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LaSalle County health plan below underwriter expectation for Q1, committee flags pharmacy and large‑claim drivers
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Summary
At an April 23 committee meeting, Marsh presenter Beth reported LaSalle County’s health plan ran at about 89.8% of the underwriter’s expected per‑capita cost through March, while pharmacy spending — especially specialty drugs and GLP‑1 medications — and a handful of large claims are driving volatility; the committee placed the report on file.
Beth, the county’s Marsh consultant, told the LaSalle County Insurance Committee on April 23 that the county’s health plan is running below the underwriter’s expected per‑capita rate for 2026 but that several cost drivers merit attention. "You are actually running at $25,007.11," she said, "which is 89.8% of expected," compared with an underwriter expectation of $28,006.32 per capita.
Beth said the year‑to‑date actual costs are 9% higher in raw dollars than the same three‑month period in 2025 because of timing and the severity of a small number of large claims. She noted the carrier’s liability so far this year was about $81,000 and said the plan had one claimant above the $150,000 specific deductible (about $231,000). By contrast, Beth said the plan had nearly $300,000 in carrier reimbursements by the same point in 2025 because multiple claimants exceeded that deductible then.
Enrollment trends also affect costs: Marsh reported an increase of seven subscribers and two members year over year through March, which amplifies overall spend even while per‑capita metrics look favorable.
A substantial portion of pharmacy spending is concentrated in a small number of prescriptions. Beth said pharmacy accounted for roughly 15% of total plan spend, with specialty drugs representing about 36% of pharmacy dollars while making up only about 4% of prescriptions. She identified GLP‑1 class drugs as prominent cost drivers — naming Ozempic, Mounjaro, Wegovy and similar agents — and explained that the plan currently covers these drugs for type 2 diabetes but not for weight‑loss indications. "We don't recommend that you open it up to cover for weight loss because the studies are just not there yet showing the expense, the benefit to expense, makes sense," Beth said, citing concerns about adherence and short‑term use followed by weight regain.
Beth also reviewed specialty medication trends — including biosimilars reducing costs for previously high‑cost biologics such as Humira and Stelara — and provided a snapshot of top nonspecialty and specialty drug spend. On the HealthJoy telehealth program, she reported a 0.7 return‑on‑investment through three months and gave usage details (for the quarter: 18 employee wallet or ID interactions, 27 app searches to find care and eight telehealth visits). "They projected about $727,300 in savings, but you paid a little bit more than that during three months for the service," Beth said; she said Marsh and county HR would continue to monitor and promote the program to improve participation and ROI.
After questions from committee members about rank and volume metrics for drugs and about telehealth detail, the committee moved to place the health insurance report on file. The motion passed by voice vote. Beth told the committee the next in‑person meeting (June) will include staff from Marsh’s pharmacy team for a more in‑depth benchmark presentation and contract negotiation discussion.
The committee did not adopt new coverage for GLP‑1 medications and did not take any additional binding financial actions at the April 23 meeting; the presentation was informational and will be followed by a deeper pharmacy review in June.
