ALC-Employee Benefits Division Oversight Subcommittee

That management contract update siegel is here so if you all don't mind if you would please come to the table. In a view if you are would just whenever you sit down if you would introduce yourselves and then you'll be recognized to begin. The. Yeah. Patrick line siegel. You had to push that button when there you go hello hi dropped beside an upper alka. Okay thank you all we appreciate you all been here and you can begin when you're ready. And we do have somebody on the phone from siegel as well mat. Yes isn't that when it take okay so we also have somebody online it's mad as a correct gay mad if you would please state your forename. Matthew when thank you. Good to go okay so I want to do provider quick update financial update on the medicare advantage but now that we have final reads we have final enrollment since most are going to be just a financial update but before we get into the update I wanted to provide some history so signal was hired by the blr in two thousand and twenty one to review all of evidence the whole program make savings recommendations. One of the first things that we saw was that ebid did not have a medicare advantage plan these are very popular with our other state clients and when we put them in we sr significant savings so that was one of our key recommendations we recommended a side by side approach so members could keep their current plan but also I had the option of the medicare advantage plan. We did. Several presentations trying to educate the members and we decided to move forward by going to the market to figure out what kind of reads we could get so two vendors provided preliminary rates and we use that to generate our estimated savings. So for a wee we are seeing around thirty three million dollars and premium savings with split between the state saving twenty one million and the retirees saving an additional thirteen million. And then for pse was covered different it was a unique situation because pse only had medical coverage. So the rates from map planner going to include a rich prescription plan so we assumed additional ford million dollars and in premium but I was giving back retirees that prescription drug plan that they were. I haven't got an individual market and purchased themselves. So it decide by side approach we assume seventy five percent of the members would move to the map and. Yeah eventually we did and our fee and u HC one the work and the plan was effective in two thousand twenty three. All right so the slide just shows what the actual enrollment came in at so a little bit below our seventy five percent assumption sixty four percent for a ce and then down to forty three percent for pse if you plan him together at fifty two percent so this could increase over time you know it's where the mouse spreads but a little bit lower than what we initially assumed. So next I want to talk about the rates now the rates came in significantly better than what we received in them the initial market analysis and there was kind of expected based offer vote in our competitor bid so the market was given us a two fifty seven number the rates ultimately came in at one sixty five for a and down the eighty five dollars pm PM for pse so that's a sixty six percent reduction from the health advantage rate in about sixty four percent further pse. Yeah. And you can see here what the retirees are paying on a monthly basis sixteen dollars versus two eleven. And for the pse that's nine dollars versus one ten. And the nine dollars includes medically enformacy whereas the one ten was only medical. So overall you know even a bigger win in terms of rates than what we expected. So we get into the dollar impact so the site shows if everybody moved to the medicare advantage plan what the cost would be in what the savings would be you know it's it's possible that this program would yield forty nine million dollars in overall savings and the way the subsidies split there be about nineteen for the state and thirty million dollars for for the retirees but we know the actual enrollment was you know quite less so right now we're looking at ten million dollars in in overall savings for a. So similar slide here on the pse. And then the overall. Total dollar impact for a smpse we have capable of sixty five million dollars in savings spot between twenty four million on the state side forty minute million on the retiree sign. Any questions about that ok members do having questions regards to this first presentation. The. Are you in sixty one representative center. Ah you're recogniser. The. The. Thank you miss share I just said go one question in regards to why do you feel that the role in numbers were were lower than your assumption I think health health care just sticky for people they're used to what they're used to sell you know the plan designs are equivalent value and you saw by the retiree contributions it's much cheaper I just think it there's some hesitance to to move over from what they're used to but you know they have the same access same plan design and it's significantly cheaper on a monthly basis so I expect that number to move gradually towards our assumption over time. Are there any educational problems for the retirees so that they're they're better educated and informed them regarding the plans in. Yeah I know grandka bray speak to this better than I could but I know you hc they travel throughout the state and educated retirees on on the plan and I think you know ebid is that a good job of communicating and educating returns as well excuse me grand you since we had that question that's a good that's a good question grant demand just coming forward and given at least a quick answer and then I probably should ahead you to come with the table anyway just so that you could be there if you would introduce yourself. Great wallace director of one answer you heard what uh yes so we really have taken this year and approached a building up a communication in education campaign around the retiree health plans we've done a lot of similars all across the state we partnered with uhc my staff when out all across the state to help answer questions and do better education around this option. So we are continuing to build or burning more resources on our website we're making things easier to understand a more important since things of that nature where people really can make a more informed decision around what is their best option for them okay are thank mischief sooner dismaying your regular and it is released since you're here grand I just. And in part of what she said I mean their equivalent plans you know allowed to have the same services the access points were the same providers are essentially the same as that all accurate I mean that's I mean it makes that what you would hear from stitch which more less was well I can no longer utilize my doctor you know they don't accept this or they don't accept that is that was that just interacter information that was out there was that just some what