City of Holyoke Health Benefit Trust Committee Meeting March 24, 2025

City of Holyoke Health Benefit Meeting

March 24, 2025

Fire Department Headquarters

The meeting was called to order by Quentin Donohue at 5:03 PM

In attendance: 

PEC Representatives: Joe O’Connor- Retirees and Chris Butler-Fire Dept

City Representatives: Tanya Wdowiak-City Auditor, Sean Mangano- HPS CFO, Dazhana Argueta-Personnel Specialist

Others: Quentin Donohue – chairman, Steve Corbin – Dowd Insurance, Rebecca Sutter – Dowd Insurance, Rory Casey – Treasurer, Ben Bonnett – SmithRx and Jordan Dhillon – SmithRx (via Zoom)

Agenda:

Receive minutes from 3/10/25 meeting

-Quention made recommendation to approve minutes

MOTION: Sean Mangano made a motion to approve minutes . Chris Butler seconded. Motion carried unanimously

Broker Update

• Steve introduced Jordan and Ben from Smith Rx to the Holyoke Health Benefit Trust. Quentin introduced himself as Chairman, Rory casey- City Treasurer, Rebecca- Admin for trust, Tanya- City Auditor, Sean- HPS Director of finance and trustee, Chris Butler- Fire Department, Dazhana Argueta- Personnel Specialist and Joe O’Connor- Retirement Board and member of board of trustees. 
• Ben and Jordan introduced themselves noting that Jordan has 10 yrs experience
• Jordan asked if we had any questions. Sean- what we are looking at is just alternatives we can make to our plan? Steve- Yes, this is a full carve out of Rx. They would be your benefits manager for Rx based on utilization. The data provided today by Smith Rx is limited based on current data from BCBS and some from HNE.
• Jordan explained that SmithRx is a full service Rx carrier that would replace CVS Caremark. Employees will be able to continue to fill Rx with CVS. Smith Rx owns its own network that is accepted at CVS, Costco, Walgreens and so on. Currently, Optum Rx and Express Scripts own 85% of networks and they make a lot of money for insurers. Jordan reviewed current clientele , savings, members and communities that they currently serve. Guarantees- 40% savings with CVS Caremark but they can give a minimum guaranteed savings. $81 PMPG saving currently with SmithRx. All rebate dollars goes back to the group. Every single dollar including admin fees. Admin fees are not how they get paid, they get paid per member.

• HRIS system would be used for data for enrollment

• Technology- can flag medication and let members know when there is a lower cost option, prior auth, grace refills and so on. 
• Connect 360- in house patient navigation- helps members find lowest cost. Ex specific pharmacy or apply for a grant if they qualify. Designed to be proactive. Example was an MS medication that was 111k but they found it for $16
  • Quentin questioned what is the threshold for applying for grants/eligibility?
  • Jordan- that was not a grant program. That was them helping members understand that the cost is $16. Grants are based on household income. 
  • Steve- each drug in the rebate program has a different income threshold. 
  • Joe- what is the percentage of people that are able to get grants?

*Internet froze and we were waiting connection to be restored*

• Rory- while we are waiting for the internet to get fixed, it’s not about one member, they work on our behalf and tell members what they qualify for.

*Connection was restored*

• Steve-what is the percentage of people that qualify?
• Jordan- 65%

• Rory- access plus savings is $732,803
• Sean asked if all drugs are carved out? Jordan responded, yes.
• Quentin asked how many years Smith Rx has been around and how many years they have been making money. Jordan responded 10 yrs and 2016 founded.
• Jordan added that SmithRx automatically applies coupon cards as they are built into pricing
• Jordan explained their autoimmune program- 
  • Humera is the most used in autoimmune class.
  • Humera went off patent and Smith Rx made another option and offered it to clients. 
  • Have also done with other drugs and saved 95% and proactively make outreach.
  • Quentin- what happens if they have a reaction?
  • Jordan- with doctor authorization, they can get on other prescription
  • Quentin- does percentage saving carry to other biosimilar drugs
  • Jordan- mostly expected
  • Steve added that the FDA will change rules where Pharmacists can change the Rx instead of having to go to the doctor. 
  • Quentin- with patient approval?
  • Steve- with doctor approval only. Massachusetts is a generic mandate state, if they get the brand the pharmacy has to do the generic brand by law unless the doctor says “as written” on Rx script
  • Rory- is this just because of the timing, the cost is just high because they are on the patent? Because there is a generic option, that is why we can take advantage of this now?
  • Jordan- Yes. We still see large carriers still filling the more costly Rx because they make a lot of money. Jordan ran claims and found 1.4 million dollars in savings using their tools. There are guaranteed savings or we get the admin fee back. Current cost is 150 PMPM but can get $88 PMPM and can help with portion 20k fee(BCBS charges) to use outside Rx supplier
• Jordan touched on the “Admin Experience”- each Broker has access to an account manager with access to Clinical Team and Account support. They will reach out quarterly with reporting but we have access all the time to financials. 
• Jordan touched on the “Member Experience”- All employees will receive a member ID card. Medication coverage looks and feels the same. Member Support is accessible Monday-Saturday. Call wait time under 6 seconds for 2 years now. Pharmacy locations are widespread and growing. No amazon account needed for mail order through them.
• Sean-1.6 million in savings which sounds great. There is usually a big rebate credit on the report, is this true? 
  • Steve- Yes, they include rebates that you are including now. They are not incentivized to make it expensive and so really your rebate will go down.
• Quentin- what is your retention rate? Have you lost municipalities? Why would someone leave you?
  • Jordan-95% retention rate. 5% loss is due to rolling up into larger plans where the option to outsource Rx is not an option or Brokers have relationships with big insurers. 
• Rory- Ex. Employee goes to Urgent Care and Rx gets called in. Employee goes to the pharmacy to pick it up. What is their experience? 
  • Jordan- no different than what I experienced today. 
• Rory- Over counter Rx was covered but when we went to self insured it was not covered. 
  • Jordan- choice you as the plan can make. We have it built in but you can turn it off. 
  • Rory-if we keep that, Steve, would we be able to do analysis of what is or is not covered?
  • Steve- yes
  • Jordan-SmithRx allows refills for 90 days, we don’t cut them off day one with the change. 
  • Rory-  what about pre-authorizations?
  • Jordan- have them built into plan. But we can look at historic data and keep historical prior auths to not go through that again.
• Chris B- For rebates, you are reaching out to members, how does that work?
  • Jordan-member outreach is usually a phone call sometimes, a letter.
  • Chris B- had one of those scenarios where BCBS did not cover and then did. How does that work?
  • Steve- if they are already on and authorized, it is approved. 
• Rory-if we (The Trust) were to move forward, what would the difference in claims/billing look like to Trust?
  • Jordan- all would go through BCBS. 

