Primary Department: Management and Budget
Primary Department Head/Elected Official: Daniel Ramos
Secondary Department: Human Resources and Talent
Secondary Department Head/Elected Official: Sakita Douglas
Regular or Supplemental RCA: Regular RCA
Type of Request: Financial Authorization
Project ID (if applicable): N/A
Vendor/Entity Legal Name (if applicable): N/A
MWBE Contracted Goal (if applicable): N/A
MWBE Current Participation (if applicable): N/A
Justification for 0% MWBE Participation Goal: N/A - Goal not applicable to request
Grant Indirect Costs Rate (if applicable): N/A
Justification for 0% Grant Indirect Costs Rate (if applicable): N/A - Not a grant item
Request Summary (Agenda Caption):
title
Request for approval to implement an Employer Group Waiver Plan for prescription drug coverage for Medicare retiree members covered under the group health plan.
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Background and Discussion:
Harris County currently offers prescription drug coverage to Medicare retiree members through its self-funded health plan administered by Aetna and a Part D plan for those enrolled in the fully insured Medicare Advantage Prescription Drug (MAPD) plan through Humana. Prescription benefits are identical to employee coverage for members not enrolled in the MAPD plan. For these members, the Centers for Medicare & Medicaid Services (CMS) allows employer sponsored plans to offer Part D coverage that closely aligns with what is offered to their employees through what is called an Employer Group Waiver Plan (EGWP).
An EGWP would provide savings to the county’s health plan through additional subsidies provided by CMS and manufacturer discounts. Disruption to members would be minimal since an EGWP enables plan sponsors to closely replicate their current plan design. Therefore, it is recommended the county implement Aetna’s fully insured EGWP called SilverScript for Medicare members not enrolled in Humana’s MAPD plan. If approved, Human Resources and Talent (HRT) will coordinate with Purchasing, the County Attorney’s Office, and Universal Services on implementation including any necessary contract requirements, Peoplesoft program modifications, and the go-live date.
Expected Impact:
Harris County’s benefits consultant, Segal, is projecting $9M in annual savings by implementing the EGWP. Aetna ran a disruption analysis using 2024 claims data, and 95% of all prescriptions filled would have either seen no change or a lower copayment under the SilverScript plan. 2% of the prescriptions would have changed from the preferred tier on the formulary to non-preferred; therefore, the members would have paid more out-of-pocket. 3% of the prescriptions were not on the SilverScript formulary, but an alternative drug was identified for a vast majority of them. It should be noted that a transition period of 90 days is available to ensure members receive their prescriptions.
Alternative Options:
Commissioners Court could continue to provide prescription drug coverage through the county’s self-insured health plan.
County Strategic Plan Goal: N/A
County Strategic Plan Objective: N/A
Justice/Safety Initiative (Goal 1): N/A
Infrastructure Initiative (Goal 2): N/A
Economy Initiative (Goal 3): N/A
Health Initiative (Goal 4): N/A
Climate/Resilience Initiative (Goal 5): N/A
Housing Initiative (Goal 6): N/A
Additional notes related to the Strategic Plan:
Prior Court Action (if any):
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Precinct(s): Countywide
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Anticipated Court Date: 8/14/2025
Anticipated Implementation Date (if different from Court date): 1/1/2026
Emergency/Disaster Recovery Note: Not an emergency, disaster, or ARPA related item
Contact(s) name, title, department: Sarah Acosta, Director of Benefits & Wellness, Human Resources and Talent; Shain Carrizal, Deputy Executive Director of Risk Management, Office of Management and Budget
Attachments (if applicable): N/A