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20 <br /> 1 Enrollment Increases <br /> 2 In addition to the cost of claims, employee enrollment in the County plan has increased over time. <br /> 3 Enrollments have increased 7% over the past five (5) years. The most significant increases have <br /> 4 occurred in employee-only plans which are 100% County funded. The number of enrollments for <br /> 5 employee-only plans has increased by 12% over the past five (5) years, or by approximately 80 <br /> 6 enrollments. <br /> 7 <br /> 8 Considerations for Cost Containment Measures <br /> 9 Staff have explored several strategies to manage rising costs while maintaining current benefits <br /> 10 and is recommending that the Board consider two changes to the health insurance plan design. <br /> 11 <br /> 12 1. Implement a RxSaveCard for GLP-1's used for weight loss <br /> 13 • The RxSaveCard offers a projected savings of $500,000 annually based on current <br /> 14 utilization. <br /> 15 • The RxSaveCard provides a mechanism for consumers to have direct relationships with <br /> 16 GLP-1 drug manufacturers through Lilly Direct and NovoCare. <br /> 17 • This direct-to-consumer relationship lowers the cost to the health plan by eliminating the <br /> 18 premium associated with the Pharmacy Benefit Manager that would otherwise serve as <br /> 19 an intermediary between the manufacturer, pharmacy, and consumer. For example, the <br /> 20 cost of a Wegovy prescription under the County's current plan is $950 per month. The <br /> 21 direct-to-consumer price is $350, saving the health plan $600 per month. <br /> 22 Instead of insurance plan coverage for this drug, employees would purchase medications <br /> 23 directly from the manufacturer. In practice, employees would receive an RxSaveCard, <br /> 24 and the County would provide a subsidy of$375 on this card each month for the employee <br /> 25 to purchase their medication. If the actual cost of the prescription is less than the $375 <br /> 26 monthly subsidy, the excess funding is returned to the County. For example, the direct- <br /> 27 to-consumer price of the Wegovy injectable medication is$350. Since the County subsidy <br /> 28 ($375) is greater than the direct-to-consumer cost, the employee receives the drug for$0, <br /> 29 and $25 is returned to the County at the end of each month. The savings and cost to the <br /> 30 employee under this plan are detailed in the table below. <br /> CURRENT PBM RxSaveCard <br /> Drug Dose Estimated Employee Direct Price OC Subsidy Employee <br /> Insurance Price Monthly monthly <br /> (after rebate) Cost(PPO) cost <br /> Wegovy(inj) all $950 $25 $350 $375 $0 <br /> Zepbound (inj) low $850 $25 $299 $375 $0 <br /> Zepbound (inj) mid $850 $25 $399 $375 $24 <br /> Zepbound (inj) high $850 $25 $449 $375 $74 <br /> Wegovy (oral) low $800 $25 $149 $375 $0 <br /> Wegovy (oral) mid $800 $25 $249 $375 $0 <br /> 31 Wegovy (oral) high $800 $25 $229 $375 $0 <br /> 32 <br /> 33 • The only drug for which the employee would have to contribute is for the Zepbound <br /> 34 injectable at medium and high doses. Those prescriptions would carry an employee <br /> 35 responsibility of$24 and $74 respectively. The current co-pay under the County's current <br /> 36 plan is $25. <br /> 37 <br /> 38 2. Implement a Surcharge for Spousal Health Insurance Coverage when Alternative <br /> 39 Coverage is available to the Spouse <br />