was happened happening so there are when you get into like the dermatologist and some of the specially builds there are gaps in the network that united health care has there is different as you would expect with any provider or any health insurance when you get more into the specialized care of those networks do start to shrink a little bit but as far as your basic primary care physicians and those things all of that should have not had any differential the unique aspect of the united health care plan is that it has the non differential as long as they accept medicare they will accept our mapde plan and that that is being part of the education gap is just making sure that not only the providers in the facilities but our members were all aware of that aspect of the plan so that we didn't run into any billing issues or any issues like that so you may have just had some providers that didn't understand correct their own situation and that's where some of this was coming from credit word okay that that helps make some sense and as far as the specially services doctors and so when someone's trying to educate themselves about a plan on whether or not they swear and they just say they want to keep their dermatologist or whatever the specialty is is there a way for them to look that up to no. You know before ham for the switch that hey yeah there's you know my preferred right specialist is on the list in this makes sense for me or it doesn't write the provider list or may publicly available that work thank you thank you center dismay reps any baker are you in sixty eight. Ok you're recognized. Thank you mister chair in regards to the access and the plan design and the overall cost savings to the member or the patient is that taken to account their out of pocket expenses when it comes to copies and car shown as well at the pharmacy counter and their primary care or hospital bills are so now I mean that II think the plan designs are equivalent so there shouldn't be too much of a difference there but what we're comparing is just that the premium rate so it's a fully insured rate that were comparing versus what the rest of the current self insured rate so a follow up. So the savings would then be tied to their regular premiums not necessarily what they may actually be spending out of their pocket at the counter whether they're getting it. Primary care bill the pharmacy bill or a hospital bill that correct that's right so there could be differences between what they were paying on the same play plan versus this current plan I mean we we told the medicare advantage of provider when they designed the program to make the point in as rich as the current plan so there may be a few. Minor chain you know differences that are patient would see when they go to the providers but you know it's my understanding especially you know at a macro level that it's it's basically the same plan design so I wouldn't expect too much of a difference well in to just up on that a little bit sent to sir the out of pocket for the member excuse me is the medicare advantage comes in and takes over that copay so it's at zero dollars out of pocket for the member where the health advantage might have had a little bit different so it actually is saving the member out of pocket expenses now on the former season it would be a little bit different because the formulary is a different design than what the health advantage formula was so there is the potential for differences on that end of it but they should be fairly similar thank you thank you who's in forty raise your hand. Right right represent your recognition. Thank you mister chairman one quick question will there be a different card there'll be issued for the insurance if we go over. Right there's a different card for the mapde plan and that the health advantage point thank you make sure any further questions as it relates to this are. Okay if you all don't mind if you would just proceed to see and grant if you don't manage to stay with them yes okay so here is we are going to talk about the divides medication and your realisation and management presentation trying to meet. Yeah. This one and this one david. Okay and all if you can see it on the screen. Good. It's a very. I'll just move. Yeah. Okay sorry about that um I just wanted to introduce a. The appendix slide first and then wanted to explain what we are here to do so I believe uhm we undertook this specific data analysis with sure you how the day beat his distribution is across your population within the state of arkansas now. What we have to remember is areas behave differently. People are the same but they are exposed to different society and inviting the mentally factors based on the way they live. And because of that the diseases the daily distype chronic diseases differ. So what we decided to do here is came up with a metric call abi area deprivation index we didn't come up with that it's a nationally known way of looking at different geographies. Within the state that divides the zip codes. Based on income education employment and housing quality. And those four things come together they actually measure what. Education access people have where they live. What employment access they have where they live. What housing quality they have where they live. And what is sort of the average income of that particular zip code. And that's what determines what's called area deprivation index. The reason to do that is because every state you'll see a drastic difference between the urban areas vs rural areas. And you are responsible for the entire state's population so just concentrating on a big metropolis like little rock is very different from how we. Have the disease published behave in the other idea as which are extremely rural and people have no access to a lot of amenities that you're urban people may have. So that's the reason we do this and this is a well known index in those area of public health I have some background in public health. And what we do is then we the areas are divided into from one to one hundred hundred being the most disadvantaged one being the most advantaged. So we then divide that to normalize we do do that in three areas so that hunt one two hundred is divided into one to ten meaning you know in the chunks of ten and then we do want to three which is the most privileged or least disadvantage four percent seven which is the middle bucket and then that eight to ten is your most deprived area okay and the reason II don't want to mention that before because all of this analysis goes into this three buckets. Now this is a map of arkansas area deployment index. And on the right side you can see the skill which is the least disadvantaged meaning most admitted is the convoluted way of seeing the most advantage versus the most disadvantage it goes from blew all the way to red the middle bucket is kind of beach so you can see limbrog is in the center here really really blue fed well another big metropolis really blue then that's the northwest and then you have some areas book