ALC-Employee Benefits Division Oversight Subcommittee

All right members all right members we will call the meeting to order mr while the shirt will be first up so we'll start with the and I think there is AB one and AB two so you can begin when you're ready. Thank you great wallace director of employee benefits division. Item b one is our normal pharmacy formulary review that occurs each month this one was for the month of december but it is gone through the advisory commission and state board of a finance. And i'd be glad to answer any questions that you have on it. Gate members in regards to be worn is there any questions for mr wallace. Garcie known so if you want to grant you can go to b two. B two this is a new thing that we're bringing before you were implementing a process to review the medical drugs that are on the formula so these would be medications that would be administered under an outpatient impatient ER type setting so we were developing that process you should see these. A once every six months we're still trying to figure out the frequency of that but these are going to be your higher cost drugs more in line with their cancer jean therapies. What we are recommending on these the reason that you'll see the exclusion is that we want to ensure that there is a prior authorization. That occurs so that are those providers do reach out and get a pa approved before we administer these drugs again these have gone through the advisor commission and state of finance. You finished in urban you have a question thank you could you just remind me who's on the advisory committee it's various members more at large general public type individuals there's somebody that represents the department of education and really we've got people that have. More of the insurance background kind of as who make it I consider the exact names of the list but you get how do you you're you're getting your recommendations though from abr correct ebrx is you have health care focus looking at this so described to me the priorities process and then the appeal of a denial rate so the the prior authorization would go to ebrex on these medical drugs they would review and look at the clinical data and work with their clinical oncologists and clinical team to make a recommendation of whether to approve it or deny it once it's denied on if it is denied on that level then it does come to ebd for review and a and a decision to be made at that point and hey how long is that process take weird it you want to see 2-3 days on the on these particular drugs. But I mean the reason asking that is because we have left you know self insured plans which the serves out of the majority of our legislation as it relates to prioritizations and the time it timeliness of those we've left you out of that so you're not mandated about that law but however you know when you have some people that have some very serious conditions that need immediate attention i'm just making sure that we're not dragging that out and that they're able to you know really get what they need at that time so. II just hope that's a shortened time frame in that your sensitive to that and if we can meet that same standard I think it's a good one just for our are beneficiaries so okay and then if it's denied is there any follow up with their doctor like their on colleges yes yes alright thank you. Thank you sender. Anyone else having any questions to this only as excuse me okay so you know this is an approval out item do I have an emotion to prove and will be approved and be one mb too while it was so I have a motion to have a second I have a second all in favor say I in the oppose ok that motion we will carry mr wireless uh we will go on to see if you want to I think you have an update on the union health care right so there are two facilities up in northeast arkansas that have notified that they will they are in negotiations with united health care but those contracts inn sharp independence the termination date is three one twenty twenty four. Five rivers that termination date is four one twenty twenty four so there's notices are gone out i've just not presented that before this committee since in that time period so I was just informing you all that those two facilities are going to be out of the network under the united health care plan one update that is not on here that happened before I could finalize the agenda is bad as healthcare has reached an agreement with united health care and they are in network again with united health care. Okay. Sharp independent practice association in five rivers medical center here the ones that are listening listed on the agenda. And then you'd send us a letter on the other ones that you were talking about if any of the members want there we can also uh. Get those to you. Senate love. Your recognition thank you i'd just cover tale land of the united native health care baptist deal can you clarify something for me like how long in the works would they be like moon has some for final honest so they have come to a final agreement on a multi contract I don't have the terms of how long that multi year is but I do know as of last friday they did reach an agreement and are in network baddess is now in network with united health care again okay in any do we have any other standing business like the so the only ones that are outstanding as of this date or the two that are listed on the agenda sharp independent and five rivers in saint bernards in northeast arkansas is currently negotiating as well and their term earns may first of this year do you think we have you think we'll be able to reach the agreement before my first to meet. As just a couple of months I am hopeful that united health care in all of these facilities will do their best to come to an agreement to terms and conditions as quickly as I possibly can ok and if not I know that with baptists they still can maintain some sort of kind of in network it is kind of in network out of network deal with that would that be the statements with these other to the sharp independent in the usa did you say mercy. Not five rivers and st bernards i've said bananas we have in writing from saint bernards on their website as well as letter that was sent out from our members that they will honour that agreement that kind of non differential and still accept our members as long as they are billing medicare are members will be able to go and not have any financial impact because of the aspect that it is a passive ppo plan there is the nine differential between in network and out of network. It's complicated but I say all that reassure our members and you all the there should not be and we were correct if it does happen there should not be any financial difference that the member experiences and they still have access to these facilities I do not have anything in writing from sharp or five rivers but they are associated with saint bernard and everything that united health care is told me is that they're understanding is that the same thing will happen that there will not be any financial impact during the access issues with our members in those facilities. Okay alright you have you all keep us in breast next month yes okay aren't thank you thank you mission your sir. Anyone else singer johnson we have a question she made grants in the far river is administrative by a saint renorance so that agreement will probably happen at the same time okay thank you sir anyone else. Yeah. Okay but say no the questions there's no additional provider and there was just an update so we appreciate your common a day grant thank you okay we're now down to d which is other business only other business that that I have and it should be laying in front of you last month the there was a members that had some questions about our our wildness program that we used to do and of course we had stopped there so as promised we went back and are staff dead not me of course our staff went back and pulled their sand that should be at your death so. That's there and if we want to have a a further discussion on this you know in a later but what are months about starting this up or doing something different of course we'll we'll do that we did take the uh uh stance that you know we were not going to do this a few months ago but that doesn't mean that we can't do something different if that's why this body wants to go send urban you have a question. Just a car comment yes mainly so I have i've visited with several folks about this state employees folks at different agencies as well as worth mr wallace. The way that this was structured was really bad. So it was a good thing that we did away with what we were currently doing because we were spending a lot of money and it was really based on nicotine and anyway and so I really do think it's worth our while to like look at revamping this type of thing but not repeating the same mistakes that we made with the way that we previously administer thus so i've been II think it's worse it's worth looking at it from edge is a very add as as a yearly check up kind of way of looking at it but we we've talked about that and mr wallace knows i'm talking about but so II think it's worse going back to perhaps and just simplifying it for just a program that was very simplified and I think it's worthwhile ok thank you sooner of an in members if you all just have just to help you out I did redo this and it's fairly simple but the last page there are consultants they did give some recommendations on that and they are similar to what center urban saying so. Others others here want to pursue this or kind of digest it for a little while and get back with either major representative about a comment yeah III would like to pursue this. You know obviously I think looking at a self serve to result base is something we want to do I hope seagle maybe can put it some actual numbers to these suggestions obviously would like to know is that use worth the squeeze on this. But obviously and I think with the logivity of the employees who stay on the employee before plan I think some of these programs might be better very beneficial to so II would like to pursue it and of course i'd also like to see so some hard numbers from sigo just that we can know what we're getting ourselves into before we make any sort of recommendations okay anybody here adamantly against looking at this. Z and c and then if it's all if it's okay with this body why don't we figure out the best way to the west the best way that we need to proceed with this either the sage and let us go to come up with a point on how we're going to do that so if it's okay with this body just give us give us a mother or so here in this figure out how we will know how we won't astructure this and try to be inclusive of what their recommendations were and possibly gets more some more information from okay great is is there any other business it needs to come before it then without we all adjourned.