Ware County renews self‑funded health plan; broker recommends dropping GLP‑1 coverage July 1

The Ware County Board of Commissioners voted Wednesday to renew the county’s self‑funded health insurance program and to accept the broker’s recommendation to remove coverage for GLP‑1 weight‑management medications effective July 1.

John Leggett of MSI Benefits Group, the county’s benefits broker, told the board the plan has run well above expected claim levels this plan year, with aggregate paid claims materially exceeding budgeted expectations. "We're running 30% over expected," Leggett said, attributing the spike to a small number of very large claimants: he identified 12 members who had exceeded 50% of the stop‑loss deductible and together accounted for roughly half of paid claims, even though those members represent about 3% of total enrollment.

Leggett said the county has received about $298,000 in stop‑loss reimbursements against roughly $3.7–3.8 million in paid medical and pharmacy claims for the plan year. He described the county as self‑funded with a $100,000 standard stop‑loss deductible and noted that one existing laser — a $500,000 special deductible for a particular claimant — remains in place from last year’s stop‑loss arrangement.

Facing a market quote that showed a substantial increase in stop‑loss premium (Leggett said the stop‑loss premium was quoted as much as 50% higher), broker and staff recommended a package of changes and continuation of existing vendors to limit disruption. Among the recommendations was eliminating county coverage for GLP‑1 weight‑management drugs effective July 1. "We are eliminating the GLP‑1 weight management medications effective July 1," Leggett said, and argued the change would materially reduce the county’s projected increase. He noted these drugs have become significantly more expensive and that some lower‑cost alternatives or manufacturer assistance programs exist.

Commissioners pressed on clinical and cost tradeoffs. One commissioner asked whether removing GLP‑1 coverage could cause higher future claims if patients lost access to medications that help control diabetes or other conditions; Leggett responded that while such concerns are understood, the current cost trajectory of GLP‑1 drugs is unsustainable for the employer plan and that pharmacy management strategies and manufacturer assistance have helped limit exposure. "I hear that a lot, and I don't think that's the case," Leggett said in response to the clinical‑impact question.

The presentation also highlighted pharmacy cost savings from Veracity’s programs, including a personal importation option (mail order from a preferred vendor) and assistance programs for specialty drugs; Leggett said the county paid about $195,000 for a sample of drugs that would have otherwise had retail charges approaching $675,000 in the reviewed period. He also recommended adopting a voluntary imaging carve‑out called "Know the Cost," which the broker estimated could have saved roughly $19,000 on 224 imaging services in a prior 12‑month claims sample by steering patients to lower‑cost imaging centers.

Leggett reviewed timelines: open enrollment for the renewal was scheduled May 18–26 with on‑site benefit counselors May 18–20. After discussion, the chair moved to accept the broker’s recommendation to renew the plans with no changes to employee deductions; the commission recorded a unanimous voice roll call in favor and the motion carried.

Affected employees and members told to expect notices; the broker said staff will make enrollment materials and counseling available during the posted open enrollment window.

The board did not release a detailed public cost‑breakdown beyond the figures presented in the meeting; where transcript numbers were unclear the presentation provided rounded totals and estimates for planning.