County proposes four benefit actions — deductible changes, a 'Surest' option, international sourcing and a weight‑loss program

Sheena outlined four specific action items to reduce the county's projected benefits cost growth: (1) modest plan‑design adjustments that raise some deductibles and out‑of‑pocket maximums, (2) adding a Surest plan option with defined copays and no deductibles, (3) an international‑sourcing program for certain high‑cost specialty medications administered by IMA Rx, and (4) a weight‑loss medication program that would operate outside the county's standard prescription benefit.

On design changes she offered examples: moving the base single deductible from $1,250 to $1,500 and premier from $750 to $1,000, plus increasing out‑of‑pocket maximums by about $1,000. On the Surest option, she said the plan has predictable copays and an estimated out‑of‑pocket maximum near $5,000; she cited a local school district that saw ~45% employee takeup by year two. For international sourcing she gave a medication example (Cabometrix) where the county could reduce a single medication's net cost and estimated total savings up to $3.7 million across 51 medications; with a conservative 40% participation assumption she estimated $1.49 million in savings. On GLP‑1s she proposed moving employer‑directed weight‑loss use outside the prescription plan with coaching support, estimating about $990,000 in savings and a path to meet the 7% budget target.

Commissioners asked about member protections, stop‑loss coverage differences for international sourcing, and employee communications. Sheena said stop‑loss would not apply to internationally sourced eligible meds and that IMA Rx provides concierge support; she emphasized education and voluntary participation as critical to acceptance. Staff will return with enrollment and vendor details before final decisions.