Self-Funded Insurance Committee

CITY OF HENDERSON SELF-FUNDED INSURANCE COMMITTEE MEETING MINUTES Wednesday, July 19, 2023 I. CALL TO ORDER Chair Daniel Pentkowski called the City of Henderson Self-Funded Insurance Committee meeting to order at 1:02 p.m., in the Mayor and Council Board Room, 4th Floor, City Hall, 240 South Water Street, Henderson, Nevada 89015. II. CONFIRMATION OF POSTING AND ROLL CALL Courtney Redsull, Employee Benefits Manager, confirmed the Self-Funded Insurance Committee meeting had been noticed in compliance with the Nevada Open Meeting Law. PRESENT: Chair Daniel Pentkowski Maria Gamboa Bret Hyde Nick McLemore JJ Moyes (left at 2:27 p.m.) Shawn Thibeault ABSENT: Christopher Aguiar (excused) Brooke Stream (excused) ALTERNATES: Carol Banks (left at 1:28 p.m.) Joann Carter Rebecca Gillis Carlos McDade Michael Page Michael Openshaw ABSENT: Michael Charlton (excused) Charles Hedrick (excused) STAFF: Kristina Gilmore, Assistant City Attorney III Bre Beaumier, Employee Benefits Coordinator Courtney Redsull, Employee Benefits Manager Michelle Reese, Deputy City Clerk Christine Scott, Employee Benefits Specialist III. PUBLIC COMMENT No public comments were presented. Self-Funded Insurance Committee Meeting Page 2 of 8 Wednesday, July 19, 2023 - Minutes IV. ACCEPTANCE OF AGENDA (For Possible Action) (Motion) Member JJ Moyes introduced a motion to accept the agenda, as presented. The roll call vote favoring passage was: Those voting aye: Chair Daniel Pentkowski, Maria Gamboa, Bret Hyde, Nick McLemore, JJ Moyes, Shawn Thibeault, and Carlos McDade. Those voting nay: None. Those absent: Christopher Aguiar. Those abstaining: None. Chair Daniel Pentkowski declared the motion carried. V. NEW BUSINESS 1 MINUTES SELF-FUNDED HEALTH INSURANCE COMMITTEE MAY 17, 2023 FINANCE DEPARTMENT Self-Funded Health Insurance Committee minutes of May 17, 2023. (Motion) Member Maria Gamboa introduced a motion to adopt the Self-Funded Health Insurance Committee minutes of May 17, 2023. The roll call vote favoring passage was: Those voting aye: Chair Daniel Pentkowski, Maria Gamboa, Bret Hyde, Nick McLemore, JJ Moyes, Shawn Thibeault, and Carlos McDade. Those voting nay: None. Those absent: Christopher Aguiar. Those abstaining: None. Chair Daniel Pentkowski declared the motion carried. 2 MONTHLY FINANCIAL REPORT FINANCE DEPARTMENT City of Henderson Self-Funded Health Plan monthly financial report for May 2023. Rebecca Gillis, Accounting Manager, reviewed and summarized the following financial reports from the backup materials: Self-Funded Health Insurance Fund (Fund 6051), Retiree Insurance Subsidy, and Stop Loss Restricted Cash, as of May 31, 2023. Self-Funded Insurance Committee Meeting Page 3 of 8 Wednesday, July 19, 2023 - Minutes 3 THIRD-PARTY ADMINISTRATOR MONTHLY REPORT FINANCE DEPARTMENT UMR, Inc., monthly report for May 2023. Russell Garrett, UMR, Inc., presented a summary of this item referring to the backup materials and highlighted the following information:  Utilization by Claim Type by Month  Medical Utilization by Claim Category by Month  Enrollment by Tier - Medical  Enrollment by Tier - Dental  Medical Enrollment by Demographic  Dental Enrollment by Demographic  Medical Claims by Demographic  Dental Claims by Demographic  Medical Claims PMPM  Dental Claims PMPM  Demographics Summary - Medical  Customer Care Call Statistics  Customer Care Call Type A brief discussion ensued regarding overall claim inventory, claim adjudication timeline, and percentage of claims automatically adjudicated. 4 VENDOR UPDATE - UMR, INC. FINANCE DEPARTMENT Update from staff on claims issue resolution with Third-Party Administrator, UMR, Inc. Courtney Redsull, Employee Benefits Manager, provided a summary of this item and reviewed the potential solutions discussed with UMR to overcome claims issues. She stated UMR is doing a review to see what types of claims are being sent for advanced claims review and said staff are being retrained to address some issues. A discussion ensued regarding what constitutes a claim edit, common billing issues, the need for checks and balances of claims, information being provided to participants when a claim is denied, and how to streamline the claim edit process. Self-Funded Insurance Committee Meeting Page 4 of 8 Wednesday, July 19, 2023 - Minutes Russell Garrett, UMR, Inc., stated there had been some issues on the FSA with copays that were not loaded; however, it has since been corrected. He stated the phone tree was recently changed to help aid customers with getting connected to the correct call center line. Ms. Redsull stated a new outreach communication was being developed for FSA participants to help set better expectations regarding required documentation. She stated longer timelines were put in place for the FSA debit card between noticing and suspension of the card. She stated there has been some consideration given to a pre-funding model to address the slow timeline for reimbursements. 