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Consultants: county's self-funded plan running well so far; pharmacy costs and GLP-1s are main drivers
Summary
Benefits consultants told Brown County commissioners the health plan had a 68% loss ratio through June, projected a carryforward surplus and recommended pharmacy-management options (closed formulary, Virta enrollment, captive/reference-based approaches) to limit future increases.
A benefits consultant presenting via Zoom said Brown County—s self-funded health plan has incurred about $309,000 in claims through the first half of 2026, compared with a $457,000 attachment-point liability, for a loss ratio of roughly 68% to date. “So what we—re looking at is for the first 0.5 of the year, we have had $309,000 in claims compared to your liability of 457,000. So your loss ratio is 68%,” the consultant said.
The presenters warned that pharmacy spending is the primary cost driver, with pharmacy per-member-per-month costs around $210, about 32% above a Blue Cross benchmark they cited. They identified nine plan members taking GLP-1 diabetic therapies whose medications total nearly $47,000 so far this year and recommended considering a switch to Blue Cross—s closed ResultsRx formulary, stronger promotion of a Virta diabetes-reversal program (17 eligible, 0 enrolled), and exploring captive or reference-based pricing models as longer-term options. Consultants emphasized staged changes and offered to support employee outreach and quarterly reporting to the commissioners.
