Insurance & Commerce- House

Ferguson Lowery you're recognized to present house bill nineteen oh seven. Thank you Mr chairman and committee at appreciate you also allowed me to move this bill up just as a point of personal privilege and I know some have been saying that I've been using my need to need scooter to get sympathy votes and so you're probably wondering where it's gonna lead to choose between an umbrella or the knee scooter today I'm brother one house bill nineteen oh seven. is a bill that will empower health care providers to make appropriate billing decisions are in the best interests of their patients Mr chair with your permission I would like to have at the table with me miss massing Gil with car time yes yes please come up and introduce yourself for the record please. Good morning Melissa massing Gil Kartheiser. Thank you question why you're recognized proceed with the presentation of the bill thank you thank you very much we're we're gonna go ahead and open with mist Masekela's testimony and then we'll and I hope the clock is started on me we want to make sure that it does but thank you Miss mask you for being here thank you representative. Thank you Mr chair. Again my name is Melissa Masonville and I am here representing car type cancer centers to support house bill nineteen oh seven. Card type provides cancer treatment services to patients throughout Arkansas and surrounding states. As you can imagine cancer treatment is very difficult on patients their families their care givers and we strive to do to make treatment as easy and compassionate as possible. When a patient comes in for treatment our team often draws lapse perform bloodwork. We also often prescribe and administer pre chemotherapy medications. These pre chemo medications are used to help stimulate red blood cell or white blood cell counts to treat nausea and for other purposes. Once those are administered we will then administer the chemotherapy itself. Recently some insurance carriers have begun excluding coverage for some of these pre chemo medications if they are provided. In medical clinics such as car type. The insurance carriers are still providing coverage for these medications they are just doing it to their outpatient pharmacy coverage. The carriers have stated that they are making these decisions because they have determined that the medications can be self administered by patients before they come in for the chemo treatment. We've even seen a couple of examples for some chemo meds themselves are excluded from being covered with in a clinic setting. The carriers are still paying for these important medications they are just doing it under a pharmacy benefit. While these might be okay for some patients this causes many patients to struggle to obtain these medications often from an out of state mail order pharmacy and struggle to teach themselves to calculate the right dosage and inject themselves which can be a very difficult or impossible task particularly if the patient does not have a care giver who can assist it also can cause delays and administration of chemotherapy which can be detrimental to care and patient with advanced disease these patients are often very frail and sometimes unable to expending energy to perform normal daily activities placing the burden on them to obtain these medications and to attempt to inject themselves with. Subcutaneous or intramuscular injections is simply not feasible for many patients house bill nineteen oh seven is a bill that simply says that the healthcare provider gets to make a decision in the best interest of the patient with the care is provided in which part of the patient's insurance they can submit a claim to either the medical insurance carrier or the pharmacy benefits manager this doesn't change anything about the patient's benefits other than getting the provider the professional discretion to determine the best location for the patient to receive treatment and then to submit the insurance claim to the portion of the patient's insurance that fits the care that the patient requires. I appreciate the opportunity to testify before you today and I respectfully ask that you that this committee passed house bill nineteen of seven thank you. The thank you listen. I know. A number of this have been yeah I mean most everyone has been touched by a family member or friend that is going to cancer treatments I know that some of our members have actually gone through that so you understand the very difficult process that a patient is going through and we we don't need to be adding this extra hurdle so just in summary the bill does three simple things it allows a healthcare provider to determine what is the most appropriate manner to provide care to patients and to determine how best to submit a claim for payment to the insurance carrier either to their medical and medical claims processor or the pharmacy claims processors Melissa said. It also prevents insurance carriers for mandating that a patient must self administer the prescription medications that healthcare provider determines need to be administered by a healthcare professional and third it prevents the insurance carrier from financially penalizing the patient with a higher cost sharing if the provider determines that the medication should be administered in the clinic instead of being self administered. This bill will help to ensure that patients are undergoing cancer treatment will have their health care providers to terminate their health care providers determining how best to provide their care. Thank you for the opportunity to present this bill and I will try my best to hold sway I have miss massing Gil here to answer your questions because I know a lot of this is highly technical and certainly would be over my head. Thank your bill I represent wooden you're recognized for a question. Well I will I will be sure I heard you correctly. You're you said that patients that are going through the trouble. Of cancer the emotional physical mental. The store is that the disease creates you're telling me that the insurance company or the insurers are making it as difficult as a okay and for their medication and they're telling on the self administered. Representative wouldn't yes in many cases there is an expectation for patients to secure their medications outside of their medical treatment facility outside of the supervision of their position and to secure either at a local pharmacy or through a mail order pharmacy management program follows you're recognized. So you're also saying that they're they're charging no more. As as a as