Edinburg CISD committee weighs biosimilars and international drug importation to curb health-plan deficit

Edinburg CISD’s benefits/finance committee heard a presentation on the district’s self‑funded health plan that focused on two immediate cost‑saving options: switching certain specialty biologic medicines to biosimilars and pursuing an international pharmacy importation program.

Dustin Garza, the district’s insurance manager, told the committee that while federal steps such as Executive Order 14273 and provisions in HR 7148 aim to increase pricing transparency, those changes largely benefit consumers or ERISA plans and will not materially relieve the district’s commercial plan in the short term. He said the district must act now to rein in specialty pharmacy costs.

Garza laid out recent fund performance and drivers of the deficit. He said 15 high‑cost claimants between June and December of last year produced $8.7 million in stop‑loss claims, pushing the fund into a multi‑million dollar deficit. For the current year, Garza reported the fund balance has improved from that low point and, based on January–April claims, reimbursements and rebates, shows about a $1.2 million positive result for that quarter, but the overall health fund remains roughly $2.6 million in the red.

On pharmacy levers, Garza recommended two measures the district could implement with board approval. First, he proposed moving maintenance biologic prescriptions such as Humira and Stelara to biosimilars where clinically appropriate. "If we were to go to a biosimilar for those two drugs, we would save the plan about almost half a million dollars just in those two drugs for 11 people," Garza said.

Second, Garza described an international importation/mail‑order option that would route eligible specialty drugs from tier‑one countries (Canada, the U.K., Australia, New Zealand) directly to members by mail. He said peer districts have used importation programs and that rough savings estimates range from $1.2 million to $2 million depending on formulary hits and population. Garza said the district currently spends heavily on GLP‑1 class drugs and specialty medicines: 117 members used specialty drugs last year at $7.2 million total, and the diabetes category accounted for $7.1 million of pharmacy spend with GLP‑1s representing about 25.6% of that category’s cost.

Several board members pressed for outside data and a second opinion before adopting major plan changes. A consultant and advisors on the call outlined common PBM practices—spread pricing, vertical integration and rebate capture—and recommended a transparent pass‑through contract, an audit of rebate flows and comparison of net cost including rebates versus international pricing. The board discussed trade‑offs that could cause member disruption: Garza cautioned that some changes (for example, removing a custom benefit or changing PBMs) could affect members’ access and require careful communication.

Committee members signaled a desire to move from discussion to action. Chairman David Torres said the committee needs to "find the best approach to start tackling this" and asked Garza to return with more detailed options, market solicitations and timelines. Garza said he would market the two recommended levers and, if the board directs, bring proposals and consultant comparisons to a committee meeting or workshop for further review.

No formal motion or vote was taken during the session. The committee agreed to pursue additional data analysis and consultant review, and to schedule follow‑up discussion before any binding changes are adopted.