Joint Peace Officers/County Benefits Committee Meeting - July 23, 2026

Agenda

• Meeting Details
  Vendor Topics of Discussion
  2027 Benefit Plan Renewals
• Time: 11:00 – 11:30 am
  Additional Topics: Review 2027 Benefit Plan Renewals
  Attendees: Committee

Minutes

Attendance and Minutes

Voting Members Present: Steve Gaytan, Rachel Forslund and Billie Hurley

Voting Members Not Present: Ben Wiley
Consultant: Joe Bober, Mercer; Morgan Hoffman, Mercer

Non-Voting: Heather Pedersen

Joe Bober presented the preliminary results of the 2027 medical and pharmacy RFP process. He emphasized that the financial comparisons were prepared using 2025 claims experience to compare vendor performance and should not be interpreted as 2027 renewal rates. The analysis evaluated provider network discounts, claims repricing, administrative fees, potential member disruption, and pharmacy benefit manager (PBM) options. 

Medical RFP Results

Medical Network and Financial Analysis

• Mercer compared proposals from Aetna, Regence, and Moda after UnitedHealthcare declined to bid. 
• Aetna's provider discounts were essentially equivalent to Providence's current network, resulting in no additional claims cost adjustment. 
• Regence and Moda repriced claims approximately 13% higher than Providence, resulting in significantly higher projected medical costs. 
• Based on the overall financial analysis, Aetna emerged as the strongest medical proposal due primarily to its network discounts and lower administrative costs. 

Provider Network Disruption

Mercer reviewed provider disruption using both billed charges and claim counts.

Key discussion points included:

• Aetna demonstrated minimal network disruption overall. 
• Regence's future loss of Oregon Health & Science University (OHSU) from its network beginning January 1, 2027, significantly impacted its disruption analysis. 
• Members using Providence providers should not experience disruption under Aetna because Providence and Aetna now have a multi-year network agreement. 
• Aetna's national network was also noted as an advantage for dependents or retirees receiving care outside Oregon. 

Alternative Care Concerns

Steven Gaytan shared that the POA member survey identified alternative care (chiropractic, acupuncture, massage therapy, etc.) as the members' largest concern due to historically low reimbursement rates under Aetna.

Joe Bober reported that Mercer had already discussed this issue directly with Aetna.

Aetna agreed to:

• Continue the County's current "any willing provider" approach for alternative care. 
• Reimburse providers based on billed charges rather than low contracted rates. 
• Maintain the current member experience without additional balance billing. 
• Continue this arrangement for as long as the County wishes to maintain it while also attempting to expand its contracted provider network over time. 

Committee members viewed this as a significant improvement that addressed one of the largest anticipated member concerns. 

Pharmacy (Rx) RFP Results

Mercer reviewed pharmacy proposals from:

• Regence  
• Moda  
• CVS Caremark 
• Express Scripts 
• OptumRx  

Key findings included:

• All three national PBMs (CVS Caremark, Express Scripts, and OptumRx) produced substantial savings compared to the current Providence arrangement. 
• Estimated annual savings ranged from approximately $600,000 to nearly $900,000. 
• Because Aetna also performed best on the medical evaluation, Mercer indicated these PBMs represented the strongest overall combinations. 

Formulary Disruption

The committee discussed formulary disruption associated with changing PBMs.

Highlights included:

• Depending on the PBM selected, approximately 40 to 72 members (roughly 1% or less of covered members) could require medication changes. 
• Most affected medications have therapeutic alternatives available. 
• Impacted members would receive advance communication before implementation and be encouraged to work with their physicians on appropriate substitutions. 
• Steven Gaytan expressed concern about members with chronic conditions who may have difficulty changing medications. 
• Mercer indicated it would explore whether grandfathering provisions might be available for existing users of excluded medications, although no PBM had committed to doing so. 

Mercer also noted that Express Scripts' proposed network does not include Fred Meyer pharmacies. 

Committee Discussion

Discussion focused primarily on minimizing disruption for members.

Steven Gaytan sought reassurance regarding:

• Continued access to Providence physicians. 
• Provider reimbursement levels. 
• Alternative care coverage. 
• Prescription drug disruptions. 

Mercer confirmed:

• Providence providers participating with Aetna will be treated as in-network. 
• Members should not experience additional provider billing due to reimbursement differences. 
• Alternative care concerns have been successfully addressed through negotiations with Aetna. 

Rachel Forslund discussed the upcoming timeline for presenting recommendations to County leadership and requested that Steven review the materials with POA representative Ben before the leadership meeting the following week.

Key Takeaways

• Aetna was identified as the strongest medical proposal based on financial performance and minimal provider disruption. 
• The anticipated disruption to alternative care providers was successfully mitigated through negotiations with Aetna. 
• National PBMs provide significant projected pharmacy savings but will require limited formulary changes for approximately 1% of covered members. 
• The committee's primary focus remains minimizing disruption while achieving long-term cost savings and maintaining quality access to care. 

Adjournment

There being no further business, the meeting was adjourned following completion of the scheduled agenda items.