5 VENDOR UPDATE - CARELON RX FINANCE DEPARTMENT Update from staff on claims issue resolution with Pharmacy Benefit Manager, Carelon Rx. Courtney Redsull, Employee Benefits Manager, provided a summary of this item and reviewed the recurrent issues with the current Pharmacy Benefits Manager. She stated Carelon Rx was not forthcoming with viable solutions for the prior authorization and quantity limit issues raised and the benefits team has spent an excessive amount of time trying to address customer issues, which was not the case with the previous pharmacy benefit manager, Express Scripts. A discussion ensued regarding the safety risks of overriding prescription limits, the cost of the buyout for Carelon Rx’s contract, potential remedy options, and a potential timeline for a new pharmacy benefits manager. 6 SELF-FUNDED HEALTH PLAN DESIGN FINANCE DEPARTMENT Briefing from staff on an exercise to review plan design for a lower cost option. Courtney Redsull, Employee Benefits Manager, provided a summary of this item. She explained the purpose of the exercise was to see if an alternate plan design would be possible to provide a plan option with a lower premium that might benefit retirees; however, the exercise suggested this was not possible without significant value loss to the plan. She said instead, staff will focus more on educating upcoming retirees on the cost of medical coverage. Shawn Adkins, Gallagher Benefit Services, reviewed the cost breakdown for the alternative plan and explained the cost savings was too small and the maximum out of pocket expense was too high to move forward with alternate plan options at this time. Self-Funded Insurance Committee Meeting Page 5 of 8 Wednesday, July 19, 2023 - Minutes 7 DETERMINE WHETHER TO ENTER INTO A CLOSED SESSION REGARDING MEMBER’S REQUEST FOR PLAN DESIGN CHANGE FINANCE DEPARTMENT Pursuant to NRS Chapter 241.030 and medical privacy laws, the committee may move to close the meeting to discuss a member’s physical or mental health. Agenda Item 8 is a presentation by a member who desires to discuss their personal medical history for the purpose of providing background information and explaining the reason for their request for a plan design change. The member may waive the right to a closed session and the discussion for Item #8 would then become open to the public. Courtney Redsull, Employee Benefits Manager, provided a summary of this item and stated the member whose request is being discussed under Item 8 has requested to enter into a closed session. Chair Daniel Pentkowski introduced a motion to enter into a closed session for Item 8. The roll call vote favoring passage was: Those voting aye: Chair Daniel Pentkowski, Maria Gamboa, Bret Hyde, Nick McLemore, JJ Moyes, Shawn Thibeault, and Carlos McDade. Those voting nay: None. Those absent: Christopher Aguiar. Those abstaining: None. Chair Daniel Pentkowski declared the motion carried. Note: The open session was recessed after the passage of the vote at 2:12 p.m., at which time, Item 8 was discussed in a confidential closed session. 8 MEMBER REQUEST FOR PLAN DESIGN CHANGE - COVERAGE FOR WEIGHT-LOSS MEDICATION WEGOVY FINANCE DEPARTMENT Presentation from a member of the Self-Funded Health Plan on their request for plan design change to begin covering the weight loss medication Wegovy. Note: A confidential discussion was taken on this request. Note: The open session reconvened at 2:30 p.m., at which time, the remaining items on the agenda were completed. Self-Funded Insurance Committee Meeting Page 6 of 8 Wednesday, July 19, 2023 - Minutes 9 PLAN DESIGN CHANGE CONSIDERATION - COVERAGE FOR WEGOVY AND OTHER WEIGHT- LOSS MEDICATIONS FINANCE DEPARTMENT The health plan currently excludes coverage for weight-loss medications. In May 2023, the Committee heard a request for plan design change to begin covering the weight-loss medication Wegovy. No Committee members brought forward a motion on this agenda item and as a result, the member's request for plan design change to begin covering Wegovy was not