Insurance & Commerce- House
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Bills discussed (35)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
|
HB1055
· 5 mentions in chapter, agenda, transcript
Matched: “HB1055 J. Mayberry TO ESTABLISH COVERAGE DIAGNOSIS AND TREATMENT T…”
|
TO ESTABLISH COVERAGE DIAGNOSIS AND TREATMENT TO SLOW THE PROGRESSION OF ALZHEIMER'S DISEASE OR OTHER … | J. Mayberry | Died in Senate Committee at Sine Die adjournment. |
|
HB1150
Act 624
· 2 mentions in agenda, chapter
Matched: “…STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM. HB1150 J. Moore TO PROHIBIT A PHARMACY BENEFITS MANAGER FROM OBTAI…”
|
TO PROHIBIT A PHARMACY BENEFITS MANAGER FROM OBTAINING CERTAIN PHARMACY PERMITS. | J. Moore | Notification that HB1150 is now Act 624 |
|
HB1159
· 2 mentions in chapter, agenda
Matched: “HB1159 J. Richardson TO CREATE THE RETAIL CONVENIENCE STORE SECURI…”
|
TO CREATE THE RETAIL CONVENIENCE STORE SECURITY ACT; AND TO REGULATE SECURITY MEASURES AT RETAIL … | J. Richardson | Died in House Committee at Sine Die adjournment. |
|
HB1295
· 2 mentions in chapter, agenda
Matched: “HB1295 L. Johnson TO CREATE THE HEALTHCARE COST-SHARING COLLECTION…”
|
TO CREATE THE HEALTHCARE COST-SHARING COLLECTIONS TRANSPARENCY ACT. | L. Johnson | Died in House at Sine Die adjournment. |
|
HB1354
· 2 mentions in agenda, chapter
Matched: “…Y BENEFITS MANAGER FROM OBTAINING CERTAIN PHARMACY PERMITS. HB1354 Lundstrum TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND…”
|
TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND THE LAW CONCERNING THE STATE AND PUBLIC SCHOOL … | Lundstrum | Recommended for study in the Interim by the … |
|
HB1409
· 2 mentions in agenda, chapter
Matched: “…EPARTMENT FOR FIREFIGHTING SERVICES BASED ON TIME ON SCENE. HB1409 Long TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE E…”
|
TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE ELECTRIC RELIABILITY ACT. | Long | Died in House Committee at Sine Die adjournment. |
|
HB1813
· 2 mentions in agenda, chapter
Matched: “…P RECOVERABLE DEPRECIATION UNDER PROPERTY AND CASUALTY LAW. HB1813 Gramlich TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPA…”
|
TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPACT. | Gramlich | Recommended for study in the Interim by the … |
|
HB1853
Act 835
· 2 mentions in chapter, agenda
Matched: “HB1853 J. Moore TO AMEND THE LAW CONCERNING AGENCY RELATIONSHIP AN…”
|
TO AMEND THE LAW CONCERNING AGENCY RELATIONSHIP AND DUTIES RELATED TO REAL ESTATE LICENSES; AND … | J. Moore | Notification that HB1853 is now Act 835 |
|
HB1863
Act 836
· 2 mentions in agenda, chapter
Matched: “…HE USES OF THE CONSTRUCTION ASSISTANCE REVOLVING LOAN FUND. HB1863 L. Johnson TO AMEND THE TRANSPORTATION BENEFIT MANAGER ACT;…”
|
TO AMEND THE TRANSPORTATION BENEFIT MANAGER ACT; AND TO DECLARE AN EMERGENCY. | L. Johnson | Notification that HB1863 is now Act 836 |
|
HB1868
· 2 mentions in chapter, agenda
Matched: “HB1868 L. Johnson TO REQUIRE AN INSURER TO PAY A FAIR AND REASONAB…”
|
TO REQUIRE AN INSURER TO PAY A FAIR AND REASONABLE SERVICE FEE DIRECTLY TO A … | L. Johnson | Died in House Committee at Sine Die adjournment. |
|
HB1905
· 2 mentions in agenda, chapter
Matched: “…Y- BASED SERVICES WITHIN RISK-BASED PROVIDER ORGANIZATIONS. HB1905 Lundstrum TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A…”
|
TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A REAL ESTATE LICENSEE REPRESENTING A … | Lundstrum | Died in House Committee at Sine Die adjournment. |
|
HB1917
Act 839
· 2 mentions in agenda, chapter
Matched: “…TO REGULATE SECURITY MEASURES AT RETAIL CONVENIENCE STORES. HB1917 M. Shepherd TO AMEND THE ARKANSAS STUDENT-ATHLETE PUBLICITY…”
|
TO AMEND THE ARKANSAS STUDENT-ATHLETE PUBLICITY RIGHTS ACT; AND TO AMEND THE LAW RELATED TO … | M. Shepherd | Notification that HB1917 is now Act 839 |
|
HB1918
Act 810
· 2 mentions in agenda, chapter
Matched: “…; AND TO AMEND THE LAW RELATED TO ATHLETIC PROGRAM FUNDING. HB1918 McAlindon TO AMEND THE LAW CONCERNING SPECIE OR LEGAL TENDE…”
|
TO AMEND THE LAW CONCERNING SPECIE OR LEGAL TENDER; TO AUTHORIZE THE USE OF A … | McAlindon | Notification that HB1918 is now Act 810 |
|
HB1930
· 2 mentions in agenda, chapter
Matched: “…RRENT ASSESSED VALUE OF A RESIDENTIAL REAL ESTATE PROPERTY. HB1930 Wardlaw TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHC…”
|
TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHCARE SERVICES. | Wardlaw | Died on House Calendar at Sine Die adjournment. |
|
HB1942
Act 1023
· 2 mentions in agenda, chapter
Matched: “…RY PRACTICES; AND TO PROVIDE FOR ENFORCEMENT OF VIOLATIONS. HB1942 L. Johnson TO REQUIRE CERTAIN REIMBURSEMENT RATES FOR HOME-…”
|
TO REQUIRE CERTAIN REIMBURSEMENT RATES FOR HOME- AND COMMUNITY-BASED SERVICES WITHIN RISK-BASED PROVIDER ORGANIZATIONS. | L. Johnson | Notification that HB1942 is now Act 1023 |
|
SB123
Act 553
· 2 mentions in agenda, chapter
Matched: “…ND TO ALLOW FOR A PRECIOUS METALS-BACKED ELECTRONIC SYSTEM. SB123 G. Leding TO AMEND THE LAW CONCERNING COVERAGE FOR MAMMOGRA…”
|
TO AMEND THE LAW CONCERNING COVERAGE FOR MAMMOGRAMS AND BREAST ULTRASOUNDS. | G. Leding | Notification that SB123 is now Act 553 |
|
SB237
Act 554
· 2 mentions in chapter, agenda
Matched: “SB237 J. Boyd TO AMEND THE LAW CONCERNING THE LICENSING AND REGUL…”
|
TO AMEND THE LAW CONCERNING THE LICENSING AND REGULATION OF CAPTIVE INSURERS. | J. Boyd | Notification that SB237 is now Act 554 |
|
SB331
· 2 mentions in chapter, agenda
Matched: “SB331 G. Leding CONCERNING COVERAGE FOR GENETIC TESTING FOR INHER…”
|
CONCERNING COVERAGE FOR GENETIC TESTING FOR INHERITED CANCER MUTATIONS; AND TO CREATE THE GENETIC TESTING … | G. Leding | Died in House Committee at Sine Die adjournment. |
|
SB420
Act 736
· 2 mentions in chapter, agenda
Matched: “SB420 Hester TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PR…”
|
TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PROGRAMS; TO AMEND THE WATER AUTHORITY ACT; AND … | Hester | Notification that SB420 is now Act 736 |
|
SB448
Act 579
· 2 mentions in chapter, agenda
Matched: “SB448 J. Petty TO AUTHORIZE THE FINANCING OF ENERGY EFFICIENCY IM…”
|
TO AUTHORIZE THE FINANCING OF ENERGY EFFICIENCY IMPROVEMENTS, ALTERNATIVE ENERGY IMPROVEMENTS, BUILDING RESILIENCY IMPROVEMENTS, AND … | J. Petty | Notification that SB448 is now Act 579 |
|
SB463
Act 580
· 2 mentions in agenda, chapter
Matched: “…CONCERNING COVERAGE FOR MAMMOGRAMS AND BREAST ULTRASOUNDS. SB463 M. McKee TO REQUIRE THE ARKANSAS PUBLIC SERVICE COMMISSION…”
|
TO REQUIRE THE ARKANSAS PUBLIC SERVICE COMMISSION TO APPROVE OR DENY SETTLEMENT AGREEMENTS CONCERNING CLOSING … | M. McKee | Notification that SB463 is now Act 580 |
|
SB480
Act 739
· 2 mentions in agenda, chapter
Matched: “…IMINATING ELECTRIC GENERATION UNITS OR TRANSMISSION ASSETS. SB480 K. Hammer TO AMEND THE LAW CONCERNING THE INVESTMENT OF STA…”
|
TO AMEND THE LAW CONCERNING THE INVESTMENT OF STATE FUNDS. | K. Hammer | Notification that SB480 is now Act 739 |
|
SB483
Act 957
· 2 mentions in chapter, agenda
Matched: “SB483 Irvin TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STAT…”
|
TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT AND THE STATE SECURITIES DEPARTMENT; … | Irvin | Notification that SB483 is now Act 957 |
|
HB1009
· 1 mention in agenda
Matched: “…AND ENTITLEMENT HOLDERS UNDER THE UNIFORM COMMERCIAL CODE. HB1009 A. Collins TO ALLOW PREGNANCY TO BE A QUALIFYING EVENT FOR…”
|
TO ALLOW PREGNANCY TO BE A QUALIFYING EVENT FOR ENROLLMENT IN CERTAIN HEALTH BENEFIT PLANS. | A. Collins | Died in House Committee at Sine Die adjournment. |
|
HB1014
· 1 mention in agenda
Matched: “…FYING EVENT FOR ENROLLMENT IN CERTAIN HEALTH BENEFIT PLANS. HB1014 A. Collins TO REQUIRE COVERAGE OF IN VITRO FERTILIZATION UN…”
|
TO REQUIRE COVERAGE OF IN VITRO FERTILIZATION UNDER THE STATE AND PUBLIC SCHOOL LIFE AND … | A. Collins | Died in House Committee at Sine Die adjournment. |
|
HB1177
· 1 mention in chapter
Matched: “HB1177 M. Brown TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND…”
|
TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND TO CLARIFY THE APPLICABILITY OF THE ARKANSAS … | M. Brown | Died in House Committee at Sine Die adjournment. |
|
HB1308
· 1 mention in chapter
Matched: “HB1308 Steimel CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL…”
|
CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL REAL ESTATE REPAIR CONTRACTS; AND TO REGULATE SOLICITING RESIDENTIAL … | Steimel | Recommended for study in the Interim by the … |
|
HB1443
· 1 mention in chapter
Matched: “HB1443 Pilkington TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY…”
|
TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY ACT; TO PROHIBIT FINANCIAL INSTITUTIONS AND PAYMENT NETWORKS … | Pilkington | Died in House Committee at Sine Die adjournment. |
|
HB1533
· 1 mention in agenda
Matched: “…RTMENT. Page 2 of 3 DEFERRED BILLS Number Sponsor Subtitle HB1533 Gramlich TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROF…”
|
TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROFIT ASSOCIATION ACT. | Gramlich | Recommended for study in the Interim by the … |
|
HB1625
Act 974
· 1 mention in agenda
Matched: “…NG A FLEXIBLE SPENDING ACCOUNT OR A HEALTH SAVINGS ACCOUNT. HB1625 Barnett TO AMEND THE LAW CONCERNING INSURANCE REQUIREMENTS…”
|
TO AMEND THE LAW CONCERNING INSURANCE REQUIREMENTS FOR LICENSED HOME INSPECTORS. | Barnett | Notification that HB1625 is now Act 974 |
|
HB1659
· 1 mention in agenda
Matched: “…NT OF FINANCIAL SERVICES WITHIN THE DEPARTMENT OF COMMERCE. HB1659 S. Meeks TO AMEND THE UNIFORM COMMERCIAL CODE; AND TO CLARI…”
|
TO AMEND THE UNIFORM COMMERCIAL CODE; AND TO CLARIFY THE PRIORITY AMONG SECURITY INTERESTS AND … | S. Meeks | Died in House Committee at Sine Die adjournment. |
|
HB1811
· 1 mention in chapter
Matched: “HB1811 Steimel TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE…”
|
TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE REASONABLE PROOF OF PAYMENT OF A … | Steimel | Recommended for study in the Interim by the … |
|
HB1850
Act 867
· 1 mention in chapter
Matched: “HB1850 L. Johnson TO AMEND THE LAW CONCERNING GROUND AMBULANCE SER…”
|
TO AMEND THE LAW CONCERNING GROUND AMBULANCE SERVICES; TO CLARIFY THE MINIMUM ALLOWABLE REIMBURSEMENT FOR … | L. Johnson | Notification that HB1850 is now Act 867 |
|
SB229
· 1 mention in agenda
Matched: “…ERNING INSURANCE REQUIREMENTS FOR LICENSED HOME INSPECTORS. SB229 J. Boyd TO CREATE THE DEPARTMENT OF FINANCIAL SERVICES WITH…”
|
TO CREATE THE DEPARTMENT OF FINANCIAL SERVICES WITHIN THE DEPARTMENT OF COMMERCE. | J. Boyd | Sine Die adjournment |
|
SB405
Act 555
· 1 mention in chapter
Matched: “SB405 J. Dismang TO AMEND THE ONLINE MARKETPLACE CONSUMER INFORM…”
|
TO AMEND THE ONLINE MARKETPLACE CONSUMER INFORM ACT. | J. Dismang | Notification that SB405 is now Act 555 |
Machine transcript
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Speaker 2
0:07
55. How many? Representative Mayberry, if you would just introduce yourself
Speaker 1
0:17
for the record, have your witnesses introduce themselves and who they're with.
And you can proceed with your testimony. OK State representative Julie Mayberry. David Cook, the director
Representative Julie Mayberry
Unverified
0:29
of government affairs for the Alzheimer's Association.
Representative Lee Johnson
Unverified
0:38
Dr. Morgan Sauer with Baptist Health and the Alzheimer's
Representative Julie Mayberry
Unverified
0:47
Association. You may proceed. OK, thank you, members, you may know that we have an Alzheimer's disease and dementia advisory committee that meets here at the Capitol quarterly at least, and, um, each session we have recommendations. This is actually one of those recommendations. We had a presentation, um, back in July
of 23 that um told us that there's a new drug that's available approved by the FDA to Not um Get rid of Alzheimer's. Unfortunately we're not at that stage. But slow down the progress of the disease. This is a first, and this is a major, major step. We had a presentation shortly
after that in the fall of 23 by insurance companies in the state of Arkansas and by some doctors who sit on that committee from UAMS Doctor Wei and Doctor Azar, and you are getting this, um, Handout by Dr. Azar from UAMS. We wanted to find out what insurance companies are covering this medication. And we learned that Centene is covering it. We learned that UnitedHealthcare is covering it. We learned that Medicare and
Medicaid both cover this medicine. We also learned that the US veterans Health Administration covers this medication. However, if you are a state employee or public school employee and you get your insurance through EBD. It's not covered. I've got a problem with that. I think it should be covered and that's what this bill will allow to take place. Um, as you can see in the
presentation that Dr. Azar gave this committee. This is not a medication that you just walk in. Very few who actually will qualify. The main thing is you have to be a diagnosed early, the earlier the diagnosis, the better, and you will hear from some folks here in a little bit who can give you um exact description of what takes place and how this benefits. I have lots of questions. I'm going to quit talking
and let some of my others who are here explain why this is needed, and then we'll be
David Cook
Unverified
3:18
happy to take some questions from you.
Mayor, thank you for the opportunity to speak
on 1055 House Bill 1055. Uh, this legislation is about access to care for our state employees and those public servants who served the state um and given their life on behalf of service to the state. The Alzheimer's Association contends that um This decision to whether uh take the treatment should happen in clinicians' offices, by physicians, and not be prily denied by bureaucrats. This ensures that state
employees have the same level of access, um, that our Kansans who participate in state Medicaid program and those veterans, um, who can't access these treatments. Um, it's not about spending more, it's about spending smarter. Um, what we do know is that delayed care leads to more expensive, uh, late stage interventions like long term care and emergency care. Prior to 2023, physicians had very limited tools in their toolbox, um, to treat um behaviors associated with Alzheimer's disease or dementia,
but 2023 was a landmark year, as the FDA did give approval to its first drug, um, that treats not behaviors associated with the disease, but actually the underlying biology of Alzheimer's disease. It's important to know that Alzheimer's disease happens on a continuum with um some of the proteins being present in the body up to 20 years before a patient can become symptomatic, um, and so this, these treatments, um, while they are not a cure, what they do promise is to give patients more time.
More time to participate in life, uh, more time to watch grandchildren grow up and graduate, uh, more time to be with family and more time to plan for the future. In its early if it's caught early and Dr. Sauer is going to speak specifically to the unique patient that qualifies for this type of treatments, but it's, it's important to understand these are different than what doctors have had in the past, um, prior to that, they only had drugs and treatments that specifically targeted the behaviors that are associated
with the disease, we call those behavior modification drugs. Um, and so we um Again, at the end of the day, this bill is just about access, creating access for our state employees to make sure
Speaker 21
5:43
that these decisions happen in doctors' offices, um, where we think they're most appropriate. Return Members
Speaker 22
5:49
of the committee, thank you for letting me speak today. I'm not into politics and politicians, so I just have a
quick question to ask how many in this room know somebody who has Alzheimer's disease or has lost someone from Alzheimer's disease. Unfortunately, Alzheimer's disease is a terrible illness, and since my training, we have not had medications that were highly effective. We didn't have any medications that worked against the causes of the disease. We tried to cover up a few symptoms, and these medications weren't very
effective. Finally, we actually have two medications that are now available that work on the exact One of the exact pathways. Alzheimer's has several pathways in it, and these medications actually attack the problem that is causing the nerves in the brain to be destroyed. These medications work on the webs that strangle the nerves and the toxins that enter into the nerve cells and cause the nerves to essentially fall apart
and die. This is how Alzheimer's is a progressive neurologic disorder. These medications have undergone rigorous testing, obviously Medicaid, Centene, Aetna, multiple agencies have had expert panels, including the VA recommending utilization of these medications. These medications are very effective. These medications are not for behavioral modification. That is a very big misconception. Everything we had before was this is completely different.