pockets and then you have several department disadvantage that looks as it goes a little bit east. I don't think we need to kind of speech to this group because you are very much aware of you know where the population they say so based on that we have done some of our analysis and now i'm going to walk you through this slight dec which is starts with the historical prevalence of diabetes lots of numbers on all of my slowed so let's not pay attention to every number i'm gonna only highlight certain numbers to you that actually make some sense in terms of. What they mean and what can we actually do about it so there's a lot of numbers were and just i'm a doctor but I am very well worse with public health and some bio statistics in my background so I am pretty good at that but i'll try to focus you on the right numbers. So. You can see the fourth column here. For in the top or would all prevalence of diabetes that stays but he constant from twenty nineteen to twenty twenty two so all of our analysis in these last four years. Twenty three we don't have complete data right so last four years meaning nineteen to twenty two to of them in the middle of the coverage year school we'd kind of disturbed olivers in different way shape of fashion while the day beat his prevalence remained quite constant so it's like at seven. You guys are a little higher than the our norm siegel has a date of is called shape which is our single health. Um. Analysis of plan experience that I would act in them for our own database and our benchmark is at six forty six percent we do have a lot of public sector in our data and you guys are a little higher than that about one or two percent digital points depends on where you want to look at that. The. The lower right bar chart here you can see that the thirty five to forty five percent increase from twenty nineteen to twenty twenty two that's pretty high in thumbs of divides medication cost and then the bottom right that that's that's what I mention and then the members were david is account for about twenty one percent on an average of the totally medical and drug spent for the plan and that's very much in line with what we see elsewhere. So now let's look at that ada the distribution by the the area that provision index that I talked about earlier. So the demographic distribution of by adi the as you can see the spreadsheet reflects the plan's demographic breakdown the top left charge shows that the dividing members are predominantly females which is another well known fact in in our industry and the top right charge shows that. The majority of david exr each fifty plus. With the high years of issuing that it would band so as you are living in a more deprived area. You're incidents prevalence of diabetes goes up. That's not a surprise at all to someone like me who has lived in public health on their life. So that's and the hand in hand what goes with that is the. Obviously prevalence and I have another slide on that that we will show you later so women over fifty and revenues increases as the index increases okay those are the two decories from this slide. This is the medical members and the claims by adi so if this is what I meant about obviously so as you. And there is a fourth line here in the left chart that shows the obviously as it goes up. By the area the provision index so as you go into the least disadvantaged areas the prevalence or will be city goes up. David is very much obviously driven disease it's insured in the resistance in some in the resistance is what causes it. The more obvious lifestyle and your physical makeup is the prevalence of data this is high so that it's very much hand in hand with that and that's what it shows here you can also see that the library's revelence is going from six point five to ten percent on the upper right chart and it's obviously is also straight up like that so those two are the the biggest decories from this slide. Then the next slide is the key utilisation by and that's also important and and why is it important in terms of again the area the provision in next because of that the education the income the resources available to the areas. They may not have enough. Pcb's physicians and especially primary care physicians who focus on prevention so the biggest take away here is. The above breakdown shows you hospital ambition and emergency room is the highest in the most disadvantaged members the ada of it to ten. The low cost student setting which is telehealt or urgent care is the lawyest among that population so there are two reasons for that one could be there just not aware of it so education is important and too is they may not have enough rabbit to get physicians in that area so anything happens they go to the emergency room and we have seen that very commonly in a lot of our. Either rural settings or some other settings where you have the. Up low level of income and. Education really low in pockets of the albanas as well. But it won't visit sublowest for the most disadvantaged group. Same reason they may not have enough primary to get physicians. And two they are simply not aware of the importance of. Prevention. Heck we were not aware of. Prevention we as in prayer to go physicians I have been a practicing physician for many years before I went into this managed physicians were simply not ought to be. Emphasising on prevention is just coming to light now I would see in the last ten years so all of that plays a rule in people simply not engaging prevention and some of those divides management programs will help in that area when you ask me you're showing us all this day that would have been going to do about it well we can start small and we can start with some sort of a diabetes outreach and management program eventually but this is just assure you some data points as to how we are kind of getting to that level of conclusion. Simple the other thing is tell a health rate if we if if are people don't have anywhere to get a physicians in that area. Eighty percent of what a pcp does can be done over telehealth. Even the blood drawers and labs can be sent. Why the testing strips at home and ten percent of the lives so all of them can be done the remotely so that's something that we can think about later and then this is that matter slide on the trop top drug indicators by the same three ads the edit is the the least the moderate the highest so you can just focus on the bottom chart on the right upper right. And you can see that the. The most deprived area which is the red bars you have david is expenditures the most. And what surprising here was on college years in cancer was the lowest and the reason I bring that up is because it's not like cancer is less prevalent in the advantage I guess it does exist. Maybe people are not getting the right care on it maybe they're not getting to the right facilities or on colleges that is just one hope of this is that that might know me and my colleague had when they were going through these numbers like why do you think on college is so low and it