Rising prescription drug costs could mean changes for Richland County's insurance coverage

Richland County’s health insurance plan may have to stop covering the cost of drugs used to treat Type 2 diabetes when they are used for weight loss only.

County Employee Benefit Consortium of Ohio representative Wendy Dillingham told the county commissioners on Tuesday that increasing drug prices continued to be the major reason for higher overall costs for the program during the first quarter and in comparison to year-to-date figures.

Dillingham reported that combined medical and prescription costs for the first three months of 2024 are running at 102.5% with prescription alone at 109.6%, while 12-month figures show 114.1% for medical and prescriptions and 123.8% for just medications. A figure over 100% means the insurance plan is paying out more in claims than it is taking in in premiums.

Dillingham noted the top 10 prescriptions represent 3.7% of the total filled but 57.2% of the medical spending for the period, with the average cost of the top 10 medications at $2,758 for 30 days. She told the board CEBCO is paying close attention to GLP-1 medications used to treat diabetes such as Ozempic, Jardiance and Trulicity that are on the county’s top 10 list.

“Our board of commissioners is reviewing that maybe for 2025 we simply stop covering weight-loss medications. Fully insured does not. We’re a self-funded plan, so if you were to go to a fully insured carrier and you were doing a fully insured product, they would not cover weight loss medications,” Dillingham said, adding that CEBCO is also looking at working with a vendor that would manage things differently. “Our concern with any of these medications is you should, while taking this medication, also be looking at some changes in your lifestyle, meaning changing your eating habits. You would have to work with a dietitian and you would have to have blood work done on a regular basis just to see where your numbers are.”

Dillingham told the board that CEBCO also is looking at ways to reduce unnecessary visits to the emergency room, noting that during the COVID period, people got into the habit of using the emergency room more than they had.

“People with a sore throat or an earache are going to the emergency room. That’s real expensive care for something that can be seen in your doctor’s office, at an urgent care or even using Teladoc online," Dillingham said.

CEBCO is trying to provide communication to members about using the ER for a non-emergency situation.

“They may receive a mailer in the mail making them aware, without targeting, that these are of some of the other places where you could seek care,” she said.

Dillingham said plan renewal is coming up in August and that she expects higher rates for member counties.

“From all inclinations, renewals don’t look great and that’s kind of across the board,” she noted.

Commissioners begin the 2025 budget process, award contracts

Commissioners also held a state required tax budget hearing for 2025 that includes estimated amounts that property tax levies will generate and overall estimated financial resources for each department. Work to put together the final 2025 budget will start in the fall.

The board also awarded three separate contracts for cost of copy services, summer road resurfacing and a bridge project.

The resurfacing contract went to Sarver Paving, of Ashland, which had the lowest bid of $638,741 earlier this month. The work will cover about 5 miles of pavement on Marion Avenue and Cairns and Cook roads.

Commissioners awarded a $93,995 administrative services contract to DLZ Ohio for a bridge project on London West Road. Ninety-five percent of the cost will be covered by federal funds.

A three-year contract with two one-year renewal options was awarded to Modern Office Methods, of Ontario, for cost-per-copy services following a review of requests for proposals that were received earlier this month. Commissioner Tony Vero said the cost will go up the first three years, partly because of the addition of five new machines at the Sheriff’s Office, but are expected to be lower if the county goes ahead with the renewal options.

In other business, commissioners

• raised the pay grades for five registered nurses at Dayspring after reviewing job descriptions;
• approved a $19,714 change order for the courthouse remodeling project for the Clerk of Courts on the L-2 level because of increased restroom plumbing work; and
• approved the use of the courthouse lawn from 7 a.m. to 5 p.m. Sept. 14 for Silent Watch, an annual event to bring awareness to the growing number of service veteran suicides.