a result of having to do this or if they don't want to self administer if it is in a clinical setting by a physician the two charge no more no Sir I don't believe the charges more the copays are the same but I think that the burden that it places on a patient sometimes in very rural settings across the state that may have to travel so be out of pocket for gas for the inconvenience of securing that medication and then storing it if their temperature requirements or quality control issues with that medication that they are not aware of. One more you're you're recognized for another follow. This is the date so. One of the patient is in in such a state that they can administer that they're asking another family member someone who's in medical person dealing with a serious illness that they are dealing with they're asking them to administer the shot. Yes Sir. Thank you Mr chairman thank you where the person you're recognized for a question. But yet I guess for Melissa I I'm just trying to figure out exactly why the insurance has this policy or they reimbursing the medication aspect of it differently for the pharmacist and for the doctor. That's a very good question represented Ferguson I could speculate if you'll let me I can't speak on behalf of the carriers but if I if I had to speculate it might be to Run that through the barn pharmacy benefit and for the carrier to receive the Drug rebates themselves. So it's not necessarily that there is not necessarily that they're paying more for the medication through the pharmacy said that from the medical side dishes there lose in the PBM rebates is that. Yes I believe so right yeah I course you know we would meet by may what we went through this what a couple of sessions ago because they were required people you had to give my the medication instead of being able given oral medication so it's kind of an ongoing battle with with insurance thank you yes ma'am represent Boyd you're recognized for a question. Thank you Mr so have you potentially observe that may be that the the companies that are requiring this the the pharmacy benefits managers or or health plans are referring people to their own pharmacies pharmacies that they own possibly. I believe that's a possibility representative. Representive for example if you're next to for questions. Yeah yes. Thank you Mr chair of the I don't know what this question is to the witnesses to chairman Lowery but I'm trying to wrap my hands around this. And my wife who passed away my first wife who passed away two thousand nine it very serious conditions what cancer. I had to administer certain medication after she had a very serious heart surgery. And so I'm assuming that this piece of legislation would allow her. Back and then to go into a clinic to actually get this medication or get a doctor or a registered nurse to do it rather than me having to do it. Am I accurate I think representative would ask the question and you might have answered my question in his question but I want to be clear. Let it also clarified there there are representatives of it insurance carriers that have been talking with us about their concerns about how broad this coverage is this. Skews me this bill is intended to judge to focus on chemo treatments or cancer treatments we will probably be looking at amendments that actually would would narrow that language down so that it's very clear the insurance carriers are concerned about getting too broad so I don't know how that would apply to the situation that you're describing represent a first or. Thank you thank you Mr. Webserver Allen you're recognized for a question. Thank you thank you Mr chairman and I don't know who to address this question to but you just mentioned that the scope of the bill is intended for cancer. Patients is that correct yes castle counsel patients only. That is that is my understanding is is that. The intent of the bill of the cover of the. Areas to. A representative Allen I believe in its original intent was to be more broad but very recently we've had discussions with insurance carriers and they've asked us to reduce the scope of this to include cancer patients only. So what's your your testimony today. German Lowery is that you're going to go back into me in the bill. To improve cancer only. That's my understanding of the conversations that are going on is that the they insurance carriers do have some concerns about how broad it is right now I don't know the scope of the narrowing that's going to take place but the legislative intent I will just tell you is covering a cancer treatment okay so when you Smith follows when you mention Legislative intent. All right I don't want to be specific but this are you saying that this joint tensions. The limit to. That that is the intent of the bill as drafted now if there's language in there that goes beyond that that's broadened we're we're needing to narrow it to the legislative intent which would be for cancer treatments. So. One one because I I need to make sure I'm clear about this. So you're saying that Legislative intent the legislative intent unit you off of the bill yes okay. So is that true intentions. Representive vision as you know we we have legislation that's brought to us all the time you know we may not be the original author of getting it drafted so when I say Legislative intent I'm I'm describing the intent of the bill as it was brought to me and brought to senator Hammer was that it was not intended to be overly broad it was to be a very targeted and that's what we're going to be working on with your permission if if the insurance carriers feel like there needs to be amendment language then we would do that to to target cancer treatments of course at any amendment that's adopted on say the Senate in would have to come back here for concurrence if you had a problem with this being way too narrow then you would be able to object to that Amendment. Of the one follow up I'm not comfortable. With your response. I'm just being honest okay and I went wait a minute we dissect eleven and I'm not trying to put in a box or anything like that but if the intent is for cancer patient and counsel patients only. I think I think it's not if you we can say we can address. Okay thank thank you represent on I don't know if that's a question we we can address that and in discussion at some point represent flowers you're if you're recognized for a question. Thank you Mr represent Lowery I so I'm listening to the back and forth and I hope that when we hear more testimony will get clarity I I'm kind of like I don't know if I wanted to be amended