ALC-Employee Benefits Division Oversight Subcommittee

The first out on the agenda's be its consideration to prove a member to revise the by a dabites management program study town blind as you all may remember we we've done this last month siegel is needed a little more time on this just to make sure they were getting everything correctly so we should do this next month so if it could i'd like to have a motion that we have in the plan so that that'll be heard according to exhibit b motion a second all in favor say I in your pose okay that motional carry the next step is going to be corn mr wallace are you here. The. If you don't mind just introduce yourself and then you will be recognized to start with the. The drug formula. The. Great wallace director of believe that if it's division what you have before you this will be the first proposed formulary from navigator's team you'll see that the layout may be a little bit different but the information that you historically have received on formula recommendations is the exact same. All of this as you'll see the rationale in the next alaskal and there really kind of outlines each of the specific reasonings behind the recommendation this work was in combination with navigators ebrx and ebd the overall theme that you'll probably notice is really getting us more towards the navigative signature select recommended formulary that they based on their rfp offer and as well as an opportunity to maximise rebates within their benefit management. So without to be glad to answer any questions. Okay thank you missed while do you need the members having questions in regards to AC one. Any discussion on their case and then I need a motion to review and approve on it. Got a motion we have second have a second all in favor of say I in your pose that motional carry mr wallace you can go on to see to and well mister chair if I can bring up the representatives from millement to help walk us through this power point that'll be great whenever you all get to the table if you don't mind just recognize yourself for the for the record. Good morning I am passing crowning from element. I'm courtney white from element okay glad to have you all and wherever you want to start mister wallace if you want him to start yet if they can start and want to the powerpoint and then I can help answer any questions afterwards okay thank you sir young begin alright so this morning we're gonna walk through the proposed twenty twenty four employee contributions rates for assist as well as pse's as well as a twenty twenty four proposed base rates and then i'll talk about a plan design change that will be needed for twenty twenty four. So for twenty twenty four for the ase population the plan is to continue the five year transition plan. Where we make the employee contributions follow best practices and terms of risk management practices as well as financial practices as well as based on market research to get the more line with market market competitiveness also for twenty twenty four on the ac plan design were proposing to change to the classic plan to maintain compliance with the irs code. So looking at the ase act of employee contributions for the most part for twenty twenty four we're proposing a decrease to the employee contributions with the exception of the employee plus child that has a minor increase and the gall of this like I said is to continue that five year transition to get into market competitiveness. On the non medicare eligible retirees what we're proposing for twenty twenty four is a slight increase on the on the premium plan and mostly decreases on the classic and basic plan. The overall increased war at retirees or pre sixty five retirees range anywhere from that one point two percent to that seven point six percent for those who are covering a retiree non medicare eligible spouse and child. With regards to the post sixty five uh retiree plan we have both the mapd offering which is a fully insured offering as well as a health advantage offering. The goal for the map plan is to subsidize that plan roughly ninety percent. And the employees are the retirees pay about ten percent that plan is fully insured with the increase this year of five dollars so we see that fifty cent increase on the retiree only right or about three percent for the mepds. On the health advantage plan what we're saying in terms to get market competitive and follow best practices were capping the rate increase to ten percent their needs to be a slightly higher increase on the apple it's being capped maintain. To maintain affordability for the retirees any questions on the ac rates. Uhm see representative richmond you're out first. Thank you miss chair just. To help me better understand this when I look at the you've got the non medicare else will retire then you have the medicare out of retirees first question is you know why are there rates going up when you take a look at existing employees looks like some of the rates have gone down on there and then why is there a difference between the rate increased for non medicare as compared to medicare. So starting last year we had a transition plan based off of market research and ideally to get it to a target stug goal or contribution share by twenty twenty seven and so the percentages are going to differ by plan and here in order to hit those specific targets ultimately as an example for the active employee contributions were targeting at eighty twenty car share mean that the state would pay roughly eighty percent of the premium plan the employees will pay twenty percent and in order to get us to those car shares it takes the different rate structures that we see over the next couple of years to get us there so there's gonna be a fluctuation to get us to those targets. Yeah. Follow up sir. I'm sorry they didn't help at all but again can you just break it down and in like so there's not a lot of room appears I don't keep a lot of stuff up in this hair to have them get rid of little bit and in order to make room for some extra and i'm in that process right now but it would seem to me that if you're eligible for medicare that medicare. Is paying. Part of that but I don't know how much it would be would be paying part