was a little bit alarming so we thought it should be the dive little deeper into eventually what day readers is again very high and we need to definitely address that and that is really the main objective of this today's meeting so now i'm going to just get a little bit of a little bit of a more spotlight on. The divides policy and the newer medications in day beat is and how that's called a girl impact your trend going forward and unfortunately I don't have any good news on that. So here is the chart on baby this medications. And it's just the cost of the day with his medications is going up so we saw earlier in your data you're your prevalence meaning existing number of baby takes in your population that has remained really steady wasn't it was in it like around seven to eight percent over the last forty as nineteen twenty twenty two however if you look at the drug cost. Is going up ready dramatically. From sixteen dollars to about thirty dollars PM PM that's pretty high in four years. And the the biggest increase that happened was in the right charge there was the biggest body you see as gld to that so according for a drug you see those commercials on tv jardians. There's you know ask your doctor about jurience ask your doctor about a zimbakhey that's what is driving these trends okay so just keep that in mind any of not an exception your state is not an exception this is absolutely everywhere in the data that we see the diabetes medications are simply going from the low cost drugs like in soolin like met for me like our simple drug that I learned you know back him med school when I went two years ago and they still exist and they're still work pretty well but now you have the newer technology in your drugs big bush from former companies do the physicians who prescribe this and was in picture drugs and that's the sport loader world so you can see those biggest increases are over there. And oh yeah I have some remarkable numbers here that those two classes there is you'll be too and glp one and there are if for your benefit in the very last slide in the appendix we have described what those acronyms are forced I don't want to get into that but they have increased by the annual rate rate of seventy three percent and twenty eight percent respectively so doctors are simply prescribing this new or class of drugs and they are expensive that's all we can see here. So this is that arm same chart by the usage of those. Um and you can see the greatest increase in the utilisers is those two classes in gldng ones followed by the combination products so the previous chart we just have distributed here by those four years from nineteen to twenty one two and it shows you the buy going out which are the which are the met formats which is the oldest class of drugs and it still works just fine it's just that you have the newer fancier drugs out there those are the last two charges here so they are kind of going up the usage of big one age has sort of remained steady zempic which is the big drug in them and will we'll talk about that I think in my next slide but this one is just to show you the greatest increases in some of those classes okay here here there is july two which are the guardians of the world so you can see the specific increase in this one name in the last four years from one point seven percent to eight point three percent. The top the costs are obviously very high too and the utiliser history as you can see on there's one good news here I late there's one good news the good news is. I didn't see we didn't see any off label use of these drugs bioflavour meaning. Those who are diabetics are getting these drugs the non day beatings are not getting these drugs why would an one day be dick big some of these drugs because these drugs are also. They also cause weight loss and that has become very much well known in fact that any of these drugs do cause a great number of weight loss and people have been just asking for that minute was discussed at the oscars it was discussed by the social media. So everybody knows about the these drugs and good news is that what we found out was you didn't have any off label use of any of these drugs because those who actually had the history of ability so the only ones getting it as particularly true for my next slowed the ozempic slide and not so much for the jardian slate but this this was the the good news is that only clear utilisers. Had a history of obviously in absence of a day we did drug okay so this is this is what this ozempic drug shows if you have heard of these names was impact. Um. Wiggle movies the same drug but. Operate for. With loss. We have a similar thing with victors are the day but is drug and then successor is it's we'd lost part is the it's really the same drug by a former companies have played with the dosage and frequency of those drugs which is up pretty high. For those to be a product with lost drugs and off label use is where we are seeing that increasingly so far we haven't seen any off liberties in your population or we need to kind of tighten the supply to make sure only the driver takes get these drugs and the weight loss once a reserve for those who are seriously more willing obays and not something life style what I mean by that is someone wants to know like to lose. Ten pounds for a wedding in next quarter they should not be the ones who were going to get that drop that's not the reason for that. So that's something that we really feel strongly about that we need to control that so anyway I wasn't because in the highest change in the dispense volume as you can see. The the top rate outlines the historical medical diagnosis of current population of good and utilizers said just like we did with these jetus there is little concern here for offering will use but the costs are just simply going up and to have more on course is my almost last slowed second lessly you can see the difference in costs here so i'm going to focus you on this middle tier that shows you cost for a prescription cost per script is what it is and you can see the difference these are the tall points the jardians was in picture listed to look at them they are in the thousand or prescription and this is actually the come to about a thousand for a month so it's a twelve thousand dollar drug for your population if they're getting any of these newer ones compared to that too but for me number twelve lane twelve. Seven dollars. You see the difference that is what is causing the cost to go up so much from seven dollars dollars to thousand dollars. And that's like in legacy you're not an exception this is what is happening and we need to have a better control over these drop costs and we will really figure that out eventually but the seven dollars to one thousand dollars and even within that some of those like simple insulin it went up in costs is not two hundred and fifty percent that also used to be in like less than a hundred like twenty to fifty. But in soolin costs implement up because the generic insulin people stop making a lot