approved. An additional member of the Self-Funded Health Plan has submitted a request for plan design change to begin covering the weight-loss medication Wegovy. This medication has an annual cost of approximately $1,295.00 per month, with other similar weight-loss medications having a similar monthly cost. Similar medications are currently covered as diabetes medications at a different strength when medically necessary. It is anticipated that more weight-loss medications that are currently approved as diabetes medications will continue to be approved by the Food and Drug Administration (FDA) for treatment of obesity and that member utilization of these medications will be extensive. Estimated annual cost to the health plan of prior-authorized medically necessary weight-loss medications is $182,500.00 to $273,750.00 in the first year of approval with cost increasing as more medications approve and grow in popularity and member comfort. Possible plan design options include:  Approve coverage for Wegovy and all FDA approved weight-loss medications when medically necessary according to CarelonRx clinical criteria, utilizing plan design of the current pharmacy plan formulary tiers, at an estimated annual cost range of $182,500.00 to $273,750.00 in the first year of approval.  Approve coverage for Wegovy and all FDA approved weight-loss medications when medically necessary according to CarelonRx clinical criteria, utilizing an alternate plan design for this class of medications that includes a separate annual out-of-pocket maximum of $3,000.00 and member cost share of $250.00 co-payment for brand name weight-loss medications and $75.00 co-payment for generic weight-loss medications, at an estimated annual cost range of $136,875.00 to $205,300.00 in the first year of approval.  Approve another plan design for weight-loss medications as suggested and discussed by the Committee.  Deny the request for plan design change to include coverage for Wegovy, as the cost profile and expected cost to the plan have not changed since the Committee last heard the same request in May 2023, and no additional information to support approval of the request has been presented to the Committee. Self-Funded Insurance Committee Meeting Page 7 of 8 Wednesday, July 19, 2023 - Minutes Shawn Adkins, Gallagher Benefit Services, presented a summary of this item and reviewed the potential cost increase associated with the plan design change request. He stated there is a manufacturing coupon for Wegovy; however, it is not part of the current cost relief program with Carelon Rx. In addition, he stated the market is changing and the cost of the drug is expected to increase. A discussion ensued regarding:  Expected length of time patients remain taking the drug  Criteria for use and estimated number of plan members that may elect to use the drug  Member concerns regarding approximate cost to the health plan  Age of the drug and timeline for generic alternatives  Weight loss drug coverage by other plans  Potential for offset costs due to decrease in weight-related comorbidities (i.e. heart conditions, diabetes, high blood pressure)  Lack of medical research showing evidence of decrease in comorbidities Member Maria Gamboa introduced a motion to deny the request for plan design change to include coverage for Wegovy, and all GLP-1 classified drugs, as the cost profile and expected cost to the plan have not changed since the Committee last heard the same request in May 2023, and no additional information to support approval of the request has been presented to the Committee. The roll call vote favoring passage of the motion was: Those voting aye: Chair Daniel Pentkowski, Maria Gamboa, Bret Hyde, Nick McLemore, Joann Carter, Shawn Thibeault, and Carlos McDade. Those voting nay: None. Those absent: Christopher Aguiar. Those abstaining: None. Chair Daniel Pentkowski declared the motion carried. Note: Member JJ Moyes left the meeting at 2:27 p.m. Alternate Member Joann Carter voted in his absence. VI. CHAIRMAN\MEMBER COMMENTS There were no Chairman\Member comments presented. VII. SET NEXT MEETING The next meeting date was set for Wednesday, August 16, 2023. VIII. PUBLIC COMMENT There were no public comments presented. Self-Funded Insurance Committee Meeting Page 8 of 8 Wednesday, July 19, 2023 - Minutes IX. ADJOURNMENT There being no further business to discuss, Chair Daniel Pentkowski adjourned the meeting at 2:59 p.m. Respectfully Submitted, /s/ Michelle Reese Michelle Reese, Deputy City Clerk