of the cost of whatever treatment drugs whatever else it might be depend on the plan. And then the state I would think would have to pay less so this should be less increase so help me with this dilemma as far as trying to understand why. The medicare retirees is is it because they're more expensive overall. Okay jump in here as with limited knowledge as i'm learning all of this it is one of those that this is the actual science behind this does include utilization and it does include outstanding liabilities around those particular populations as they age yes it is more expensive to treat there is the difference between the health advantage plan which the state assumes all of the liability around that versus the medicare advantage offering by united health care which we shift the liabilities over to united health care so that's why there is such a huge difference in the pricing structure because the liability to the state is limited only to the membership as far as what that premium rate would be and that's where we get the ninety ten cost share on the united plan with the health advantage plan we still assume all of that liability obviously are retirees are living longer they are dealing with potentially more complex health issues as they age so that does that is part of the calculation that goes into that okay thank you thank you representative richmond singer chesterfield. Concern thank you so much and thank you all for being here I too am concerned about the free medicare eligible individuals and you're talking about in the state of arkansas you can retire with full benefits what twenty eight or thirty years and you're talking about in your fifties if you started when you were in your twenties and so between the fifty and the sixty five or sixty seven depending on when you were born you are asking them to bear a larger bird is that correct. I would say that the burden would be equal to the larger liability and expense that we potentially incur when I get that you think that the liability but they're steal bearing a greater burden as far as money expended is concerned is that correct. They're having to pay more wording increase was more yes you're saying it's because the individuals who get between that say fifty two n sixty five age group are a greater risk of needing medical attention is that what we're saying and therefore this is why you have increased their amount of contribution yes tell me again exactly what that is I rated and I can't remember what was the what was the increase so you're looking for that it pre sixty five eligible retirees that percentage ranges just like seven point eight. To a one point two percent increase what are we talking about with dollars and cents I don't have that total I hated somewhere and I can't seem to find it. For the retiree only it would be roughly nine dollars and for. Spouse in or tari with a medicare eligible spouse that seven point eight percent would be forty eight dollars. So you're talking about what did you say twelve dollars or in forty eight dollars for family. Something like that nine dollars nine dollars for an individual would be the increase and for a family. I just for spouse it's forty eight dollars I get out I don't want put on my glasses my friend over here's pointing up here and I don't want to put on my glasses so I wouldn't ask this question she'll start pointing thank you and for a family. Because in your fifties used to may have some children if you married late in lie you may have some teenagers around so how much would that be for family for the total family planning up for a retiree with a non medicare eligible spouse that would be thirty one dollars and a retired with a non medicare eligible spouse but the child would be thirteen dollars and if they have more than one chair would still be thirteen okay mr chair are we going to at some point a day talk about. The decreased amount of money that is going to. Our pharmacies as they navigate this name or is that for another day. I think this for another day I mean but because it's adding a profound impact if I can't go to the pharmacy and the pharmacy can afford to feel my prescription because the pharmaceutical amount that we're getting is less than it has been then this would have a profound impact on all about retailers. And our current members as well so i'm just trying to find out where we are with them where we we approved the we've approved the the the initial rfp that was put out so we've we've approved that. In the end there was a some amendments my understanding that went back to the stateboard but finance which they've approved it. But it's my understanding that procurement has to look and look at it to see if there's any substantial changes before it's brought back to us to see if we need to do an approval on that amendment because i'm hearing that there is a distinct difference between the amount of money that are going the amount of money is that are going to pharmacy providers and those and more urban settings could you find that information from me and share it with me please we can if I remember correctly in the rfp I believe that and I don't know if it was tired break and mortar or the independent pharmacies that they were supposed to receive at least the same the same reimbursement as as the other so that's actually was all in the rfp that those were supposed to be at least the same I if i'm mistaken here i'm just operating off of memory on some of their so no you have a good memory that's correct so that that should not be the case on with the with the changes that has mitigated that situation. It's supposed to be yes ma'am now again it's my understanding and that I don't know what the changes are that that the contract that we have approved which this does seem a little that we approve the contract. And but there was some other changes that that were within it so they took it back to the state board of finance mister wallace and then we still we may or we may not have to to have it back in here based on what the procurement director says in he's in that process now yes so that's great go just just please know that my concern is that we equalize those payments to pharmacies across the state and just real quick