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County told medical premiums will rise nearly 19% for 2027; committee narrows coverage on weight-loss drugs
Summary
County HR and Alliant presented a 2027 renewal showing an 18.9% medical rate increase driven by utilization and GLP-1 weight-loss drugs; the benefits committee removed coverage for weight-loss medications effective Jan. 1 to reduce costs and staff will pursue education and utilization strategies to protect families.
Lake County human resources and broker Alliant told supervisors on July 28 that the county's employee medical premiums are projected to rise 18.9% for plan year 2027, a change HR described as "significant" and tied to unusually high utilization and prescription drug spending.
Tom Shearer, a benefits consultant with Alliant, said the Prism Health purchasing pool saw dramatic pharmacy spending driven in part by glucagon-like peptide-1 (GLP-1) medications used for weight loss and diabetes care. "Taking weight-loss medications out of coverage reduced the program renewal from almost 16% to 10.7% overall," Shearer said, explaining why the county's original renewal was higher and why the pool's committee recommended removing GLP-1 weight-loss coverage for Jan. 1.
Pam Samach, HR director, and Erondi Campbell, senior HR analyst, told the board the county's enrollment mix (fewer dependents and an older average enrollee) and inflationary medical costs contributed to the county's higher-than-pool increase. HR proposed a communications push, mandatory open-enrollment meetings, and better use of existing programs such as Accolade navigation, Rx and Go pharmacy options and telehealth to reduce high-cost emergency-department use.
An IHSS supervisor who called in, Jonette Moffett, told the board county employees are already stretched: "The reason you have few families enrolled is that many of your county employees are eligible for Medi-Cal; we still cannot opt out of county coverage and this still impacts the county's costs," she said. Several supervisors asked staff to return with options to protect employees with families and to explore one-time county supports for dependent coverage if possible.
The benefits committee's elimination of GLP-1 weight-loss coverage drew emotional public comment. A caller who said she benefitted from GLP-1 treatment urged the board to consider medical necessity for severely ill patients. HR said it will publish guidance on alternative vendors and assist employees to access lower-cost direct-to-consumer options where appropriate.
Staff said the county will not exit the Prism pool for the 2027 plan year and will focus on enrollment education, targeted outreach to high users and additional provider- and program-based savings; the board requested further analysis before finalizing budget implications.
