Brokers warn specialty-drug and high-cost claims are straining county health plan; TPA change likely

HUB International, the county’s employee-benefits broker, gave a midyear review and warned that a near-term vendor change may be required to contain rapidly rising costs.

Broker Ryan Secord and the benefits director told the council that the county’s self-funded plan has seen an unusual concentration of very large claims this year — "most of them or 3 of them over a $100,000 year to date," a presenter said — and that specialty-drug spending has "more than doubled in the past 2 years." They said current contracts between the county’s third-party administrator (TPA) and local hospitals have weakened, limiting options the county previously used to control costs. "TPA is essentially a fancy term for insurance company," the broker added when explaining roles.

The brokers said they expect to present formal change recommendations in roughly 90 days and indicated any structural changes would likely take effect around Jan. 1, 2027. Options discussed included replacing the current TPA and pharmacy benefit manager (PBM) with a vendor that allows more direct purchasing and specialty-drug management. County staff and council members asked about wellness checks, clinic utilization and the current employee contribution level ($92.50 cited in the meeting). The brokers recommended a market check and said they would run the procurement process on the county’s behalf if directed.

Council members asked whether proposed changes would reduce out-of-pocket costs for employees and how an altered plan might affect enrollment; brokers said the plan changes aim to reduce the unit cost of claims and mitigate the budget impact of high-cost claimants but cautioned that individual health events remain unpredictable.