not to believe the issue but we are monitoring that we have had formers to give us some data that we can go back and analyze and and make sure that we stay on top of that issue and if there is something system it going on that we did not white or that was not included in the goals of the rf that those get addressed by navigators thank you so much thank you mister chiran i'm not a member of the committee thank you for your indulgence. You finished center chest feel thank you mate thank you. Okay I think sender hammer you're up next. And retrained think they can as share and along those lines what I want to ask is on the all of this as intended to contain call so we keep the rates now to a minimum understand that that's agreed on the the question I have is the areas that you are identifying cost savings in order to keep these rates down and let me let me preface that add to that. How does situations like it it may have no bearing at all but how to situations like what happened with united in conway hospital and I understand there's some other negotiations deadlines are coming how was all that going to have an impact on any of these rates or does it have any connection points at all. At this point because of the united health contract we're still in that first year I really don't know that I have a good answer few other than it's still the the member still has the ability that like we did with conway regional if we get into an issue where there is a provider who has a large sector of our membership and their access is going to get impacted through that negotiation we would do similar to what we did with conway regional and afford them a one time opportunity to roll back to the plan to where they're cut their health care would not be interrupted but we are working with united health care there are aspects of that plan that in network and out of network have non differential so we're making sure that our membership fully understand that benefit and so that it doesn't end up getting into a situation that even if they are out of network they can still utilize their united health plan and still continue to get the coverage with no increase out for out of pocket copays or anything like that we're having to do a lot of education around that plan and a lot of awareness around that and that that's what i've taken on here recently is to make sure we get a good communication game plan in strategy around educating our members on all the benefits they're afforded when it comes to their retiree health plans chair. Yes sir okay and and we're we're kind of trying to look at the trends in the future in what are wondering my mind is that as these negotiations happen outside the first year and if this is going to be ongoing challenge where there are battles between united and you know provider groups hospital or whatever how how much have you calculated that into what the future rates may be outside of that one year time frame and and what allowances have you made for that so we don't have a bad hiccup down the road so we are sitting on healthy reserves for the state employee plan and the public school employee plan that is part of the reduction in this and and looking at this is that we appropriately in responsibility split down those reserves because they are a bit over what the legislature has targeted that they would like to have in reserves so that we do have that cushion to work with as we kind of learning the experience I think to the point if i'm understanding the correct the question in the point you're trying to get to is that if we were to see individuals shift from the united health care plan over to the health advantage plan that utilization would go up that would add additional cost in future years that we would have to calculate between the state and the retiree and in their premiums right because if if a hospital united as they negotiate their terms and reimbursement rates and everything has an adverse effect on what we're doing at what point would we recognize that so we should react accordingly to it or not be surprised and then life seeing our her shoes what what are the reserve bounces now if you don't mind answering that they can mischer let me get my computer fired up i'll get you those answers as quickly as I can but I will say in the united health we are locked in two rates for the first three years okay so those have already been set their five dollars increases each year if our one of this year was a five dollars. Increase I think next year is the same five dollars so we do have that locked in already now for when it comes time to do the one year renewals that really is are checking ballots to make sure that we're not over burdening that member increase or anything like that when it comes to your four through seven of that agreement thank you name is your missed sooner hammer do you want do you actually want the balances or you want the percentages because we had put that in there what we wanted to maintain you want the percentage or do you want to actually dollar number if we get both but don't hold up questions waiting I mean if it gets it to me afterwards but other members may want that information to other to the chat i'll send that after if that's a whole week it was at seven percent so four pse it's sixteen percent for for assistance fourteen percent and I may have those backwards but those are the two towers when we are missed it big terms of okay thank you. It represented back her europe i'm sorry I haven't trouble with these numbers appear today I actually think my questions on the next slide so okay thank you sir and then representative ladyman I think you're in that chair thank miss chairman and this may be more of a statement than a question but I want to add what's interesting ask earlier i'm not sure you guys were the ones to ask this question but mister chair there is a problem with the pharmacies i've got a number of calls in and what happened was we had a new pbm which put in a new national right schedule and arkansas that we did not have before in those reimbursement rates for the pharmacist are lower and i've had a number of farmers call me and tell me there so we do need the study this because sent to chest feels absolutely