ALC-State Insurance Programs Oversight Subcommittee
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Unknown speaker
0:00
Thank you.
Thank you.
Thank you.
Thank you.
Thank you.
members if you'll find your seats we're going to go ahead and get started. With that we're going to call the State
Insurance Programs Oversight Subcommittee to order. Chair sees a quorum our first item up for agenda is a consideration for review and approval of actions by the State Board of Finance which is exhibits B1 through B3 and I believe mr. grant Wallace the director of EBD is going to present all of those for us mr.
Wallace you know the routine but if you would for the audience online maybe introduce yourself for the record and then you
Speaker 8
3:48
may proceed good morning grant Wallace director of the employee benefits division and office of property risk. The first item before you is item B1. It is the review of an EBD contract with Boston Consulting Group. This is a contract for $280,000. This is utilizing the new program that the Office
of Procurement has done where there are five vendors that can assist us in procurements and developments of RFPs. Boston Consulting Group was the one that we selected to assist us with development of the third party administration rfp that we will be issuing
Speaker 10
4:26
uh early hopefully in the next couple of months with that i'd be glad to answer any questions thank you mr
wallace are there any questions from the members i do
not see any so with that i need a motion to review the
the contract i have a second all right have a motion in a second all those in favor let it be known by i
Speaker 10
5:00
any opposed motion carries next item is item number two okay item number two is the december 2025 pharmacy formulary recommendations the first three items we are just removing a pa for the injectable cgrps these are migraine medications and we have found
that after review almost 100% of these members are being approved so we're just going to make it easier streamline that process to get those drugs the next one I would like to highlight is item four we will the capsule is currently on formulary but is soon to be discontinued so we're replacing that with the tablet items 5 6 9 and 10
and 11 are all updating due to fda updates in guidelines and dosing recommendations the remaining items we are going to leave at not covered just because there is either already covered alternative that is less costly for the plan or the efficacy has not been proven uh up to standards yet to add it onto the formulary be glad to answer any questions for the december formulary recommendations
members are there any questions seeing none i would need a motion to approve the december 25 recommendations have a motion and a second all those in favor let it be known by aye any opposed motion carries next
Speaker 10
6:40
item up is the january 2026 pharmacy formulary recommendations all of these we are leaving items one and two are new to market that we are leaving not covered until we get more clinical
data the item nine we are removing just because there are over-the-counter alternatives that are less costly to the plans available be glad to answer any questions all right members
looks like we have one representative Pilkington you are recognized thank you
Representative Aaron Pilkington
Unverified
7:12
mr. chair this isn't necessarily on the formula but I am curious and I just wanted to before this meeting got over obviously there's been new pharmaceutical you know the Trump rx plans have come about obviously there's a whole
list of how cheap how those drugs are now do we have any sort of impact for how that will affect our um our list of drugs and then of course what the over total impact to our plan will be if we're pushing members to use that program or anything like that could you give us a little bit of a summary i know it's not on the agenda but since we're talking about these and what we're adding to our formula or not i just thought it might be good for my knowledge to to know what how's that
Speaker 8
7:53
affecting us right and thank you for that question we are there's a lot of unknowns still
with the rolling out of the trump rx plan and those kind of things but we are in the process of working with navitas and figuring out with like the mark cuban cost plus and all of these programs that are now coming out how do we take advantage of that how can we negotiate better pricing with the manufacturers as well a lot of that is still being studied i don't have all the answers at this point but the questions are being asked and we are looking into that
Speaker 17
8:30
anybody else other than the weather forecast
all right seeing none then i need a motion to approve the 2026 recommendations i have a second all those in favor let it be known by i
Speaker 10
8:49
any opposed motion carries all right moving to the february 2026 pharmacy formulary recommendations item one two and three and this will be probably the biggest talking point skyrizzy and renvoke we are going to remove those from our formulary
as we are preferring lower cost alternatives which do include biosimilars in the market and the pricing on this is just now we're getting pricing and availability to where it makes sense to remove those from our formulary at this point. Looking at the next two items, we are just re-tiering those as we look at the other alternatives that are available.
Generics are being added on for item number four and item number five. This is an interesting one. We are adding this one to the formulary. This is an anti-seizure medicine. This was developed by the Department of Defense to use in chemical warfare, and it has proven very effective. We're not at the point that we can really get it in commercial packaging. It is still pretty bulk packaging, but we are working in adding this in advance of that. The remaining items on that page, 6, 7, 8, and 9, will be not covered, as we don't have any superior efficacy data around those.
