ALC-Employee Benefits Division Oversight Subcommittee

I have a see employee benefits division oversight subcommittee meeting to order Uh. First before we go into the discussion of diabetes management studying timeline just wanna make sure my co chair did have any comments you want to start off with. Yeah Arkansas Code. Members of a good I'd like to have your attention I'm going to give you a little update of of why we're here today and and so you'll understand the of everything's transpiring at one thirteen of twenty twenty two and A. L. C. and the A. L. C. rules assigned to this subcommittee a study regarding the viability in the State sustainability of a general's diabetes management program for the State and Public School Life and Health Insurance program this subcommittee is tasked with developing recommendations for potential legislation for the twenty twenty five regular session related to a possible diabetes management program for A. B. D. a final report is due to a L. C. by July first of twenty twenty four last year AOC approved a contract between BLR in the Siegel group and part of the scope of that scope of the work for that contract is assisting this subcommittee with this with that study. Segal is proposed topics for the study for a timeline present representing those topics to the subcommittee today we'll hear from Siegel ask any questions that you may have and we will need a motion to approve the topics at a time line for the study it at the end at this time of Mister chair I believe that David Searles and Patrick Klein was C. will be joining us as soon they're going to. President this a timeline to this. Only please enter introduce yourselves and your title and they will begin. after Klein with legal. They serve the same vote vice president on the it or else. Just give me a little status on where we are we received the. At a submitted early July we. Been able to get that downloaded into our servers we have. Been from inspection it looks like we we receive everything we're still in the process of. Tracking control totals and ranks increase just make sure that we we have a. Not that I want to turn it over to David he's out walking. Some of certain rights that we have planned Scotsman. Can you hold on just a second we're having a little bit technical issue with the volume OR have some of the members of a little hard time hearing you. Hey Patrick in you Say few words so we can test it out to see we got the volume issue corrected. The. Hey Patrick is there anything you can do on your and it seems like over here everything's at a hundred percent volume and so were I wonder if maybe your Mike is turned down or something like that can you can check that. I cannot. I can't turn off my we choose see if that makes it any better Hey did you want to say something and see if it's just me or maybe a. Could be a good chat for the record I hear you really well so I don't know whether I'm going through the same year. Thank god there any better. Technology. Just for the committee's benefit. This is only the this is the only month they will be busy with us B. as in the other meetings they will be here personagens this is the one which. The Bill Cosby is in. He tried again one more time. Our. It's a little bit yeah talk loud I think we're just we're just gonna power through and. Okay I got out I don't think we have too much to say we just got that early July You mean controlled access to make sure there's no gaps and we can work with what we have we have. A. A series of topics that Dave's gonna go over should be about six months of. That's okay with your time frame. The debut on a. Based on what we planned the cover over the project. Your and the. This type of process the kind of builds on itself so month by month we're going to have different topics that we addressed and and then have to come in from recording so we have a front row from Ford in about six months so we're going to start off with medication or utilization and management so we want to see what percentage of people are inherent with medication Also what percentage of taking medication and was trying to make a determination of those people who are not interfering how many actually need to be done here there's we're gonna start off way of breaking this down between type one and type two. And so I wanted parents usually is not that much of an issue but most of the focus is on the type two diabetics of which generally speaking you'll find eighty five percent of your diabetics are I'm trying to write. So the first thing will be to get a sense of what's going on on that side and now with some of these anti diabetic medications being used or BC management I will also be looking into how many false positives we may have on the right side we decided that is someone that looks like they're not because they're taking into diabetic medication what they're really not taking it out for taking for weight loss also there is. and there are ways for us to. The fact that those people out there some people to start with my form I thank you once recommend the government does affect so so that would be the first month is getting a handle on utilization of medication adherence and by making sense of. kind of you know most people are not really that and this using drugs for herpes. the second month we're going to focus to the extent that we can upon obesity nutrition and lifestyle management so For the city and the claims data births are typically very under reported so that people will have made claims they that would generally be morbidly