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ECISD talks pharmacy claims and collaboration with Driscoll Children’s Hospital

The Edinburg Consolidated Independent School Board held an insurance committee meeting Tuesday to discuss pharmacy claims and collaboration between the district and Driscoll Children’s Hospital.

Prime Therapeutics Account Executive Lashay Cooper reviewed the district’s pharmacy performance, starting with data from 2019.

“This is when you all made changes to your benefits and you moved from the basic drug list to the balanced drug list,” said Cooper. “And then you moved from our traditional select network to our advantage network.”

The advantage network, according to Cooper, is the narrow network that excludes pharmacy chain CVS. Through the balanced drug list, the district gets higher savings and less disruption from members. The projected savings from the drug list change in September 2019 was  $257,000.

In 2019, diabetes and autoimmune disorders accounted for 58% of the total plan spend at over $9,206,000.

In 2023, the cost for pharmacy spending sits at $11,486,092, a 26.3% change, with the prior period at $9.1 million. The cost per member sits at $203.21. It was $162.79 last period, giving a 24% increase. Generic utilization increased to 80.9%.

“Although your members increased about 1.2%, the claims did go down 1.8%,” said Cooper. “Specialty is almost up 51%. Non-specialty has almost increased 14%, so we’ll dive deeper into what is driving both of these.”

According to data provided by Prime, traditional drugs represent 99.4% of all claims and account for 60.6% of drug costs to the district.

The current cost for traditional drugs is $6.9 million over the prior period of $6.1 million. Monthly member cost increased by 12% to $123.14.

“This is all driven by diabetes,” Cooper said.

Dustin Garza said that the district was looking to speak with Driscoll due to two interlocal agreements. One agreement focuses on parental involvement with the Driscoll Health Plan, and another about staffing teachers for children with extended hospital stays.

“We’ve seen an uptake in members and children of our employees that have our health plan utilize Driscoll Children’s Hospital in Corpus, especially with the NICU babies,” said  Garza, claiming that there were two of the highest cost claims in 2022. “It’s been very difficult for the district for the last two years, difficult for some of our employees.”

Garza reviewed pediatric care data to consider an MOU (Memorandum of Understanding) or direct contract with Driscoll to help with cost.

“We all know that hospital is expensive when our members go there, and we want to make sure that if we can do something for our children, our employees that have children that have long stays in the hospital, obviously we want to limit some of that cost,” he said. “They have data, they’re looking at the data, looking at what they can do for Edinburg CISD. But this is something we’re trying to be proactive with.”

Driscoll Children’s Hospital is set to finish construction in December and will open in April 2024.

“I would like it if ECISD would be the first school district to use their services for medical and health, and help somewhat provide health insurance for our uninsured students at ECISD,” said Secretary Luis G. Alamia, who sat in place of Vice President Xavier Salinas, who could not attend.

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