Posted 1:04 p.m. Tuesday, March 17, 2026
Last Friday, the Group Insurance Board approved cost-sharing changes for plan year 2027 targeted towards mitigating trends in plan utilization and rising costs.
In addition, the Board approved the coverage of GLP-1 anti-obesity medications (AOMs) and drug copay assistance for Group Health Insurance Program (GHIP) members.
The March 13 meeting was a follow-up to the February 25 Board meeting at which the Board directed the Department of Employee Trust Funds (ETF) to further evaluate options for cost-sharing and plan design changes, drug cost savings from the Access Guidance Services (AGS) program, and cost estimates for AOMs.
ETF responded to myriad questions from Board members, with input from Navitus Health Solutions (Navitus), the pharmacy benefit manager, and Segal Consulting (Segal), the Board’s actuary.
Cost Sharing and AOM Coverage
ETF presented several updated options for cost-sharing and plan design changes. The Board approved ETF’s recommendation for targeted cost-sharing alignment, with additional adjustments to the pharmacy benefit, which Segal projected would save approximately $29.3 million. ETF used extensive industry and program research, including aggregate claims utilization data and feedback from members and employers on their out-of-pocket cost preferences.
Members in the program’s largest plan designs will have minimal cost-sharing increases for emergency room copays, deductibles, out-of-pocket limits, and Level 1 drug copays. The maximum out-of-pocket limit for covered in-network medical services in the non-High Deductible Health Plan will be removed.
The cost-sharing changes bring the GHIP plan designs closer to those of neighboring states. The objective is to focus on moderating premium growth, encouraging better care utilization practices, and maintaining a competitive and sustainable benefit structure for members and employers.
In addition, the Board approved coverage of AOMs at a separate cost-sharing level for non-Medicare members, effective January 1, 2027. Members will have a $200 copay for these weight-loss drugs.
Drug Copay Assistance
The Board also approved adding the AGS program, which will allow non-Medicare members on high-cost drugs to apply manufacturer copay assistance toward their cost sharing and out-of-pocket limits, effective July 1, 2026.
Navitus recently estimated that the GHIP would have saved approximately $28.5 million between 2024 through 2025, if the AGS had been implemented.
The Board is expected to set rates for 2027 at its next meeting on May 21, 2026.