This does not arrest the disease and its development. It slows it down. This, these medications, both of them are only used in people who have very early Alzheimer's disease or have what we call mild cognitive impairment, which is kind of like pre- Alzheimer's disease. It's a syndrome that you can get and most people who get that syndrome will progress into Alzheimer's disease. These medications start early attacking the process that leads
to neural degeneration. Sorry to leading to neurodegeneration to slow the process down, buying time where people are functional, where they can go out, where they can be with their families and sadly where they can start planning for the future because unfortunately we do not have a cure for Alzheimer's yet, but we do have treatments that significantly improve quality of life. We know these medications work. UAMSs are fine academic
institution with incredible reputation and integrity. The the UMS has been administering, not only ordering this medication for their patients at the Don Reynolds Institute on Aging, but also administering these medications, showing that they know that this works. Um, the medications are not easy to take. Not everybody can do it because they're IV infusions and unfortunately there are very few places in Arkansas where people can get this. People do have to travel. Also, in order to get these medications, there's a
rigorous process that you have to go through to be sure these medications are being used appropriately. You have to make sure that there are no other types of dementia that are present like frontotemporal dementia, Lewy body dementia, vascular dementia. You also have to have a specialized imaging. Most people have to leave the state to go get that because we don't have a scanner scanners that can do that except in Northwest Arkansas, they're starting this. The other option is to get a
spinal tap and take spinal fluid and test fluid in the spine for markers of these proteins. We hope soon that we will have blood markers that can test this, which will be much easier for the citizens of our state. Just getting to get this medication is actually a very rigorous process that involves a lot of activity. Also, when people use these medications. We do have to monitor. There are some side effects of these medications, and so we have to monitor for these side effects and we also have to look to see
if it works. I would certainly recommend if you have interest in it, you can look at Aetna's criteria. You can look at the CMS website, which is really chewy, and if you would like something that's much easier to digest, the Aetna website clearly has the protocols that we use after people use these drugs to make sure that they're not getting side effects and we monitor for for a effectiveness, and that is a big thing, unlike most other medications we monitor for effectiveness to be sure that
these medications are providing benefit and if the patients are in a class that are not getting benefit from the drug, then you do discontinue it. Again, these medications are used only for mild cognitive impairment and for mild. Alzheimer's disease. It is not used in moderate and severe dementia. I know multiple people have said, well, once you start this, does this mean they're on this drug for the next 11 years. No, absolutely not. You have to monitor to make sure that people
have not progressed into a state where this drug, these drugs are not effective. I will tell you that my mother died of Alzheimer's disease. I grew up in a house where my grandfather died of the illness. My mother died of the illness. My aunt died of the illness. My uncles have died of the illness. This is not A behavioral modification medicine. This is a real medication that has real world data that shows that it is effective and can help patients.
I strongly encourage you to allow the
Speaker 21
11:41
people who serve our state. The same access this medication as patients on Medicare, Medicaid through the VA, Aetna, Centen. Um, I'm certainly happy to take
any questions that you might have. Thank you for your testimony. We do have some questions Day,
Representative Carol Dalby
Unverified
12:01
you are first to be recognized for a question. Thank you, Mr. Chair. Rush in my Barry, I apologize. I was late
getting in here because I was over in the Senate, um, and so I missed the first part of your presentation, was there any mention and, and I've read the projected cost and this is $90,000. Um, a patient, evidently for this treatment, um, what is your proposal and how is the state going to pay for this
and and I apologize, you may have covered that and I just didn't hear it, but yeah, I mean, and I think, you know, I'm sympathetic, but
at the same time I, I think we have to also
weigh, you know, what's going to be the cost to the state and I, and I have a really a two-part question, so that's the first part and the second part, uh, I'm sorry, I didn't catch everybody's name. But um. It sounds like that this is a covered drug. With other insurance companies. Um And I would be curious as to if there was a rise in premiums for having to cover such an expensive treatment.
And, and we all understand, you know what
Representative Julie Mayberry
Unverified
13:17
it might be because it's somewhat experimental, but could you kind of address those and once again I apologize I missed that part. I did not talk about cost, but obviously, that's a question to talk about. Let me back up and, and I will repeat that this is covered by um this came out of the Alzheimer's disease and dementia advisory Committee that meets here almost quarterly. Um, I co-chair Clint Penzo as my Senate chair on it. We've had, um, many discussions in those committees on this. this particular medicine and,
and, and all that. We did ask all the insurance companies in the state of Arkansas sent team covers it, UnitedHealthcare covers it. Um, the US Veterans Health Administration covers it. Medicare and Medicaid cover it. So our state is already covering it through Medicaid, um. I believe that our state employees and our public school employees should have the same benefits that our Medicaid patients currently have. Um,
this medication is expensive, but I would
say that it's not $90,000 a patient. Um, I'm gonna let David Cook from the Alzheimer's Association
David Cook
Unverified
14:25
kind of share more of what those dollars are, that's OK. Representative
Dalby, um, you know, seagull put out two fiscal impacts on this bill. The, the first, uh, showed that it was a negligible impact to the state budget. Um, EBD disagreed with those findings, um, and then produced theirs, um, based on what we're seeing in terms of claims data and the criteria
that Dr. Sauer just mentioned, um, the scope of patients who would qualify, who are currently covered by um EBD is, is very small. Uh, the Alzheimer's Association, um, um, back up a little bit. According to the Mayo Clinic, only 110 out of 100,000 people ages 30 to 64 have younger onset Alzheimer's or early diagnosis of Alzheimer's. Um, and so the Alzheimer's Association in our initial analysis,
contacted the Arkansas administrative statewide Information System in the public school network, and what we discovered based on um the participants in the the state plans, um. Of those aged 55 to 64, an estimated 26,310 Arkansans, um, if we apply the Mayo Clinic's risk rate of 0.11%, we conservatively expected around 29 individuals to develop early cognitive decline in this pool, whereas EBD suggests there'll be
100 I know there's currently 120 on behavior modification drugs, um, we're not seeing the rate of utilization that they forecast. Um, so the association looked at real claims data. and specifically we looked at um Indiana. Um, it's, it's apples to oranges, but it's kind of give you a perspective, uh, and we look specifically at their Medicaid claims data. And just to give you perspective, um, you know, India has 357,600 enrollees between the ages of 45 and 64 on
their state Medicaid, uh, population. In 2023, only 8 of those people qualified for treatment, um, which is 0.002% of that population. So the association contends that because the, the, the, the patient who qualifies for this treatment is so specific and based on what we're seeing in terms of age group and the claims that we see across the country, um, at the most, and it's a high
estimate on our part. 29 people of the 26,000 would actually qualify for
Representative Carol Dalby
Unverified
16:49
something if you catch it at the right. stage Uh, Oh, once someone starts
Speaker 21
17:00
this treatment, are they on it for the rest of their life? No, ma'am. They certainly excuse
Speaker 22
17:05
me, no, ma'am, they certainly are not. This medication is only to be used in mild cognitive impairment and mild Alzheimer's disease, as the disease progresses, which unfortunately at this time we don't have an arresting medication that stops
it dead in its tracks. The the time will move forward and when people move into moderate or severe Alzheimer's disease, which is tested by doing what
Speaker 39
17:34
we call neurocognitive testing when those scores reach a certain point, then this
Speaker 22
17:38
medication is discontinued. Where was it started? Additionally, I wanted to bring a point that Mr. Cook brought up, um, while there were 120 people. 120 people that were found to be
on behavioral modifying medications. Um, there is some concern with that number because the best we can tell that wasn't also cross compared to the people who had the diagnosis of mild cognitive impairment or mild Alzheimer's disease, which would be through an ICD-10 code, not just a payment code, a payment code for the behavioral modifying drugs. So the behavioral modifying drugs are also used in multiple other disorder. s such as multi-infarct dementia, vascular dementia,
Lewy body and Lewy body dementia. And so just because 120 people get a behavioral modifying drug, an exceptionally small number of those people would be anticipated to actually qualify for this drug. Thank
Representative Kenneth B. Ferguson
Unverified
18:39
you, Representative Ferguson, recognize for a question? Well, I do have one. I think that
Speaker 42
18:45
was representative, uh, Allen, who was raising his hand, but.
Representative Jon S. Eubanks
Unverified
18:54
But since you called me, I'm gonna ask my
Representative Kenneth B. Ferguson
Unverified
18:57
question, your name was on the list. I want to be clear, so, OK, um, go ahead. Let me, let me ask this question
this way, allow me just a little latitude, um. Uh, I've got a friend who's a veteran. Yeah, I've got a friend who's a retired business person. Now the friend who's a veteran has what he says is mild dementia and he's taking a drug that he's
a VA he's going to the VA and it's helping him. I'm not sure if that's the drug or not. But it is helping him. But my other friend who's a business person. I was at his wife's funeral last year. He was there. He was looking for his wife. He was at the funeral. Same age as me. Hurt me to my heart. So I guess what I'm asking is this now. And I noticed on the On the uh
Uh, physical impact statement. Siegel. Doesn't say very much, but I think EBD does, and it says somewhere between 2 to 4 million. I think so, uh, I think you're looking at it too, so is it 2 to
Representative Julie Mayberry
Unverified
20:12
4 million estimated costs, not savings. Correct. Correct. We, we would argue with that cost as, as David has pointed out that
we don't think it would, would be that amount, but, but yes,
Representative Kenneth B. Ferguson
Unverified
20:23
that is correct. That is the cost. does not consider the savings.
OK, OK, OK. And, and then going back to my friend who, who's who's a veteran, um. So, let's get back, I know you said that the VA covers this medicine. And but only uh
Speaker 21
20:49
uh what, what's the qualification just briefly, to be eligible for it. So the qualifications are that
Speaker 22
20:55
you have to, you have to have what's
either diagnosed by neuropsychiatric testing as mild cognitive impairment or pre- Alzheimer's pre-dementia, Alzheimer's or you have to have mild Alzheimer's disease. It cannot be in the moderate stages or the severe stages, so people who are bed bound, they don't qualify. People who don't know what month it is, they would not qualify. It it's to people who are very early and mild in the disease. They also cannot have had any type of blood thinner.
Added within the past 4 weeks. We also typically wait a year if anyone has had a stroke or what we call a TIA because there are some bleeding risks with these TIA TIA is where an event happens, it's not a full stroke, a TIA by definition must resolve. So if an area of the brain doesn't get blood for just a little bit of time or enough blood for just a little bit of time. You can have some physical or mental, not mental cognitive symptoms from that. And then it resolves by
Representative Kenneth B. Ferguson
Unverified
22:03
definition, and if it doesn't resolve, then that is actually considered a stroke, OK, OK, that, that answers another
question I had because I've got, I've got an in-law that kind of fits that profile, but he too is a veteran and
Representative Jack Ladyman
Unverified
22:18
he's too receiving some help. Thank you, thank you, Mr. Chair. Resentment, you recognize her question. Thank you, Mr. Chairman. Uh, well, uh, Mr. Cook and, and Representative Mayberry, I know we all work on this. I know you work on it every day and, and uh
you, you really want to improve treatment for these folks, and it's a big problem. And uh I have actually followed these drugs, uh, for years through the testing process, the different levels, because I thought, you know, we have nothing as as you said, Doctor, uh, to help these folks, nothing. And I thought this is, this is going to be a great thing, and I think it is. I don't know. where it's at today. I don't know when it was released, but I know it's taken many, many years and many, many dollars to develop this through the testing
process. So my question is, uh, what are other states, you mentioned
David Cook
Unverified
23:08
Indiana, but our other states doing what you all are asking us to do. Sure, yes, Illinois enacted legislation in 2023. I know there's pending legislation in Georgia and then um but
you know, this, this is kind of our initial ways just trying to make sure the state employees are covered so more states are coming on board, but the two that we have right now, I can point to Illinois and of course the legislation pending in Georgia, I'm not sure what how
where that's at right now. Thank you, Representative
Weidman. Representative Richardson, he recognized. Representative Representative Johnson, you were recognized. Thank,
Representative Lee Johnson
Unverified
23:49
thank you, Mr. Chairman, and yeah, thank you for the testimony. I, um, I guess the question I have is around the guardrails, right? I mean, I think it's important to recognize that if I'm understanding you right, it's a
very narrow group of people that would qualify for the more expensive therapies, and to be clear, it looks to me like this bill doesn't say anything about specific drugs, right? It just says any drugs approved for FDA approved treatment for Alzheimer's. It doesn't look to me like it characterizes mild versus other forms of Alzheimer's or dementia. It's just a broadly just saying drugs, right, so not specific to this drug or Is that correct? Yes, sir. That's correct. And and so, and maybe this is more of a question for EBD, but I'm just curious
about the process to make sure providers are following these criteria, and they were not inadvertently opening this up for just anyone to prescribe these medications, right? I mean, I'm an emergency medicine physician. I feel very qualified to treat emergencies. I don't feel qualified at all to weigh in on whether somebody qualifies for one of these drugs or not, right, because that's not my area of expertise. Yet because I have a medical license in Arkansas at pretty broad scope of what I can do, right, whether I'm really qualified or not, I can hang a shingle and
start treating people for a whole variety of things, right? And so what's to keep me or other colleagues who, who maybe are intending to do good things, right? They're seeing a patient in their office and they think, hey, this may be a drug that fits them and they prescribe the drug, um, that's not appropriate, you know, mechanism to prescribe this medication. What are the guardrails that are in place. I know you've precluded step therapy in this. What are some of the other guardrails in place to keep this from being overused.
Speaker 22
25:39
I'm going to speak a little bit to that, um. When you look at other other programs that provide this medication, uh, one requirement is that people, people do have to have a specialized
Speaker 21
25:49
scan, and I should have mentioned this when answering your question. A specialized scan showing that the target of the medication is actually actively presents
Representative Lee Johnson
Unverified
25:57
that scan? Is it the insurance company that requires it or who's requiring that they have the scan and does this bill allow for EBD to have those same
Speaker 22
26:10
Requirements. I'm gonna speak to the medicine part of it I'll let him speak to the legislative part of it. When you look at all the other corporate all the other entities like Centene, all of those who did this, they pretty much follow Medicare guidelines in general in medicine, when Medicare comes down with something, they usually are the most, they are the most stringent and have put the most research into it and companies instead of reinventing the wheel, they follow Medicare's Medicare's guidelines for this. And so we look at those, like if
you go to Aetna and look and see what Aetna did, um, you have to have specialized type of doctors, so neurologists, geriatricians, um, behavioral neurologists are limited to prescribing this. Additionally, you have to have both the patient and the physician register with a Nationally approved registry registry, all's Allsnet is one of those um that works and so patient and provider both have to be registered that go through these types of criteria and that is one of the guardrails that
David Cook
Unverified
27:14
are in place for inappropriate prescribing and does this bill require those same guardrails? Yes, sir. If you look on page 2, beginning in line 13, the Alzheimer's Association believes the FDA label restricts access to these treatments we have given, um, EBD some flexibility that they can't be more restrictive than the label, um, but the label does require, uh, again, the presence of amyloid, which is an extensive test, um, and of course the registry requirements as well, um, and positions across the state are following the appropriate use
recommendations that were put out in place, um, I
Representative Lee Johnson
Unverified
27:50
believe in early 2024, uh, by a panel
David Cook
Unverified
27:54
of physicians from across the, the country. Does this allow them to seek a prior authorization for Sure. I, we, we, we spoke extensively about the step therapy piece um for these particular treatments, there is no step therapy. The only option to, to have step therapy in place for EBD was to put a patient on Aricept or another behavior mod, because these are
Representative Lee Johnson
Unverified
28:17
a unique type of treatment, so we suggest there is no step therapy unless it's behavior modification that step therapy and prior authorization are two different things. I mean, prior authorization is an approval, step therapy is, you know. first therapy, um, and I, I didn't know if this bill allowed for because you know, the members of the committee are very familiar with my stance on prior authorizations, right? I have a pretty strong opinion about that in general, but when we did the go-kart legislation, I very specifically carved out, uh, pharmacy, um, benefits
because I, I, I recognize that, hey, look, there are some drugs that are so expensive they should require prior authorization every time. And so we put the pharmacy board in charge of deciding Which drugs might be eligible for exemption for prior authorization, and which ones we said, hey, look, under no circumstances, this is always going to require a PA because I think there are some drugs out there and whether this qualifies as that, I don't know. That's why we left it up to the pharmacy board, medical board to decide, you know, where those drugs, where that line is drawn, and so my question would be
David Cook
Unverified
29:19
this, this does this allow them to seek a prior authorization. I apologize, I misunderstood your question. You referenced that therapy earlier, but, uh, there's nothing in this legislation that that restricts them from doing prior authorization as long as they're procedures are not more
Speaker 65
29:32
restrictive than the FDA label, which is where we, we ended up.