until we hear more because my concern is that it seems that. Through The policy decisions of insurance companies that there's some practice of medicine going on I would think that the decision as to whether or not and some sort of medicinal treatment to a patient be their cancer patient or not a cancer patient you know I would think that decision should be made by the doctor as to whether or not a patient is competent enough to inject or ingest whatever medicinal treatment is required I would like to hear more and and for that reason. I'm kind of comfortable with that not being definitive yet and I guess my question to you is has there been a firm commitment made and it sounded like and I'm asking that question because it sounds like you all are still working on what that language would look like. I'm in agreement with you And representative Alan that we need to give more power flexibility to the healthcare provider in each treatments but the intent is the bill was brought to me was to deal as representative foods and dress this very traumatic time in person's life and we do know that there other illnesses that are also very dramatic and and where there may be issues where the insurance carriers saying you know to save money or whatever to go through the pharmacy benefit we want you to self administer that that's probably just more than likely just as egregious but right now we're trying to to narrow the scope so that we can get the bill get it passed but hopefully in crafting the language we can be allowed given some latitude to be more broad that's that's what I'm going to be working for. Thank you and and I'll make that commitment to use that that I am going to try to hold the line that we not be to their in this because I agree with what you're saying. Represent Boyd you're recognized for a question thank you Mr chair chair Lowery representative Larry just. Check it will be adding to the conversation you know while I'm staying focused on this bill I'll make the point is there was a another bill we heard yesterday about insulin and we focused in on insulin because we don't know what's going to happen elsewhere so it might that concept of staying focused and narrow right now actually be a good idea so that we can make sure what the impacts are before we brought it everywhere I believe I believe that's true but I think also you may be the you have to have this was brought to me by car time you know and and they're they're not going to be brought get too broad in terms of their application they're they're dealing with cancer treatments I think you're making a good argument maybe for another bill but if we can accomplish being more flexible being a little brought more broad than just cancer treatments I'll fight for that and I'll make that commitment to you. The. there's no one signed up I'll I'll get to that right down to it there is any other any further questions committee saying none would do not have anyone else signed up to speak against the bill but is there anyone in the audience who would like to come to the table speak against the bill. Okay regularity you have anyone else to speak for the bill no no I don't and dispensing guilty of anything that you like to. No representative on I'm an additional testimony thank you thank you members I I appreciate your your indulgence with me I mean this is something that has brought been brought you just in the last day or so I think it's a very important health care issue that we need to address But my ex wife dealt with radiation treatments that card ties she didn't have to go through chemo thank goodness but I remember how difficult that was on her and that she she would come home and all she could really do is just sit on the couch and lean against me that's that's all she wanted to do she she couldn't even focus on reading a book watching television so it's a very traumatic time and we certainly do not need to make it even more traumatic it also problematic and in their delivery of the drugs that they need so I would appreciate your support and I appreciate your indulgence and allowing me to continue to craft this and as such I'll I will make a do pass motion okay representative Lowery has close for his bill and has made a do pass motion that is a proper motion do we have discussion on the motion. The north's of wooden you'd and you'd try to. Get my attention thank you Mr chairman. Let me say I will I will make it very clear biased. I've been a patient of court my what if the loss was a patient of car to. We have conversations about insulin relative to the insurance companies we've had discussion about temporary hospitals the way they were treated by insurance companies we've had discussions about the PM these or whatever you call a month are they hearing about. Of is it relates to coupons and and some of the things that are going on let me share with you and now a lot of along with us but I am a cancer survivor myself. But exactly what Mister representative Lowery said my wife with the. She went through it in a serious serious situation she knowingly have chemo she had radiation at the same time. And it and you you were fortunate represented well at all she wanna do is lay on your shoulder as that's wonderful too but what I had to go to is is nothing nothing. Compared to what my wife went through and to be jerked derailed. Is is just not right. With that when you're when you're facing a serious illness so of all the a yes vote on this bill. Thank you represent wouldn't represent Allen you're recognized for discussion. Thank you Mr chairman. For those of you who don't know in those that that probably do know I'm stage four. And every month I have to travel. Our state from a treatment. And I'm all email. And sometimes I have to do radiation after the session is over. So I can see you what is bill. Can be very very helpful. To counsel patients And I'm grateful. To be able to play. A small part. If we are legitimately trying to help. Counsel patients and anything that can. M. ease the burden because I know what it's like to go home. And wear a helmet. NBM house on Walker. because of the new property in your freight that you might fall it hit something with the heat break it. So I know with I know what that's all about. Representative brown you're recognized for discussion. Mister chair committee sorrow so late getting here there was a wreck on the bridge in a I missed most of this discussion the presentation of the bill but I can tell you that My brother in law I believe is going to part time in my sister has to take him every day and she's no spring chicken. And