of form of for manufacturers moved away from meetings now the supplier smaller and smaller and that's why you have. A pretty a drastic increase in those numbers but this is a pretty eye opening slowed in my opinion when it comes to well when it comes to the cost of the drugs. So here is the actives and your non medicare retired is behaving in uh behavior by. The list advantage of assessment moderately was the let the. Most disadvantaged and you can see that distribution is. Pretty normal it's not changing drastically by the edi II can see the bars start popping exactly where they were earlier also in the hiltitudes and gl beyonds the gnp ones are actually higher in the most disadvantage and I was a little surprised with that I would have expected that to be a little lower. He made a un you're on the phone rate do you have any insights into any of these distributions of these drugs if you want to change in. Yeah so what we're seeing you know that you appear on the activity huge there more expensive medications in general so you would typically expect that you used to be lower in the most it is this is a very group but considering we're seeing higher rate served commodity conditions so whether the will be city or heart failure that's what's driving out the higher realization in the higher adi group. It's a good point yeah it's it's hard failure that's also combined in the in the high disadvantaged areas and this this chart will show that there are chf is conductive heart failure are on the lower right side you can see that bar is is very high in the most disadvantaged population and it goes again hand in hand with obviously divides and some of the hypertension code related who more where it is so to speak so the most disadvantaged group has higher utilisation rate of the new original drugs the newer essential during and the combination medications that's that's what we saw in the previous ones. And this is just the appendix light that shows you the abbreviation of all of the drugs that I am insurance if you somebody wants to refer to this slide for the different drugs in the class this is what that is. So with that i'm going to stop and then take any questions because they know I gave a lot of information and in a very short we can discuss now and thank you we do have some questions. The first one send your hammer you're in fifty six. Your recognitor. Thank this year thanks for all the information a lot of information the the one they want to clarify the the driving of the cost. Is it new medications that are more effective but are costing more is at a lack of excess care is it the pharmacy companies pushing different drugs I heard you talk about one drug that is being decreased is that because pharmaceutical companies are trying to push a more expensive drug and understand it through lifestyle and there in cause of diabetes which kind of mixed bag but if you had to put the top three what would they be your number one and number three so you mention the newer drugs are getting more expensive and the three words former companies pushing the new orders that's definitely the cost driver the spreadsheet divides has kind of remained steady so I cannot see that the number of diabetes are going up in the population so anything to do with lifestyle be city and everything we continue to do that we will continue to do that but the costs right now are higher mainly because the newer drugs that are way more expensive as you can see in the slide company number twelve with the top five over there and you can see why the costs sound going up and the fire companies are definitely pushing these new or drugs and they are more effective i'm not seeing their not effective out there they aren't definitely more effective they are sort of were instant gratification they work faster so people like it and offers like it because you know you know it's a good instant gratification. But that doesn't mean the microphone when it doesn't take care of them with forming works pretty well even now with their diabetics so and it says seven dollars so unfortunately we cannot with all that from you know we call our people from seeing all you know you're going to get the new drugs. That's we have to sort of make sure that yet its reserve for the right people and eventually people get off the drugs and can be maintained. On just lifestyle modifications a divided can be maintained once they get off that i've started used with and they can be mentioned without any medication eventually. But the costs are going on mainly because of the new drugs there is no doubt about it or follow up mister yesser so i'm not you know I think one of the challenges we face the majority of us are not physicians and and about have trying to pass legislation that is trying to control cause but not playing doctor or PCP nurse practitioner anybody else it's on the front line and yet and i'm curious do you and your professional opinion. Think that the pharmaceutical companies are are out pushing drugs that have higher costs when in reality there are other drugs that would cost less but because they are driven by the bottom line there is a restriction or reduction in producing those drugs so they can push the other ones so that the doctors may be don't have the choice or maybe the doctors are being influenced by the pharmaceutical companies you need to be pushing this drug now and and can I help me give my mind around that should we know where where some of the responsibility can lie and I think you you touched on all the right points there all the right points that their bottom line is better in former companies when the expensive drugs are dispensed no doubt about it and then if the supplied as an exist of the cheaper drugs that after it has to describe what's available which have the expensive drugs so the price control of the drugs is something that we as a society need to work on for sure and that will benefit all of our population as well as get them the best in plus dogs miss chair allowed to go on the bond with you if you don't mind thank you sir just let me know when everyone back in. Okay I think the next one is they seater car i'm sorry i'm having trouble with them I think they're represented crawford. You're in thirty nine you're recognized man yes thank you thank you mister chair and it's hard to hear over here or so authority something forgive me. But the the cars going from seven dollars and dollars is that what you said yes on this yeah. Just asking it you know you talked about the weight loss people using nonsense and zimpic for white lances do you think that's driving up the cost so in your population we did not find people who are non divided using ozen thing. If a diabetic is using them being that is what it is. A approved for as an indication for by the fda so in your population we found that the existing day beating are just being switched from the cheaper drugs to a higher class drug like. So they are not necessarily using it for weight loss they will see where it lost happening but they have to have