Representative Fred Allen
Unverified
29:38
OK, thank you, thank you. Representative Allen, very nice for a question. Thank you. I appreciate what you all are trying to do, uh. I'm very sympathetic because my
mom died from Alzheimer's, but I do have a, uh, just a question or two. When you all talk about the ministry of the drug, he says it's done intravenously, so will they, will every
Speaker 21
30:08
do we have designated sites in the state of Arkansas that qualifies to do this. Unfortunately at this point it is, it is limited to designated sites, um, and that's another
issue I have with the way that the
Speaker 22
30:22
data was collected on impact, um, right now, very few institutions are actually registering and are administering this drug, and that is unfortunately a disservice to our citizens who are in rural areas because they are not able to go to their local hospital and get this if they are going to use this medication. They have one, they have to drive out of state just to get the testing or to an extreme corner of the state, and then if they're going to use this medication, they actually have
to drive to larger institutions in our state, which puts in my
Representative Fred Allen
Unverified
30:56
opinion, an undue burden on them as compared to people who live in urban centers. What, what sites
David Cook
Unverified
31:04
do we have here in the state of Arkansas right now that can administer this drug. Um, currently, UAS
Conway Neurology, um, is, is online as a provider, um, there's a physician in, um, Pear gold, um. Not bar go.
Northwest Arkansas. I can't starts with a P, parable. Um, that's prescribing, and we're seeing more and more clinics come online, but that, like he said, access is really limited right now. I can look at them. I can get a more exhaustive list for
Representative Fred Allen
Unverified
31:36
you, but those are the ones I can think of on the top of my head. OK, great. Pray growth, pray grove. That's, again, I appreciate you all. I have
Representative Dwight Tosh
Unverified
31:45
a couple more questions, but I'll get back in the queue. Thank you so much. Representative Tosh, you ask for a question. Thank you, Mr. Chair. I want to
go back to just help me to understand, uh, Representative Johnson brought up a good point and if I see if I see my primary care physician, and you said this, usually the onset or the early signs is when this medication would be able to provide hopefully successful treatment. Are those signs so obvious that my, my PPC would be able, and I guess he would have, or he or she would have to make
Speaker 73
32:18
a referral to Who, a neurologist or how would
Speaker 21
32:23
that work? I'm just trying to understand it. If you go to your primary care physician, the first step would If, if
Speaker 22
32:32
doing it efficiently would probably set you up for neurocognitive testing and then referring you either to a geriatrician or to a neurologist or a behavioral neurologist and quite frankly, if you've tried to call and get an appointment with a neurologist in the state of Arkansas. You may very easily be waiting 6 to 8 months to get
an appointment with one of those geriatricians do tend to have a little bit faster time. And so then then they would evaluate
Representative Lee Johnson
Unverified
33:03
you and start the process of
Representative Dwight Tosh
Unverified
33:05
going through the testing either the specialized imaging testing or the spinal tap. OK, I understand that, but I'm trying to hopefully address this concern. When you go see your primary care physician, sometimes you're only in there. 1520 minutes. And, and you said this was an early onset, and
sometimes those signs may not be that obvious to your PPC, so I'm trying to understand if he's going to make a referral and you're only in there 15 to 20 minutes. Is, is that the protocol? Is that the process that we'd have to take, and I can just see, uh, where, uh, it may not be obvious to your primary care
Representative Julie Mayberry
Unverified
33:45
physician that you, you've got this, uh, early stages and I, I'd like if it's OK, I'd
like to just kind of bring this up because I, I have somewhat a
companion bill that's in the health committee that deals with cognitive testing and the importance of getting that cognitive testing, um, and so it's, it's sitting there. I hope we can get it passed tomorrow, but that is, that is a key to all of this is early testing very much
Representative Dwight Tosh
Unverified
34:13
akin, we want to make sure that that's covered as well. OK, thank you. last question, and David, this is for you. Uh, Is it Alzheimer's or
Alzheimer's? How do you pronounce that? I struggle with that every day a little bit. I've already pronounced in here this morning. I heard first I thought somebody a while ago said old timers and I think
David Cook
Unverified
34:39
they were saying Alzheimer's, but anyway, so which one is it? I'm just curious.
Speaker 1
34:44
The discovering physician's last name was Alzheimer's with with a Z. 1906 Alzheimer's thank you for clearing that up. Any other questions? Committee. Reverend McGurk.
Representative Richard McGrew
Unverified
35:01
Thank you, Chairman. Uh, a couple of questions, uh. It says in here that uh in addition to these treatments, there are new treatments that will be required, mandated maybeD because of this. So could you talk on them just here also the, what is the cost to the patient now if they were taking, I was wondering,
David Cook
Unverified
35:21
I'm curious to know the cost of this treatment itself. And uh Representative McGrew, you, you'll hear testimony today from a retired educator, um, kind of talk about his out of pocket
cost and also a patient who's Representative McGrew, you, you'll hear testimony today from a retired educator, um, kind of talk about his out of pocket cost and also a patient whose family was denied access to this treatment. The
Representative Richard McGrew
Unverified
35:44
cash price negotiated with the drug company was $5000 a month in terms of the cash price, um, and Can you repeat your first question
David Cook
Unverified
35:52
again? I apologize first in the sheet we have here, it says that this bill would mandate EBD to begin covering some other treatments. Sure. Um, so the EBD, uh, the paragraph you referenced, um,
they are discussing or they're referencing, excuse me,
uh, Lakembi, which is um one that's been widely prescribed here in Arkansas. There was a second drug approved by the FDA in the same class, called Kasanla, um, the Naimab is its clinical name that that was approved in 2024. We do expect that to start hitting um the market sometime. Um, if I told you just be a guest, but we're hoping to see that start being prescribed from what we're hearing from a clinicians
and researchers. There's a lot of excitement about Kasula because of the
Representative Richard McGrew
Unverified
36:41
way it's performed in its clinical trials and in terms of its efficacy and given this treatment, how long does it, what are the end results, how long does
Representative Lee Johnson
Unverified
36:53
it put the decrease the effects of Alzheimer's for how long? What's,
Speaker 22
36:57
what's the outcome? Hi Actually, at this time, at this time it is looking to prolong things for several years. There
also is post-market analysis that's happening when you look at Medicare, Medicare and Medicaid, you have to go under registries where continuing post-market analysis is being done to determine how this works in the real world as compared to just the studies. The other comment I would like to make to add on to the question is cost is a huge factor, and I know that there is somebody in this room today, right now, who is married and
that person's spouse is not able to get the medication and when they went to see, you know, can we get help from the drug company. They just don't qualify because they make a little too much money and unfortunately the only option for them. After decades of marriage would be to get divorced and he would not have the funding and would then qualify, so they would literally have to get divorced in order for him to get his treatment, and that is heartbreaking. I've heard that
Speaker 1
38:09
on Monday and I'm still pretty disturbed by that. Thank you. Any
more questions from the committee for these witnesses. Thank you for your testimony. It appears we do have a couple of other folks
Speaker 87
38:21
signed up to speak for this bill. Um, Laurie Melton.
Speaker 1
38:43
Thank you for allowing me the opportunity to see, I don't know the
rules. Now you're, you're good, but before you start a couple of things, um, introduce yourself to the record and then if you can be as, um, I'm not limiting you, but be as
Speaker 95
38:58
brief as you can as you can see we have a, a, a lot to do today. I, I totally get it. I've got a 3 minute, I, I, I'll stick to it. Uh, my name is Laurie Case Melton. I am a wife, mother, grandma. And I'm a banker. I'm a longtime
lifetime Arkansan. Uh, last year, I noticed my husband, Gerald repeating himself, but don't we all do that and isn't that normal aging and don't we all like misplace our phone, or keys or glasses, um, do you ever have that flash though? What if, what if I have dementia, and then you laugh it off because, you know, you're busy. Um, well, in July. Gerald sent a text to our daughter. Youngest daughter saying I can't
wait for your wedding. Her wedding was 2 months before, and he had forgot walking her down the aisle. That was the final straw for me, uh. I got an appointment immediately and I'm one of those lucky ones that just happened to know a neurologist and had his cell phone in my contact list and He immediately got us in and we
began weeks of testing. Um, our insurance wouldn't let us go out of state to have the scan, so he had not one but 2 spinal taps. And then we got the most dreaded news that we've ever received, um, Gerald has early onset Alzheimer's. He was
Speaker 97
40:36
62 at the time, still working. And we were planning
Speaker 95
40:41
our retirement days together. I would rather have been told he had cancer.
Because you see, my mom had Alzheimer's just like all of you've talked about today. So did her parents. I've changed the diapers. I've dealt with taking the car away and I've watched someone literally waste away. But this isn't an old person. This is my 62 year old husband. And he's my life partner and so that's, that's different. But then I hear this wonderful opportunity about this new drug.
And that Alzheimer's is not the same as it was 10 years ago when I dealt with my mom. So, through the tears, we started uh changing, making our life plans. All we had to do was wait on our insurance approval, uh, which should be no big deal. Because we've had great insurance. Through my husband's pension after his 33 years in the oil field. Two months later, we were denied.
But oh wait, we can file an appeal denied. Another appeal, another denial. Oh, but wait, we can apply for financial assistance through the drug company. Finally, an approval. We have dance and I share the news with all my family and friends. a couple of months go by and nothing. I finally start rattling the cages and realize the drug company denied us after all because our household income is just too high.
Remember, I'm a banker, but I'm not one of those bankers that you see in Arkansas business, making the large money. I just have a job. No one even asked me how much money I made, so we never dreamed that that was, um, that would keep us from access to this drug. Come to find out the drug company called my husband while I was out of town for work. And of course, he had no memory of
it when I returned, he also was supposed to pick me up at the airport and got lost and couldn't find it, and I had to find an alternative way home. Last week we were chatting and he said if I was ever told I had Alzheimer's, I might just kill myself. Because he had forgotten already that he had that diagnosis. So here are options. We can get a divorce, OK? Um, because just his income from his pension and his Social Security would
Make him fit in that category, then I lose all the benefits of his. Well, that's 17 months. What is he going to be in 17 months. Hopefully we won't be too late. We could file for disability, but I guarantee you everyone here knows that would take more
than 17 months. In the meantime, Gerald retired. Started drawing his Social Security. We sold our dream home and we moved to be closer to our family. And I anticipate watching his decline. I put Life360 on his phone. I called multiple times a day. I make lists of what he's supposed to do. I answered the same questions over and over, knowing what my future likes looks like without this treatment. But I will not go down without a
fight. being hit, but being here today will absolutely do nothing for me because we are not state employees. I'm here to fight for my many friends and families who are state employees. I'm here to bring awareness to what is happening and that there are people that are being excluded from this this drug. I'm here today to share with you the pain of watching your loved one gradually disappear in front of your eyes and the
frustration, frustration of knowing it would be different. If we were simply given what
Speaker 101
45:05
we were paid for and I'm here to remind you that this could be happening to you, right now. So I thank
you for your time and I welcome any questions. Thank you for your testimony. I, I don't
see any questions, but we appreciate your testimony today. We have 2 more people sign up to speak for, looks like Cheryl and
Steve Daniels. for the record, and you can
Representative Robin Lundstrum
Unverified
45:54
proceed with your testimony. OK.
I'm Cheryl Daniels. I'm Steve's wife. Um, and I'm here because this summer he was diagnosed with Alzheimer's. I'm also here because I come
Speaker 105
46:10
from a family of teachers. I was a teacher
Representative Robin Lundstrum
Unverified
46:17
myself. I'm retired after 36 years of teaching special education, loved every minute of it. um. My mom was also a teacher and she passed away from Alzheimer's in 2017. What I wouldn't give to
have had a treatment for her disease, not just her symptoms for her disease. Um I know all of you probably have the same kind of story about a relative or someone that you've known. Something you can't put a money value on after Steve's diagnosis, I read everything I could find. I talked to everyone that would would give me information. Um, I, I'm not a real studious person after retirement, but I, but I became one and then found
out about this treatment that could actually help him, not the symptoms, but treat the disease, the amyloid plaque that was in his brain. I could see minor symptoms when this first started and I didn't want to believe it and I sugarcoated it, but I knew that it was there. And then we find out about this treatment that he could have. I can tell you that it, it is working.
After about the 3rd infusion, I thought, you know, could this, is this possible that it's working and I wish that you could go with us to the treatment center, see the, the people that are there. There are not many of them, but, but here there's stories, here the healthcare workers' stories that finally there's something to be done. Um I'm so grateful to be here. To speak to you in support of this bill to support it. And to support teachers and to support my husband.
Steve Daniels
Unverified
48:07
name is, excuse me. Been sitting there for a while, uh, my name is
Steve Daniels, uh, coached and taught school and was an athletic administrator, athletic director, assistant principal for 38 years, state of Arkansas, North Little Rock, and Conway Representative Allen I used to watch
you play basketball at Little Rock Central and you were real good. That just shows you how well this
drug is working because I
remember, I remember watching you shoot that basketball over there we're North Little Rock we play Central. My mother, I've come from a family of educators as well. My mother was a secretary for Mr. Barnett, Rabbit Burnett over there and was there for over 50 years, or around 50 years, and my grandmother was over the cafeterias for North Little Rock for years, but that's a whole different story, but I do remember you, yes, sir. Um, and I would never dreamed that I'd be sitting here in front of a bunch of legislators at the state capitol
talking to you today, but um Needless to say, I'm a little nervous about this and probably some of you are looking at me thinking, OK, this guy's got Alzheimer's. I'm going to see how he's going to act about all of this, so, uh, I'll do my best, but um, After Uh, I love my job. I met my wife there, and when I was diagnosed 6 years after I'd retired, I'm 67. I didn't know much about it and I couldn't see because of the pole back there
who said they couldn't pronounce Alzheimer's and I, I don't know who it was because I couldn't see you. I don't still don't know how to pronounce it. I did the same thing. I called it Alzheimer's and still do, but um I just watched an ant and my mother-in-law, her mother, I watched both of them suffer. From it until they passed away and even then I still didn't think much about it except that uh I knew there wasn't anything that you could do about it at that time.
And I, you know, some of you ask you some questions about what I just tell you what, how, what I went through and what I'm going through and how it happens. I was having some headaches and, and I went to my primary care physician, Dr. Throneberry there in Conway, and because I was an athlete and had concussions like all of us that and life brought you when you were growing up as a kid, uh, he wanted to do an MRI to just to check some things to see what it was all about. And uh so that's why I went in
for the MRI. I guess I just really got lucky when, when he found the stuff. And when I had the MRI came out of that um met back with him and he didn't really say much about it except for the fact he thought all of that, that he was really looking for was OK. It wasn't too concerned about that, but he said, I'd like to send you to the neurologist here in Conway, Dr. Timothy Fra Aldenhoven and have him take a look at this MRI and so I went to see Doctor Fri Allenhoven, and he mentioned something about amyloid. Plaques, which I knew absolutely
nothing about. And uh but as I learned, it had a lot to do with having Alzheimer's. He did some cognitive testing there a little physical therapy, some occupational therapy, uh, those types of things, blood tests, so I went through a variety of tests and discussions with him, and but he was very excited about a new drug that was coming out and for this one for me was Lakembi. I knew nothing about. that and he was very excited about it though, as far as it
was the only drug, he said there was nothing available, which I, I knew there was and I knew what lay in store for me because I'd seen what happened when you get this. There's a lot of you have witnessed that has gone on in your lives, but I, I, I Listen to him and and he was excited, but then he also discussed the side effects of this drug with me, which were pretty serious and a little scary. Uh, so I, when I, we talked about this and uh went back to my primary care after visiting with him and discussed
it with him. I had a cardiologist. I've had no heart problems, but I see one anyway. I discussed it with him. I discussed it with my pharmacist about the drug, and I ask all three of those guys, which I trusted. They're a lot smarter than me, and I said, if this was you and you had this opportunity and you were in my shoes, what would you do? Would you do this? And all of them say resounding yes, without a doubt, and uh when I was asked if anybody discussed those, those
side effects with me. I said, yeah, and uh but I also know what lays in store
if I don't do this, I know what's going to happen, and I, and
I accept that and Anyway, I've been taking the infusion treatments. I go every other Monday. And I went yesterday and had one. I've had no side effects, I do fine. I'm a little tired after it's over with for that day, but um after that, I really don't have any problems. Haven't
had any problems with it. I do think clearer than I did. I, I was asked, uh, in fact, Representative Mayberry asked me, said, Do you think you could go back to work? And I absolutely do. I don't have the step that I had back in my day, but I promise you I could go back and do my job and do it effective. mentally for sure, um. I did get on the internet, which was the worst thing I ever could have done when I found out I had this stuff and what I, what I typed in there, and I'll tell you what it said, and I'm gonna be quick because I know you guys got a lot to do and you want to
get out of here. But When I typed in this worst diseases to live with. This is what I said. It said, the answers were said to be subjective and depends on factors such as severity. Impact on quality of life and availability of treatment. The number one worst disease to live with at the top of the list was Alzheimer's. All of us are going to be affected by this one way or the other. Somebody in your family,
yourself or somebody. It's the way it is. Never thought it'd be me, but it's the way it is. But there is something out there that's helping people, and I'm, I'm positive that it's helping me. Nothing else is going to hopefully expend my life, extend my life a little longer than what I, what I would have had. Um
Speaker 73
54:36
And I'm gonna wrap this up. I've had the most wonderful wife. I've got two unbelievable children.
Steve Daniels
Unverified
54:53
It's OK. I've got two beautiful granddaughters. And I'd like to be able to see. can remember them for a lot longer. And I appreciate you.
And representative Mayberry, Mr. Cook. And all of you. For this opportunity in support of this bill. All of you have an awesome responsibility. God bless
Speaker 112
55:36
you. Thank you. And I'm not taking any questions. Yes, sir. I, I,
Speaker 1
55:41
I, we appreciate your testimony. Thank you so much for coming. I don't see anyone else signed up. Is anyone else who wants to speak for this bill.
OK. There's no one signed up to speak it. Is there anyone to speak against this bill. There's no one signed up. This does affect DVD. I believe we need to hear from EBD on
this matter. So if somewhat for ABD could go into the table. Sorry, just
Speaker 113
56:10
introduce yourself, who you're with, and Just give us your perspective on this matter, if you don't mind, sir.
