ALC-Employee Benefits Division Oversight Subcommittee

All right we're going to begin the meeting first thing we'll do is just call it to order next week and go to b. Grant do you want to come forward. And whenever you're there mr wildest you can if you'd introduce yourself in that you can begin. Good morning great wallace director employee benefits division all right starting out with it and b. That these rules are in response to act five thirty three of twenty twenty three and it really outlines the process by which we will work with our siever it administering the voluntary products and procuring the voluntary products for state employees so these range for example your cancer policies your additional life health disability policies those types of products are or what are going to be governed by these rules and what they are responsible for be glad to answer any questions. Hey do we have any questions training in the members owned by. Case see a known i'll need a motion just for review on that okay we have a motion for review do we have a second hand second all favorite say any opposed like saying okay that motional carry. Er which was you can go to c and we'll go to see one is that what you want to do okay she went would you like to go over these individually by month or just kind of review all of them at once without objection will just do all of them at once unless everybody wants to do over individually we can do that. Okay I don't see anybody objections who will just to open okay so these are the norm normal formulairy reviews for the months of february march april in may. Um. Just would take a second to highlight a couple of items. Looking at march. For excuse me. Looking at the march branch you mirror is going from tear for to not covered and this is in response to the production of bio similars which are coming on to the market we do cover quite a few biosimilars already but the rebates are now going away for humirous so we are removing that from formula there is also a revolut that's in. The most. I think that ones on february this is in response it's a name brand that were bringing back on to the formula the generic has had some issues with fda approval there have been some supply issues that have caused shortages there so we're bringing on the name brand while those get worked out. Outside of that everything again is the normal kind of. Tearing restructuring bring some things on kind of making sure low cost options are available for our food with formula so with that if they're any specific questions i'll be glad against them team members this is see one other any questions in regards to it. Yeah. Can I not see any questions now everything this under c is actually going to be a review and of approval so I need to I need a motion to review and approve on that particular way I have emotion I have a second all in favor of sar in the opposed likes earn. Okay that motion will also. Okay mr wireless if you want to go to c two two will go each of these individually the first one is the mimit to the contract from mainstream technologies this is an extension from for to the end of the year for our technology partner they're the ones that do the programming and support for the are benefits portal which is our administrative platform that we utilize. For health records in our member management oh this is for a million dollars and if you take that we've actually took the twelve month experience divided in half and then shaved off two hundred and fifty thousand dollars so million we just kept it at around million dollars in this really is to keep the light time between now in the end of the year as we go through and look at either and rfp or whatever copics available co operative agreements that are available to us for our technology providers in this service so we just needed an additional time to complete that work. The. Okay are there any questions member. Okay since urban had a motion to review and approved we have a second center board all in favors they are in your pose. That motion carries you can proceed in the next okay the second one this is an earned amendment to the agreement with ebrx which is the partnership with uams and the college of pharmacy they are are pharmacies consultant this is keeping it level to what the existing funding is which is one point six million against same as current contract and this will we've adjusted a little bit to provide some additional operator operational assistance for appeals in reviewing those and making sure that or stay in on top of that work but otherwise everything stays the exact same with the relationship that we currently have any questions in regards to this one. Again this one is c two b or doing these individually so do you have a motion to prove soon about makes motion since urbans are second i'll in favor say any oppose. The emotional carry. If you want to go now to see two. To see two c is this is a new this is our tpa consultant with the rfp and the award e was foster and foster they will help guide us through the development of an orange p for the third party administrator currently that's health advantage but again I did not want to presume that I knew how to do that on my own and of seeking a consultant to help guide to make sure that the state is maximizing everything that's available in the market in in the industry right now and not just doing the same all same old with this particular rfp so that's why we are seeking this contract. Any questions in regards to this one. Just warn how many how many folks are. Did hammy replies did you get back on the only have one case of but you did put it out retired in its just come back with one yes okay but we had the motion to review and approve i'm sorry sender boy did you have a question yes go ahead sir my my mistake I just want to make sure I understand what it is we're voting on and so I think I do but I want clarity so when we're looking at health advantage that's the payer that's covering physicians hospitals. All pretty much non pharmacy medical benefits correct so we're we're going to go in and re evaluate the way to our partnership without advantage to see if somebody can get us a better deal correct in this consultant is going to help make sure we do that correctly correct thank you. Good question any other questions. Can we already have the motion do we have a second can we have a second okay all in favor in your post. The emotional carry. Okay never down to c three. Okay so see three these are the medical drug recommendations in were pulling these separate these are still prescriptions that they have a formula they get managed but these are different than the previous months that we've reviewed because they are done in a hospital clinical setting these are your more expensive medications and these are your newer to market. Medications these have been reviewed and advised from ebrex so the recommendations that you have before you are a lot of it is to exclude because again the evidence and the efficacy is just not fully developed because these are neutral market drugs but they are constantly being reviewed and continually being looked at when it comes to new medical information new research information and things of that nature be glad to answer