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Consultant: large claim spikes and expensive new drugs drove Accomack County plan costs
Summary
Gallagher consultant David Costa told supervisors that unusually high large‑claim volume and expensive new drugs (including GLP‑1 and gene therapies) largely explain the county’s rising health costs, citing stop‑loss reimbursements and actuarial tables showing several claims far above expected thresholds.
A consultant for Accomack County told supervisors that an unusual concentration of very large medical claims and accelerating pharmacy costs are the principal drivers of recent spikes in the county’s health‑plan costs.
David Costa of Gallagher Benefit Services said stop‑loss protection limits the county’s exposure at $100,000 per claimant but carriers are raising rates after paying far more in reimbursements than they received in premiums. "For example," Costa said, "you would only expect to have 1.2 claims surpass $300,000 last year. You actually had seven claimants exceed." He added that specialty pharmacy (including GLP‑1 medications) and new high‑cost gene therapies are increasing overall trend rates.
Nut graf: Costa’s analysis framed the board’s procurement choices: unusually large claimant activity and pharmacy inflation are pushing stop‑loss and carrier pricing higher, reducing the number of viable market bidders and limiting options to mitigate FY27 costs.
Costa showed county stop‑loss premiums and reimbursements for the most recent plan years: roughly $750,000 in stop‑loss premiums with about $3.3 million in reimbursements in one recent year, and ongoing above‑average large‑claim activity into the current plan year. He explained that carriers have increased contract terms and stop‑loss rate caps because they have paid out materially more than premiums in recent cycles.
Costa recommended plan‑design and network options to mitigate cost pressure; those proposals were considered by the board when it later authorized staff to pursue a contract with Anthem HealthKeepers.
