I want to start this article by welcoming Spring with open arms while looking back with utter annoyance at the literal feet of snow that this winter dumped on our area over a few short weeks. Tragically, those storms claimed the lives of a few of our members who had fatal cardiac episodes while dealing with the heavy snowfall. As many of you dealt with those sudden losses you still found a way to go to work and perform at ridiculous levels just to take care of your customers. It’s sad how the jobs you do don’t often allow you the time you need to breathe and reset after difficult times. The expectation is that you will just be back tomorrow to do it all again. Sadly, some of us are walking around unaware that our own serious medical episode could be just around the corner.
This cycle it didn’t take long for me to decide what to write for this edition of the Advocate. I have been focusing a lot of my presentations on your health (mental & physical) and your healthcare plans over the past few years. I am disappointed that we didn’t get as far as we hoped towards adding a mandatory wellness component to your healthcare plans this year, but it doesn’t mean we have stopped trying to find the right vendor and proceed aggressively down that path. We believe it is our mission to help find ways for you to use your benefit plans more responsibly, both to better your own health while at the same time protecting the long-term financial health of your healthcare fund. Although there are exceptions to every rule, helping you (or even pushing you) find ways to take a little extra care of yourself or mandating you to get yearly physicals and preventative care will often accomplish both. Unfortunately, people will always get sick, that isn’t something that we can prevent. But discovering issues early can often mean avoiding lengthy hospital stays, expensive prescription drugs, invasive surgeries, and long-term recovery plans. It could mean adding years to your life, while at the same time avoiding the high-cost claims that negatively impact your healthcare fund every year.
I’m going to throw a few important numbers out for you to think about regarding your healthcare funds. In 2025 your healthcare funds paid out almost $82.7 million dollars in total! $63.3 million dollars (76.5%) was spent on medical claims (doctors, surgeries, tests, hospital stays, etc.). But $15.2 million dollars (24% of the medical spend, 18.4% of the total fund spend) was spent on 140 High Cost Claims (HCC). Those 140 claims ranged from $50K to $506K and averaged out to $108.5K per claim. Just to break it down a little further for you, those 140 claims consumed the same amount of dollars that 9718 monthly full-time welfare contributions bring in. That is the equivalent of 810 full-time members’ contributions for the year! This is why we spend so much time talking about how to use your healthcare plans more responsibly. If we cannot get the HCCs under control it will have an extremely negative impact on your funds and the level of coverage we can provide.
Coupled with containing the rising costs of medical claims Trustees are also trying to deal with the single most concerning aspect of healthcare plans around the country today, prescription drug (RX) coverage. Last year your funds paid out $16.1 million dollars (19.5% of the total funds spend) in RX claims. It seems that every year a new RX hurdle appears that we must figure out how to contend with. In 2025 a huge issue for our funds were the large number of GLP1 scripts (for diabetes & weight loss) we had. You know all the names, the commercials run non-stop on every channel of your TV. Last year the funds paid out $2.33 million dollars (approx. 15% of the RX spend) on GLP1 scripts alone. These drugs were also the top 4 individual drugs in terms of spend across our fund. If you know anything about these drugs there is a ton of waste, fraud and abuse associated with them. I mean let’s face it your podiatrist shouldn’t be writing you a script for weight loss drugs! Each day hundreds (maybe thousands) of GLP1 scripts are written off label, meaning being prescribed without the approved indications, age groups, dosage or form just get someone the weight loss drugs. Because of rampant abuse in this area, we have been forced to put many utilization management (UM) programs in place to help ensure anyone getting them meets the medical criteria and isn’t just someone who wants to lose 25lbs to go to their high school reunion! This will continue to be a battle for us but it’s one we cannot afford to lose. If you want those drugs and don’t meet the medical criteria, please go buy them on your own, there are dozens of commercials for that too! Those options will cost you WAY less than the fund pays having them run through the pharmacy.
In an effort to keep doing our part the Board of Trustees for the UFCW Local 1500 Welfare (healthcare) Fund ventured down a new path in 2025. For the first time we partnered with two other, much larger, welfare funds on the east coast and conducted a joint request for proposal (RFP) for a new pharmacy benefit manager (PBM) contract. Your current PBM, Express Scripts, was notified after the completion of the RFP process that as of July 1st, they will no longer be our PBM. We are excited to announce that we will be moving our PBM business to Prime Therapeutics (Prime) effective July 1st of this year. There will be communications coming to you soon via mail and I will record a video, that will be available on our social media pages and the Union website, to help explain some of the early steps to look for. Some of you will need to get updated letters from your doctors to keep getting certain medications. Some of you may have to switch to a biosimilar that will have no impact on you medically but will save the fund thousands of dollars a year. Prime will be working with you and the fund to make this transition as smooth as possible. This switch will save our funds over $7 million dollars over the next 3 years. That is a savings we MUST take advantage of. There may be a few new or different UM programs you may have to work with to continue to have a drug covered but isn’t that a small price to pay. Once we get further into the implementation process you will be able to go online to Prime’s website and get all the information you need and speak with Prime representatives who will happily guide your way. This change will also give the folks in our welfare fund office more access and an increased ability to help you with issues/questions when you call the office.Nothing we do can be successful without your buy-in, so I am asking you to partner with us early, as opposed to resisting the change and fighting us over it. These days the changes we make as Trustees and leaders are not changes we WANT to make; they are changes we NEED to make! Never forget, every extra dollar spent on your healthcare coverage is a dollar we can’t negotiate towards your wages. No matter how you slice it, if you use your benefits more responsibly you will not only help avoid major medical issues for yourself, but it can also result in millions in lower healthcare costs which can be negotiated towards your wages. Let’s work together and get this done, for all our benefit! I’ll see you soon in the stores and wish you the best of health. #MyUnionHasValue