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Fort Worth health fund faces deficit as GLP‑1 use rises; council debates reimbursement versus restriction
Summary
Staff warned the group health fund is projected to run a deficit and cited sharply rising use of GLP‑1 drugs; council members debated policy options including audits, partial reimbursement (one proposal: up to $200 per employee) and whether restricting coverage could interfere with doctor‑patient relationships.
City staff told the council the group health fund is projected to operate at a deficit for FY27 and that rising pharmacy costs—driven in part by increased use of GLP‑1 drugs—are a major pressure.
The presenter said the city’s health plan has seen a surge in GLP‑1 utilization and that "the number of subscribers or members that are using GLP ones, purely for weight loss increased almost 50%" since the prior presentation. Staff described a cost‑containment focus: rebuilding a contingency reserve, rightsizing claims utilization, and exploring plan and program design changes to sustain the fund over multiple years.
Staff provided a planning estimate that claims and third‑party administration costs for the fund could total between $89 million and $99 million (staff characterized that range as the cost for claims and TPA for the referenced period). Council members asked whether the wellness and coaching vendors are local; staff said most are large branded programs and that the city has authority to engage a claims audit with Blue Cross Blue Shield as a best practice. Staff estimated the audit could yield about $800,000 in savings, while the audit cost was discussed at roughly $850,000.
Council discussion centered on how to respond to GLP‑1 cost growth. One council member argued against an outright prohibition, saying it could "interfere[] with my relationship with my doctor" and proposed a reimbursement model for employees, suggesting a cap of $200 as a policy option. Staff said one modeled option assumed covering 50% of the cost; staff also reminded council that the city already funds participation in NOOM as part of its offerings.
No formal action or vote was taken; staff said they will include options for the council to consider in the budget process.
Next steps: staff will return with options—including potential audits, benefit design changes, and reimbursement models—for council consideration during the budget cycle.