right that i've had farms as tell me that they may not feel performance prescriptions for state ploys because they can't afford to lose that much money so it's it's something we really need to look into maybe we need to do this in public health those view there in your own public health committee maybe that needs to be on the agenda we talk about that but somebody I would like to know what the action plan is to sturdy this problem because it is a real problem and those does the skations as far as whether or not they can be reimbursed but. A dish higher than the other ones is his own going like a say right now so that is is kind of going going but as far as what was our in the rsp it said that they would be paid or reimbursed a at least the same amount I believe is whether it was written so that as far as public care for me in public accounts can do do what they won't but that's what that is the reason that this committee set up so if there's something that we need to address. You know again we approved the rfp or the we approved that contract already. That this german you say the same amount that you mean the same amount they were getting before or the same amount at the as the big pharmacist pharmacies. Mr wallace do you want to make sure i'm saying that correct it's it would be the same amount that the big box changes are getting an through the rfp I think we can all understand and appreciate that there was going to be a change. I mean everybody that proposed in you know again I don't want to believe it because I know that's not the topic but for example on the retail thirty brand name the current experience was a sixty three sent dispersing fee met impacts proposal was forty five cents nowadays is at fifty eight. So they are within the market they are within a competitive range we've had siegel analysis we have met in pattern millerman analyze in all the analysis that's come back is that nowadays and the current contract that we're work that we are operating under is at market and is competitive with whatever with plans of our size and what they're doing we we continue to monitor the independence and the brick and mortar and that is something that i've taken to heart I have gone back numerous times to navigate an emphasis the importance that they communicate with our pharmacy association that they look at those rates and that they make sure that they are competitive that they are competitive and are at a level that allows those facilities to continue to operate as they should in and do so in a profitable manner now there is that greyer of what is profitable that we do have a responsibility in a fiduciary responsibility to the plan to the general revenue and the tax dollars that are in this plan but at the same time we have an equal responsibility to make sure that with not putting those independent pharmacies of brick and mortars out of business while we that is not the goal in that in we are very sensitive to that and continue to emphasize that I know nabitus is having conversations with the pharmacy association and is working through those issues and fortunately my hands are a little bit tired because those contracts are between the pharmacy and the the pbm and there's only so much that I get to reach in to those negotiations but we it is something that we will continue to monitor and I will make sure that we continue to reemphasize the importance of those reimbursement rates and making sure that they are not at a disadvantage to the box stores so yeah I understand your positions are but that I believe this body we need to know if we're putting our rural small pharmacies that it disadvantage. Because a walmart walker is not going to go out and rule area and put in the pharmacy and we are think we as a body need to study that little bit closer thank you mister chairman for left thank you representing later. The. St urban are you yes thank you just just quickly on in network and out of network that discussion back from senator hammer and united health care and conway regional the disruption and and I understand what you're saying as far as the disruption for the employee the retiree the beneficiary may not come in the forum of disruption of their change in their cost but it will come in the disruption of they will not accept them as I patient anymore because now they are out of network and. When you're out of network you're reimbursement rate I believe and don't quote me will be different than if you're end network so that's where the disruption calms and so I understand you said we're trying to educate around the plan however we we have to understand that dynamic that's going to occur because that's where the disruption and the healthcare when when the doctor or the hospital says we will not accept you as a patient we will not treat you I would be sleep to come in the er you can't refuse but you know they have to be able to pay their bills as well so II think that has to be closely monitored in and I understand you don't want to get an involved in those negotiations of those contracts II do understand that but but we are also the feduciary for on behalf of all these state employees and public school employees say there has to come a level of where you do look at that and so i'm concerned about just you know a wholesale rejection of the plan I mean that that's you know there it's one thing to you know look at your rates and all the discussion you've had and i've been through that be process I feel like you'll do the great job of following that process fairly for the rfp on the on the pharmacy side of things. But but I am concerned about people pulling out completely and not accepting it completely because then you're absolutely losing you know your health care and that's a huge destruction so I just and it will calculate into like you said I mean we want people to utilize that medicare advantage plan because of the car share in the rest share and and then that takes more than share and that does the fact the rest of the premiums because that's what seekles said and you know we can only go on that information so all of these kinds of things just seem to hanger on each other so I just I think it's really important I wanted to stress that you