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DeKalb County commissioners order deeper review of employee health plan after staff reports nearly $949,000 in drug spending
Summary
County staff told commissioners the self-funded plan spent about $948,841 on prescriptions in the plan year, with anti-inflammatory drugs and diabetes medications the largest drivers; the board agreed to a nonbinding analysis by Gallagher to probe pharmacy pricing and contract design.
DeKalb County commissioners on Dec. 16 heard that the county’s self-funded health plan spent roughly $948,841 on prescription drugs in the plan year, prompting questions about pharmacy pricing, rebates and whether the county is receiving benefit from programs such as GoodRx.
The staff report to the board said anti-inflammatory drugs were the single largest driver, with about $423,601 charged to five members, and diabetes medications covered roughly 40 members. “We paid, $948,841 for the first year of the plan,” the staff member reported, adding that the county and employees will need education and contract review ahead of next year’s negotiations.
Commissioners expressed bewilderment at the difference between plan pricing and cash prices available through retail discount programs. One commissioner said: “I can go on GoodRx and buy the drug flat out for 40. Why does our insurance pay a 100 and I pay 20 for a total 120 when GoodRx… shows that you get it for 40?” The comment captured a broader concern about pharmacy benefit manager practices and rebate transparency.
Gallagher, an insurance broker invited to present, said it uses data-driven reviews and can perform a forensic contract and claims analysis to identify low-hanging opportunities. “Data drives decisions,” Gallagher’s presenter told the board, and Gallagher’s employee-benefits team recommended exploring PBM models that incorporate GoodRx-type pricing and pass-through or transparency arrangements so members and the plan both benefit.
Commissioners emphasized protecting employees from disruptive changes. One commissioner said any change must be “workable for everyone” and involve the county council. Another council member asked for caution given the county’s recent shift to self-funding.
Rather than approve an immediate broker change or an RFP, the board agreed by consensus to allow Gallagher to perform a nonbinding deep-dive analysis of plan claims, pharmacy spend and the county’s contract terms; commissioners said the analysis should not interfere with the current broker-of-record or precipitate an immediate change. No formal vote was needed to request the analysis, and the board directed staff to provide claims and plan data to Gallagher for review.
What’s next: Gallagher will analyze claims and contract structure and report findings to commissioners; any recommendation to change brokers or plan design would return to the board and county council for formal consideration.
