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Brown County reviews options to curb rising employee health costs after consultant briefing
Summary
County commissioners heard a detailed presentation from a benefits consultant showing pharmacy spending and several fiscal levers — including closed formularies, Medicare education and captive pooling — that could reduce plan costs and build reserves over 5–7 years.
The Brown County Commission on May 11 heard a detailed presentation from the county’s benefits consultant on rising costs in the county’s self‑funded health plan and directed staff to gather concrete proposals for cost‑containment and reserve building.
The consultant told commissioners that pharmacy now accounts for about 40% of Brown County’s health‑plan spending and that the county’s pharmacy cost per member per month is $2.33 versus an industry reference of $1.59. “Pharmacy is the active cost pressure that we have right now,” the Presenter said. The consultant also said the county typically receives about $20,000 per quarter in prescription rebates, projecting roughly $80,000 in rebates for the year.
The presentation outlined the plan’s current finance picture: an adopted 2025 health‑insurance budget of $1.2 million, a proposed 2026 budget around $1.3 million and a projected county cost after offsets near $1.2 million. The consultant said Brown County had a carryover surplus from 2025 of about $114,005.44 and a projected two‑year surplus near $268,000 under current assumptions. The county’s specific stop‑loss level was reported as $50,000.
Why it matters: Commissioners said the program’s cost trajectory affects the county budget and employee compensation, and several members stressed the need for a multi‑year reserve to smooth spikes. “These are people’s lives,” the Chair said during discussion, urging careful consideration of employee impacts as the board looks for savings.
Options the presentation and commissioners discussed included: - Adopting a closed formulary (Blue Cross’s ResultsRx) or other pharmacy management to reduce high‑cost drug spend; - Offering Medicare education to employees eligible for Medicare, and evaluating whether some Medicare‑eligible members could move to Medicare plus a supplement to lower the county’s group costs; - Introducing an HSA or other employee contribution changes to create some “skin in the game” while balancing family subsidies; and - Exploring captive pooling or third‑party administrator (TPA) models to gain flexibility, reduce the risk of renewal laser‑rating and build a larger reserve so the county could raise its stop‑loss attachment in future years.
Commissioners pressed for details and asked the consultant and staff to return with market quotes, a more granular cost‑containment analysis and scenarios showing tradeoffs (for example, the fiscal effect of modest employee contributions versus increased family premiums). The commission asked for a follow‑up presentation and proposals to arrive in coming weeks so staff can include options in upcoming budget planning.
No formal action to change the plan was taken at the meeting; commissioners authorized staff to seek additional vendor proposals and analytics and to schedule return briefings. The county also noted that final rate and quote confirmations will depend on formal market renewals later in the year.