any specific questions a grant are you are you doing both c three a n c three b in your presentation right there or you guess okay so you're at I thought so but I want to make sure that the membership understood that members on this particular one what he did was just three a and then also see three you have two sheets on that are there any questions on either of those. Sooner urban. And then sooner board you'll be up next so these lists are generated primarily by new drugs that are coming onto the market not necessarily by beneficiaries who are on the medications that correct thank you sooner board. Again just want to make sure I understand what we're doing and what we're voting on right so like there's some not inexpensive drugs on there there are some that are rather so can you just give me a brief overview of with the process looks like to determine what what we do to make sure they are covered or pay or excluded rate so we rely upon if you're x in the college of pharmacy at um their clinical reviewing of these and they're bringing these recommendations to the advisory commission and two evd around here's what we've seen here's what we believe in here's how we think you should treat this medication one either excluded from the plan because there's not enough science behind it yet or two put it on but put it on with these particular restrictions pay whether it's for a particular utilization or a particular prescriber needs to be prescribing this so that's really kind of where we're coming or it hey there's enough science there's enough money behind it everything's kind of balancing out added on and just let it go up so that's really the decision making process and putting it in great words I who really simplifying it so there are people with a clinical background who are involved in this decision making this isn't just a bunch of bureaucrats with an mba who are deciding how health care should be practiced in the state correct thank you. Thank you center board. Are there any other questions again now we're doing c three a and c three b. Okay we have a motion to review and approve we have a second all in favor in your post. Okay that motion will also carry on both seat that's on both that one. Case if you want to proceed to see four okay item for these are the proposed per twenty twenty five plan rates for state employees and public school employees. So looking at state employees the recommendation before you is to continue with our five year. Transition plan this would be utilizing spending down some of the reserve balance finding that equation of reaching a seventy five twenty five cash share between the state and the employee and as well making sure that our employee rates are competitive within the surrounding area and in surrounding markets more looking at other states so what you'll see before you are the various. Everything really does have a reduction on kind of the active side there is some increase on the retiree side again that is driven due to the subsidy and trying to level out the subsidy between the united health care in the pd plan and the health advantage plan so the state you're wanting to make sure that the state is subsidizing both of those at an equal or parity rate and as you can see right now it's heavy on the health advantage side and and we need and we still need to kind of work on that transition in that ballots out. And and again keep in mind that when somebody is on the health advantage plan the liability is a hundred percent on the state when it is on when they are on the united health care plan the liability is then put on to united health care so we are only responsible for the monthly premium at that point. So any questions for state employees. So we talk about wanting to be economic between what the retirees are paying percentage and what the workers are banned but I mean obviously a retiree and a younger worker are too. Their finance situations are completely different I mean can you walk me through the reason why we want these to be equitable to just so looks good on paper because in my mind I would rather not see an increase for the retirees because simply these are you know I mean. There are fixed incomes they've kind of accept budget and obviously you know increases I think effectively hurt them more where like a younger worker well i'm glad to see that they're their contribution is going down I mean maybe they have an ability to take that on the channel or more than a retirees you know has worked for the past forty years and is now having to see an increase in their contribution whereas someone is just working actually seeing a decrease so walk me through that a little bit more just that I can. Better understand or rationale for why we're doing it right in and so when i'm talking about trying to create equity it really is only active employees within their comparators across other states that are in our surrounding areas in making sure that we're willing remaining competitive when we're offering these benefits to our employees that i'm not comparing active employees and retirees. Um and then the driver really on the rates there's always going to be inflation but with medical and pharmacy benefits that are going to drive increases in it be a natural increase we're trying to contain those increases on the retirees that's why there was the creation of the united health care in a pd plan and that's why you're able to kind of cap and control the cost more by having that offering available to them with the health advantage plan however and the one hundred percent liability that the state is assuming that those cost we do have the experience that gets factored in there we do have the elization that gets factored in there and so that's what's really driving why that number is what that number but we are capping a for a retiree they will not experience ever anything greater than a ten percent increase. So let me make sure that that I understand and if and if I can tell me if that this is not correct so because we gave that option is actually because that's the reason that that it is higher is because that that option they wanted that to be available. And since that is available of course the state takes on more risk that the reason for the higher premium right to be able to continue with the health advantage plan sure okay and as far as what we've seen rolling off I think we discussed that and you thought that that we would continue to see people roll off and roll on the other plan is that correct correct in the and I will stay the state employees are picking up the united health care plan at a greater percentage than the public school so we are starting to see some of that movement might not be as fast as what we all want but we're getting there I hope to continue to improve that over the next few years. Thank you sir senator boy did you have a question europe okay so just just to clarify i'm not sure that I want it in our so when you say that maybe you want but like there's a lot more choice when you have your health advantage versus the other one right so there's a balance between choice in and cost and we got to think about other but that my question really is. What are you hearing about health advantage and struggling or or a