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Collin County human-resources director flags medical-plan cost surge, proposes cost-sharing options
Summary
Human Resources Director Cynthia Jacobson told commissioners that catastrophic claims and rising GLP1 use have driven medical-plan costs up; she proposed options including outpatient-surgery coinsurance, a $100 prescription deductible, and dependent-premium adjustments to offset rising costs.
Collin County’s human-resources director told the Commissioners Court the county’s self-insured medical plan is facing rising costs driven by catastrophic claims and higher use of expensive diabetes medications, and she laid out several policy options commissioners could consider.
Cynthia Jacobson, Human Resources Director, said the plan experienced nearly a $6 million increase in claims from 2023 to 2024 and noted a single $2 million claim as a material driver. “We carry stop loss coverage to even out our expenses over the year, and stop loss covers any claim over $100,000,” Jacobson said, explaining existing protections and the limits of budgeted stop-loss and administrative coverage.
Jacobson warned that 54% of insured people with chronic or complex conditions account for over 90% of costs and that pharmacy expenses are now more than a quarter of medical spend. For the first time, she said, diabetes drugs — GLP1s — are the plan’s top drug category, driven by a large increase in users and by previously looser authorization rules; UnitedHealthcare later required diabetes diagnosis authorizations, reducing counts.
To address rising costs, Jacobson presented options for court consideration: a 10% coinsurance for outpatient surgeries (actuarial reduction in claims estimated at roughly $100,000), a $100 annual prescription deductible per insured (actuarial savings about $70,000), and modest dental premium increases for dependents paired with stronger wellness incentives to encourage participation. She described efforts already underway to manage utilization, including nurse liaisons who work directly with high-cost members.
Commissioners asked questions about formularies, the county’s flexibility with third-party administrators and how the county might treat existing patients dependent on drugs that are removed from the formulary. Jacobson said the county can pursue reimbursement mechanisms and medical-necessity exceptions in individual cases but that some drugs (biologics moving to biosimilars or being removed by the administrator) pose negotiation challenges.
No formal decisions were made; Jacobson said staff will provide additional cost-impact charts and a one-page cheat sheet to quantify per-employee impacts if commissioners request them as the court continues budget deliberations later in the week.