know i've had a lot of people in my district that were affected by that decision yes me i'm in I will say I had that kind of same conversation with united health care through that process and it is a confusing process it was for me because when we first started going hearing the rumblings that the negotiation might not go well you know I was told oh it's not going to impact this potential population and then as we got closer wait a minute it is impacting and and we did have conversations with the conway regional and trying to understand what we were being told from united health care in making sure that that billing and how that would operate in there were some confusion around that so it was an emphasis and it is something that we are very sensitive to you making sure that we fully as the administrators understand what the what the reality is for the plant for our providers where are members when we go in and we hearing that there is this negotiation going on and and it may not be going well it it's not just trust but trust and verify no I appreciate that and an also important to work closely with our insurance commissioner and our department of insurance because they're the regulatory side of things that are important to that discussion so thank you thank you. Thank you center represent a banker. Thank you direct wallace. Uhm I have a question is specifically about this issue with united health care and the hospitals and what appears that when we've moved these patience who are medicare eligible to this new plan that we then obviously turned over the authority for the management of that plan to unite health care or whoever the medicare plan management is due members who. Chose that plan have a paperway back to the primary plan from thank you for that question so what happened last fall was that everybody was auto enrolled over in the united health care plan and the member had to actively opt out to go back to hold advantage now i've changed that because we now have an open enrollment for our retirees that's going to happen in november of this year if you have an open enrollment experience you can't necessarily have an opt out those two don't necessarily align with one another so what we are going through with an open enrollment just like active employees during that open enrollment time period they get to choose whatever plan works best for them if they want to go back to health advantage they can if they want to stay on united health care they absolutely have to do nothing then and everything will remain as it is so everybody does all the retirees will have that one time a year in november open enrollment experience to make what ever change they would like to that best fits their life circumstance. Follow up. Yes sir and what what do we have in place to help market that or keep them educated on that because that's right in the middle of medicare open enrollment as well so I anticipate there being a significant level of confusion with them being in a medicare plan it's now time for me to enrollment there's also this open enrollment that's right in the middle of it how are we communicating with them and or what should providers who have been fielding complaints from members and they're actively wanted to get back in advise or what materials do we have actually we are in the process of creating that communication tool care it will be social media it will be earned newsletters are a q three newsletter has gone out with the open enrollment information and kind of the awareness around that i've actually done something as simple as change the color scheme for our retirees so that it stands out different from just all the other information that ebd sends out so we are actively building out that campaign to really inform people of their time period we're telling people that call and have questions here's the time period it's coming up I agree november is a very confusing time of the year I can't say that I would necessarily pick november in future years just to kind of help with that so but yes there is an active awareness campaign around open the room and that experience that will roll out in september or start rolling out. That's all thank you thank you sir representative thank you mister term is it's true they will have a you change. A healthcare plans benefits change is that correct right there would be some underlying benefit changes or can you select different plans under this plan are specially drugs covered. Are we back on the farmers to benefit manager are specially drives cover that yes there there is still the specialty. So the sun will be in a change with specially drugs I guess that's my question so there will be no changes to the formula the formula that was existing on june in june is grandfather through the end of the year so that particular whatever that formula was whatever specialty drugs that were included in that formula still exist and are still grandfathered through the end of the year now as we get into next year I do I anticipate that there would be some changes to that the to the formula absolutely that's what we did today but specialty drugs will still be covered I can't say that the specific specialty drug won't change to an equivalent from a different manufacturer something along those lines II don't know what that looks like but yes there will still be a specialty to your structure comment is is but it's my understanding that most especially drove and that generate drugs so if that's not covering and you say that a person could get a generic draw if the generic drug it's not equivalent to especially drug then the person owned especially though would probably eat in that day. And not necessarily following because I think those are two different class structures of medications. The specially driving would not have a generic equivalent in most cases and they would still be on that specialty drug now when you're looking at the tour of her station and maybe its named brand equivalent that that would be different but the same underlying chemical compound between those would be the same so it's too different. Kind of classes of drugs at that point and I guess that's i'm just not understanding your question well I think that we can