ALC-State Insurance Programs Oversight Subcommittee
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- October 2, 2026
Members if you'll find your seats we're gonna go ahead and get started with that we're gonna call the statesur programmes 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
Speaker 8
3:53
you 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 the EBD contract with Boston Consulting Group
this is a contract for $280,000. this is utilizing the the new program that the office of procurement has done where there are5 vendors that can assist us in procurements and developments of RFPs Boston consultingroup was the one that we selected to assist us with the development of the third party administration RfP that we will be
Speaker 10
4:31
issuing early hopefully in the next couple of months with that I'd be glad to
answer any questions 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 contract have a second all right have a motion in a second all those in favor let it be known by a any opposed motion carries. Next item is item number 2. OK, item number two is the December
Speaker 10
5:09
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 to streamline that process to get those drugs. the next one I would like to highlight is item4. we
will the capsule is currently on formulary but is soon to be discontinued so we're replacing that with the tablet items569 and 10 and 11 are all updating due to FDA updates and 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 plant or the efficacy has not been proven 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
Speaker 10
6:42
by I. any opposed motion carries Next item up is the January2026 pharmacy formulary recommendations all of these we are leaving items one and two are new to market that we were leaving not covered until we get more clinical data the item 9 we are removing just because they're over the counter alternatives that are less costly to the plans available. be glad to answer any
right members looks like we have onepresentative Pilkington you are recognized thank you Mr
Representative Aaron Pilkington
Unverified
7:17
Chair. this isn't necessarily on the formulary but I am curious and I just wanted to before this meeting got over obviously there's been new pharmaceutical you know the Trump Rxxx plans have come about obviouslyviously there's a whole list of how che how those drugs are now do we have any sort of impacts for how that will affect our 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 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
Speaker 8
7:58
my knowledge to to know what how's that affecting us and thank you for that question we are there's a lot of unknown still with the rolling out of the TrumpRxx plan and those kind of things but we are in the process of working withavvitas and figuring out with like the markk Cuban
costs 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
Speaker 17
8:35
looking into that Anybody else other than the
weather forecast all right seeing none then I need a motion to approve the 2026 recommendations
have a second all those in favor let it be known by a any
Speaker 10
8:54
opposed motion carries all right moving to the ebruary 2026 pharmacy formulary recommendations item 12 and3 and this will be probably the biggest talking point Skyrisi and Renvo 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 number4, and item number5. this is an interesting one. we are adding
this one to formulate this is a anti seizure medicine this was developed by the department of defence 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 page678 and 9 will be not covered as we don't have any superior efficacy data around those
excuse me the next 11 through 16 we are retiering those just for 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 and because we already cover a lower cost alternative. be
glad to answer any questions members are there any questions I did have one sort of
unrelated to any specific drug but but in general because these are all recommendations by EBRs and and our pbm
Navitis with with all the news around our pbm law and the lawsuits and you know across the country and and and even our federal folks are are considering action and against pbM s have most recently I saw an article and and I believe it was West Virginia or somewhere where uhavvitis had they had passed a similar
bill and navidus was found and fined I believe7 or 800 $1000 regarding violation of that law are we doing anything or do we have any idea whether or not our our Pbm Navitis is violating our law. I know there's there's litigation but can you comment to that because it is a lot of there's a lot in the in the media about that oncece that article came out
Speaker 8
12:16
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 and and when you say additional research or we are you auditing claims or or ok all right and then in terms of of their input on on these and the changes to these these are obviously published
drugs but is there any is there any feedback or any any thoughts on these decisions may disproportionately benefiting them and in in any way that would affect these most of these don't affect anybody but but some of those like you mentioned Skyrisi and and renvoke those those are some some you know some higher numbers normally we don't have high numbers on impacted members but any any
thoughts on that process when you're when you're having the conversations with them about what do we do with this or
Speaker 8
13:32
or you know, cover or not cover so really the approach that I take 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 to rebates play into it but ultimately it it is really what is the lowest net cost to the plan is what is going to meet one of the top criteria of driving the formulary design. and and I I
certainly understand that and and we want to be conscious of our fiduciary responsibility when it comes to financial but we want to make
sure it's it's good long term financial, not just short term. we're not in the the the publicly traded stock market so we don't really particularly care you know what current earnings look like so to speak as much as we do the long term sustainability so thank you for for that looks like Senator Boyd you are recognized thank you Mr Chair.
Senator Justin Boyd
Unverified
14:48
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 they 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's 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
15:44
for months for an answer and haven't gotten it
thank you. OK. Thank you Senator Boyd and and that is that does bring up another question because overall it could be good for the the the EBd program but if it's disproportionately affecting our community pharmacies versus affiliated that that's you know the net is good but that's still
doesn't make it right and I'm not saying that that's happening here so any other questions from the committee all right if not then I would
need a motion to approve the ebruary 26 recommendations have a motion and have a second a motion in second all those in favor let it be known by I. any opposed motion carries item number3 Mister Wallace.
Speaker 10
16:29
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 12,3,4 and6 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 Skyrisi andrevoke 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 um5 this is a subcutaneous version ofuu Keytruda which is a much quicker injection time then 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 11 we are excluding because we still cover lower cost alternatives be glad to answer any questions
youllace. Any questions of the members if
not I need a motion to approve for otherwise have a motion to approve the recommendations have a motion we have a second have a motion in a second all those in favor let it be known by I. 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