obese want to go to inner peace or buying houses there's a high percentage of the population most likely that's considered obese from a medical standpoint thirty to forty percent off usually publicly in the data we only see about maybe ten to twelve percent of people actually being diagnosed with a patient so we're also going to take trying to figure or try to fill those gaps within the mental that'll be the second month. Third month will focus on mental health a little bit of the read the code the Committee of mental health with diabetes over the chicken and egg problem trying to make a determination One at first like Moses I was. About the health issues present after that or the opposite. When someone presents with a mental health. The issue what impact does that have on there if you're their medication so that's what I was saying before the work that we do all kind of built on the chart. then after we we have a lot of that the local government and what I'm looking pre diabetes because any any diabetes management program that you entrance to. What we want to consider preventing or or slowing down that journey to date these on there are there are diagnosis codes for pre diabetes so we can identify people that their doctors said so that their pre diabetic but we can also identify those people who are like the pre diabetic based on other comorbid conditions which is gonna be our our Long announces also those two hundred one DuckTales into the other. so we had to get a sense of. What how would how would be identified that part of the population that you would want to manage that are not yet considered by about. so that that's where the other comorbid conditions from them so that we want to see if with various conditions like hypertension coronary artery disease plans whether there's something in those corporate conditions specs out as a problem area that would need to be addressed and any type of management program. one all that analysis is done the final month will be wrapping up putting all that together into a story in a final report and then include a recommendation based upon what we found looking at the data and then try to estimate of potential savings based upon those recommendations. I will move on to our next item I I don't see other business I think there's been some questions is EVD here. Yes please if. General thank you for coming and we'll we'll see you next month. I am. I'm here from several legislators or their here today And and patients that in the first nineteen days of the PBM rollout there's been some claims and patient access issues and so I just was curious could you speak to that address those concerns of some of those legislators and please introduce yourself yes Sir Amanda land deputy director of the employee benefits division and we contracted with a new PBM and nowadays Health solutions and I did roll out on July first as you recall the RFP process took a while a little bit longer than expected I so we had a little bit shorter of a runway we've run into some seven programming and coding issues and that rollout that was on seven one and as they're coming up with it you know as pharmacist come to us as members come to us we are addressing the problems as they come I we're fixing them as quickly as possible and hope to continue to do so and would encourage anybody to reach out to EDT pharmacist members anyone with those issues and and we're needing some more time to continue to work out those Kinks. Thank you are you are you able to take some questions sure I see one from centre Boyd you're recognized. Thank you Mr chair thank you for being here today just I'm kind of new to this committee and I'm kind of learning what's going on with this this you know I've been in legislature but the purpose is I understand the permit per per month cost for the plan were approximately ninety three dollars before rebate with the form for me learning manager private navis compared to the approximately hundred fifty dollar per member per month for the benchmark of the state plans to cut across the country which sounds like we were doing okay so I just want to make sure how you plan to keep this committee apprised of progress on that per member per month what what it's doing in a report to us monthly quarterly twice a year what can we do to you know make sure were. In the number one what what's happening yes Sir so we're actually still in the process of continuing to negotiate with notice on what the final rates and what all those numbers are gonna be looking like our plan is to hopefully have that come before this committee next month and go through whatever we need to on those on those rates with you all and my understanding is that we will be before you all every month I'm updating you on that as well as any other member issues not just with the PM. Does that answer your question. You just specifically I want to make sure like. The way I interpreted and decision was made to save money right. Based on the numbers I'm saying we were already doing quite well I just wanna make sure that we are saving money or things are going off the rails so that we can be engaged in this legislature you know we fired the the plat the past DVD oversight committee we say we're going to do something new and we engage this subcommittee and I just wanna make sure I'm doing my job as you know a committee member to make sure we're doing what we think we're going to do as we go down this this. New York path thank you yes Sir and and one of our priorities is paying attention to the savings and we