diabetes. To get that prescription because we were able to verify in your population in your data that previously they were on some entity that means they had diabetes yes okay follow up please just ma'am a do you know as a doctor are there any adverse effects in those people who use it because I know some people who are not diabetics I don't know how they're getting but is there will there be a facts over time at burst effects using a drug that you don't really need absolutely and it's coming into the news now that these drugs are too news so we don't have well known side effects but what I am hearing is those guesting gas comparisons meaning paralysis of the gastric muslim because ultimately these drugs work by slowing the gastric empty. Slowing the movement of your interest in stomach and indistance slowing the movement will cause the muscle to parallels eventually how they work for weather loss is because you're slowing the movement you're full you always feel full so somebody on their drug doesn't feel like eating because they feel full that is the whole idea behind with loss. So yes the side of exact definitely in guest or balances and illegal batteries as we call it the paralysis of the gastric muscle and the understanding must it in he made am I forgetting any other side effects my zero one constitution something like that those are the best ones and i'm kind of going that's your point we didn't do the specific analysis among saw but we did look at this for other clients of ours where we look at members who start one of those grp drought so that take you know wake over for week loss those things can't look at the rates of the art hospitalizations prior to starting those drugs at about twelve months or eighteen months or so and then also through same rates on the applications and we're seeing you know five to ten fault increases in your visits for example because of some your gi issue that as members are having so we are seeing it at our data it turns out overall on her side attacks on started metro that is sort of tell us what we are seeing someone was more acute directly in operated settlements occurring in our claims data okay alright that's great information thank you yes ma'am thank you represent any back europe. Without getting too much into the weeds on this net you can follow up with some information if you want but I just looking at one drive and II just want to need a down on this drug cost they cause you have one driver to solicitors point eight i'm assuming that was eighty cents I don't know it's a point eight in nineteen nine and twenty nineteen and now at six point three and twenty twenty two relatively I think you call it no drug so that my point is over a span of four years it was on slot one listed flood one may they're all one I don't know my question is what makes a drug that's a relatively new drug. Starter and start out with the cost of point eight go to six point three. Yet so II know which one you're talking about talking about and met you can die deeper into the number but I think you're talking about jardians and it's the point eight pm pm to six point three that's the cost of the drug that's the total cost that means more people are getting on the drug it's not decost of the dragon met can you correct me if i'm wrong but I think it's the total cost because more people are getting on your deals okay so the charges what we're basically paying for the guy thank you for claiming out at four people thank you. Representative pill continue recognized. Thank you I was curious on the side effects of ozimpec the paralysis of the stomach muscles how many is that per hundred thousand. Um human insurance officers solve I don't have that number right now okay I don't but I have heard any documents stories in here there yeah yeah we don't have the story catch it okay then the other thing is you were saying it's a good thing that we're not having off liberal use of some of these weight license but i'm curious has there ever been any attempt to do a cost benefit analysis for people who are pre diabetic four people to see that if they're being on this drugs using it to similar way laws you know I mean you could you could game player to say that we're actually saving expensive money because we're not dealing with other complications that come with people who are overweight or large they were weight i'm curious could you elaborate on that a little bit absolutely yes good question and there there is a. So if the drug is used correctly and a level of weight loss is achieved in a bmine the body must index and anybody over thirty. Is you know considered obvious so if you bring the down by fight even five points and somebody maintains a healthy wait they will get rid of a lot of other illnesses that they have which I will be doing related which is not hypertensioned I really can just failure chronic reasonable failure I can just go on there on it on when the the associate many of the other even you're almost a condition that is with obviously i'll try this is having a society with that so if the drug is used correctly end of correct level of weight loss is achieved. And that's what's the objective of a daily rise management program is which is I think eventually we will get to. You can get rid of all of these other chronic diseases and a person can live relatively held their life and will save money eventually the data exist today while I the former companies themselves so I kind of take it third with the green of salt we don't have a data yet but obviously and managing people to lose with and then keep them off the wait and off the drug is worth because then to maintain its all about the lifestyle modifications so once you lose that way you can get you can read somebody of the drug and they can maintain on like style management we can definitely use this drugs as a have start and those programs do exist if properly administered. So our problem is when doctors just for describing somebody can stay on the drop forever or not taking it properly not managing their side effects that is when the problem happens if it is managed tightly weekend we can definitely see some positive impact of these weight loss drugs for sure I mean is there any that make you share those numbers with us. You have off savings yes i'm not right now but eventually mad hear you taking notes or we will still be able to share that with you okay yeah I think that because it did impact yes yeah I mean I obviously we're very overweight state and so I think if we can show ultimate savings I mean that's that's a bit I want to explore and in fact I think our next presentation is going to focus on some kind of a metal beside and obviously related. Printer in discussion yeah and one thing got a jumping all over the page I didn't see anything regarding just stational diabetes with our plan I mean you have any data information on just stational diabetes we have not dived deeper into that area for this purpose but i'm sure the data can show you that as well thank you. Thank you sir sender