Significant trends in medical and RX claims were noted, particularly the rising costs
associated with GLP-1 medications, which contributed notably to the claims trend.
The Board discussed the financial strain these medications placed on the insurance
trust, with expenditures reaching $930,000 over five months. The Board considered
the potential exclusion of these medications from coverage, which would affect 241
members relying on them for weight management. Concerns were raised about the
long-term implications of removing coverage and the balance between financial costs
and health benefits.
Two options were proposed: implementing a higher co-payment for GLP-1
medications or maintaining current benefits while monitoring the situation. The need for
effective communication and oversight during the transition was emphasized.
Sebastian resident Nathan McCollum, expressed serious concerns about Blue Cross,
particularly regarding their customer service and the difficulty in contacting them. He
noted that many others faced similar challenges but hesitate to complain. Mr.
McCollum criticized the contract language on performance measures and called for
accountability through a performance bond. He highlighted potential HIPAA
violations, as the contract allows Blue Cross to share medical information with
employers and subcontractors. Sharing his frustrating experience, he described delays
in responses and issues with the misclassification of his medical problems, questioning
the reliability of Blue Cross's independent reviewers and emphasizing the need for
service improvements.
A motion was made by Commissioner Adams, seconded by Commissioner
Earman, amending Administrative Services Only (ASO) with BCBS providing for
increased wellness funds, rate hold for two (2) additional years, reduced access
fees, and performance guarantees. The motion carried by the following vote:
5 -
Aye:
Aye:
Aye:
Chairman Flescher, Vice Chairman Loar, Commissioner Adams, Commissioner
Earman, and Commissioner Moss
A motion was made by Commissioner Adams, seconded by Commissioner Moss,
to transition Pharmacy Benefits to Rightway and continue coverage for GLP-1
weight loss benefits for one year with HR providing a monthly report on claims.
The motion carried by the following vote:
5 -
Chairman Flescher, Vice Chairman Loar, Commissioner Adams, Commissioner
Earman, and Commissioner Moss
A motion was made by Commissioner Adams, seconded by Chairman Flescher,
renewing Dental ASO with Ameritas to include modifying coverage for annual
cleanings from once every six months to two (2) times per year. The motion
carried by the following vote:
5 -
Chairman Flescher, Vice Chairman Loar, Commissioner Adams, Commissioner
Earman, and Commissioner Moss