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Excellus seeks 19.5% rate increase for 2025

Excellus BlueCross Blue Shield is seeking an average rate increase of 19.5% for individual and small group members.

The rate increase is estimated to affect 11% of its members across upstate New York, or roughly 167,000 policyholders — mainly small businesses.

Excellus blamed rising hospital expenses and drug prices.

“More than half of our rate increase request is due to hospital costs as more upstate New Yorkers are going to the hospital for more severe and high-cost procedures (including cancer care and transplants),” Excellus wrote in a statement. “And prices overall continue to climb.”

Excellus Blue Cross Blue Shield logo

Health insurers across the state had to submit their requests for rate increases last month. Excellus' proposal is slightly higher than the average.

The state will review and can adjust those rate changes.

If approved, policyholders would see the change on their renewal date, on or after Jan. 1, 2025.

In addition to high-cost procedures, Excellus pointed to rising costs for outpatient services like hip and knee surgeries. As for drug prices, the company wrote in its filing with the state:

"Substantial savings have been achieved over the years with broad acceptance of competitively manufactured generic medicines,” the company wrote in its filings to the state. “However, the savings trend associated with generics is being eclipsed by another trend around the rising cost and utilization of specialty medications including biologics.”

Biologics are drugs derived from living organisms that target specific parts of your immune system.

“Every year,” the company explained, “more and more highly complex specialty medications are approved by the FDA to treat both rare and sometimes more common diseases. Specialty medications are used by approximately 2 percent of our members, but they account for more than 50 percent of total drug spend.”

A state agency says it has cut the requested rate increases for small group plans by half, and also made a substantial cut in the increases requested for the individual plan rates.

Brian Sharp is WXXI's investigations and enterprise editor. He also reports on business and development in the area. He has been covering Rochester since 2005. His journalism career spans nearly three decades.