Representative Fred Allen
Unverified
56:30
Grant Wallace, director of the Employee Benefits division. Um I'd like to start out by saying this is the toughest part of my job. And probably the part of my job I take the most serious. Um, I knew when I was offered this, that I would be dealing in some respect with life and death decisions. At some point during my tenure, little did I know that the reality of that is that I deal with those decisions almost
every day. I take that very, very seriously. Um, so it is challenging when you're confronted with legislation such as this, to have to come down and talk to you all about concerns. that you have. The other part of my job that I have to take seriously and and I keep with a very high regard is my fiduciary responsibility to this plan.
So unfortunately I do have to also look at the dollars and cents when it comes to legislation such as this. This legislation does have a high price tag with a cost of $2 to $4 million. And I know we can probably debate some of the numbers that went into that, but the reality is I have to look and I have to project off the worst case scenarios. I don't really get to look and play what if. I have to go to the extremes and figure out if everybody that could potentially
did potentially go, what would that do to the plan? So that's where these numbers come from, to put a little bit of that into perspective. We do have 127 members who are taking Alzheimer's-related medication for the diagnosis we did pare it down to this diagnosis. And so that's where you come up with some of the projections that we're working off of. Out of those 127 annually the spend is 39,000 or approximately
$39,000 for the medications that they're taking currently. The ones that are proposed in this legislation are around $26,500 per patient per year. So that's a dramatic shift in the medication spent. The other concern that we have with this is the medical costs that come around that. You have to take 5 MRIs or you have to have 5 MRIs within the first year of taking this medication due to the increased brain bleeds that come.
So those add costs, that's where you'll see some of the 90,000 figure is factored into that. There is extensive testing that comes along with that. So those do increase costs as well. So that's The cost factor is issue number one. The other concern that we have with this is the utilization management. Appreciating that the FDA is written into this legislation that does not give us the ability to do a prior authorization. That does not
give us any ability to have any management of the utilization of this drug. The FDA may say all of these things or it's written this way today, but that doesn't mean they're going to ride it this way tomorrow. This also says that if any FDA approved medication comes on, you have to automatically come to that. So I do have to relate this to another disease that is equally as serious in cancer. And we do not do that with our cancer treatments. We don't always go to the very newest drug that the FDA approves and say, hey, let's go after that one.
We have a rigorous protocol and review process that in coordination with UAMS, we go and try to make the best decisions based upon efficacy, based upon clinical data and the latest clinical data and cost factor into that to make sure that we're making the best possible decision, not only for our members but for the fiduciary responsibility of the plan. So this bill prohibits our ability to do that. It defaults that we automatically have to just go to anything that the FDA approves. And again, I would
just put the question. The FDA often changes its mind. We need more time to study and just to give you a little bit of insight in what the process that we do follow when it comes to looking at drug reviews. We do look at these on a monthly basis. We, if we say new to market, which is the drugs that have come out within the last 6 months. If we say, hey, we're not quite ready to accept that. We don't have enough data yet or we're not showing the outcomes
that make the most sense just yet. You know what, let's give it 6 months and we'll re-review it. Or let's give it a year and we'll review it. It's not like it's a one-time decision that for then ever goes away and we never look at these things, and I'm not going to tell you that a year from now we wouldn't cover these drugs. But I don't think that quite frankly, we need to be passing mandates in legislation to our plan. I think you need to let us as
the agency overseeing it, make the best decision when it comes to medical care, pharmacy care, and the costs and fiduciary responsibilities that we have. So with
that, I'd be glad to answer any questions.
Representative Fred Allen
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1:01:59
Thank you for your testimony, Representative Allen. You're recognized for your question. Thank you, Mr. Chairman. Thank
you for coming, Mr. Wallace. Is there a cost savings associated with this drug? I don't think we've had these drugs out on the market long enough to assess a true cost
saving. I think the testimony you heard earlier, um, is a guess, and I think that's all we have to work on right now is, it's a guess, so I can't say that there have been any studies that I have been presented or seen that
Representative Carol Dalby
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1:02:35
would show the savings that's come that comes here. Thank you. Representative will be recognized for your question. Thank you, Mr. Chair. Grant, is there anything in the uh. policies and procedures of your
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department that keeps y'all from, um, Adopting
Speaker 125
1:02:53
These drugs without. Without this bill, I
Representative Fred Allen
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1:02:57
mean, can you do it without this bill. I could, I could do it tomorrow
Representative Carol Dalby
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1:03:03
if Your department has the ability to do this now. Yes,
Chair
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1:03:13
ma'am. OK, thank you. Representative Richard recognize
Representative R. Scott Richardson
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1:03:18
your question. Thank you. What is the What's the average cost? Or contribution from an
individual into a plan. That may, let's say um it it individual 65 years old, he's been contributing, we find out. What's
Representative Fred Allen
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1:03:38
that individual? Contribution into the plan. That's a great question that I don't have off the top of my head. Um, you know, so I'd say
our average per monthly premium is probably between all of the, the plans, active, retired, all of that, you're probably going to lay in the average somewhere in the mid 100s that somebody's doing on
Representative R. Scott Richardson
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1:04:00
a monthly basis for their insurance premium. OK. And how, what's the How
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long are people normally contributing to the plan, right?
Representative Fred Allen
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1:04:09
So if you look at kind of the averages that we have on a state employee, I think our average state employee has about 10.5
Chair
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1:04:19
years of service, somewhere in that range.
Representative Sonia Eubanks Barker
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1:04:24
OK, thank you. Any other questions from the committee? Representative A recognized. Thank you. Thank you, Grant. Uh, I think we're all exceptionally sympathetic to the job that you have that None of us probably would want, um, I'll trade you sometimes. But when we talk about the fiduciary responsibility, there's obviously some opportunity costs or opportunity benefits that come from an individual who doesn't progress.
With this medication. The long stay the long term care costs, uh, the emergency room visits, the car crashes that happened, um, I agree that it is in your purview to look for all the opportunities to allow for the safest use of these medications, but also with the best return. and we discussed earlier. Having this in the medical benefit. Can you commit to getting an answer from Our health advantage to see if there's a way for them to audit after the fill because
essentially what could happen and in my experience of being audited is that a prior authorization on the front end is basically a pre-auit. You're basically making them prove the necessity. Having healthcare practitioners do the review, do the side effects, issue the prescription, have it filled, and then be audited after the fact to see if it was appropriate. I believe there's an option to help give you the opportunity to curb the bad actors while still providing access, and I would just we would need
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obviously health advantage to say that that's something that they can.
Representative Fred Allen
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1:05:54
Put forward. Absolutely I'll ask the question and see if that's even possible within their system. OK, thank you. And I would say, you know, I know there's been some comparison to Medicaid, Medicare covering this, but keep in mind um those programs automatically have a mandated rebate. Uh, so they're not spending the same amount that our plan would be. There's a 23.1% rebate that is mandated by the federal government to a drug manufacturer when it comes on to
those programs. So it's not really when you look at the costs, the costs are different between those federal plans and the state plan. Representative Allen, you recognize for your question. Thank you. Maybe my questions relevant, maybe not irrelevant to what we're talking about, but it we're late in the session right now and to me this is a good piece of legislation and we just got the financial impact statements back. So is there any
way that we can get these statements earlier
in the session so we won't have to be. Fighting time like we are right now. I want to say that I have been uh talking with Representative Mayberry and, and I love working with her. I've worked with her for many, many years on many different pieces of legislation. We have been talking on this bill for a long time. Um, these are things that we have been doing the analysis and I've expressed I'm not surprising her
by anything that I'm saying today. These are concerns that I have routinely expressed around the way the bill was drafted. Um, as far as getting fiscal impacts, you know. I have a, we have a deadline. I appreciate that a request for data from us is going to come after that deadline so that you're only asking once and you're getting as much data as you possibly can through that initial ask. Um, there Did it come as fast as it should have?
I think we did it the best that we could, uh, but we're only one piece of that, of that puzzle and that work. All right. Any other questions from
Representative Julie Mayberry
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1:08:19
the committee? CNN. Thank you, Mr. Wall, for your testimony. Representative Maybury, recognize clothes for your bill. Thank you. I know y'all have spent a lot of time here listening, but I do want to follow up with just a few
things. First of all, thank you for the question. I filed this bill in November. It's been ready since November and I'm not able to present this bill until this week. The last two weeks of session. Not just my bill, but you may have a bill next time that you file well in advance and you're waiting on this fiscal impact to come back. I wanted to present this bill the first week of sessions so we could iron out
even more things, but here we are. Um, second thing, I want y'all to think about this. That This applies to our state employees. And our public school employees. There could be a 55 year old, 60-year-old teacher. Who gets this diagnosis. And wants to continue to work and as you can see, By listening to Steve, he said
he could still work. He's 67. He's already retired. But imagine this school employee who says, I still have another year before I can officially retire. I need to get another year in. That keeps that person working, bringing home a paycheck to their family. Contributing To their family. And there is a cost benefit to that, and that is really hard to factor in.
I will continue to argue that I don't think that it's the 2 to 4 million, um, but That that's what it is. I do appreciate working with Grant. We've had a great relationship. We've talked many times, and I know that
David Cook
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1:10:17
this was a hard one for him, and I appreciate um working with them. Um Thank you members for your time. I'll be brief. Um, just wanted to add to Coach Daniels's testimony. He is retired from the school teachers, um, retirement system and, uh, he
does have Medicare, so CMS is picking up the bulk of that, but his advantage plan, he chose to stay with the state, um, and they have denied him access, so he pays $500 a month out of pocket to receive this treatment. I think he appealed the denial 3 times, but each time he was denied just on the advantage plan piece, and so we just
appreciate you stepping up for our state employees and appreciate your time today and um thank you for the
work you have before you. All right, thank you,
Representative Mayberry. Mr. Cook. What's the will of the committee? Oh I got a motion to pass. Representative Richardson. Although or any discussion on the motion? See none All those in favor say aye. I supposed to say no. Congratulations, Representative Maybury, your bill's passed. Moving right along, we have Representative Moore presenting
Representative Kendra Moore
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1:11:34
House Bill 1150. If you would, please go to the end of the table. Recognize yourself, and you may present your bill. Thank you, Mr. Chair,
and if I could have a couple of members, uh, from the audience come up to help and speak
Representative Mark Perry
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1:11:51
in favor of the bill. Absolutely, if you would, please go to the end of the table, recognize yourself and uh you may proceed. Thank you, Mr. Chair, members of the committee, Jeremiah Moorehouse District 61. Um. 1150 is unique and I had
full 2 pages of comments prepared, um, but I'm just gonna Speak from the heart, if you will. Um, I represent parts of 5 counties, 127 miles from top to bottom for district 61. Represent possibly more pharmacies than any other state rep in the state. It used to be 12, now it's down to about 10. Um. Pharmacy benefit managers for far too long have been able to reimburse their competitors while they reimburse themselves. Uh, I'll give you an example of
why this could be seen as predatory, uh, and Crony capitalistic at best. Take Tyson Foods, for example. Tyson's a great company. But imagine if they were able to set the sales prices for their competitors' chickens, that's Simmons, that's OK Foods. That's Mountain Air, that's Georgia's Sanderson Farms, if they were able to sit their competitors' price of chicken. At a lower cost, yet set their own price and sell their own
chicken at a higher cost. That's exactly what's happening with these pharmacy benefit managers. Uh, the FTC reports over the past year have been quite damning in nature. Uh, one drug specifically they reimbursed independent pharmacies, $97 while reimbursing their own pharmacies, $19,200 for the exact same drug. It's a very complicated issue, and I've been over backwards throughout the past several months and trying to make certain amendments to get a lot of people on board or at least
neutral, including hospitals and in fact some hospitals are blatantly in support of House Bill 1150. Um One thing you know about me is that I'm pretty upfront. I'm pretty direct with all of you. If I'm for you, I'm for you. If I'm against you, I'll tell you before I speak against your bill, um. I'll be upfront. But what really irks me, what really gets on my nerves as a legislator representing 30,000 people back home or when certain lies are told about myself or my legislation.
I'll read a direct quote from an email that I've gotten probably. 100 times from 100 different constituents that have been told by pharmacy benefit managers that my bill will deny access to care for 2.7 million Arkansans. That is patently false. I don't even know if there are 2.7 million Arkansans that are on medications. But what they are claiming, what they are scaring our constituents. That is wrong.
Pharmacy benefit managers are gaming the system. to line their own pockets with, with taxpayer and patients money. People ask me, why are you running this bill? That the pharmacy Association bring you this bill? I can tell you
Representative Kendra Moore
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1:15:00
with the fact this is an original idea from yours
Representative Mark Perry
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1:15:06
truly. Zach Smith Good friend of mine who happened to be in my wedding. Right over there has told me he may have to shut down his
pharmacy and sell his family business which his father and him have built over the past several decades because of predatory pricing and reimbursement rates by these pharmacy benefit managers. I ask you to vote in favor of this bill. For my constituents, for your constituents, for the patience and the taxpayers of Arkansas.
And with that, I'm open for questions. Well, first off right quick, we need you at the end of the table that joined you to uh
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recognize themselves and identify themselves for the record.
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1:15:47
John Vinson, CEO of the Arkansas Pharmacists Association. Britney Sanders, current
president of the Arkansas Pharmacists Association and co-owner of the pharmacy at Wellington. Thank you. Questions from
Representative R. Scott Richardson
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1:16:00
committee Jay Richardson. You're recognized for your question. Thank you, Mr. Chair. Um Representative, I've, I've gotten a ton of emails, as I'm sure you're aware, but one of the things that continued to come up and I was hoping that you could speak to was uh that this legislation will not only lead to pharmacy closures, but
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disrupt specialty and mail order pharmacy services. Can you speak to that?
Speaker 156
1:16:24
Yes, so, is that OK? John Vinson, CEO of the Arkansas Farmers Association, so Senate bill Excuse me, House Bill 1150 does not force closures. It gives PBMs that own pharmacies, the choice of whether they want to be a PBM or a pharmacy. Pick one or the other. The conflicts of interest that have been exposed
by Wall Street Journal, New York Times, US Federal Trade Commission, and two separate reports in the last 6 months. The Axios News Columbus Dispatch to his point that shows the higher prices. They are being paid at pharmacies owned by PBMs versus the lower prices and local access in Arkansas, it would stop that and it would require them to either choose one or the other, or to divest and sell that pharmacy to someone else to operate, and that's happened many times over the years.
That's a common practice that does occur. It would affect up to 36 pharmacies that I know of from talking to state border pharmacy based on their current knowledge. Now, they would have to apply information and there's an amendment in the bill that would require the board of Pharmacy to outline a public written policy on how that would work, but it could affect up to 36 brick and mortar pharmacies in the state. There are another 700 that would not clearly be affected by the legislation and
all 75 counties. And then there are also up to 6070 mail order pharmacies only 100 of those roughly somewhere between 90 and 102 depending on different information of who is currently licensed could be affected by this. Of those 700 plus pharmacies, any of those pharmacies could fill specialty medications, which are loosely defined mainly by the PBMs, by the pharmacy benefit managers,
not by the state Board of Pharmacy. Department of Health or the FDA, it's almost unilaterally decided by the person who's setting the prices and also taking the prices by filling those prescriptions, but we do have over 25 pharmacies, including Carta, including UAMS, Children's Hospital, Allcare pharmacy, I know Carta and um All care here in the room, I believe both are willing to come to the table and testify or answer questions if you need
them to and patients will still be able to fill
Representative Kendra Moore
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1:18:56
prescriptions, and they should be able to access them locally at
Representative Mark Perry
Unverified
1:19:00
better prices with this legislation. And if I can follow up with that, I've run the maps. There is The furthest PBM owned pharmacy from a non-PBM owned pharmacy in the entire state of Arkansas is 2 miles. There will be no pharmacy deserts.
2 miles is the furthest distance. All right,
Representative Carol Dalby
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1:19:23
Representative will be recognized for your question. Thank you, Mr. Chair. Uh, Rep C Morris, I read your, your legislation, it appears to me that we're turning over the rulemaking authority, uh, to the pharmacy board and can you explain why we would not have the rulemaking authority remain with the legislature and, and AOC as we do on. Everything else I can think of, but it appears that we're turning that legislative
Representative Kendra Moore
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1:19:54
authority over. Can you speak to that for me, please. It's my understanding
Representative Carol Dalby
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1:19:59
that their rules will still have to be approved by ALC. And I don't see that anywhere. Can you point that out?
Speaker 156
1:20:08
And I apologize and I've read it a number of times, but I, I can answer. Do you mind if I? So it, it does have the amendment has that the Board of Pharmacy would develop their written policy and their written policies, of course, are subject
to any legislator calling the state board of Pharmacy and the ALC or whatever committee, public health, insurance, commerce, whichever committee member would like for them to in terms of rulemaking, the Board of Pharmacy still does have rulemaking currently in the current statutes on any permits they issue, whether it's defined in this law or not, but they, my understanding, They still have that ability to promulgate rules if needed to happen. But for the sake of Of
Representative Carol Dalby
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1:20:54
Implementing this particular bill, that would be supported by current. Statute is the makeup
Speaker 156
1:21:00
of the board of pharmacy all independent pharmacists. That's a good question. So More Pharmacy has 8 members that make decisions and only 2 of those 8 members are what I would consider independent pharmacists. One of them's a true independent pharmacist that has a single store. The other one is part of a, a, a network of several stores and some other businesses that are tied in. The
others have experience from either Walmart or Walgreens or hospital, there is a couple of public members of the board that are not practicing their licensed pharmacists, including a senior member that's over 60 years of age that is
Representative Carol Dalby
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1:21:39
on the board serving. One more. Uh, and, and just switching topics, but I can't help but go to this when I think of it because I, I put on my other hat, how does this bill not conflict.