anything that we can do to help alleviate any burden that that a patient and their family is going through to receive the treatment they need I would gladly support thank you. Thank you remember on any further discussion committee. Seeing none we have a proper motion of do pass on the floor all in favor say aye. Ippo se NO. Graduations represent Lowery pastor bill thank you very much committee and I'm going to leave the chair with representive Matix I. State your indulgence I have to go to another committee. Thank you so very much. Representative arrives looks like your next on the agenda of the come present HB ten twelve. In the. I'm not a level one. Okay. Yes Sir thank you thank you Mr chairman thank you Committee as pleasure to be with you today the reason I'm here is is concerning Stealing and and things is going on and and the biggest thing that we are hearing now is actually the stealing of Catholic converters. Across this state In the last year this is all on I have heard me from different mayors. Different mayors across the state if if calming and they are saying that you know we don't know who is stated in the law and where it's going unless you know its it's actually sold to a of a reputable dealer. And this bill actually that we have today is to require people to go on ways on a lease online thanks for all your converters are are done at the present time and basically what's going on with that is they have the buyer and they have the seller and they have the numbers and they have the vehicles that these cars come off of. And I believe that it would probably cut down on a big part of the problem with this situation if we can have people actually registering the converters during sale and input online within a certain amount of I think it's what is it twenty four hours or forty eight something like that yeah and I've got a gentleman here that can explain a little bit too yeah about it go it yes Sir if you would please entered introduce yourself for the record in presenter testimony. I'm Josh amber president of the Arkansas recyclers association also work Adam Tenenbaum recycling group we do this already so every nonferrous or if it's a catalytic converter we take from France we get driver's license and they have to fill out a form where they. What the material or where they got it and we turn that in every evening to Leeds online and have been for the last I think. Eight or ten years when the with legislation I think ten years ago where That was a bill that you guys passed and we've been doing it ever since for the largest recycling the state of Arkansas so I think this is just making sure We can catch thieves are stealing these counted converters. Yes okay thank you. Represent flowers I believe you were first in the queue with questions. Okay this is so crazy. My. My mom's car I was driving it and had a blow out. And. I'm not even going to talk about how triple a is the devil but they wouldn't I couldn't get through so I had to have somebody come my dad come pick me up it was one night like on Thursday night about three weeks ago. And because I couldn't get the car towed it stayed overnight. And it was an ongoing saga bottom line is from Thursday to Saturday the cars on the side of the road before it finally got towed by my wonderful insurance company by the way. And turns out the car wouldn't start and Two two things happened they cut the battery blind or something. But they stole the catalytic converter. Right there on five thirty I don't I don't even know was a thing until then so I am so excited that you're bringing this bill and motion at the proper time. Thank you reg inclining you're recognized for a question. Thank you can you just speak to whether something like this is in effect in other states and what other states do it about this where we. I don't really know what other states are doing I mean some states have tag and hold which they buy material may hold it on the yard for like thirty days or sixty days are I'm not really familiar with what other states are doing. I thank let me add this miss flowers there was a church bus that it six buses that pulled in with with loads of children and they went into McDonald's and when I come out all six of those have been taken off some and it's a real problem and it's a drug problem what we think it's really a drug problem these things when you buy a car cost between fifteen hundred and twenty five hundred dollars on the price of gold. So they sell this for a hundred dollars or whatever they can get out of the estate just gonna fix or whatever but it's becoming a real real problem. I believe our representative Richardson you were next in the queue. Thank you Mr chair of. Currently it's my understanding that scrap yards recycling places you guys. Keep a pretty robust list of people will be going back to copper right had a lot of people still in cooperating you guys had to start tracking copper whose bring it who's doing it in a and from what I'm hearing you say you guys are doing that now with catalytic converters. Yes okay so if you're already doing that why we need the legislation or its vision caught representative J. not everyone is registered okay so this mandate everybody has to do that's right register they're doing everybody has to do the copper right now what is not copper amenity Jett I thank him or I think everybody I mean other people are buying commercial not Spotify but yet. This was okay but to my understanding but from the scrap perspective from those recycle centers that we have you guys most of those guys already tracking that information on the current system that they had. Okay that's what I was wondering thank you and and representative J. this is pretty well bootlegging deal you know so what we're trying to get everyone is this got any exchange with the US to have directional lines. Mmhm. Represent voting you're recognized for a question. Thank you Mr chairman of I know you all of tracking called pursuant to thank. Don't require the same thing upon jobs but they have to keep a record of the. I thank so only well I believe that's right and if it's so not serve honestly Mr will need for signage it's it's it's within the bill well because we think that they have. Just one of the so this bill will be reported to the sheriff they'll have to serve right at the record with the sheriff's office in each county has exactly right if the if there purchasing these thank you Mr representative Deborah Ferguson you're recognized. Thank you Mr chairman. And I'm for the bill I just my question is I mean they're bad actors in this space and we all