hammer. This. Thank you and I will go back pick up on on the point I left off on in that ears. If you got a pharmaceutical company that's out pushing a drug but if and if i'm here and you're right if i'm not you straight me out you get a phone super company out there pushing a drug to the physicians that is now the latest greatest embassed but that's going to result in leaving a drug that is less lease costly but yet they're going to push him to a new one are the pharmaceutical companies reducing production at that less expensive drug in order to push that more expensive drug without any doubt at a shell that in a cost comparison it is providing any greater benefit. The year i'm unable to see yes or not that they can yeah you can okay might go ahead so may I too have to speak up to goods kind of hard to hear your members if you whenever especially their own line lectures we can't hear so if we could count to have the chatter down out to appreciate it it is any better yes. Okay so to add them color to that generally the manufacturers of these. No medications direct affect for example nobody I was topies beijing up to our experience themselves they may have situations where they have an authorized generic map over for example they carry the copies that make those general products like the format or separate of those brand companies completely so you do generate on see the increase of production there prepared to do our grand medications the issue we're seeing down that you have reckon if these association updated their guidelines over the last few years to add in these normal occasions had the first fine recommendations at a hello or a conjunction with your order once serious thing a lot were used there because the guy that recommend their use for many method of it it was one of that b diabetic with a week diabetic with its heart failure for example though to the two k areas and that's where we see the increase you for other clients have thought I had mentioned we are saying a lot of possible thing for some plans about a third of their sped for example is in members of the obligation but without typing that the case here yours appear be in use appropriately it's just at the game and that's a good recommendation as well very few patients I would say are you using the door medications in errors where they would not be able to use my form for example received still it out three quarters I believe you're populating have you diverted population using that for me which makes sense for your you are started there it's just your individuals need the combination of a higher you know I had well had effective these. An inmet there. The supply of met foreman is is not compromised right now right it does exist. It it does varies essentially the way internet connected is that they'd pretty states the patches it also they can't establish there was a shortage for temple they can't say this ramp up their production. That's what you can see third party compounders coming it coming to play they can tell that gap but yeah which say general there's that a supply issue it's more just the the driver using your medication something i'd like so the guidelines are just promoting the more expensive drugs over these older generics but the supplier is not compromised and when it's sure yes sir. Okay so I just yeah yeah I do this so generally so you know the manufacturers of these brands are are probably their products you know here advertisements and offer to the positions but the packages don't do that there's no one started for that at that cost of a word because it's actually the margin of the generics is so low as it is. There's no you know benefit there to promote the general use of compared to with the brands and may I wear it very hard time here and you and it's probably because of this room again members I might be the world's worst about this chatter but whenever we're here trying to hear this online and you're talking we we cannot hear so we've asked if we could turn it up and as my understand this is how they can get so if you would police bare with this on this and they just get through their cell center hammer what what was your next question sir that my next rushes is on these more on the more expensive drugs that these patients are having to go to for whatever reason. Do those are those classified is specialty drugs and as it relates to our payment program is that going to cost our plan any more money or is that going to be deferred as a cause to the to the member taken in consideration any rebate and and I think. Matt i'm going to do for this to you as well. Yeah these are generated box considered the medications despite the high cost it really depends I believe you have the research rate types of full page back to the court transtructures by your members these are considered generally tier one brands so those defacle pay it's the I believe forty dollars or so for the thirty day and eighty eight dollars for ninety eight mail to the cost of that you know absorbed there but those that have a you know a co insurance where that be fifteen percent or so it will have a higher cosport to this members. They were sure so I understood he said it's not a special drug as far as the cost it'll cost the members and the plan yes so on a when it's cobby based mean the members pay in forty dollars and the plans pick in up their remainder of the thousand hour drugs so basically the plans picking up you know over ninety percent and then come insurance it's fifteen percent for the member and then eighty five percent for the plan so it's gonna be a it's gonna be a cost for all more more for the plan but we have very much understood. Okay reps any account. Are you you have a question sir yes sir you're recognized. Thank you and thank you for your presentation on the utilization of ozen pick in non diabetes this is I see it's referencing year twenty twenty two. Secret in that in the window pa's were being managed by ebrex is that correct. Yeah they were it's my understanding experience that i'm after july percent those pa's have since been removed and it's more of a stated diagnosis do we have any trends on how this is impacting the off label utilization number is impact now. And what the impact that's going to be the per member per month if it's not also ninety nine point six percent. I don't think we have that data yet but you know as we as the data comes through we can definitely take a look and see if anything's changing is there any expectation that now that the pa removal has been removed that there would be an increase in the off label utilization that will be my hunch yes there will be I think and do we know what the direct impact that would be on the per member per month costs to the plan. No that's hard to do. But we do have a diagnosis code restriction on these drugs so we are managing and that way yes it works similar to a pay the the provider would have to enter the diagnosis code and have that for the claim to go through so we are still managing this under the new pbm with the tools