The next 11 through 16, we are re-tiering those just to promote the lower-cost generic for high-blood-pressure medications. And 17 and 18, you're looking at restructuring those because these are our lower net spend than the generics for our plan for the acne medicines. And outside of that, everything else would remain not covered
because we already cover a lower-cost alternative. I'd
be glad to answer any questions. Members, are there any questions? I did
have one, sort of unrelated to any specific drug, but in general, because these are all recommendations by EBRs and our PBM, Navitus, with all the news around our PBM law
and the lawsuits across the country and even our federal folks are considering action against PBMs. Most recently I saw an article, and I believe it was West Virginia or somewhere, where Navitus had, they'd passed a similar bill, and Navitus was found and fined, I believe, $700,000 or $800,000 regarding violation of that law.
Are we doing anything, or do we have any idea whether or not our PBM Navitus is violating our law? I know there's litigation, but can you comment to that? Because it is a lot of, there's a lot in the media about that. Once
Speaker 8
12:11
that article came out, I did have them go back and review, and Rule 118 is really kind of the similar to what that situation was. Have them review. They have come back saying that they are in compliance, but we are doing additional research into that to verify that.
All right. And when you say additional research, are we, are you auditing claims or, okay. Yes, sir. All right. And then in terms of their input on these and the changes to these, these are obviously published drugs. But is there any feedback or any thoughts on these decisions, maybe disproportionately benefiting them in any way that would affect these?
Most of these don't affect anybody, but some of those, like you mentioned, Sky Rizzi and Renvoke, those are some higher numbers. Normally, we don't have high numbers on impacted members, but any thoughts on that process when you're having the conversations with them about what do we
do with this or cover or not cover? Right. So really the approach that I take,
Speaker 8
13:27
and this may sound a bit cold, but I think it's the reality of the position that I'm in, is that I'm looking at it from a financial standpoint.
And as the fiduciary for the plan, what is the best financial decision along with the evidence, the scientific evidence that backs the utilization of that drug to make the best decision for the plan? So really, those two things are what are driving the decision. Obviously, we're looking at rebates and how do rebates play into it. But ultimately, it is really what is the lowest net cost to the plant is what is going to meet one of the top criteria or driving the formulary design.
Yeah, and I certainly understand that. And we want to be conscious of our fiduciary responsibility when it comes to financial. But we want to make sure it's good long-term financial, not just short-term. We're not in the publicly traded stock market, so we don't really particularly care what current earnings look like, so to speak, as much as we do the long-term sustainability. So thank you for that. It looks like Senator Boyd, you are recognized.
Senator Justin Boyd
Unverified
14:43
Thank you, Mr. Chair. Now that
you brought this up and brought it to my attention, I appreciate that. So I just remind Mr. Wallace that whenever we had committee hearings during the legislative session that the Novita CEO was there and she promised to get back to me on one of my questions, which was, are we paying our affiliate pharmacies more than we're paying our independent pharmacies within the plan? I haven't ever gotten an answer back. And it just turns out that that West Virginia issue, one of the things I found is that the affiliate pharmacies were being paid more than the independent pharmacies.
And so I just think that we need to continue this conversation. And, you know, the video testimony is there. And maybe you can go back and figure out exactly what I asked her. I just know that I've been waiting
Speaker 5
15:39
for months for an answer and haven't gotten
it. Thank you. Okay. Thank you, Senator Boyd, and that is, that does bring up another question, because overall, it could be good for the EBD program, but if it's disproportionately affecting our community pharmacies versus affiliated, that's, you know, the net is good, but that still doesn't make it right, and I'm not saying that that's happening here.
so um any other uh questions from the committee all right if not then i would
need a motion to approve the february 26 recommendations have a motion i have a second have a motion in a second all those in favor let it be known by aye any opposed motion carries item number three
Speaker 10
16:24
mr wallace all right this is the february 2026 medical drug recommendations again the disclaimer that i give with these these are drugs that are administered in a clinical setting you'll look at item one two
three four and six are biosimilars that are coming on to the market that we are just moving towards on the medical side we are also doing the same with sky risi and revoke on the medical side because it is one that can be administered in a medical setting as well as the pharmacy so we're making sure that those line up and then item five this is a subcutaneous version of coach Keytruda which is a much quicker injection time than the IV so we want to make sure that that's
added on for patient access and alternative delivery mechanisms and then you'll see the last item uh 11 we are excluding because we still cover lower cost alternatives be glad to answer any questions thank you mr wallace any questions
of the members if not
i need a motion to approve or otherwise have a motion to approve the recommendations
have a motion you have a second have a motion in a second all those in favor let it be known by aye any opposed motion carries seeing no other business we are adjourned
Agenda
A. Call to Order
B. Consideration for Review and Approval of Actions by the State Board of Finance [Exhibits B1-B3]
C. Other Business
D. Adjournment
Documents
Speakers
Senator Jim Petty Chair
Unverified
Speaker 8
Speaker 10
Representative Aaron Pilkington
Unverified
Speaker 17
Senator Justin Boyd
Unverified
Speaker 5