know that it is very important. Representive acre you're recognized for a question. Thank you Mr to. Kind of continued discussion about savings we've we've seen reports testify that there is an expectation of between sixty to eighty million dollars in savings presented by now but this. Do you have an itemized list of those savings and how they're being allocated. A No representative not at this time as I mentioned we are still going through this those final touches on everything but we would anticipate having a better idea of what the savings are about six months down the line and we we are working with Siegel as well and they look in their we're gonna be working closely with them to make sure we look into what the savings look like. Follow up. You're recognized. What information did your institution receive that. Voted the sixty to eighty million thanks that's a very large savings that I think we're all they're interested and and seeing as it's monitoring state funds how is that number generated. I believe that would that number was generated by Siegel during the RFP process and. When it was looking at potential rebate savings if I understand your question correctly. Rebates in regards to the actual drug product itself yes Sir thank you. To if if I'm not mistaken that that was on the medical side close to plus the street is that correct because if I remember right whenever we first looked at this and see what we ask for some estimates who is going to be like eighty million a year and that was one of the reasons that we went ahead and pushed for the mid year because we thought that the savings would be close to forty for the by beginning in the fiscal year in the in single come back and thought that the more of more appropriate thing if I remember correctly would be like thirty million for the for the last half of the fiscal year so and again I believe that the pharmacy and the and the medical side. So just just to make sure that to fully explain that. Thank you thank you thank you okay chair a centre Dotson you're recognized thank you Mr chair so. Just if you could refresh my I know we're still doing this we don't know exactly what the per member per month is going to truly work out to be but if you could refresh not all my memory but the rest committees on what are estimated per member per month should likely be now I mean it if it was ninety three dollars. Prior to rebates before we did all this what what is our estimated now with new rebates and that's right thank is should be significantly less I would thank you for seven thirty million. This fiscal year. Senator I don't have that number right in front of me but I'm happy to get that to you after committee if you could get to the staff of the whole committee can be apprised of an yes Sir thank you. Senator Hammer you're recognized for a question thank you thank you Mr chairman the. You mentioned something about it indicated your answer will go to questions was that the potential costs may go up from what the PBM originally bid for the contract for deed I misunderstood stand what you said was is there some indication that from what they originally bid you may actually go up then. That's that's not what I intended to say what I was intending to say was that we are still working with another test on what the final numbers look like we are also doing that in conjunction with Segal to ensure that it does line up with what was did. To ensure compliance with the R. F. P. you think that'll be known by the next meeting perhaps for next thirty days yes okay Mr McInnis chairman questions please. Yes go ahead if you don't feel it's appropriate that's fine but because the media is at the table and if if she is qualified comfortable answering the the situation with Conway and United healthcare and the dispute that was going on is that adversely going to affect any of our members that are covered by EBT that might have services expected to be delivered by Conway memorial if you don't feel is appropriate said answer that that's fine but one to find out thank you. Are you sure like what if not we can. I can get this over as much information as I can about that so we learned in June that Conway regional and you agency we're not going to renew their contract once ET learned of that we send out a letter to approximately one thousand fifty members that we believe we're going to be impacted by or potentially impacted in receiving services in that area and we gave them the option to switch back to the health advantage plan one time and and if they were to do so by July eleventh they would be able to have coverage with health advantage effective July first those who got their forms into us from July eleventh through July thirty first they could have coverage with health advantage effective August first if they choose to do so You know we really haven't had our team available to answer any questions and that we wanted to just make sure that it's any of our members were uncomfortable with maybe not having that access to care they could have that choice to go back to health advantage so far we've had two hundred and forty members elect to do so and then go back to health advantage we anticipate that number could go up a little bit more by the end of the month but so far what happened United healthcare has indicated to us is that many of the providers and in in fact they indicated that. None of the provider so far have refused to see any at U. H. C. members and Conway they're just being treated out of network and I believe their billing should. You know