know who they are there some that for around my area I mean they're probably still not going to do this right The people that are the bad scrap metal dealers nail it at the United. I mean we can require them to do it but if there are already bad actors are probably not going to do it anyway right and what what kind of content I guess what kind of control that we have scrap the words of the registered scrap dealers they're supposed to be doing it already and if they're not there's laws on the books that there's fines and. I don't know what the felonies are do you know. But I mean there's already laws on the books they should they shouldn't be in business if they're not doing this already. But I can answer that question I mean what should we do about we should shut him down. Representative what we finish reserve okay reserve Alan you're recognized thank you Mr chairman question. The the people that steal catalytic convertibles. they don't do it for the metal they do it because of the minerals. That that is made out of is that correct. I think they steal it because the money they can get from it from for the mental right yes there's a plate AM rhodium and platinum and right. Okay thank you. A regular flowers recognized for a question thank you I'm meant to point out that the just to replace with the used catalytic converter and in my mom's car is almost twenty years old it was two fifty to five hundred dollars and that doesn't include the cost of you know reinstalling another catalytic converter and asked for a twenty year old car my question is. what what happens now for a consumer so the all of this is being done to sort of make sure that it's not stolen if it is it's registered. You know I would this happen and for them from up I don't know what to do for my parents we just got a fix but is there a place that could be called is there some sort of ID on that part two bridges connected with that car like how to you re re cover if it's happened to you and we're doing this. I would not know that answer sorry. But I would think of may flowers It ways online is a place where we need to go in and their their telephone numbers there. Yes ma'am. Thank you reserve right any further questions from the committee. Seeing none there's no one else on the that I see but is anyone in the audience who would like to speak against this bill. Represent right you still have a little time on your twenty minutes do you would you have any anything else you like to present fines or and as pleasure to be with you today find committee thank you okay represent wouldn't you're recognized. Do pass motion. Okay we have a do pass motion members of wooden to the proper motions or any discussion on the motion. All. So I represent flowers at the service okay saying that discussion we have a motion do pass all in favor say aye. Any opposed no. Congratulates or if you have passed your bill. Estabrooks. Let us. Representative Brooks I believe you're next on the agenda. Yeah. Committee members I believe there is an amendments being passed out yes. Representative Brooks one of the while the members being passed out if you would like to go ahead and explain the amendment to the bill if you'd like to we'll do the Keith Brooks they resent District thirty one and I hope that this is relatively short presentation to be conscious of your twenty minutes maybe we can do two minutes or so that a girl Tucker or start to lose full except that the amendment is just agreed upon language with the insurance department we have a chance to sit down if they initially reviewed the bill sit down to get this a little better level of comfort with some things a repose is simply a technical corrections bill so this is just a meeting a couple portions of the legislation now we have this. Okay. Thank you I apologize for the way that we have a motion and a record breaking climb you're recognized. Most adopt the amendment any discussion on the adoption of the amendment saying none all in favor say aye opposed no your amendment has passed you cannot present the bill as amended as amended represent approx thank you committee appreciate that in the most recent session two thousand nineteen the legislature passed multiple multi employer welfare arrangements simply allowing small businesses organizations to come together to to have a more competitive place to offer their employees healthcare this we haven't had that many organizations that have chosen to do so thus far within the last two years currently there's only two in the State of Arkansas there's one that currently has an application so what we're doing is just a technical correction within this legislation going back to ease some of the burdens on starting these multi employer welfare arrangements I really only making a couple of changes in the rules that were promulgated by the insurance department one of those is related to the method of funding an agency that's part of the amendments made and made an adjustment to say instead the cash reserve you may also include a line of credit that you use as a source of a cash reserve how often times these organizations have not been in been around that long and maybe it's a small chamber of commerce it doesn't have significant caches or so hopefully just removing some of the barriers there second change was related to the trustees obviously a number of folks may be asked to be serving on boards of trustees but they may not desire for all of their information to be released so this still permits the trustee information name and address to be obtained by the insurance department however not disclosed to the public of the administrative plan still must have their information disclosed with this is simply just a little bit of additional privacy within that then in the final change within it is allowing the organization to have been in existence for one year as opposed to two previously in the siege of. In line with the the federal guidelines on that and without a because I take any questions thank you resented works. Any questions by the committee. The original version recognized for a question I am sorry but I have no idea what you're talking about what are. So multi employer welfare arrangements me was just like cafeteria plans me was for shore so let's say that you've got the Benton chamber of commerce in the Bryant chamber of commerce I know that they are both too small to offer health insurance and I don't know if they are I'm just use this example they're both too small in terms of of employees to offer a health plan for their their employees so they decide to band together as a