Iowa County weighs higher specialty drug copays and a $3,400 high-deductible HSA plan
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Summary
The Board reviewed broker recommendations after pharmacy costs—especially specialty drugs—drove recent rate increases. Members discussed raising specialty drug copays, adding a $3,400 high-deductible/HSA option with potential county contributions, and asked staff for actuarial runs and precise cost impacts before any change.
Unidentified Speaker 1 (Board member) summarized a benefits review the county held with its broker, saying pharmacy and specialty drug claims—not hospital visits—are the principal drivers of premium increases. "Our facility claims last year were 1,100,000.0. Our drug claims were 1,100,000.0," the speaker reported, and asked the broker for modelling on how changes would affect the county’s budget.
The board discussed several concrete options. One proposal was to raise the specialty‑drug refill copay; during discussion a speaker used an illustrative figure from the meeting ("If your prescription is over $400,000, you're paying a $100 to refill"), which board members asked staff to clarify because the number appeared inconsistent in an off‑the‑cuff remark. Members also discussed offering a $3,400 high‑deductible plan paired with a health savings account (HSA), which the broker noted is tax‑advantaged and could reduce employer renewal costs if enough employees adopt it.
Board members and staff weighed tradeoffs: keeping lower‑deductible options to preserve the county’s insurance perk, or offering a new high‑deductible plan as an option that could include an employer match to encourage uptake. The county’s reported loss‑ratio improved year‑over‑year (the speaker said it fell from 97% to 77%), but members noted a few expensive specialty claims can reverse that trend quickly.
Unidentified Speaker 4 (Board member) urged education and a phased approach: "We’re just gonna make this an option...people that know about it, that are educated about it, that wanna do it, maybe the word's gonna get out." Consensus was procedural: staff will return with precise cost runs and employee‑impact models. Deadline pressures were discussed because any payroll withholding changes would need to be in place for June payroll; board members asked for numbers back next week to allow deliberation ahead of that timeline.
The board did not adopt plan changes at the meeting. The next steps are for staff and the broker to provide actuarial runs showing budgetary impacts and suggested employer contribution levels; the board scheduled a follow‑up discussion to review those figures.