Human-resources director Suzanne Boyle told commissioners on Jan. 13 that Indian River County's health plan finished the plan year with a $2.5 million deficit, better than an earlier projection of about $3.24 million.

Boyle said total medical claims for the year were about $17.4 million (up from $14 million the prior year) and total pharmacy claims (after rebates) were about $7.4 million. She said the plan had 75 high-cost claimants (medical costs over $50,000) whose bills totaled about $8.6 million.

Boyle attributed a significant portion of pharmacy-cost increases to GLP-1 medications. She said approximately $2.3 million of the pharmacy spending was tied to GLP-1 weight-loss medications (pre-rebate) and that an additional roughly $1.3 million related to GLP-1 use for diabetes — separate figures staff said were reported by their pharmacy-benefit manager. To manage utilization, the county implemented a prior-authorization process for members seeking GLP-1 drugs and notified affected members by Dec. 31; staff said it will return in March with updated utilization and cost data through Dec. 31.

Representatives from the county's advisors and PBM noted the market is shifting with direct-to-consumer manufacturer programs and a new oral GLP-1 tablet; however, they said current wholesale pricing used by PBMs remains comparable to injectable GLP-1 products. Staff noted employer options such as subsidizing direct-to-consumer purchases via HRAs as alternatives to covering the products on the medical plan.

Boyle also reported encouraging biometric improvements at the county health center among roughly 1,005 patients, with improvements noted for 601 patients in measures such as blood pressure, A1C and lipid ratios; she said those improvements complement clinical outcomes some members achieve while on GLP-1 medications.

The board asked staff to return with March data that will include the effects of the prior-authorization process and any change in GLP-1 utilization and cost.