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Apex: DeKalb County health plan costs jumped; brokerage recommends shopping carriers and carving out pharmacy
Summary
Apex Benefits told commissioners that DeKalb County’s self‑funded plan is running well above prior‑year claims—medical paid claims rose to about $1.36 million vs. $888,000—and pharmacy accounts for roughly 30% of spend. Apex recommended issuing RFPs for third‑party administrators and pharmacy benefit managers, evaluating narrow networks and alternative plan designs, and presenting renewal options in May.
Lauren McMahon, Apex account executive, presented an executive financial summary and clinical report showing that the county’s health plan is trending materially above prior years. "Medical gross spend on paid claims so far this year is $1,360,000, where the prior plan year we were at $888,000," McMahon said. She and Apex colleague Bill Sylvester pointed to multiple recent large claimants and rapidly rising specialty‑drug costs as primary drivers.
Apex reported…
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