conglomerates to have little bit better buying power to offer better rates premiums for their employees that's simply what what me was our. And and they already exist in the entry point is that is it in two thousand nineteen we pass legislation the insurance form promulgated rules this is just some adjustments of those to make a very little bit easier to get through okay thank you yes ma'am. Thank you represent works any further questions about the committee. I represent Ken Ferguson I apologize. You're recognized thank you Mr chairman representative Brooks would this bill also allow people to band together and form self issued plans I'll defer to the Department yours is here they probably know more about the specific language of the previous legislation passed this is simply technical correction to that but I'll be glad to do for them. Yes Sir please come up introduce yourself for the record and and you can answer the questions that have been threatened managing attorney at the Arkansas insurance department and yes it would apply to self funded plans. Thank you. President flowers your next recognized for a question. Okay okay thank you regular brown you're recognized. Okay we still have questions back to represent Ferguson for questions sorry bout that it how it I mean I'm trying to figure out how this compares associated health plans I mean are they the same thing or same thing it allows as a representative Brooks describe it allows multiple employers to band together to create a health insurance plan one conglomerate health insurance plan me was can be self funded meaning that assets are coming from the employers themselves or they can be fully insured we've got several that are fully insured we've only got to their self funded. But these plans the and are exempt from essential health benefits and those of things or they're not they are but they're under our rules required to cover all state mandates for large groups so we do we do we do we do regulate what they can cover what they don't what they don't have to cover but me was under our rules have to cover all of this state mandates that you pass that large group insurance plans have to cover so what did they not cover essential health benefit essential health benefits in the H. B.. Okay thank you. Thank you any further questions about the committee. Okay saying none we do have someone signed up to speak okay I'm getting the signal that he does not want to speak. Okay thank you okay we do not have anyone else then signed up to speak against the bill is there anyone else who would like to speak you have anyone else you like to speak for the bill you still have some time no Sir I'm fine okay. We are about good. Thank you for that clarification I believe we have would you like to close for your bill Clifford bills thank you I believe we have risen Brown you wanted to be recognized for the motion. Motion to pass a motion to pass by resident brown which is a proper motion to waive any discussion on the motion. Okay saying none all in favor say aye. Any opposed no regulations represent Burch you pastor bill thank you committee. For delivery next. Okay the lessor one seven. What we do. Representive Clowney we where you going to run that bill for represent of Elliott Senator Elliot and that will be fairly quick is that correct hopefully okay you're recognized you're recognized. Committee members there is an amendment that is being passed out. Representative plan would you like to go ahead as is being passed out would you like to go and discuss the amendment sure so committee this is this is a bill that I brought before I believe it was last week about commercial websites and criminal background checks posting an accurate information after it passed out of committee representative Lundstrum came to me with some concerns that some members had had and this amendment addresses those concerns of this amendment does three things first it that there is some federal law that limits what state legislatures can do over a subsection of commercial websites so this amendment exempts those commercial websites since we don't have the authority to legislate about them again that's just a small subsection of the commercial websites that the bill is aimed to address the second thing that it does is it lowers the fine for websites who are in violation and it was initially ten thousand dollars a day that the inaccurate information stayed at we lowered it to one thousand dollars a day and then the third thing the amendment as ads representative Lundstrum as a co sponsor so with that I would appreciate adoption of the amendment and I move that we adopt the amendment unless there any questions. Question on the motion to amend or no I wish to make a motion to okay we'll have to what we have and we have number so all in favor of the of the amendment being adopted say aye. It opposed no. The Amendment has passed you can now present your bill as amended. Thank you Mr chair so I won't take too much your time this is the same bill that I presented last week I just want to make clear in case there any outstanding questions that and this does not apply to brick and mortar companies who are operating in good faith all of the supplies to its kind of these big national commercial websites that fail to remove inaccurate information after they are alerted by the person about whom the inaccurate information is posted to take it down then they have a period of time in which to take it down after that time has passed and they still have the inaccurate information up then this bill gives gives the person a right to sue that company again this would just get everybody to the table get everybody in court at which point a decision would be made. Thank you after brown you're recognized thank you Mr chair just just for clarification if So for me. For instance if somebody is publish something about me that's inaccurate and I contact them and I let them know Hey that's not the year of my birth there that's that's not you know the church I go to or whatever idiots. did they just have to take my word for it or do ACT president but provide some sort of proof I mean can. That they need they need some protection too so do I have to prove that what they're saying is inaccurate yes so after you have asked them to take the inaccurate information down they haven't this bill just gives you the right to sue that would give you the right to take them to court so if you go to court and you're not able to prove that the information is an accurate you obviously have no cause of action against the person who published it then again