Teton commissioners to approve 2026 RxBenefits pricing exhibit for pharmacy plan

Teton County commissioners are scheduled April 7 to approve the 2026 “Pricing Exhibit” for RxBenefits, the county’s pharmacy-benefits vendor, which updates the rebates, program fees and formulary/guarantees for the plan year Jan. 1–Dec. 31, 2026. The exhibit reflects terms already presented during the county’s October 2025 benefits renewal process, but requires board approval as an updated Exhibit A to the county’s administrative services agreement. (See the staff report in the Administrative Services Board Meeting Packet.)

Among the notable changes: the specialty-drug guarantee shifts from a single benchmark (AWP minus 23% in 2025) to two separate 2026 guarantees (brand AWP minus 20% and generic AWP minus 70%); the agreement adds language automatically enrolling HSA-qualified high-deductible plans in a “consumer driven health” program at $0.10 per member per month (less than $1,000/year, per staff); and it adds language that certain GLP-1 medications may be excluded from rebate guarantees under specified conditions. The exhibit also clarifies what counts as a “high-dollar claim” ($1,000 for a 30-day supply; $3,000 for a 90-day supply) and adds contract language about cooperation with third parties on subrogation claims. Administrative Services Board Meeting Packet.

Staff told commissioners the net fiscal impact should be positive because rebate guarantees increase — cited as rising from an average of $51.33 per employee per month to $73.08 — though the exact amount depends on actual prescription usage. The item is on the April 7 BCC consent agenda. Teton County Board of Commissioners regular meeting agenda.