lot of negotiations with networks are you hearing anything like that like health advantages is having issues coming to agreement with some of our hospital providers or other. Providers in in the network like we've heard with the young medicare advantage folks are just like some kind of update and clarity on that thank you right so i'm not hearing network issues or negotiations i'm not provided to that but i'm not hearing any responses back on the health advantage i'd like a with united healthcare. Representing the baby europe sir thank you missed just a quick question just to make certain one fault on this this will be an annual process to look at these these rates and with. So every year will will go through this stay up to to look at the the the premiums correct correct and if I understood what what you said just a minute ago the most the any of our retirees are that are the highest change it would be affected is a ten percent change correct okay and was. Annually yes so my question did they provide any forecasts for the future of what the anticipated increases are only near these beyond just this year. So I have financial forecast. Globally in total as far as you know millions that are going to be needed for out out years they're not broken down all the way into individual rates at this point we do review those annually so I don't have a forecast of what that looks like moving forward okay could you provide an information yes sir we will thank you thank you mister yesterday. Anyone else. Okay again this is see safe forward we'll need a motion for review and approval on this particular one got emotional at do need to go with the public school as well so i'm sure my gate go here so on the public school this one will be really quick weird not making any changes for the upcoming year we're going to keep everything level to the for the current year. It any questions on that on that particular one. Okay so same way we but if it would give me a motion again sooner call well I think I heard you so we have a motion for review and approval we have a second basin or board all in favor say in your pose okay the motion carries on but on that particular one. Okay now we are on d so item d this is just a providing the committee but you have all asked for an update on the united health care network this document just reflects the latest there been no changes that still the same bernards is out of network at this point but to my understanding conversations are still ongoing there's just not been a new progress on that but everything else is informational for you. Again this is just a courtesy as a report in anybody having questions in regards to that. Okay there's no no action on that when it so you can proceed in the next i've had the last item is a retiree first this is a pilot project that we would like to do it's for three months at a total of forty nine thousand five hundred dollars in what they would do is we're gonna hyper focus looking at our public school pre sixty five individuals and just do some education do some awareness with them and work with them and connect some concerts type services with them and in working on the mapd plan there is a lot of disinformation of the pickup of the mapde plan is lagging on the public school side so this was an effort just to see if this is something that would be beneficial would make a difference in would help with that effort so again a pilot program for three months at forty nine thousand five hundred. And. Thank you grand for this one question is for the program how are they going to determine which members will participate in this pilot program is it geographical base random draw lottery rate it will be all over the state it will be though it would just be on our public school side for those that are pre sixty five the there are going to be turning sixty five within this time period but I imagine everyone is pretty sixty five or is it everyone it would be everyone on the public school universal okay you may have said that I miss that point so appreciate the clarification. I think i'm I think i'm a question that we had we had that we're just having an overview of this. But this is actually going to be a contract that you're going to entered into correct so are you going to bring because we are going to have to review review that contract at some point are you going to bring that back to this or. Exit this is where it would what you have before you is what the contract would be. So if you have you all have not entered into the contract there's been nothing that's been sight correct okay so whenever you do that though that's going to be an actual contract that you will it'll have to come over and our poor rule or however you do that and then we're going to have to request we're going to have to review and approve that at that time we understand maybe you're just given us a preliminary thing of what we're looking at but again that the same way as these other contracts I think that'll have to come it does need to come through on the policy we'll get that done okay sold all the members understand that we're just having a preliminary here if so if there's any questions in regards to that will be happy to happy to go over it but again once you. Get to that point you're going to need to send that overdurs. That's not going to creating problems with the owner who know no this was one of the it was since it was a pilot it was new for so I didn't know to put it in the in the portal but I will get that done yes we've got everything ready we can do that no problem okay. Any questions. Okay. So but they had I guess you're finished lot of work oh singer urban you have a question. Is in regards to yesterday this was recommendation but correct basically not this particular company right that's what I was and I mean I just was trying to remember back but this was one of the concepts that was presented to as via the consultants that we hired and say this is just a specific company other other companies that do the non that have been brought to my knowledge that's why we we decided just to go straight with them okay this would probably be a sole source problem likely II just wanted to get that information for clarification and then I just missed her terror if you don't mind I just. When i'm looking at exhibit b and the the comments that were which were you which one are you own against center urban I just wanted to make a quick comment on which and back to exhibit b and I would already approved it but on the common minutes I just wanted to thank you personally because repeatedly in the comments they give you high praise for just being very communicative very thorough and are very thoughtful in the way that you were communicating with the different people that were coming on this and so it's it's noted and I just appreciated your I really appreciate your directorship the optus program and it's reflective in these comments thank you mister chair thank you soon urban. Anyone else. A direct wireless I think you are finished then you appreciate you being here in presenting all that today. Okay members were down to other other business did anybody have anything they want to discuss. Okay c n n I don't have a gavel so we're going to be adjourned. Yeah.