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County reports spike in projected catastrophic claims for 2026 and rising drug costs; staff outlines possible plan design changes
Summary
Benefits staff said 2025 claims were lower after fewer catastrophic claims, but 2026 projections include a likely $3 million claim and two others over $1 million; pharmacy costs, especially GLP-1 drugs, have grown and the county does not cover GLP-1s for weight-loss indications.
Human Resources and benefits staff presented the county's 2025 claims experience and 2026 projections. They said 2025 had fewer catastrophic claims, but the county expects at least one $3,000,000 claim in 2026 and two likely claims above $1,000,000. The county carries stop-loss insurance, which reduces the fiscal exposure, and staff said stop-loss reimbursements have materially affected net plan costs in prior years.
Pharmacy costs are a major driver of rising plan expenses; benefits staff said 11 percent of adult plan members are on GLP-1 drugs and that over four years the county spent roughly $2.1 million on those drugs. Staff confirmed Collin County's plan excludes covering GLP-1 prescriptions when prescribed solely for weight loss; coverage is limited to diabetes and FDA-approved comorbid indications.
Staff presented potential plan-design considerations including modest coinsurance for outpatient surgeries to encourage cost-conscious provider selection, modest premium changes for dependents, and continued investment in wellness and nurse-liaison programs. Staff emphasized statutory stop-loss requirements and that stop-loss helps smooth volatility due to catastrophic claims. Commissioners asked whether staff could identify screening history for employees diagnosed with cancer; staff said vendor data are de-identified and that programmatic nurse-liaison follow-up can help assess screening rates.