it's only applies to commercial websites thank you. Thank you reserve any further questions by the committee. Seeing none do we have anyone item I don't live there is anyone who would like to speak against the bill. Saying nine represent Clowney do not close your bill close for the bill. Okay and yeah I make a motion do pass as amended to have a motion do pass as amended by represent Clowney which is a proper motion any discussion on the motion. Seeing none all in favor of the motion do pass as amended say aye. Any opposed no. Graduations your bills passed thank you Committee. I do not see represent Bentley represent gray would you like to kind of have presenter will. And I don't know if you were in the room earlier but we have a motion and we're limiting now the presentation to twenty minutes so that probably will be plenty time but just so you know okay thank you Mr chair and I do have an amendment that I need to adopt first. Okay members the amendment will be passed out and while it's being passed Everson great would you like to go and discuss the amendment. Yet the amendment spread bestest discussed in the bill but essentially this bill deals with three forty B. drug pricing and in the amendment for the most part what it does is we are excluding the Medicaid program the past program and self funded government programs from this statute. Okay so revenue growth has explained the Amendment do we have a motion on the amendment motion on the amendment by representative eleven all in favor say aye. Any opposed no revenue great you're recognized to present your bill as amended thank you Mr chair and if I could get I have a question and Spencer come up with me with committee health centers to help me explain it. Yes yes please come to the table and introduce yourself for the record if you would. I know I know she'll be able to go into a lot more detail than what I'll be able to go into so it we just can't tell you one of the issues that I'm starting to see from my side it's at three forty B. it's a national program that allows those that participate entities such as like critical access hospitals if you agencies to essentially dispense medication to patients at a reduced cost What we're starting to see is and I may use terms wrong here but we're starting to see PBMs are manufacturers we start to see people contract or use that could use the contract with pharmacies in a discriminatory way so for instance if five if I'm contracting with the same my local pharmacy in Batesville Arkansas there at three forty B. provider. In the contract process I'm going to say well I'm not gonna let them participate because I'm going to use a mail in three forty B. as a PBM and I can reimburse them at a lower rate so we're starting to see and I hope that makes sense we're starting to see some inequity in and how conduct these contracts are done so that said to me that's the crux of what I'm trying to do is make sure that all pharmacies in entities that participate in three forty B. are treated equally across the board and no special treatment is given to at PBMs pharmacy who might be owned by that PBM where there might be a conflict of interest that machine and. Good morning Mr chairman Shannon Spencer sorry about that. We live in and assume world right now and you always want to make sure you muted. Let's Shannon Spencer CEO for community health centers of Arkansas thank you for the pleasure of being here this morning three forty B. as a national program that's available and all states that allows eligible hospitals in certain clinics to access discounted prices for brand name drugs so often many of our critical access hospitals community health centers depend on the savings to be able to offer care charity care to some of their patients that actually arrive within an emergency room setting we have a hospital closure issue here and so a lot of the savings that is from that drug program goes back into patient care. And so we started seeing the discriminatory practices within the PBMs that's actually going to hurt patient outcome not only does this prohibit that but this really helps to save and gives more access to the patient's. This bill is super complicated. Is that you guys wanted to start asking questions you're welcome thank. The representative Pilkington you're recognized for a question and this is for the chance Spencer Tracy again great to see you as well full disclosure I work for an FQHC just of the committee knows And so I just I'm I'm curious obviously they're ones that do mail order pharmacies does this affect them in any way shape or form now this does not affect this is truly about patient access okay that makes me feel better. Thank you resent fielding you're recognized for a question. Thank you Mr chairman I don't know who this will go to move the sound of my to see my to find it but. I'm confused. All who this bill help with this consumers bill law what is how would I know whether my friend is a three four to be aw P. B. animal for the how what how would I know. When I go to my pharmacy. So do you want to tackle that sure it actually would you would know if your farm Mrs is actually at three forty to be a recognized entity based on your prescription that's written by your your your doctor when you go to actually receive the discounted price so it is a three part of building out content on no Sir it would not necessarily say three forty B. but clearly your physician clinician would understand your financial situation to ensure that you receive those cost savings. So usually usually the physician will direct you so if you know if it's a high cost medication they could direct you to a pharmacy that does participate in the three forty B. program which will help lower your cost to the medical Moses is the provider of nods NO one. Whether that's a three four to be I'm not to send you to get the best price for. The growth target as a lot of times in like with the FQHCs most of them are three forty B. and so they they they have like their own network I spit at you know pharmacies and they know who to send patients stayed for and representative building just for additional clarification within the south Arkansas we have numerous of pharmacies within your time geographical location that at three forty B. entities thank you government chairman. Represent brown you're recognized for a question. Thank you Mr chair Actually what is a if you H. C. and then I'll ask my question sure at two eight C. as a federally qualified health center is also known as community health centers we provide care on a sliding scale fee primary