talk after me. Thank you everything sooner cole will europe. Thank you miss chair as far as same taking of her a replacement layman on all the formation reimbursement in which while she are should eventually about to crush but verify them assurement i'd like to hear from the pharmacy association to make sure that the communication is is taking place at the level that missed while says they are that the we're trying to get to the bargain of this in making sure that forms this will be taken care of. Uh if you don't mind i'd like to expect come to the table and an interesting question do you do you mind when that under other business can we just do that daniel we need to go back and forth with them sitting there okay well that objection we're gonna take data but under other business today. Okay so whenever we get to that i've. If the pharmacy association for your assume you're here of course if you have okay if you need someone else here now to be the appropriate time to to get them to come down also. Or be getting getting hold of so. Can we go through the public school rates let me make sure we don't have any other could we have anybody else as soon as yesterday feel thank you mischief what we're doing this and I know we're gonna deal with the pharmacy stuff on under other business but what is the relationship between never tasks and costco to my understanding I think costco is a preferred provider with navities but I don't know the exact contractual relationship that they have. II do know through it like the mail order when we were going through implementation and talking about that the mail order service was going to be provided by luma sarah who utilizes costco as the mail order well also rest my questions institute that portion is coming up because that okay thank you so much thanks soon okay I believe. The. Is there anybody else. Representing breath you're recognized okay so thank you mister chairman mister wallace on page toyota the retari only. And also the retiree and spouse. Is those two are they going up just a little bit right that would be on the public school so we haven't reviewed all of them yet but yes there are some slight increases and decreases across the various bands for that that population thanks or thank you miss chairman okay members I believe that's all the questions of course you did the state state employees so now you are going to continue on with the public school there may have got some we may have got some questions that were intertwined there of course but we won't have to hopefully ask the same ones again whenever we are dealing with this. To your recognized thank you so much will go through the twenty twenty four proposed employee contributions and retired contributions for the public school employees so somewhere to assa we began that five year transition plan looking at sort of the markets in terms of what is best practices and what our other benchmarks paying out at the public school side and we'll get into that rate proposal for twenty twenty four somewhere to AC there is a slight plan design chains that needs to be made to the classic plan to maintain compliance with the irs code. So the for a public school employees and the active side all of them would be seeing a document for twenty twenty four. For the pre sixty five retirees those on the premium plan and the classic plan would see a document as well those on the basic plan when predominantly see a document except for the retiree plus spouse that's user about a five dollar increase and those with family coverage is about a dollar fifty increase. And then for those who are medicare eligible so what the health advantage plan there is at ten percent cap on the return only which is about a ten dollar increase for those who are retired only. And those who are covering their spouse is also sorry eleven dollars increase and those who are covering this house would be about a twenty six dollar increase. For those on the map plan that's a fully insured plan. As we discussed earlier that's a five dollar increase per year that's contracted and so that's a fifty cent increase that we're seeing for the map the retirees and those who cover a spouse on the map plan when she get dollar increase. Any questions on the posts on the public school employee contributions okay members they went over the state employee pharmacist is a public school of course we got a bunch of generic questions up I hope we got answered is there anything as a directory relates to the public school employee rates. Case see a known. The. Horrible or you'll finished with their okay where do I have to have a emotion to. Revert review and approve this. So we got a motion we have a second i'll in favor say any opposed okay they will pay us. Okay do you all have anything else as far as this agenda okay we we appreciate you i'll be in there mr wallace if you don't mind although we're we're about to go into other business and and have the the pharmacy association come forward do you mind staying at the table just in case there are some questions I don't want you to have to walk back up if we get into that so think that would be prudent. Yes ma'am buyer here today. Nabatas are they here today no ma'am. It'd be interesting to be able to hear from them as well okay as far as you must mention you want to come forward. Okay center car will do you want if you don't mind if you feel recognized yourself just for the record and then I will let center call well ask his question again to get to start it off good morning my name is john vincent a pharmacist and ceo of the arkansas arm association thank you mister chairman or thank you sir send you column. Thank you again with chairman of miss pension you've heard several people in room of voice concern that our local pharmacies have been contacting us about the low pay or below cost pay on prescriptions uh indicated that he's communicating with you. In the association trying to remedy this and II want to hear your side story of the relate me of thanks are you that I have with my forms of special thanks in a call well though so my response would to that would be is that new rates new pbm went to a fact in two h and there's counted two sets of problems that i've seen heard