County benefits consultants from Gallagher Benefit Services and SAS outlined escalating costs in the self-funded employee health plan and proposed several interventions focused on pharmacy spending.

The consultant said the county's net paid claims were about $7.8 million and, without changes, the plan could run roughly 10% higher next year. To reduce pharmacy-driven expense, they proposed a closed/formulary model that would encourage switching to biosimilars and lower-cost alternatives and an optional program (described in the briefing as KanaRx/counter-health) that would offer alternative sourcing and mail-order options. The consultants described a fee of about $3 per member per month for that optional service and said the vendor guarantees savings (the fee would be refunded if projected savings are not achieved). They estimated a closed formulary could save about $500,000 in the coming year; broader uptake with the alternative-sourcing program could increase savings to as much as $800,000, depending on participation and engagement.

Board members asked whether changes would restrict access to necessary drugs; consultants emphasized clinical appeals would remain available and that doctors could override formulary choices on appeal. Members also asked about provider-network negotiations (Ochsner, Singing River) and out-of-state inpatient claims; consultants said network negotiations are ongoing and that some high-cost hospitals are more difficult to discount. The consultants recommended bringing a formal contract to a future meeting; staff said they will return with the PBM/formulary contract and do a concurrent reinsurance renewal review.

No contract was approved during the briefing; the board directed staff to present a contract and supporting documents at a later meeting so members could consider formal approval.