Deschutes County government may open its own pharmacy to save on medical costs for employees. It already opened an on-site clinic for employees this year. We’re all for the government saving money. If the pharmacy saves money, the county should move ahead with it.

Unfortunately, it’s not that simple to make a decision. There’s risk. Success depends on how county employees use it and whether the county’s projections hold up.

There’s an even better place to look for savings: Change how much county employees pay for health insurance.

Earlier this year, the county studied it’s health care future and saw insolvency. It’s health insurance plan was on track to become insolvent by 2014.

The county is self-insured. It spends roughly $14 million on claims and medications a year. The county budget is about $267 million a year.

If county health costs aren’t brought under control, it’s going to have less money for everything else.

The county has made some changes already. As of Aug. 1, it added a $100 co-pay to an emergency room or hospital visit. That’s in addition to any deductible and co-insurance. The change is designed to make employees think about options before rushing to the emergency room.

The county is also trying to move more employees to cheaper generic drugs by making them available at no cost at the on-site clinic.

On Wednesday, commissioners are set to discuss contracting for an onsite pharmacy.

The county issued a request for proposals in the spring. It got only one serious response — from Take Care Health Systems, LLC. It is owned by Walgreens. The county visited sites Take Care is operating. It’s been negotiating with Take Care.

Take Care would operate a 850-square foot pharmacy on county property. It would only be for county employees.

There would be a pharmacist and a pharmacy technician on staff. Prescription drugs would be available. Generics would have no cost and no co-pay. Brand name drugs would have a $10 co-pay and specialty drugs would have a $20 co-pay, according to the staff report. There would also be some over-the-counter items available for sale.

Take Care would basically bill the county for the wholesale price of the drugs, cost of operations and a fee for overhead and profit. The county might have “cost avoidance” of as much as $600,000 by the fifth year of operation, although the county says it will likely be less than that. Success depends on how many employees switch to generics, how many use the county pharmacy, how much the county ends up spending to build an on-site pharmacy and more.

County Administrator Dave Kanner said the cost of construction will be about $100,000.

There’s also the matter of Take Care’s fee. What might it be?

That would be negotiated. Kanner said franchises like garbage haulers get profits of between 9 percent and 12 percent.

Is there an out for the county? Kanner said all county contracts have such provisions. And Take Care has also discussed including performance guarantees in the contract.

Those provisions are all important. Some county residents may see the onsite pharmacy as a perk for county employees. The county needs to be able to prove it is pinching pennies.

Whether or not the county moves forward with the pharmacy, the county has a more fundamental problem in its health plan. County employees are paying little per person a month for health coverage.

The county charges departments a set amount per employee — currently $1,169 a month — for insurance coverage. That is essentially the county’s premium. Single employees and employees with families all pay the same $65 a month. That is a fraction of the premium share workers across the country pay.

Workers on average pay 19 percent of the premiums for single coverage and 30 percent of the premium for family coverage, according to the Kaiser Family Foundation’s 2010 survey. The situation may be slightly different in Oregon. Oregon workers paid 22 percent of the premium for family coverage in 2009, according to a 2011 state report on health insurance.

The county is negotiating wages and benefits right now with one of its unions. The county has asked employees to ramp up to paying 9.5 percent of their premiums. Employees should at least do that.