dental mental behavior health services and so often some of those FQHCs are actually located within a school based setting as well now to my real question if a person goes to at three forty B. pharmacy. If they did. It are the three forty B. prices offered to every customer or to certain qualified customers it is based on income it is certain customers thank certain patients yes ma'am okay so those two Emma. We're represented. Thanks so if I if I have good insurance in my and I'm not and not qualified then my insurance pays the price but if I do qualified then I get the discounted price thank you. Thank you represent flowers you're recognized. Karilyn turn yours off. Thank you. Thank you Mr. thank you all for bringing this and and just for clarity when you were talking about in either one of you or both can answer how this is working now and what this is resolving I just wanna be clear is this designation or this program being offered Where is the discrimination taking place like how or some pharmacies is it a picking and choosing some pharmacies are not allowed to offer these prices so that then people can't come to them or how's that working yes go ahead represented flowers these discounts are meant to actually stay in local communities for patients and actually for the entity and not necessarily go to that middle man but to really benefit that consumer guide for those patients and also this legislation prohibits pharmaceutical manufacturers from discriminating against or blocking hospitals or clinics from partnering with local pharmacies and so this is really to help this is about your committee this is to ensure that local pharmacies continue to maintain the business whether taking care of the patient awesome thank you. Thank you represent Boyd you're recognized for a question. Thank you Mister chair I just want to disclose before saying anything that I do own a pharmacy and that it used to participate in a three forty B. program but it does not anymore so with that said the the first question I'd like to ask is on page four the there's a sense in here all pharmacy claims process by a pharmacy that participate in three forty B. drug pricing for final the board of education and so I I guess the. Questions last point I want to make about that to to get clarity is sometimes in the the process of you know in in the contract between the pharmacy the PBM there are price increases that happen usually they happen right after the first of the year on brand name drugs and so the pharmacy as part of its contract might be reimbursed at a low it the previous eight MVP minus rate and then like later on in the week there's an update done by the PBM and the reverse and resend and be reimbursed so I guess I just wanna make sure that that's thought through completely that you know it when we say at the point of education with that allow for that practice to continue or we risking all of a sudden you know a lower reimbursement at that point in time I know that's a complex question but I just wanna make sure somebody thought about that so. And yes Sir to your to your question we have definitely thought about it we're working with the pharmacy Association we wanted to make sure and again not only protection of patients and community but local pharmacies as well. And just a follow up you're recognized at and I think you said this but I want to ask it my way so that I have clarity for me so what this bill is about is it's insuring local access to. Local provider choice whether that's the three forty B. clinic or the three forty B. choice to participate with the a pharmacy in that community and this is going to preserve that potential access yes Sir and I said the word contracting pharmacy just you know when you provided a more simplistic terms but it's local community local patient local pharmacy slash provider yes Sir thank you you're welcome represent wooden you're recognized for a question. Thank you Mr chairman question for you. These PBMs will. Of the of the world it would you explain them hello there affecting this. So I can sure I am and I may get this totally wrong because this is so complicated okay anti representative voice point real quick and I will come to you on page three it's line and eight says it is prohibition it does were to require pharmacy to reverse resubmit or clarify three forty B. drug pricing claim there might be some conflict and what that says and that on that page four column all pharmacy claims process our final with the point of adjudication so honestly I may need to clarify that and Senate Amendment but let us look at that so PBMs C. Fite moved that the chain is so complicated so pharmacy benefit managers Well let me let me let me save you some time okay thank you let me. For the exist this is the same thing this owned by a CV is correct yes Sir Walmart in the Walgreens would not Walmart Walgreens but it's more like CVS express scripts so there the middle man so Walmart and Walgreens they will Walgreens may have been but they get bought by one yeah I think they did it help sister business yes the lease is this the same organization that we won the this subprefecture routing about how they operate and try to control in the monopolize the yes Sir this is something group is the same group the same group that we've had three or four Bills about in the past two weeks three weeks yes Sir. Love said thank you Mr chairman thank you represent wooden. Any further questions by the committee. Okay saying none do we have anyone out there who would like to speak against the bill there's no one signed up I don't believe Okay saying no one represent great you still have time if you like to continue presenting no I will save you some time and just we're we're closed appreciate your time and appreciate a good vote got a reserve grade has closed for her bill and represent would not believe was referred to put up his hand to be recognized. Of the record make a motion for do pass we have a motion do pass as amended on H. B. eighteen eighty one to proper motion is our discussion on the motion. Okay saying none all in favor say aye. Ippo se NO graduations you've passed your bill thank you Mr chair committee. Okay we'll committee thank you so much for the efficient of work that we did today we've worked through with argent as far as I know we have no other House bills that will be taking up but we will still meet Monday morning unless there's nothing coming over from the Senate okay. What's that. You like that twenty minute rule okay we'll we will go ahead and we'll talk to Buddy Johnson about putting that in the rule book.