from members of our association pharmacy owners small chains etc across the stay the first world some of the rates on individual claims were sell aggressive through take it or leave it contracting from the pbm where the pharmacists weren't actually involved in those negotiations at all they were just implemented national rates that on individual claims they buy a way to stay off and I don't remember how many if you were here to hear from the insurance commissioner but they've been very active and working with grant and ebid he and narvatives to get those issues resolved on individual claims so that is true that on on an individual coining paying below the cost of the drug on one claim most of those issues and compliance with state law have been worked on but I do worry about what that means for any projected savings that was where the projected savings even accurate in terms of those rates didn't comply with state also at least which site should look into that as you're studying it and then the second piece of that is is that the overall market basket and keep in mind whether it's a generic or a brand name some of the reimbursement there's a lot of flexibility where in this contract the pbm it's proprietary there's not transparency and to work that exact rate is or what the exact payment is to pharmacy so i've had one pharmacy and desert tell me rates are great I mean I did take a cur and their savings but their fair and then I have another pharmacy in rose city tell me or in bitten or in another community like alma that the rates are super aggressive and below the costs are doing business and on the overall market ba. Ask it for the entire month of july compared to you last year that the reimbursements dropped between twenty two and sixty percent on the overall claims volume to a point where in some cases it's three hundred percent lower than medicaid which this state did study through a accounting process through mars and stuff or determine what the dispensing fee should be in the ingredient cast eight years ago prior to inflation and so even compared to that as a benchmark in some stores and independent stores the reimbursement is so terrible that it is. Two hundred percent below on the same market basket in the medicaid point in the state as just a comparison. Car well do you have any other questions senators to field I think you would indicate is you might have some questions to do so yes thank you the way we treat pharmacist matters tremendously and i'm wondering if the car interact this is either for you or i'm as to wireless. I needed deals specifically with each pharmacy or are they only dealing with the pharmacy association. Because my people are saying they're room to me. When I tried to call them. This date does not recommend in entities that are rude. To the customers or the constituents with only deal that are part of the pharmacy committee I mean pharmacy community so are they supposed to deal specifically only with the association or or later deal with each pharmacy as the pharmacy presents itself to them. What won't I will take ownership of the customer service and I apologize at that experience happened that is not acceptable and i've already made a note that i'll be going back to navigators in correcting that the only thing I would ask is if afterwards if you wouldn't mind sending me the individual so that we can track that customer call and we can go back and have them understand exactly what went wrong in that call so that we can get that corrected with their customer exervice service team as far as the negotiations that the state through its rfp process obviously had some guarantees that navigates provides to the state around here is the bride range or the average of the reimbursements that we'll have across the entire state but as far as the negotiating with the specific pharmacy that occurs between navigators and a psao organization or navigators directly with the big box stores so that's where I don't have as much sunlight into what that experience is I know what is in the guarantees and what's the kind of being calculated off of the proposals that were submitted through the artic process so not only make but it may be more specific if a pharmacist picks up the phone. To call nevertheless. About a specific question are data respond to the end of visual entity or are they only to respond to the association they're navigating supposed to work that out with the individual pharmacists when that pharmacist calls to work out whatever issue it is they should be responsive to that pharmacist it will my understanding is from the individual source but and we will share their offline. Is that their rude. They don't want to deal with individual pharmacies. And so that is a concern of man and i'm hearing both sides of this are appearing from one of my colleagues that his pharmacies are just great with what is going on but that's not the experience that my pharmacies are having in dealing with it with the organization thank you so much mister cheerful allowing me to ask the question thank you sender hammer europe sir thank you miss chair and more directors john last week one of the largest independent pharmacies in arkansas closed down and that was all transferred to wall range. Real quiet if mischair lous I think it's important for people to know in it in a nutshell real quick what happens when I independent pharmacy shuts down as far as the scripts because that was a real source of confusion and in my necklace when that pharmacy shut down so miss chair would you allow like two minutes to give the explanation of the process because at the same time. I'm also involved with question of detail of how many others are on the brank because of what where we are right now and that must chair would you allow them yes I mean if you want to do that I don't I don't want to get specifically named on the next next question of course because I don't need some things like that that if if you want it if you want to go down that road and so I don't have an exact number I know their national estimates of thirty percent of pharmacies are at risk that are independent or your own and over ninety percent and recent national surveys or concerned about take