With um, You know An organization or even a person's right to contract and how does it not conflict with the commerce clause in the US Constitution. temporary but that
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1:22:14
you work at the AG's office. OK, um, I represented more answer, but in addition to me, but yeah, but at the first week of session when this bill was filed remind me of the conversation earlier on
fiscal notes. We'd also hoped to run this very early in session, but here we are. And we asked the AG's office, we actually worked really close initially in conversations with Governor staff, but eventually to the Attorney General staff where Tim Griffin and his team look at this, um, AG Tim Griffin is supportive of this legislation. He was at the press conference that we held in the, in the rotunda back the first week of session, he gave testimony of being both in
support personally but also as the Attorney General wearing both hats of how he'd been personally impacted, and he answered questions about his team believes that it would They would be able to defend it to your question. I'm not an attorney. I'm just trying to explain that we did work through the Attorney General's office, and he feels like this legislation
Representative Carol Dalby
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1:23:16
he can defend if it was challenged. Uh, one more question if I can for uh Representative Moore and
My concern and I understand the, the PBM I've been in the legislature long enough and know the. The push and pull and all of that, but you know, my question is, is we. Do this for this industry. Have we not opened the floodgates to, let's say we don't like someone who grows trees and has uh a sawmill and a lumberyard and there. Setting the prices for everybody
around them, it just seems like we're starting down a slope of where we as a legislature are going to tell A person or a company, how they can set their business up and how they can run it and, and that is a concern not just in this area. But in all areas of commerce and it, it just seems like. We start down that slope, then somebody else has a beef with something else, then we've set
Representative Kendra Moore
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1:24:31
that precedent that we can then tell people how they can operate their business. Can you speak to
Representative Mark Perry
Unverified
1:24:40
that representing more? Thank you, Representative Dalby. Um, I'll just be the first to say that this is not necessarily against all vertical integration. This is against vertical integration regarding an industry in which they are responsible for setting the prices of their competitors. Um, so with regarding, uh, Somebody growing trees and having a sawmill and a lumber
company. There's nothing wrong with that regarding Tyson Foos and their vertically integrated chicken farms. There is nothing wrong with that. They don't
set the prices of their competitors, and I hope that answers your question. Any other questions from
Representative Les D. Eaves
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1:25:23
the committee? Representative Eves for your question. We've been dealing with PBMs for quite a while, and I think we're all pretty much aware what they're doing to our rural
pharmacies. But do the PSAOs have any responsibility. Are they
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1:25:36
causing some of the problems that that our
Speaker 151
1:25:40
local pharmacies are seeing. That'd be a good question for Brittany. Britney, would you mind? Sure, I can try to answer that. There, the PSAOs are very limited in the contracting that they can do on our behalf, they hold the contracts for us, but they are not able to negotiate on our behalf. Um, it's, it's a take it or leave it or contract that the PSAO is offered on our behalf and they have the choice to either accept and we enrolled
Representative Les D. Eaves
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1:26:04
in that network where they can decline and we're out of
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1:26:09
network and unable to serve those patients. those organizations don't,
Representative Les D. Eaves
Unverified
1:26:13
don't. have anything to do with how much you're reimbursed. They cannot negotiate the
Speaker 156
1:26:21
contracts. They hold the contracts. Does the pharmacy Association receive any money? From PSAOs. Yeah, we do not receive any money from PSAOs. Thanks for that question. And, and just to clarify, they do try
to negotiate because they have a relationship with the PBMs, but under federal antitrust law, they're not allowed to take different pharmacies that are owned by different people and collectively bargain. So they can pass through in a messenger model offering, but they cannot collectively bargain under federal antitrust law, if that answers your question.
All right. Any other questions from the committee? and you're recognizable. Thank you, Mr. Chairman. Um
Representative Jack Ladyman
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1:27:05
The question that Representative Dalby asked, uh, I'm gonna relate to that, um, Representative Moore, I know you've studied this quite a bit and been working on it for a long time. And we talk about vertical integration and that's not a bad thing. I work for major companies that had that, and it's, it's fair, but you know, we have things called monopolies and we have to be aware of that as well, but You've got a company's vertically integrated and controls the purchase and the selling price. That's what you mentioned earlier. And I think this
industry is unique in that, uh, with the research you've done, have you run across any other industry like
Representative Kendra Moore
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1:27:47
this where they set their, the prices basically for the whole industry. Thank you Representative Ladyman. And to answer that
Representative Mark Perry
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1:27:52
question quite bluntly, no. There may be other industries that exist in this similar scenario, but to my knowledge that PBMs pharmacy, this is the only instance where that happens.
Any other questions from the committee? Representative Perry, you recognized for your question. Thank you, Mr. Chairman. So Listening to previous discussions talking about brick and mortar. So if, if this were to pass, companies would have had to diversify and not own a brick and mortar, which includes a pharmacy. So what would be the cost, do you reckon on a company who's, so I'm thinking CVS, Walgreens,
so those companies would no longer have a, they would either have to contract with someone. To run that pharmacy or To diversify, sell the building, start
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over, what kind of impact would that be, loss of jobs,
Representative Kendra Moore
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1:29:01
the communities. Can you kind of touch on that.
Representative Mark Perry
Unverified
1:29:06
Thank you, Representative Perry. Um, The actual cost of divesting or
contracting out. I cannot speak to that, um. They have valuable assets in which they, um, could sell and spin off and make profitable. But The real The fact of the matter is, if you're going to operate as a PBM, you need to operate as a PBM. If you're going to operate as a pharmacy, you need to operate as a pharmacy. You shouldn't be in a position to where you can be such a bad actor. be in a position to pay yourself higher than your competitor. Um, this is not about
This is about free and fair markets, and I would emphasis the word
fair. Um, which this market is so obviously not. Thank you. Does that answer your question? Yeah, kind of, but
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so Besides eliminating competition, what else would this bill do? Do you mind if I answer? OK. So, uh, in terms of the jobs question, I just would
Remi or educate for those of you don't know this. There have been a net loss of 65 pharmacies and more than 20 in the last 12 months because of unfair competition that has eliminated thousands of jobs where pharmacies have lost their investment to your point about worrying about your constituents and the reduction. There are about $5 billion somewhere between $2 billion.05 billion dollars of prescriptions that are being forced to out of state mail order pharmacies. higher prices according to the
FTC reports that should be able to be filled locally if a patient chooses. If there's a fair and free market, that should increase jobs, that should increase and grow the economy locally and give patients choice and local access not only at independent pharmacies, but Walgreens, Walmart, Harps, who is supportive and is in the room. Um, and also our new hospital nonprofit permits that this legislature approved this session where they want to grow their specialty drug offerings and their services and their
infusions instead of having their patients forced to a hot truck from Alabama or Arizona that
Chair
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1:31:26
the patient didn't choose. So hopefully that answers your
Representative R. Scott Richardson
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1:31:32
questions. Thank you. Yeah. Representative Richardson, recognized for your question. Thank you. So If I heard you correctly, you said that you that the PS. I'm going to get the acronyms all screwed up, the organization that negotiate for you. So, but
I have spoken to a pharmacist who has the ability to negotiate his own contracts. So when I spoke with him, he
said he takes the time to go through and negotiate each one of his
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contracts to ensure that he's being paid an adequate amount. Is that common practice or no? In my experience with attempting to negotiate a contract with a PBM, we can redline the contract, send it back. And there's either no response or the exact same contract is sent back to us. They're not
Representative R. Scott Richardson
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1:32:19
willing to accept any negotiation on our behalf. OK. Maybe some other we have more speakers they can speak
to. Nobody else is speaking. Or signed up to speak. OK, thank you. Representative Richmond, we do have people, you know, that will be speaking for and against
Representative Austin McCollum
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1:32:37
this. I didn't know what you're referring to. Uh, any other questions from the committee? Representative McCollum, you recognized for your question. Thank you, Mr.
Chair. I guess this question is kind of along the lines of maybe similar to what Representative Dalby was
asking earlier and sorry, I did step out for a little bit, but essentially like thinking about what the difference is between rule making and policymaking authority as a granted to by the board. In this bill and as a lawmaker, I know we do it a
Speaker 156
1:33:05
lot, but I like to legislate and so just kind of understanding where this is going to go. Sure, on the, on the poly back to the question about rulemaking again. My understanding is the board can promulgate rules if
they need to and shower or whatever you want them to do, but they also can develop policies with existing rules that they currently have or to implement the details, the nuances of what this legislation really means in reality. And the biggest concerns are pushback we had. We're, we're from in terms of what's the timing look like? How does it affect patients? Will patients lose access, came from hospitals worried about will a patient present the emergency room or hospital if
they cannot fill a medicine and in conversations with the hospitals who had the most concerns about that, um, developing a written policy with their existing statutes and existing rulemaking was the most efficient way to do that in a timely way to ensure that no patient loses access. So that's where we landed is bill sponsors. Pharmacists Association, Hospital Association, Carta and other partners that looked at it. It's the best way I know to
Representative Austin McCollum
Unverified
1:34:25
Would you give me some encouragement and give me a little more, talk a little more about
Speaker 156
1:34:32
maybe guardrails that exist to prevent the idea of like a board effectively creating. out of this, so the Board of Pharmacy currently already has in their rules from many years ago, the ability to provide exceptions for prescriptions to be filled by pharmacies that don't currently have a permit, even if they're not permitted and there's a need, they can approve that. If those exceptions become
repeatable or where it's obvious that there's a need for a permit that this might otherwise prohibit. There is an amendment in the bill that allows for a limited use permit for certain drugs that may be unavailable in the market or, or hard to get or patients unable to receive them based on their benefit design or the type of drug, there's the ability to give those oversights and not oversights, but to approve limited use permits for those medications for patients, but
that's assuming the patient's not able to receive those from Walmart, largest retailer in the world from Amazon, the 2nd largest retailer in the world who is also permitted in Arkansas. It's not affiliated with PBM. Walgreens, the 25 specialty pharmacies I was talking about earlier, you're ACAredited, and the other almost 600 miller pharmacies that are not affiliated. So if there is a problem, The amendments, current rule and current statutes, I feel confident the Board
Representative Kendra Moore
Unverified
1:35:56
of Pharmacy and the community has the
ability to meet those needs. Representative Cullum, uh, totally understand your concern, uh, and your assurance is
Representative Mark Perry
Unverified
1:36:04
that this is not a broad ability to create. Broad rules that may or may not apply, um, to unforeseen circumstances. This is gives them the ability to make sure that patients have access to care and to those life saving medications that they need. OK.
Chair
Unverified
1:36:30
Representative Ferguson, you recognized for your question. Well, actually I was before. I'm sorry. Well,
Representative Kenneth B. Ferguson
Unverified
1:36:37
you can go ahead and we'll get to McGrew here in a second. All right, thank you. Hey, I, I want to go back to uh Representative Richardson's question about here again POS or PSI oh whatever it is. I've got a couple of pharmacies in my district. That we're negotiating with PBMs
and it appears that at some point, it would stuck and kind of the PBM was saying
this is what it is, take it or leave it. I've got another follow up to that, but are you, are you, are you saying
Speaker 156
1:37:14
that's the case? You said something similar to that. I would comment to you, and I, I
Speaker 151
1:37:20
know your Doctor Sanders, so go ahead, Doctor Sanders. Yes, so that is the case. I mean, it, it comes to a point whether they accept, I have not
seen them accept any red lines to a contract. But it becomes to a point
Representative Kenneth B. Ferguson
Unverified
1:37:36
where it's take it or leave it. There's no further negotiation, but I have not had any success in my last question, reason why I asked that question. I used to do business with another small pharmacy in Jefferson County that used to be in my district, no longer in my district,
but they closed down and they said they closed down because it was a drug that they couldn't get,
Speaker 156
1:38:01
uh, it had something to do with some negotiation. would this have been with the PBM or with the insurance with with the uh It it could be any and all the above. I know this committee's debated legislation and passed out of this committee and the full floor a bill that dealt with manufacturers restricting access to drugs. So that's one issue. The other is the PBM or insurance company could limit access to the drug. There are also coupons that the manufacturers provide that I'm hearing this week that they're
now limiting to only PBM owned pharmacies, which is another example of an anti-competitive act that is anti-Arkansan. and anti-patient access and to the question about PSAOs too on the negotiating side. I know there's a couple of bills down the other chamber that would register PSAOs, and I think if that language gets right, we, we are supportive of that to
Representative Kenneth B. Ferguson
Unverified
1:38:55
happen for the insurance commissioner to be able to better enforce the laws and protect citizen that question because the pharmacy
Chair
Unverified
1:39:03
said it had something to do with the contract and I ended up having to get, get it from Walgreens. OK. Thank you. Thank
Representative Richard McGrew
Unverified
1:39:13
you. Thank you, Mr. Chair. Representative McGrew, you're recognized for your question. Thank you, Mr. Chairman. I, I have been getting several calls from pharmacies in my district, all of them explaining what you are that that PBMs sets the price at which they can charge and it's, it's going to take them out of business. In fact, one called me yesterday and said that this bill don't pass, I will be out of business by the end of the year.
So could you, it, it's unbelievable to me that One organization can set the prices of their competition. And have we ever got here to begin with, but, but can you tell me what you forecast seeing if this bill doesn't pass. But you've already said so many small pharmacies have went out of business and I would assume that in my world, in my career business and my competition had the ability to set my prices pretty soon all of us small business would be out. Then we have just one big one and we know what's going to happen to
the prices then. So can you paint
Speaker 156
1:40:09
a picture for me what you see is going to happen in the next year or two if this doesn't get under control. I just got back from Billings, Montana, where my nephew was married. I love my nephew. It's awesome, but in the Train depot where he was married, there was Teddy Roosevelt visiting that train station with thousands of people. He was the original trust buster that said we should not allow this to happen to small American businesses. We should not allow this to happen in Arkansas, but it's happening. The Arkansas Constitution says
we have the right, we have states' rights to prohibit monopolies, yet here we are. I agree with you, it shouldn't have happened in the first place, but here we are, the, the nation is watching. There are other states that have introduced similar legis Senator Josh Hawley of Missouri entered, uh, just, um, put forward national legislation in Congress to prohibit this from happening because of those FTC reports, it needs to start in Arkansas. Now, to your point about how many in Montana, 10% of the
independents have closed in the last year, so 1 in 10. In Arkansas, there are 350 approximate independent owned pharmacies that similar type of, of rate I would expect here, and we've had 6 that have closed since the first of the year of 350. So, That's hard to project, but I do think that pharmacies are bleeding, they're hanging on. Walgreens is under collapse if you've read the articles about Walgreens, a company that's been publicly traded and is the largest non-PBM owned pharmacy
Speaker 204
1:41:40
in the entire world is now selling to private equity and who knows what's
going to happen with them. It's bleak without intervention from legislatures.
Representative Jon S. Eubanks
Unverified
1:41:52
So thank you for considering it. Representative Eubanks, you recognized for your question. Thank you, Mr. Chair. I'm sympathetic to the uh what
you're trying to do here. Uh, did you say it was Aximately 35 pharmacies across the state that might close.
Speaker 156
1:42:06
So, I mean, I think that's this bill
passes. No, if yes, if this bill passes, there could be up to in the state, 36 pharmacies that are affiliated with PBMs if they didn't divest, sell, lease out to somebody else who's not owned by people, yeah, they did
Representative Jon S. Eubanks
Unverified
1:42:29
not contract. Yes, that would be worst case scenario within the state. Yes, sir. I guess I'm wondering. How this bill is going to affect The reimbursement rates The independents are receiving
right now. I mean, I can see we can, we can limit the PBMO pharmacies, but are we really changing how the reimbursement is taking place. Is anything going to change there if nothing changes there, then our independents and the other pharmacies are going to be in the same boat they're in right now. Now with I've read an article about Walgreens, and the reason that they're In the trouble they are has a lot more to do with other business decisions that they've also made.
Representative Mark Perry
Unverified
1:43:16
But anyway, with how's this gonna change or the reimbursement rates for the rest of the pharmacies. Thank you, Representative Eubanks. That's a very good question. Um, the first thing I'll say is that this is not a bill about reimbursement. This is a bill about fair practice, um, a lot of people may get it confused with setting the full record straight, but this is merely a step in the right direction, um. It will help because they won't be able to steer. patients towards their own
pharmacies, um, but A good friend of mine who has a pharmacy in DeWitt, Arkansas, um. He's had to turn patients away because he couldn't afford to fill their prescription. He said, you got to go to Walmart because I can't, I'm losing money on this, um, last summer, He used to hire some help. Not pharmacy techs, just high school kids, college kids. He
Representative Kendra Moore
Unverified
1:44:10
couldn't afford to hire him. DeWitt, Arkansas. You tell me if there's a CVS
Speaker 156
1:44:19
going to go and do we, and I'm going to tell you no. I would add to, if, if you can't, if the person that's setting your process also owns their own pharmacy, and they would rather the patient go to their pharmacies, you're never going to get a fair contract. It's fair for your reimbursement in that scenario. So I feel like that's part of the reason why we've been working on this for 10 years, and we've made progress, but we still have pharmacies closing this type of anti-competitive behavior should stop.