• Joe-Most saving through pharmacy with EE filling Rx?
  • Steve- yes, how it’s sourced.  Mail order will be less
• Quetin- going back to Rory’s scenario- I can get Rx where and when I need it?
  • Jordan- Smith processes claims and continues to fill where they are at. Mostly for prior auth and specialist drugs.
  • Chris Butler-worried about scenarios with rare drugs. Will we know if a drug got appealed so that we can take a vote to cover it?
  • Jordan-yes, in any scenario, you can override to approve medication
  • Quenti- looks too good to be true. Why should we trust you?
  • Jordan- You don’t have to. Numbers show models and that numbers work.
• Joe- what municipalities in MA do you have?
  • Steve- none at moment
  • Joe- what companies in MA
  • Jordan- can get the numbers
  • Rory- do know some of the larger ones (companies)?
  • Ben- Williams College
  • Jordan- can get references
• Quentin- how well do you play with BCBS
  • Jordan-pretty well. They just won’t print ID cards
• Joe- requested that SmithRx provide companies, municipalities and unions that they work with
• Chirs Butler- There is a 15% guarantee?
  • Jordan- yes
  • Steve- about 700k
  • Joe- disruption report, can’t really read the numbers
  • Steve- that was how it was printed
• Quentin- what is the worst thing someone would say about you guys?
  • Jordan- nothing we are incredible. At the beginning most people don’t want to speak to their insurance carrier in the transition process and that is probably the largest hurdle. 
• Quentin- What about Open Enrollment support?
  • Jordan- We can definitely come up so that there is someone there in person. Also like to include account manager
  • Chris Butler- you do realize we have different departments with different availability?
  • Jordan- maybe a recorded webinar is helpful but we can support. Open to full days as well
• Joe- $6 PMPM?
  • Jordan- yes and but $10 PMPM with everything
  • Joe- what was the price last year?
  • Jordan- change from the per claim model to PMPM model and don’t plan to make any more adjustments. 
  • Joe- so what was it before?
  • Steve $6 per claim

• Quentin- how many calls has BCBS got for Rx problems?
  • Steve- not sure but have gotten some
  • Rory- There is a big difference between this and insurance company
  • Chris Butler- we have to pay BCBS for something that Smith Rx is doing
  • Steve- There are areas/individuals sue self funded plans because there are low cost options that are not being implemented. With SmithRx we would have:

1. Performance guarantee. 
2. $720k bare minimum savings plus 8k. 
3. BCBS said-20k the first year and 10k every year after with a 10% increase to admin fee if we go with carving our Rx

• Quentin- Fear is if SmithRx has enough history that we can trust it.
  • Steve- over the last 5-10 years, they own PBM and can see their share cost. Does trust have authority to override? Yes, you have ultimate authority. First level appeal, gets denied and then can appeal. BUT not covered by stop loss policy.
  • Chris Butler- if we go with this, it is significant savings. Ride it out this year and lower rates next year.
  • Steve- that is my job to show you guaranteed increase vs savings. 
  • Joe- is this guarantee on the rates?
  • Steve- self v fully insured, there is a difference. You choose them now.
  • Rory- with Cigna- that was them recouping their own cost. Smith or other- if we don’t realize the savings, they can say they don’t guarantee it. If you move forward, I would not change the 9% increase and what savings comes in you decide then.
  • Quentin- when they come up with $1.6 that is compared to BCBS?
  • Steve-Yes, compared to current spend. My hesitation is incentive for employees to participate.What is the incentive to pay for generic brands instead? Can insure special Rxs and say if an employee does not participate, they pay 20%.
  • Joe- compared to BCBS and SmithRx what is the difference?
  • Steve- I would get a detailed report with drug codes and give to Smith to give exact savings/disruption.
  • Quentin- what is our timeline?
  • Steve- meet next Section 19 meeting April 7, 2025

Quentin welcomed a motion to adjourn

MOTION: Chris Butler made a motion to adjourn. Joe O’Connor seconded. Motion carried unanimously

The meeting adjourned at 6:52PM

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