it or leave it contracts in the future where a reimbursement is headed there's a race to the bottom in the past this legislature has rejected that type of methodology and in fact I know grant talked but earlier his hands are tad but my understanding is the finance board in this legislature can set whatever rate they want I mean the plan works for you not the other way around and that's the way they've treated it for the last thirty or forty years they haven't really just turned it over to a pbm and ebd's been one of the the points it's been a model for the rest country and now we've adopted at least for now at back ten years ago twenty years ago uh pbm take it or leave it methodology is going on with this current contract but to the pharmacy in a bitten and what happens when a pharmacy closes like that pharmacy was sold patience didn't have notification that was going to happen until the day of that it was by wall they they didn't have a choice correct well they're I mean there's a little wiggle room in that and some of that is between the seller and the bar to be honest with you there are some situations where they do give a little bit of notice in other situations where they don't depend on the circumstances of what's going on financially what they're with their store what's going on but in this case they deny so that was a top five in the state of arkansas volume services full service nursing home stereo compounding one of only two. Pharmacies left in arkansas that does retail specific sterile compounding and the decision was made to to sale and it wasn't sustainable in terms of where reimbursement was going mainly with some federal plans with medicare and what's going on the medicare round which congress is looking into an addressing the federal trade commission is investigating but the the ebd rates were very on power with the very lowest bottom to and the entire country reimbursements for that pharmacy and other pharmacies in so in county and so that that pharmacy that filled between a thousand and fifteen hundred scripts a day that represents between ten and fifteen thousand lives overnight it was the only way I know how to describe it as it was chaotic it was very difficult to coordinate and not have patient safety issues while greens did a good job of staffing up and doing the best they could in a situation to try to make those ends meet the local independence john martin and victoria's and zack hayley and and madison and ten family and his crew did the best they could have to take phone calls and text and staff up when they found out but most of them had no idea that was going to happen until the day happened so it was a lot of scrambling it has been a lot of weight narrow it's in the local pharmacies have been work until ten eleven o'clock at night to do everything to meet the needs in your community. But they're not as far as the the patient can request that script to be transferred should it but it found them so they can get the of the patient they can request but when you have a thousand prescriptions a day he the logistics of being able to really get that transfer are realistic and so there's been a water phone calls with prescribers and prescribers have concerns because they don't want the prescription to be at two different places especially if it's a controlled substance and they don't want it filled more than once and I can understand that but it has been thank you for the question and now it's indirectly related but it I think it's directly related in terms of take it reimbursements or driving that count of sale and closure I final I do think it strectly related because. If this is an example of the fifth. Then what happened to rabo the fifth because we can add to a fifth it can happen to whatever number down the line so i'll take it's important to include it in this in this discussion like mister. Thank you all right is there any other questions in regards to this. Do everything else same as the only other thing it was a question about costco alumus luma sair is holy owned by navities so their vertical integrated and costco owns novetis and their vertically integrated so the mail would or pharmacies you're all owned by the pbm so that also applause into point designer rates. Okay see enough other questions and will make a comment here probably shouldn't there as I look across here there's more than half the legislature that is coming to this committee because of constitution because of the pharmacy association and a whole host of things and what I want us I will remember and we all know this is there whenever we started this process years ago the legislature was having to put in twenty million eighty million hundred and twenty extra million dollars a year every time we turned around you all knew the debt was not sustainable and we went down this path we went down this part to to get it corrected. And then this this committee was structured by representative board low and senator rash so that we could have these tapped discussions. And I just wanted says we do this we understand that we we do have a commitment to our constituents we do have a commitment to the rule of areas but we also have a commitment that we do not go back to the part where it's not sustainable and things are out of control we've got to get accurate information. Because we all know that money's involved just to be quite quite on is quite blunt we got to make sure that we get accurate if information with all of this whenever we're doing it so if there are other entities I heard center chest field you know as we get into this and we might need to gather some other information if we need to have the navatives for them here we're going to do that through this committee so but again I just want everybody here to recognize and I know we get a lot of people pooling pulling on us and they're all our friends and they from constituents to theirs and then the taxpayers themselves from and I want to make sure that we're not throwing extra money at things that we should and so again maybe I should say that maybe I shouldn't say that or whatever here but by the thing I believe that's how we got to this point and I just want to solve remember that so with their order thanks.