Representative Carol Dalby
Unverified
1:44:50
Representative be recognized for your question. Thank you, Mr. Chair, and I appreciate the conversation, and I'm not, I mean, I'm not. Pro PB PBMs, but what's gonna happen in my town is I'm gonna lose one of my 3 pharmacies and. And that's gonna be it. You know, and so I'm, I only have 3 pharmacies. I don't have any independence. I'm gonna lose that, that business is gonna go
across the state line, we're going to lose the tax dollars and um so you know, just say oh it's only, you know, only 35 or only gonna do that. It's gonna have real. Uh, specific consequences for my area and um. You know, so I guess my question. I, you know, what am I gonna tell my constituents who used that particular pharmacy all these years. Well
Go over to another state and use them there, we don't, you know, or that, but that's what's gonna happen. So my question is, how do I answer my constituents that are
Speaker 156
1:46:03
going to lose the pharmacy in my in my town. I would say there's at least one person in the room that did own a pharmacy and your or his company owned a pharmacy in your district that closed their doors because of these egregious practices. If we have a fair market. I would expect, I know there are other people in the room. I don't know if they've come up
here and testify that they're interested and want to open in Miller County and want to open in Little River County where we've lost every single independent pharmacy in those communities, so we hope to have a fair market to bring those pharmacies back, and I know that they're hospitals, not in Texarkana, but in other areas on the Arkansas side, but in other areas in that part of the state that could also fill
Representative Carol Dalby
Unverified
1:46:47
those gaps with the new legislation that was passed. session. Well. I appreciate that comment, but
once again, I know what's gonna happen in my
Representative Jack Ladyman
Unverified
1:47:02
town, and all of that's gonna go to another state. So thank you. Thing you in Dolby. Any other questions from the committee? Represent a light and you recognized. Thank you, Mr. Chairman. Um, this might be a do you agree question, but since this was brought up as a local issue, in my district, I have, I think 6 private small pharmacies. I have 5 large pharmacies, Walmarts and
those kind of people. And I have one pharmacy, large pharmacy that would be affected. Closed whatever uh sold uh with this bill. So I mean, we're like a Miniature I mean this is a hot spot, OK? Uh, and you know, it's been brought up that If that pharmacy closes, people lose their job. We're going to lose economic, we're going to lose money. It's going to affect the economy, but the fact is these other pharmacies will pick
that up and there's plenty of capacity there for them to pick up that and, and these people that work at this one pharmacy, they've got 9 other options. And there and as you mentioned, Representative, there may be people that open pharmacies. And here's the problem I see. Uh, you know, we passed legislation some time back that said that pharmacies could not be forced to sell drugs at a loss. We passed that. We were the 1st 1st state in the nation.
That passed that bill. Now many other states have passed that. But that bill does not say that you, you You can not make profit. So in other words, you don't make any money. The PBM can control you where you do not make money. You're not selling at a loss, but you're not making any money, so you're not covering your cost. And that happens all the time. And some of the small pharmacies in my district have talked to me about that. And I say, you know, I, I, I'm not up on the PBMs exactly how they work, but each day they get this
list and like half of the things on there, they didn't make no money. And they can appeal. But this is a small pharmacy has 4 people working there. They can't appeal 100 of these things a day. I see the pharmacist shaking her head down there, and I think this is a common thing across the industry. So, you know, we really need to fix this problem. And I know this doesn't fix it totally, but as you said, Representative, I, I believe it's a good step in the right direction. Do you agree? I agree.
Speaker 1
1:49:33
Thank you for that. Uh, we are, we are in the question phase. So let's, let's
Representative Mark Perry
Unverified
1:49:39
try to limit it to questions. At this point we will have discussion later. Any further questions? Anyone represent Perry? Thank you, Mr. Chairman. So, You mentioned earlier that you'd be able to direct the patients. To another pharmacy on that side of it that if one closed. Uh, if
Speaker 178
1:49:58
you have a lack of accessibility or demand. Yeah.
Representative Mark Perry
Unverified
1:50:03
Could you, I'm sorry, could you clarify about the question? Just want to make sure I understand. So if, if a pharmacy closes, uh, you would be able to allocate, pick up the, um, good Just want to make sure I understand. So if, if a
Speaker 156
1:50:16
pharmacy closes, uh, you would be able to allocate, pick up the, um, and where would you do that? How would you direct those people to another pharmacy. So the couple of things. One, the, yeah, their physicians and prescribers for sure, but also the language and the amendment asked for marked with, with the Arkansas Hospital Association
and also with Arkansas Children's Hospital and UAMS. In that policymaking, this part of the state board of pharmacy would require that if the Board of Pharmacy assesses and sees that there might be a conflict where they might have to either divest, sell, not be eligible, that that affected pharmacy would also be required to notify their patients if they do intend to divest or close or not be available as well as the prescribers. So there is a communication element in the
bill that would help with that, and I'm confident that with the existing pharmacies we have, the, the pharmacies that are going to open because Senate Bill 58 and also the fair competition that that we talked about earlier for that this bill would create
Representative Mark Perry
Unverified
1:51:17
that we would have the capacity in this state to meet the needs, would that go against Act 922 of 2021, where Make steering illegal. Of 2021.
Speaker 151
1:51:35
Act 922. So Yeah. I'm gonna have to go ahead. I'm, I'm not familiar with the act, but you've referred to steering since they're not owned by that company, they're not steering to themselves. They're not staring to something that they're owned. If CVS or, or Genoa divest that pharmacy and they refer them to Walgreens or Walmart that's in the community. It's not a pharmacy that they own or would benefit from. It's just
Speaker 156
1:52:06
providing that information, so they're not steering to something that they own. I wouldn't I wouldn't characterize this me personally, that particular Act 922, which is House Bill 1852, I wouldn't necessarily Characterized that one as a justice or a steering bill per se. It was a delivery standards bill for pharmacies that use common mail carriers and the rulemaking process of how you provide those prescriptions to patients. It, it, I'd have to go back and
review all the details, representative Perry, and it may have some provisions in it that are anti-steering provisions, but it was mainly a drug delivery by using common carriers rulemaking process for the
Chair
Unverified
1:52:48
Board of Pharmacy to protect patients. OK, thank you. Representative Richardson, you recognize for a
Representative R. Scott Richardson
Unverified
1:52:53
question. Thank you, Mr. Speaker. The PSCs. How many of those are there?
There are 6 PSAOs in this state of Arkansas. OK, and if I heard
Speaker 156
1:53:11
you correctly earlier, you said that you guys aren't associated. Did I hear that correctly? You guys aren't associated with them. The association doesn't receive any funding from PSAOs. There are companies, just to clarify to representative Eaves, some of them do have ownership or are owned by wholesalers and we have received support at meetings or sponsorships at various things, but they're not members dues paying members of our association, and we've not received. anything directly from the PSAOs
in terms of financial for the association can you tell me who they are? Yeah, sure. So Epic is an independent PSAO out of Maryland to line RX out of Oklahoma. Um, there's one called Pharmacy First, which is merging with a line RX out of Oklahoma to become one company as we speak. There is uh Cardinals as leader that's affiliated with the company called Cardinal. You may be familiar with. There's one called Elevate and there's one called Healthmart Atlas. And
those last three do have some ownership ties or, or fully owned and wholly owned by wholesalers. Cardinal Sincora Marchwarzbergen, and McKesson. The other three are mostly independent or partially owned, and one
Speaker 220
1:54:21
of them I think was partially owned. OK, thank
Representative Robin Lundstrum
Unverified
1:54:29
you. Thank you. Any other questions? Resins. You're right now. First of all, thank you for bringing this bill. I, I haven't heard from a single small town pharmacist in
my area that isn't terrified of what's happening with these PBMs. Absolutely terrified. Um, and it concerns me, the small town pharmacist. If they can't survive, and you've even got Walmart and Harps concerned, this, this little guy's got no chance at all. If the big guys are getting beat up. So it worries me, we're going to be losing competition. I also am afraid. That if they're steering patients to theirs. Eventually they're just going to take theirs out and do mail in.
Speaker 156
1:55:14
Just have everybody mail in and then we can just close all our brick and mortars. I would say that if you read the Federal Trade Commission report on drugs that are more than $1000 that are defined as specialty, it was staggering that 70% are being filled by 3 pharmacies owned by PBMs. So if you want to see higher prices and less competition, keep letting things go the way they are. You want to stop that and encourage. Petition and bring down prices and bring back access locally
Representative R. Scott Richardson
Unverified
1:55:43
past this bill. That's a great question. Thank you. Any other questions? Yes. You're
Speaker 156
1:55:47
what you said there were 3 pharmacies that owned, what are those OptumRX, which is part of UnitedHealthcare, CVS, which is part of CVS Health and Aetna, and then Cigna, which is Express Scripts PBM, which is also a credo. In the FTC report that was filling $225 billion worth of specialty drugs and just those three in the United States.
OK. Seeing no other questions, we thank you for your testimony. We members, we do have numerous people signed up, so we're just going to start working our way down the list. The first person on the list to speak against this bill is Randy Zook, if you're in the room. There's Mr. Zuck. Just introduce yourself for the record and
Speaker 227
1:56:40
have your guest introduce himself and you can
proceed with your testimony. Thank you, Mr. Chairman and thank you members of the committee. I know the hour is getting a little uncomfortable for you on your schedule, but I'll try to be as brief as possible a minute like Mike to talk about some of the more technical issues around this process. Um, um, my comments
are going to focus on the effect on the Arkansas business
Mike Castleberry
Unverified
1:57:02
climate. Before we start, would you have your guest introduce himself. Yeah. Thank you, Mr. Chairman. I'm Mike Caseler. I'm with
Speaker 227
1:57:10
Consociate Representing and self-funded employers here in the state. Thank you. Proceed,
please. Thank you. Uh, my comments are going to focus on the effect of this bill on the business, the overall business climate. I've got members on both sides or maybe on all four sides of this issue. Uh, this is not just a one a quarter. with two sides to it. It's a complex issue, but I want to make some comments about the theoretical impact of of This direction of this bill. HB 1150 is a simple bill that
says a pharmacy benefit manager who owns a pharmacy must decide to be a PBM or a pharmacist in Arkansas because it can't be both under this bill. When did the government extend the government's job extend such arbitrary demands on our markets. The bill is a direct assault on innovation of businesses and consumer choice. The practice of a business purchasing part of its supply chain.
Our vertical integration is common and often used by large organizations including Exxon, Walmart, Tyson, McDonald's, Apple, you name it. Vertical integration is a very common business initiative. If you remove the term pharmacy benefit manager from the bill, I would imagine that none of you would touch it because of its clear government overreach. Let's consider the obvious
intent of the bill, which is to eliminate competition from the market. And guess what happens when you eliminate competition. Prices go up. Since 2018, lawmakers have placed regulations on the PBM industry to prevent predatory practices such as paying an affiliate pharmacy more than other pharmacies. From steering patients to affiliate pharmacies including mail order pharmacies, paying below the national average drug
acquisition cost, which is The industry priceless standard requiring rebates to be shared at the point of sale with the insured. And according to the last audit by the Arkansas Insurance Department, the PBMs were complying with the law. If a PBM behaves in the egregious manner described by proponents of the bill, AID has full authority to assess penalties and even revoke a
license. AID can audit any PM PBM at any time to ensure compliance with the law. This bill is a punitive measure to remove competition from the market. It is not about protection, patient protection or lower costs. Hundreds of thousands of Arkansans through free market competition, choose to fill their prescriptions at a pharmacy owned by PBM. Perhaps they like the convenience of mail order or picking up while shopping, picking up scripts while
shopping at a favorite retailer. Maybe they choose a PBM owned brick and mortar location because of service or convenience. Who knows? But the choice is the consumers. And these pharmacies made good faith business investments in our state with the expectation they'd be able to compete in our economy. This bill would unjustly force them to. the best putting about 600 hardworking Arkansans on the market or out of a job. With the
strict regulations, I just recounted. AID has the authority to throw out bad actors. So unless the state wants to get into the business of picking winners and losers in our economy. I see no reason to pass this bill. Just a few months ago, independent pharmacists were advocating for a dispensing fee rule. Because they claimed Arkansas's network was inadequate to support our market. Today, the same group is advocating to
force 40 or so plus pharmacies out of business. To me, that tells me what the bill is really about, which is using the government to ensure or increase market share. All businesses should be concerned when a bill like this comes along because it is a slippery slope that can jeopardize us all. If the pharmacists are successful, get ready for the next group to show up trying to do the same thing. I'll conclude by reiterating that the bill is
a classic example of unwarranted government overreach meant to eliminate competition in a mostly free market economies. Thank you for your time and I'd invite Mike to
Mike Castleberry
Unverified
2:02:03
make comments for you as well. Thank you, Mr. Chairman. Thank you, everybody on the committee for letting me come speak with you today.
Mike Casselberry
Unverified
2:02:09
Again, my name is Mike Casselberry. I represent self-funded employers around the state. So for those of you may not understand what that means, that means they pay their own claims. So if you go out and buy a Blue Cross policy and you pay a premium, Blue Cross is responsible for those claims. These employers pay their own
claims. They pay them every week. And so they're very conscious about cost. They see rising costs. I tell you that from my employers from Northeast Arkansas to Southwest Arkansas, one thing in common they all have is they can't afford anymore. They are to the point where they don't know that they can continue to offer benefits at the level. They've been offering them today. And we believe any time you remove competition from a sales market. I don't care if it's one of your three pharmacies or if it's 5 of your 25 pharmacies. We think fewer choices is going to rise prices.
