Indian River County staff reported that the county’s self‑funded group health plan closed its plan year with a $2.5 million deficit, driven by higher medical and pharmacy claims and a growing share of high‑cost claimants.

Suzanne Boyle, director of human resources, told commissioners medical claims rose roughly 19.2% to $17.4 million and pharmacy claims rose about 32.2% to $7.4 million for the plan year. She said there were 75 high‑cost claimants (those with over $50,000 in annual claims) accounting for about $8.6 million of medical claims. Boyle said roughly "$2,300,000 of our claims...was attributed to the GLP 1 weight loss medications that we...allow under our plan." Prior authorization requirements were instituted and staff implemented new PBM controls; staff will return in March with results through Dec. 31, 2025.

Commissioners asked whether GLP‑1 prescriptions for diabetes were separated from weight‑loss use; staff confirmed they track those separately. Benefits advisors noted direct‑to‑consumer pricing and manufacturer programs create options to reduce employer plan exposure, and some employers are subsidizing manufacturer programs via health reimbursement arrangements as an alternative to covering the therapies on the health plan.

The board directed staff to continue monitoring utilization and return with full year data in March so commissioners can consider plan design options.