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Health trust warns of near‑double‑digit rate pressure; commissioners approve preliminary budget with modest raise
Summary
Mako (health trust) presented a plan review showing an average trust rate change of 9.8% and warned of an upcoming rural pharmacy dispensing fee; commissioners discussed plan alternatives and preliminarily approved a budget including a 2.5% raise pending final enrollment decisions.
Pam Walling, a representative of the county’s health trust partner, presented the trust’s annual plan review to Treasure County commissioners and outlined changes likely to affect county premiums and benefits in the next plan year.
Walling said the trust’s average recommended increase is 9.8 percent. She traced much of year‑to‑year variation to prescription drug costs and highlighted two items for commissioners to consider: a new state law (effective Oct. 1) permitting rural pharmacies to charge a dispensing fee of roughly $10–$15 per prescription, and steep projected increases for group Medicare retiree coverage that the trust is still evaluating. "Those rural dispensing fees are coming right around the corner," Walling said. "We didn't change plan design this year, so you won't see those fees in this year's contribution, but we will need to determine who absorbs that cost going forward." Walling also described plan design changes the trust is implementing: limiting first fills of newly diagnosed oral cancer meds to 14 days and piloting a red‑light therapy program (Xyrygo) for certain dermatologic conditions to reduce long‑term drug spend.
Commissioners asked about options to contain costs while maintaining coverage. Walling reviewed alternative plan options (traditional plans and several high‑deductible plans) and explained how the county’s contribution can be applied to employee or family coverage and how part‑time employees are prorated. She said counties under 25 employees will receive the trust's average rate change. Walling also flagged the Medicare retiree market as volatile: "We're seeing a 50 to 60 percent rate increase for some retiree offerings in early estimates," she said, prompting discussion of whether the county should continue offering a group Medicare product or allow retirees to seek private supplements.
After the presentation and further budget discussion, commissioners moved and seconded approval of the preliminary county budget that includes a 2.5 percent salary increase proposal. The motion carried by voice vote; commissioners asked staff to finalize contribution amounts and plan selections before the open‑enrollment deadline.
The commission also authorized a county signatory for the ambulance Medicaid renewal and approved routine buy‑sell and interlocal paperwork during the meeting.
Next steps: staff will work with Mako to complete contribution figures and open‑enrollment materials and will present a final budget for adoption at a future meeting.