Uh, what I'm more concerned about and what seems to have gotten glossed over is the lack of the ability to be able to use mail order. Um, this is, this is a big deal. A lot of people, this is the most cost effective way that my employers can pay for medication. It's through mail order. Absolutely. And the part the first phone calls y'all are going to get from your constituents is someone who's on a specialty drug. It's getting it through a mail order because that's how they can afford it, right? Most employers share the cost with specialty drugs on a percentage. So unlike a copay,
we may pay $5 or $10 or $50 for your drug, they actually share it in co-insurance. That employee may be paying 20 or 30% of the cost of that drug. And if they have to go and get it locally and the cost of that drug doubles, that's gonna be more money out of their pocket, and they're going to ask me and they're going to ask their employer why? Why is this? costing me more and I'm not going to have a good answer, right? Um we've hired numerous people in here indicate that the PBM actually sets the pricing. That's not correct. The pharmacy manufacturer, the person who actually makes the drug, they set their own pricing, right? They decide what they want to
get paid for that drug, and we've seen all those high cost drugs. We've seen all those million dollar drugs, that is the industry, that's who sets it. The PBM can negotiate. They can try to get better rates, but that's who actually sets the cost of the price. Just like when you go and buy a car, it's Ford that towed. Ford dealership, how much the car is going to cost. What they sell it for is their choice. Uh, so my, my employers are to the point where they are scared of every single piece of legislation that could add costs to their plan. Um, and, and because they pay their own claims and they pay them
regularly. They see it instantly. So you might say, well, what are the big insurance companies doing? Why are they not here sitting beside me? Why are they not concerned at the same level that I'm at. Because they don't have that issue right off the bat, right? They're gonna give you a renewal a year from now, right? They're gonna add to the rates a year from now. If y'all remember there's probably many of y'all in this room that were not in favor of the patient protection Affordable Care Act, Obamacare, right? There are probably many of us in here that were against that. If you recall the one thing that they constantly said was this was going to improve
the overall program and bring down costs. Well, we know that's not true, right now, looking back over the years, the cost did not go down, but what every major insurance company did is when they came back to renew your plan, and they came to give you your new rates. next year. They said, OK, I've got to add 3% to this because of this legislation. Now, we could argue if that's right or wrong or if that's true or not, but that's what they did. That was the actual impact. And so that's what my employers come from. They're so worried about continuing regulation that's going to add the cost of their health plan. And ultimately, as we all know, and for those of you that are small business owners, you absolutely know. At
some point, that's got to, you just give it back to your employee, right? You could only take so much to your bottom line and you give it back to your employee. Most employers would tell you they After salary, it's benefits, right? That's your single largest costs that they have, if we keep down this road where we're making it more expensive. I don't know when the break will happen when an employer just said, I just can't do it anymore, you know, we're just, we just won't be in
business because I can't afford the healthcare. I'll be happy to take any questions, Mr. Chairman. Thank you. There are numerous um
Representative Mark Perry
Unverified
2:06:04
ls ask some questions. We're going to start with Perry. Thank you, Mr. Chairman. I appreciate that, Mr. Casselberry, uh, I understand the, the insurance side of it. Mr. Eson made a made a comment that this would prevent like the OptumRx Express Scripts, those wouldn't be
Mike Casselberry
Unverified
2:06:23
able to sell. are in the state. That's my understanding is that if you're an out of state, mail order PBM pharmacy, you would not be able to sell those products here in
Representative Mark Perry
Unverified
2:06:35
this market, which you would almost forced to go to a brick and mortar, right, where the cost is definitely going to be more and being in Jacksonville, we have Little Rock Air Force Base, and they do all of theirs, all of their mail order through Express Scripts. So this would do that. I know a lot of my clients use, uh, Express Scripts and OptumRX. So this would
Mike Casselberry
Unverified
2:06:57
eliminate that and they would have to Uh, pick a different option. Yes, sir that's my understanding, and, and I would add to that that
The change is a problem, right? Having to make a change and go to a new location and I'll get your prescription. That's a little bit of a hassle, but what's more concerning would be the cost. If they've been accustomed to paying this amount through the mail
Representative Jack Ladyman
Unverified
2:07:25
order program and all of a sudden that's now increased. That's going to be a shock to them. Thank you. Yes, sir. Representative Leeman, you're next. Thank you, Mr. Chairman. Mr. Castleba, you said a couple of things that I I can't agree with you on, uh, from what I've heard and what
I've talked to people about for years, PBMs do set the selling price. You said they don't, I think, I think I heard you say that or maybe you just said they, they said the the manufacturers set the selling price. So when I was chair of public health, we had numerous calls with manufacturers, PBMs, and, and pharmacies about trying to figure out this thing, OK? The, the manufacturer, which I worked in manufacturing for many, many years. They set the selling
price. That's true. So the PBMs use that, but the PBMs also set the selling price. That's not the pharmacy setting that price. Now there are negotiations that can be done, but Basically, the PBM sets the price. Do
Speaker 234
2:08:20
you disagree with that? No, sir. I agree with you in principle about how the process works, but I'm talking about
Mike Castleberry
Unverified
2:08:26
where the price starts from. So I agree with that drug, right? They say this is how much I want for that drug, and then depending on what partner they work with, they try to negotiate, right? They try to
Representative Jack Ladyman
Unverified
2:08:41
get a better price. They want to agree on the selling price at the manufacturer level. But at the, the PBM sets the price for the pharmacies. The pharmacy does not set the price. But let me move on. You say it will kill mail order. As I said, I worked for, I worked for a large corporation in the world. We had mail order. I used it. Right? And we changed companies periodically during the 30 years I worked there. So that's not an unusual thing. If you have a pharmacy, a mail
order pharmacy drops out, gets too high, whatever the thing is, you know, we had people looking at that all the time. That's not an unusual thing to do. So I, I think you indicated that this would kill mail order pharmacies. I don't believe that's the case. There are other people that can provide these services and large corporations or companies and medium size, they can change that's, we're talking about competition here. There is
Speaker 234
2:09:35
competition out there. Would, would you agree with me on that? I definitely believe in competition. Absolutely, and I
Mike Casselberry
Unverified
2:09:42
think it should be fair and open and, and everybody should be able to develop the program that they think is most effective and that their employers want to buy, right? So I'm definitely in line with you when it comes to competition. My comment about mail order is, is It is the most cost effective way. All my employers will show you and tell you, I agree with you. This is the way it saves them as
Representative Jack Ladyman
Unverified
2:10:04
an employer and their employees' money. So I'm, I'm just trying to be real life here, right? I mean, I agree with that. but You would agree with me that
Speaker 234
2:10:13
this does not kill mail-order pharmacies. From reading of
Representative Jack Ladyman
Unverified
2:10:16
the legislation, there's going to be a lot of pharmacies that will not be able to participate in this
Speaker 234
2:10:20
market, but there will be mail order pharmacies still available. People can still get mail order drugs. If you, if your mail order in your PBM, no, right? That's what the legislation
Mike Casselberry
Unverified
2:10:29
says. So you're going to have to be a mail order but not a PBM. Which means you're going to be brick and mortar, right? I
Speaker 234
2:10:34
mean, I, I, I don't know, I don't know of one, I guess is what I'm saying. I don't know of a
Representative Jack Ladyman
Unverified
2:10:39
mail order company that is not attached themselves in this structure that we're discussing
Speaker 234
2:10:44
today, but if I want to buy a mail order drugs, I would still be able to do that, yes or no,
Representative Jon S. Eubanks
Unverified
2:10:51
not the way I read it, no, sir. And maybe we'll get more clarification from others, but that's the way I understand it, sir. Yes, sir. Representative Eubanks. Great answer for a question. Thank you, Mr. Chair. Mr. Zuck, you were talking about vertical integration and one of the companies you mentioned was Tyson, which is I'm very familiar with. I think the difference here is I don't, Tyson has still negotiate whatever they, their contracts
with their vendors. that on the in-market side, whether it's Kroger or Walmart or whatever the grocery chain is that's buying their product, whereas in this case the PBM is owning the end market. So if, if they are reimbursing their company-owned pharmacies differently than what they are the independence that puts them at a competitive advantage, so
that's problem that I see in this case, I still go back to I don't know that this bill is going to actually help anything because it doesn't solve the reimbursement rates for the other independents, but With my problem with the vertical integration in this case is that
Speaker 227
2:12:05
they're controlling the in market. Where the consumer, maybe a better example would be Exxon or anybody in the gas business where they own some of the retail stores as well as supply
the product wholesale to other dealers. They certainly don't set the market price. I, I was in that business. I'm one of the total failure of common sense on my part. I bought a convenience store. That is the worst business model in the Western maybe maybe globally. There's no way for an independent to make a nickel. that business other than selling. Crackers and Cokes and Now THC and views Selzer or whatever the heck it is, whatever the
heck it is, they survive on these days. Uh, but that, that I think is more, more akin to what we're looking at here where you've, where you've got um The the the the supplier of the product in several different aspects or different,
Representative Acker
Unverified
2:13:07
different channels in the marketplace. Reckon the Baker, you recognized? Thank you, Mr. Chair. Uh, this will be for both of
Representative Sonia Eubanks Barker
Unverified
2:13:13
you. Either of you read the FTC report or the House Oversight Committee report, yeah, so you saw where $19,000 from the mail order
pharmacy was not the most cost effective to the 97 used by the mail order pharmacies. I'm not doing my questions here. Oh, OK, sorry. So my question is, when we read that and you speak about eliminating competition, limiting competition is happening. That's what's happening and what it sounds like to me when you're here advocating for employers that you're advocating for what I'm calling PBM. Stockholm syndrome. You're advocating to not have access to the 600 mail order pharmacies that are licensed by the state board of pharmacy that are available today, tomorrow,
and regardless of whether this bill passes or not. Are you aware of that? Are you aware of the 600 mail order pharmacies that are not associated with the PBM that are licensed in the state of Arkansas for your members. Your members are I'll take your word for it. Your members aren't aware of it either because their PBM doesn't allow them to to engage in that, to give choice. Um, as far as cost effectiveness, the most cost effective in health care, we're not selling toasters. We're not selling tennis shoes. These are scared grandmothers. These are scared parents who have sick children. What they want is outcomes, and the only way for
them to have outcomes that are more beneficial is compliance, and we would have compliance is if they have freedom of choice. And you're here advocating against your employer's opportunity to make that freedom of choice because they have signed up with a vendor who has steered their patience, charged them thousands of over and you want that to continue. Randy Zook. Sir, you sat in this committee when we did 128 and acknowledged to Chairman Maddox that this is not a fair market. And we're here Advocating that
Speaker 226
2:14:53
Somehow They should be allowed to continue. I find
Speaker 227
2:14:57
that just Well, I think, I think, I think any time the state puts its heavy hand on the scales rather than market competition, consumer choices, expressed through purchasing, through buying and, you know, I, I'm, I'm, I live in Little Rock, so I have a lot of choices for where I go today, yeah, where I get my scripts. I, I drive by and now empty Walgreens, but I think that Walgreens, somebody acknowledged earlier that there
were a lot of things that caused that to collapse, just bad business decisions. Over, over expansion, um, getting out over their skis, and they paid the price for it. That's what markets do
Representative Sonia Eubanks Barker
Unverified
2:15:34
to people who make bad decisions. So you're saying that all the pharmacies that have closed have made bad decisions to be with their at and serve their members because they aren't a PBM and aren't mail order. Not saying that at all. You also did testify that
Speaker 244
2:15:48
the market's not fair in its current form, and this is
Representative Sonia Eubanks Barker
Unverified
2:15:51
before we regulate it. Um. When you mentioned that AID has full authority
we can watch the video later. AID you mentioned has full authority. The Federal Trade Commission can't even get CVS to comply with turning over the data. What makes you think that AID's full authority gives them full capacity. Why doesn't
Speaker 226
2:16:04
revoke their license. That's a great question. In fact, actually today when we
Speaker 139
2:16:08
passed this bill, that license will be revoked. There you go. So you're in support of revoking the license. Thank you for going. Thank you very much for that. OK, and far from it. Let's see here.
Speaker 1
2:16:27
I believe it's all I have for the moment. Thank you. OK. Say no other questions for these witnesses. Thank you so much for
your, thank you for your text. OK, we're gonna continue to move down the sheet to speak 4 11:50 Adam Head. Adam Head in the room? Go to the end of the table, sir. Introduce yourself, who you're with, and proceed with your
Adam Head
Unverified
2:16:58
testimony, please. Good afternoon, Representative Maddox, members of the committee. My name is Adam Head. I'm the President and CEO of Cartai. We're a cancer provider with 18 locations around the state of Arkansas. I was asked to speak here today just to provide a provider perspective on this, and
Carta's mission making trusted cancer care accessible. Has meant a lot of things to a lot of patients. We have an opportunity to take care. Of more cancer patients and we Look at this with a a lot of humility than than any other provider right now in the state and a lot of that's been because we have tried to go to a lot of locations where um cancer care has been Not accessible previously. How does this affect what we're talking about today? Well, a lot
of cancer care like other aspects of care, any other aspect, and any other health care provider in this room could attest to this. It takes a lot of care coordination with the patient at the center. Routinely for us, and we've got 20 at least 20 licensed pharmacists across our network with a number of different locations. Uh, they work hand in hand with our physicians to try to eliminate barriers in taking care of patients in very complicated drugs.
Um Very often, you know, a lot of this conversation we're having today is about uncomplicating things for patients. I hope it is anyway, from our perspective and what we have seen very often is a patient may inadvertently have Um, a plan, an insurance plan attached to a PBM that they don't really fully understand and they never used drugs before they go to car time. There's a lot of patients that we see and
we see this all the time where They typically are not getting any health care. They've never taken anything in their entire life, and then Cancer happens. And so they see us and Then it's discovered that they need to have a, a very complex drug that they're unfamiliar with, that they've never heard before. It's got 14 syllables and they come to us and say, I
had no idea. I'm having to use this. out of state pharmacy and have something mailed to me. And so that really bothers us as an organization because our heart is a nonprofit like a lot of our healthcare organizations are around the state is we're trying to uncomplicate things for patients. We're trying to provide that integrated model where whether we're working with one of our own pharmacists in-house or whether we're partnering partnering with a local community pharmacists, we can work together on behalf of a
patient and so from our perspective as we look at this, we are in support of it because we think it does just that. uncomplicates things for patients and readily provides that access that right now with many PBMs and putting them in the middle of it, it, it complicates it. It unnecessarily complicates it and creates an undue burden on patients that
Speaker 182
2:20:28
were taking care of every day. So Thank you. Thank
Representative Fred Allen
Unverified
2:20:33
you for your testimony. Questions? OK. Allen. OK.
Thank you, Mr. Chairman. Uh, thank you, Mr. Head for what you all are doing in that car tie. I was recently treated at Carta in my last treatment was in December and you all have some of the best doctors in the state of Arkansas and probably around the country, but I do have a question. Uh, when you talk about
Adam Head
Unverified
2:20:57
specialty drugs? Are you all able to get specialty drugs like some of these other companies are. We are through our licensed pharmacies, we can do just that, and we have
20 pharmacists that are working in our various sites all around. The state Among all our locations, so yes, we can access those, uh, we can. provide
those to patients in-house and working hand in hand with our physicians, our oncologists, or
Representative Fred Allen
Unverified
2:21:24
we can work with community pharmacies are some of the Um, pharmaceutical
Adam Head
Unverified
2:21:31
companies restricting you all from selling their drugs. So through the, through the PBMs we do hear
those stories routinely where patients will say, I had no idea that I couldn't get this handled for me here, or I couldn't get this handled for me at my local pharmacy. I can I do that? And say, well, according to this right here, you're actually going to have to get that mailed in and there's just, there's such fear that I, I think Many in this room can understand. I mean, there's 19,700 Arkansans that are projected to be diagnosed with cancer this year. And It flips your world upside down.
And you're hearing all sorts of phrases and treatments and words and drugs oftentimes because that goes hand in hand with cancer treatment, and you don't want to have to think about, oh my gosh, now I'm gonna have to get something that's going to be mailed in from out of state to me. Um, So it's, it's really important for
Chair
Unverified
2:22:31
us. It's our heartbeat as an organization to make that as easy
Representative Fred Allen
Unverified
2:22:36
as possible. follow up. Uh, I can relate to that. Because I'm a victim. It just recently happened to me.
I had my uh prescription given to me from the cancer treatment centers of America. I tried to get it filled here in the state of Arkansas, and they were not allow any pharmacist here in the state of Arkansas to fill my medication. So now I'm having to go to a company outside of the state of Arkansas and they'll mail it to me. So I think that what we need to do is try to find a way where we can eliminate those things from happening to patients, not just in the state and the city of
Little Rock, but around the state of Arkansas. So I appreciate
Representative Sonia Eubanks Barker
Unverified
2:23:21
what you're doing and I Thank you for your services. I appreciate it, Representative Representative Baker, for a question. Thank you, Mr. Head. Um. You know, as you know, when you speak to those, you know, 100% of my immediate family is suffering through cancer, 100% of my immediate family, myself included. Use your services, um. And so I really appreciate the
commitment you have and the access that you provide. Is Karta a member of the Arkansas State Chamber of Commerce. Yes. Are you familiar with the op ed that Randy Zook authored. In as a patient of yours, I found it. A little insulting, but I just, I want to ask you, do you feel like your services and your locations and your equipment and access are able to offer patients like myself
Representative Acker
Unverified
2:24:09
and my wife a better experience than a mailbox. Yes.
Speaker 1
2:24:15
Were you consulted at all before that op ed was written. No. Thank
you. Thank you. Any other questions? Thank you for your testimony, sir. Thank you. Next to speak against the bill and I believe they want to come up together is Ashley Ellis and Lynette Washington. If you're in the room, come up together. Please introduce yourselves and Who you're with and you can present your testimony.
Members before they start, just so you know, from a housekeeping perspective, it doesn't look like we're going to finish this bill before session. So we're gonna work until one, I apologize for that and the word come back after and finish this
Lynette Washington
Unverified
2:25:04
up and hopefully finish some others up, so that's just the way we're going to have to do it. You may proceed. Good afternoon. Members of the committee, my name is Lynette Washington, and I am the director of pharmacy practice at Accredo Health Group, and I'm testifying in opposition to House Bill 1150
Speaker 258
2:25:20
and the impact that it would have on current patients utilizing our pharmacy. Hi, I'm Ashley Ellis. Um,
Lynette Washington
Unverified
2:25:35
I'm in the district leader for CBS retail here in Arkansas. Thank you. You can proceed with your test. OK. Accredo is an accredited both your rack and TJC specialty pharmacy that serves patients with rare, complex and chronic health
conditions including cancer, hepatitis C, HIV, bleeding disorders, and multiple sclerosis. These drugs are often available through a select number of specialty pharmacies. Eredo has access to the widest list of these limited and sometime exclusive. Distribution drugs on the market. A credo specially trained pharmacists and nurses take pride in delivering personalized care, providing educational information to facilitate medication adherence
and manage adverse events. We collaborate closely with our patients and prescribers to ensure compliance with FDA mandated risk evaluation and mitigation strategy programs, also known as REMs, making sure that we prioritize the patient health. And safety. Our clinical team is structured around condition-specific therapeutic resource centers given us Allowing us to offer patients the support they need to effectively manage their
condition, with over 600 of our specially trained infusion nurses. Our patients can receive face to face care in the comfort of their homes. Additionally, we provide direct medication delivery to even the most remote areas and comprehensive administration guidance to ensure optimal treatment outcomes. We're dedicated to helping patients obtain, manage and understand these medications. Especially medications are typically very expensive, as you've already heard, and require complicated financial
support to ensure patients have access to therapy. Accredo billing specialists help patients minimize significant out of pocket copays and co-insurance costs by helping them find manufactured copay assistance program and foundational support programs for their prescriptions. The reimbursement specially removes the claim foul and burden from the patient by submitting claims directly to retail and major medical insurance plans and copay assistance programs on the patient's behalf.
Uh, patients receive services beyond dispensing. They also receive the essential administration supplies, infusion pumps, and ongoing clinical support, including education and counseling to manage their serious and complex conditions. Many of our patients required treatments involving 24 hour infusions and self infusion administration to ensure their safety and success, our pharmacists are available 24/7 to provide guidance. Answer questions. and offer step by step
instructions for self-administration and monitoring. The passage of House Bill 1150 could disrupt Arkansas patients' access to life sustaining medications and infusion pumps, leaving them without a timely solution. Most Arkansas hospitals or local pharmacists do not have access to these specialized therapies and equipment as a specialty pharmacy with extensive access to these exclusive products. Accredo is the most practical
option. Additionally, infusions are often administered in the comfort of the patient's home with the support of infusion nurse. Without a credo, these patients would be required to travel to hospitals and infusion centers to receive their treatments, which is not most. practical or efficient setting for their needs. In closing House Bill 1150 will negatively affect Arkansas patients currently being serviced by specialty pharmacies affiliated with the PBMs by a potentially
causing access to care issues and administration burden on patients and prescribers. I urge you lawmakers to consider
Speaker 258
2:29:35
the serious consequences of this bill. Thank you for your time. Thank you again for the opportunity to speak today. Um, again, I'm Ashley Ellis, a district leader for CVS Pharmacy. I live in Greenbrier and I um am based out of Conway. As a pharmacy leader, my role is to support my pharmacy teams as they provide care directly for
patients. A mentor, pharmacist, and students and coordinate the delivery of high quality care and pharmacy services at 23 CVS pharmacies across the state. I've been with CVS Health for 10 years, but I've lived in Arkansas all my life. I'm a proud alumna of the University of Central Arkansas and UAMS where I studied pharmacy. Today I'm here to personally share my concerns about HB 1150 and the harm it will do to the patients we serve and the colleagues that I work with every day.
As you hear testimony today, I'd like to plainly say that my colleagues and I are community pharmacists. We live and work in the same communities as our patients. Regularly serving around 340,000 of our neighbors every year. We're like family to our patients, providing them with support, guidance, and care. Whether I'm behind the counter or out and about in Conway, I see patients who I know both as as a pharmacist and as a neighbor. These relationships matter deeply to me, and I believe it matters to them as well.
I often see patients come in late on a Thursday or early on a Saturday because they need care immediately and other pharmacies are closed. This bill will limit that timely care that we all know patients often need. I was raised by my grandfather and was driven to become a pharmacist after seeing his struggle with Parkinson's disease. This was a hard time for my family, not only what he was going through, but the confusion we all felt and how I wished someone could help us understand how to manage some scary side effects.
That experience led me to become a pharmacist. Beyond filling prescriptions, my pharmacy team and I provide medication therapy management, over the counter counseling as well as help triage any adverse effects they may have while on therapy. This bill will not improve patient care in Arkansas. It will disrupt it. 340,000 of our neighbors will lose a long-standing relationship that they have with a pharmacist they trust. Relationships that cannot be rebuilt overnight. It will mean longer lines at
existing pharmacies and risk hurting people's health by interrupting their medications. I can't imagine that any legislator would vote for a bill that prevents me from continuing to see the pharmacy provider of my choice. On a direct and personal level, passing this bill will eliminate my job and the job of hundreds of colleagues that I serve every day in communities across the state. I do believe that this is a decision. I do not believe that this is a decision that the government should be imposing on us. I came to Little Rock today
because I care about patients that I serve. I want to go back to the work that I do to help them and
Speaker 262
2:32:43
my community. So I urge you legislators to vote no on this bill,
Representative Richard McGrew
Unverified
2:32:48
and I'm happy to answer any questions. Thank you for your testimony. We have a
couple of questions. Refson McGurry, you recognized him. Thank you, Chairman. And you represent CVS, uh, I have got Numerous emails on this on this bill. A lot of them opposing the bill.