that they have available to us what processes are being used to audit this process if the pa seemed to be a much more extensive we have ebrex monitoring this and watching those claims come through do they have any reports of any misuse of off they will use not at this time that that night that's been brought to me. You finish sir. All right I see no no further questions we greatly appreciate you appreciate this we know that a very important subject and then of course of the brought us from great information so we do appreciate you appreciate that thank you I know that a lot of information so will be available just to second I think if you don't mind sinder urban do you have a question yet and I grew up if you don't mind we're going to do that this one as the last one yet thank you center heaker II really do I just I appreciate your expertise and your information and have found this repeatedly where you know there's new as drag that's been advertised as what's being prescribed and then you go and it's you know five hundred dollars and you don't have that information at that point of prescription and so do do do we have the ability to you know present this information to the provide to to put people that are prescribing that shows this is the same drug the same effect and and it's less for that patient and that they should have a conversation with their patience about whether you can afford this or not I mean I mean week week I see this every day but so much of this like you said is driven by advertisements on tv and then the people come in impressed or the providers and their prescribers and then if they don't prescribe the medication that they're patient is asking for even though they have no clue what so ever whether it's effective or less effective more effective or anything else but it's putting those prescribers and providers in such a bad position because in the patients are demanding that and so it's really creating such a horrible scenario and they don't realize that you know it's just going to cost them more money so is there any is there any effort by drug by plans like hours like our plan is there any efforts to be able to go in. And really come back that message. So we can definitely work with your pbm to do that educational campaign with the providers but even better than that I think is a. It very tight divides and weight loss management program that you have the day management companies and we can eventually talk about that but there are some very good ones that exist that actually hand hold of patient to the whole journey and the health coaches from those forms to explain to the patient about what drugs is best for you and who has the least side effects and it will get you to the same level of you know business free state without getting into that more expensive we are not with holding the drop from you but we are only giving it four e either defined time period and you can get off the drug but it's important for that person to be in used with the health coach to maintain that lifestyle so yes that's something you can definitely do as a year I would say employer slash plan sponsored to hand hole your visions in using the right right drug you and an employer can do very little to influence the physician slash provider behavior that's fine my experience they kind of make up their mind based on what the medical specialities tell them the american diabetes association with save prescribed this they represent that and to influence that will take a bigger level of discussion then you and I over here notes that I really appreciate that this conversation because you know I have advocated for a long time we would be better off paying ten dollars a month for fitness on ten gym membership for everybody it will it with and then they would save them money because they would not have to be paying for these medications monthly if they just exercise became more physical and and literally we would save money if we actually did provide a you know contract and provide jim memberships for people and then have somebody and. To to make them understand if you do this it saves you this much money if you walk every single day you know our exercise thirty minutes a day it's going to save you at the end of the month this much money because you'll be able to get off at this medication that's medication and this medication and you want you know and then you won't you know it won't lead down the road to congest of heart failure which is a way okay no you're actually talk telling us exactly what we have been telling our clients in and our scott population hence management right keeping the healthy healthy keeping the healthy from getting from held they do moderately another thing at another part of this count thank you for the latter team but I think a part of this other conversation too is that some of these drugs have really bad side effects and if you're not taking it in consideration of the totality of what they're taking and medication you know you can alter you can absolutely screw somebody at screw somebody's good screw their body because you know it could immediately lower their buy pressure or whatever we've seen that repeatedly and so you know it's prescribing in a vacuum is really bad and and so I think that's also where we're seeing like looking at your information your data you can see that that trend is happening where you know they're they're prescribing one of these more popular drugs but the end the side effect becomes just an awful crash in scenario where now we have to spend more money hospitalizations more money to manage now this new problem you know if we had just gone back to the seven dollars drug that we use thirty years ago we'd be just far and that's a well well veteran drug for fifty years and we know it's absolutely I see this all the time thing that you thank you sooner urban okay with that you all are dismissed grain if you don't mind sitting there of course we at this point we're going we're down to other business. And without objection i'd like to let ebd present a contract extension for clothing away. The. Okay see a no objection you're recognized to present that. So this is the supplemental life insurance that the state of words are I believe members that you should have. In priority. So the state provides us for all state employees and public school employees it's the base ten thousand policy. That the state covers any of the employee can expand up to forty that's at one level of the expanded base basic life they adds an additional forty k to that and then the employee can go up to a hundred thousand additional on top of that. And that's that's where we're at there's a fifteen percent increase for the twenty twenty four rates and that's about it. Any questions in regard to england to this. Okay seeing no no need emotion to approve motion to approve we have second old favorite sar in your pose like saying seeing known that those pays. Okay any other business come for this party. Okay with that thing so right for being here we're german.