they should still have the same level of coverage that they would have had it and and and network. Cash one question. Yes you're recognized thanks does that put a higher burden then on our members that are remaining under the United healthcare plan just get the headset shifted a greater cost to them because they're out of network it should not shift any greater cost to them I believe it would be just a billing negotiation issue between you H. C. and whoever that out of network provider is in whatever they do on the back and to to make sure it's it's covered but to the extent that anybody does have any billing issues we certainly want to know about it and address it with you agency but we've been assured that there should not be any additional cost if they see a provider that's out of network that is still choosing to treat them. On the cover by UHC our thank you thank you Mr Fletcher. recognized chair Hickey for comment yes just just of the members I just wanna make sure it's we're in this public meeting that everybody can understand our contract that we have with Siegel one of the items within that is is that they will be available for us we can have them back so that they will go over the cost savings and everything and I don't wanna get get too far outside of my balance here but whenever we're talking about these per members we're going to have to be make sure that we're comparing apples to apples because we dealt with this here recently whenever right before the contract before you know we had to review that through here if I remember correctly you know used to it was on per member and now it's on per contract so in other words and again we'll we'll get you some specifics but I believe what that is like if there's a of you know my husband and why for you know spouse or whatever that they're actually covered in that contract so we we need to make sure that we're comparing apples to apples whenever you get that so I want to say that here but I want to make sure that if you do send that to the members as requested. You know whatever we get all that that that we also explain that out because that has changed is my understanding. I hope that's helped. Thank you for the comment Representative flowers stumbling recognized. Thank you so much Mister. I just had a couple of quick questions first just in terms of the transition of Providers. How what how long is that process taking once a provider has completed their application. Are you referring to. Pharmacists the pharmacist It should not it should be. Since pretty seamless of my understanding there the contract negotiations between novice and the pharmacist has been going on kind of simultaneous with our negotiations with notice and that. The match there is a very large majority of pharmacies Act will continue to be a network with the office that's that's what I thought and I'll get with you afterward because I got a call from the pharmacist who completed his application and he would have already been you know a provider previously and he was told they would be. A couple of. Months I mean it was a long period of time and I didn't understand it but I'll get with you afterwards yeah I could so we see if we can get that resolved and then my other question I just was thinking about this the drug product rebates just for clarification are those manufacturers rebates. I believe they are yes so is the entirety of the sixty to eighty million dollars in savings based upon those product rebates. And it's it's. Based both on the at pharmacy rebates and then a Senator Hickey said some of the medical costs were factored into that savings amount as well but to the extent the rebates are factored into the cost yes they would be coming from the manufacturers rebates okay then set this is my last question. so. Because there are we're talking about manufactures rebates and they're sort of outside of the contract I'm wondering if those went away for whatever reason and I'm asking because I'm aware of this circumstance where manufacture is is doing that. what would happen to this the contract with the state and what would happen in terms of the cost to to the state employees. So one of the things that we're making sure is is and the contract and that was a part of the R. F. P. processes that their guarantees in there of what rebates we can get so to the extent that those guarantees aren't being met we would certainly be examining that contract if if the if the guarantees are falling short and we were doing everything on our end that we assist you. Thank you. A representative back you're recognized for a question thank you Mr follow up on representative flowers question. Justin and rough figures What are the what percentage of that rebate money would you say is coming from these pharmaceutical product manufacturers rebates purses the medical side. I'm really not sure that that answer but I'm happy to to look and I don't wanna give you a figure in it the way off and just gas but if it's something that I'd be looking at When I go back and get that per member per month figure as well after the committee. That I do believe that the good information to share with the rest of the committee as as far as what persons is because there's a vulnerability there if that's a large percentage changes thinking on this thank you. All right say no further questions I appreciate your time and take any questions and we look forward to getting that information from you thank you thank you. All right any other business. Senator Eddie. All right with that we are adjourned.