I make it a point if those are from my district, I call them back if I can. Some of them had the phone numbers. Almost all of them I called knew nothing about this. Their name was used on an email, obviously by lobbyists, the one I I called and checked on this morning. was from Hot Springs Village and when I explained what I'm calling for, they said, we haven't, we didn't email you. We don't know anything about this, and I explained it. They said, well, how did these people use our name? I said, I don't know. I don't know how you got.
And I said, I know, he said, well, we get our drugs filled from CBS. Can we call them and complain? I said, absolutely do. Integrity is very important to me and when If that information is coming through CBS, which several of them it seemed to be. To me it's terrible. They're representing falsehoods and breach of integrity and some of the information on there wasn't right. So SCBS,
Speaker 258
2:34:02
do you advocate for that? Have you been part of that? I don't know anything about
that, and I do work for CBS retail, but I'm, I'm here as a community pharmacist. OK. Thank you.
Speaker 1
2:34:25
Thank you. Any other questions for these witnesses? Thank you so much for your testimony. Next to speak for the bill is Brittany Butterfield. OK.
I don't see anyone, so. How about Cali, I can't read the last name, Birch or Bunch. There
anyone outside the These are 4. We're looking for a 4. Is there anyone who has signed up with like to speak for this bill? And if you feel your side has been advocated for, you certainly do not have to testify. But um, anyone else so
I speak for this bill. OK. So we're going to move back to the against.
We have Russell Harper and Sharon Faust. I would like to come to the
table together. If you would just introduce yourselves for the record
Speaker 267
2:35:40
and proceed with your testimony, please. first. Yes, sir, still, or I guess in the afternoon hours, so good
afternoon, uh, Mr. Chairman, members of the committee, I'm Russell Harper, I'm an executive of government relations with Navitas Health Solutions. Uh, Navidus is a 100% pass through PBM. Uh, we're fully transparent and we serve over 167,000 Arkansans, including the state employees, Baptist Health and others. We do what is in the best interests of our clients. And others to provide top quality customer service and improved patient health by partnering with Arkansas
Provider community, including locally operated pharmacies. It's a belief that House Bill 1150, as I did. Will result in lots of unintended consequences that will bring patient disruption. Patient confusion and patient access issues to important drug treatments, not just in the commercial market, but in Medicare, Medicaid, and Tricare. Sharon is
Speaker 269
2:36:44
going to outline These concerns in more detail. Thank you, Russell. Sharon
Faust, Chief Pharmacy Officer for Navitas Health Solutions. Again, I thank you for letting me speak today on a on a matter that's very, very important to me, which is access to patient care. We have deep concerns about House Bill 1150 for these these access reasons. I want, I want to talk a little bit about my history. I've spent 15 years in the pharmacy profession as a pharmacist. I've spent time with hospice care within mental health pharmacies,
specialty pharmacy, retail community pharmacy, um, and then the PBM space. So a wide breadth of experience. I'm also recognized nationally for patient care and sit on boards for national associations, so I'm very passionate about how our, our patients have access. Three things I want to highlight today as it relates to this bill. The pharmacy access to care. While we've been talking a lot about access, especially when we look at our Alzheimer's patient.
Patients earlier in the day, Access matters. Uh, I also want to talk about patient disruption and how fragile patient disruption can be for the care of the member. And then lastly, patient choice. I know we've talked a lot about vertically integrated entities and understanding where else in the industry does this occur? It's occurring in a lot of healthcare industries. We've got United Healthcare that owns providers. We've got health systems that maybe own health plans and own their own
specialty pharmacies that may be direct right into their specialty pharmacy. It is a slippery slope and it is occurring all over as, as we have. Vertical integration and let's say supply chain integration across a number of industries. The prevention of PB owned affiliated pharmacies will have a very great impact on Arkansas residents. We've heard the 30 number from Navitas account, it's actually more like 50 to 60.
Because while we're focusing on the big 3 PBMs that exist in our industry. There's actually more than 100 PBMs in the, in the pharmacy benefits industry. For example, Kroger has Kroger prescription plans. The 26 pharmacies of Kroger, 9 of which are in Little Rock, were also be included as excluded pharmacies in this bill. We already talked about the 23 uh pharmacies of, of CVS, but there's also specialty
pharmacies within Arkansas that provide critical care, for example, Genoa, which is, which is owned by Optum has 5 mental health pharmacies in mental health facilities. Jadaa is actually a pharmacy that I worked in, uh, early in my career and got to see the impact that that pharmacy in particular with a specialty. On mental health is able to produce, um, as it's directed to some of our most serious mental
health conditions. The schizophrenia and things like that. So specialized care in um components for for those members. Uh, a lot of this uh really creates disruption when we talk about eliminating these pharmacies. We talked about how 2 independent pharmacies may have been to run out of business in the last year as it was stated. We're looking at greater than 60 in this. So 1 out of 20
pharmacies will be going out of business in Arkansas, related to this bill. That patient disruption does have an impact. In a recent JAMA article, they mentioned that 15% decrease in adherence when members have to switch pharmacies. If you think about the fact of what your setup is, I know for me, I dropped my daughter off at gymnastics. I go hit the pharmacy and I come back to
Speaker 273
2:40:54
pick her up. that Disruption creates adherence
Speaker 269
2:40:59
issues within within Arkansas residents. The other uh unknown is also Costco, as Costco looks to enter business into Arkansas, this would limit Costco from having pharmacies in the state. Finally, I want to talk about patient choice. Arkansas has been a leader as it comes to pharmacy legislation and regulation. As a as talked before about the fair and reasonable pricing that the AID has access to.
The anti-steering and the option and the choice, actually a front runner. This takes it, I would argue, a step too far, a step further, where you're now actually limiting patient choice, reducing competition, uh, for, for uh those members. Um, I would encourage you to think about how patients can choose pharmacies that are maybe outside the scope of our standard retail. We heard about an Alzheimer's patient this morning who wanted to get free
drug from a manufacturer. A lot of those free drug pharmacies for low income patients may be run by a PBM owned pharmacy. For example, freedom fertility is is owned by ESI Freedom Fertility offers special programs for military members that are looking to get fertility care at cash prices. All of those programs weregovi weight loss drugs,
direct to manufacturer with the novo program through Humana's insurance. Uh, or Humana pharm pharmacy, I should say. Patients don't have the choice to go to those direct to consumer pharmacies if they are looking to shop the market. And that is a, a risk and does create a gap to care for those members. I don't want to take up too much of your time, but I hope I've been able to highlight just some of the things that maybe we haven't thought about as it
relates to the conversation thus far and how we'll have a great impact if we limit PBM affiliated or owned pharmacies in the state from providing care for for patients. I
welcome any questions. Any questions from this witness? Thank you for your testimony. Sir, if you'd like to introduce yourself, who you're with, and you can proceed with your testimony. He's good. Oh, I'm good. I, I, I started off, sir.
Speaker 267
2:43:34
I can keep going though if you want. Thank, thank you. We would like to leave the committee with a list of impacted pharmacies that will, that will have to close, um,
Speaker 1
2:43:42
if we do I pass those out or somebody will. Thank
you. Thank you, thank you for your testimony. Thank you. OK, we had, as I said, we had numerous people who had signed up to speak for. Is there anyone else who'd like to speak for this bill? Yeah. So anyone else would like to speak against this bill.
Represent more you recognize the clothes for your bill. And Member of staff is passing out the Handout that was referenced. Thank
Representative Kendra Moore
Unverified
2:44:21
you, members. I'm going to let Mr. Vinson answer and rebut some of the points that have been made by some of the testimony.
just a few things. There were comments that The prescription drug, yes, sir. I, I don't want, I, I hate to do this, but I
Representative Mark Perry
Unverified
2:44:50
think we're just in the closing now. So go ahead you can close and then we can discuss. Thank you, Mr. Chair. Um, there have been a lot of testimony on both sides today, some of which I believe is very true and factual, some of which I believe is less so, um, the issue at hand is not vertical integration
as it sits and typical normal business. There's nothing wrong with vertical integration. Unless you have the opportunity to set the prices for your competitors. Um, I've got a list of 8000 patients here in Arkansas that have signed a petition asking us to vote in favor of this legislation. Um, just yesterday, Just yesterday, I have a list of 3 prescription drugs of what an independent pharmacist was reimbursed and what a PBM owned pharmacist was
reimbursed. And I'm not going to pronounce the names because they're too big and too many syllables. Um. One drug CVS was paid $13.04. The Independent was paid $7.68. The next drug CVS was paid $54.83. The Independent was paid $21. The third drug, CVS was paid $50.64. And the Independent was paid $24.80.
These stats came from yesterday, April 1st. And if that doesn't disturb you, it should. This is a very weighty topic and a very serious issue, and I appreciate the honest deliberation among the members today and with that. I would appreciate a vote for fair for free and fair markets. A vote for our patients and our taxpayers. Thank you. I'm close to the bill.
Speaker 103
2:46:47
Whereas a maker, he recognized. OK, we have a
Representative Jack Ladyman
Unverified
2:47:00
motion at the proper time. Members are any discussion amongst the members, Representative Ladyman. Thank you, Mr. Chairman. Well, I mean, this is very difficult, very complicated issue, um, but to me, uh, it basically boils down to the monopolizing an industry or a a
a section of an industry and I know we have to be very careful when we limit choices and we restrict businesses, and I am not for that, but we are the gatekeepers when it comes to monopolies. I'm not saying this is a monopoly, but if it looks like a monopoly and it smells like a monopoly, it might actually be a monopoly. So that's why I'll be voting for the bill. I think we, we have to be the gatekeepers and and take all this data and make a decision. Thank you, Mr. Chairman.
Thank you. Further discussion from the members. saying no Representative Acer, you are recognized. I make a motion do pass. We have a motion do pass. Any further discussion on the motion? Seeing that all in
favor say aye and say no. The eyes have it. Congratulations and more, you've passed your bill. Members, we are going to break for lunch and we are gonna come back, um, 15 minutes upon
Unknown speaker
2:48:22
adjournment, try to handle as many house bills as we can. Thank you. right I gotta run. I got a baby.
Agenda
REGULAR AGENDA
Number Sponsor Subtitle
HB1055 J. Mayberry TO ESTABLISH COVERAGE DIAGNOSIS AND TREATMENT TO SLOW THE PROGRESSION OF ALZHEIMER'S DISEASE OR OTHER DEMENTIA-RELATED DISEASE UNDER THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM.
HB1150 J. Moore TO PROHIBIT A PHARMACY BENEFITS MANAGER FROM OBTAINING CERTAIN PHARMACY PERMITS.
HB1354 Lundstrum TO REGULATE PHARMACY BENEFITS MANAGERS; TO AMEND THE LAW CONCERNING THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM; AND TO AMEND THE LAW CONCERNING CERTAIN HEALTH BENEFIT PLANS.
SB237 J. Boyd TO AMEND THE LAW CONCERNING THE LICENSING AND REGULATION OF CAPTIVE INSURERS.
HB1295 L. Johnson TO CREATE THE HEALTHCARE COST-SHARING COLLECTIONS ACT.
HB1308 Steimel CONCERNING UNFAIR PRACTICES RELATED TO RESIDENTIAL REAL ESTATE REPAIR CONTRACTS; AND TO REGULATE SOLICITING RESIDENTIAL CONTRACTORS AND TREE CONTRACTORS.
HB1811 Steimel TO AMEND PROPERTY AND CASUALTY LAW; AND TO REQUIRE REASONABLE PROOF OF PAYMENT OF A DEDUCTIBLE TO RECOUP RECOVERABLE DEPRECIATION UNDER PROPERTY AND CASUALTY LAW.
HB1813 Gramlich TO ADOPT THE FAIR AND EFFICIENT TRANSMISSION COMPACT.
SB405 J. Dismang TO AMEND THE ONLINE MARKETPLACE CONSUMER INFORM ACT.
HB1850 L. Johnson TO AMEND THE LAW CONCERNING GROUND AMBULANCE SERVICES; TO CLARIFY THE MINIMUM ALLOWABLE REIMBURSEMENT FOR GROUND AMBULANCE SERVICES; AND TO DECLARE AN EMERGENCY.
HB1853 J. Moore TO AMEND THE LAW CONCERNING AGENCY RELATIONSHIP AND DUTIES RELATED TO REAL ESTATE LICENSES; AND TO CLARIFY THE OBLIGATIONS OF DUAL AGENCY.
SB420 Hester TO EXPAND ELIGIBILITY FOR WATER DEVELOPMENT STATE PROGRAMS; TO AMEND THE WATER AUTHORITY ACT; AND TO AMEND THE USES OF THE CONSTRUCTION ASSISTANCE REVOLVING LOAN FUND.
HB1863 L. Johnson TO AMEND THE TRANSPORTATION BENEFIT MANAGER ACT; AND TO DECLARE AN EMERGENCY.
HB1868 L. Johnson TO REQUIRE AN INSURER TO PAY A FAIR AND REASONABLE SERVICE FEE
DIRECTLY TO A FIRE DEPARTMENT FOR FIREFIGHTING SERVICES BASED ON TIME ON SCENE.
HB1409 Long TO AMEND THE LAW REGARDING ENERGY; AND TO CREATE THE ELECTRIC RELIABILITY ACT.
HB1177 M. Brown TO AMEND THE ARKANSAS FRANCHISE PRACTICES ACT; AND TO CLARIFY THE APPLICABILITY OF THE ARKANSAS FRANCHISE PRACTICES ACT.
HB1443 Pilkington TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY ACT; TO PROHIBIT FINANCIAL INSTITUTIONS AND PAYMENT NETWORKS FROM USING CERTAIN DISCRIMINATORY PRACTICES; AND TO PROVIDE FOR ENFORCEMENT OF VIOLATIONS.
HB1942 L. Johnson TO REQUIRE CERTAIN REIMBURSEMENT RATES FOR HOME- AND COMMUNITY- BASED SERVICES WITHIN RISK-BASED PROVIDER ORGANIZATIONS.
HB1905 Lundstrum TO CREATE THE BUYER BEWARE ACT; AND TO REQUIRE A REAL ESTATE LICENSEE REPRESENTING A SELLER TO DIRECT THE SELLER TO THE OFFICE OF THE COUNTY ASSESSOR FOR THE CURRENT ASSESSED VALUE OF A RESIDENTIAL REAL ESTATE PROPERTY.
HB1930 Wardlaw TO MANDATE MINIMUM REIMBURSEMENT LEVELS FOR HEALTHCARE SERVICES.
HB1159 J. Richardson TO CREATE THE RETAIL CONVENIENCE STORE SECURITY ACT; AND TO REGULATE SECURITY MEASURES AT RETAIL CONVENIENCE STORES.
HB1917 M. Shepherd TO AMEND THE ARKANSAS STUDENT-ATHLETE PUBLICITY RIGHTS ACT; AND TO AMEND THE LAW RELATED TO ATHLETIC PROGRAM FUNDING.
HB1918 McAlindon TO AMEND THE LAW CONCERNING SPECIE OR LEGAL TENDER; TO AUTHORIZE THE USE OF A BULLION DEPOSITORY; AND TO ALLOW FOR A PRECIOUS METALS-BACKED ELECTRONIC SYSTEM.
SB123 G. Leding TO AMEND THE LAW CONCERNING COVERAGE FOR MAMMOGRAMS AND BREAST ULTRASOUNDS.
SB463 M. McKee TO REQUIRE THE ARKANSAS PUBLIC SERVICE COMMISSION TO APPROVE OR DENY SETTLEMENT AGREEMENTS CONCERNING CLOSING OR ELIMINATING ELECTRIC GENERATION UNITS OR TRANSMISSION ASSETS.
SB480 K. Hammer TO AMEND THE LAW CONCERNING THE INVESTMENT OF STATE FUNDS.
SB331 G. Leding CONCERNING COVERAGE FOR GENETIC TESTING FOR INHERITED CANCER MUTATIONS; AND TO CREATE THE GENETIC TESTING ACT.
SB448 J. Petty TO AUTHORIZE THE FINANCING OF ENERGY EFFICIENCY IMPROVEMENTS, ALTERNATIVE ENERGY IMPROVEMENTS, BUILDING RESILIENCY IMPROVEMENTS, AND WATER CONSERVATION IMPROVEMENTS.
SB483 Irvin TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT AND THE STATE SECURITIES DEPARTMENT; AND TO REVISE CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT.
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — INSURANCE & COMMERCE- HOUSE, Apr 2, 2025 | Agenda | 3 | Official source ↗ |
Speakers
Speaker 2
Speaker 1
Representative John Maddox Chair
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Representative Julie Mayberry
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Representative Lee Johnson
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David Cook
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Speaker 22
Representative Carol Dalby
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Speaker 39
Representative Kenneth B. Ferguson
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Representative Jon S. Eubanks
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Representative Jack Ladyman
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Speaker 65
Representative Fred Allen
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Representative Dwight Tosh
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Representative Richard McGrew
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Representative Robin Lundstrum
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Steve Daniels
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Representative Trey Steimel Chair
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Speaker 125
Chair
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Representative R. Scott Richardson
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Representative Sonia Eubanks Barker
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Representative Kendra Moore
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Representative Mark Perry
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Representative Les D. Eaves
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Representative Austin McCollum
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Mike Castleberry
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Mike Casselberry
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Representative Acker
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Adam Head
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Lynette Washington
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