Insurance & Commerce- House
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Transcript
1 document
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 agenda, chapter
Matched: “…ONCERNING THE LICENSING AND REGULATION OF CAPTIVE INSURERS. 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. |
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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 |
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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…”
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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 |
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SB448
Act 579
· 2 mentions in chapter, agenda
Matched: “SB448 J. Petty TO AUTHORIZE THE FINANCING OF ENERGY EFFICIENCY IM…”
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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…”
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TO REQUIRE THE ARKANSAS PUBLIC SERVICE COMMISSION TO APPROVE OR DENY SETTLEMENT AGREEMENTS CONCERNING CLOSING … | M. McKee | Notification that SB463 is now Act 580 |
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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 |
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SB483
Act 957
· 2 mentions in chapter, agenda
Matched: “SB483 Irvin TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STAT…”
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TO REPEAL CERTAIN REPORTING REQUIREMENTS FOR THE STATE INSURANCE DEPARTMENT AND THE STATE SECURITIES DEPARTMENT; … | Irvin | Notification that SB483 is now Act 957 |
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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…”
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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 … |
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HB1443
· 1 mention in chapter
Matched: “HB1443 Pilkington TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY…”
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TO CREATE THE SECOND AMENDMENT FINANCIAL PRIVACY ACT; TO PROHIBIT FINANCIAL INSTITUTIONS AND PAYMENT NETWORKS … | Pilkington | Died in House Committee at Sine Die adjournment. |
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HB1533
· 1 mention in agenda
Matched: “…RTMENT. Page 2 of 3 DEFERRED BILLS Number Sponsor Subtitle HB1533 Gramlich TO CREATE THE DECENTRALIZED UNINCORPORATED NONPROF…”
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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 |
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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. |
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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 |
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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 |
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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
0:02
present HB 1055. Representative Mayberry, if you would, just introduce
Speaker 1
0:12
yourself for the record. Have your witnesses introduce themselves and
who they're with, and you can proceed with your testimony. State Representative Julie Mayberry.
Representative Julie Mayberry
Unverified
0:24
David Cook, the Director of Government Affairs for the Alzheimer's Association.
Representative Lee Johnson
Unverified
0:33
Dr. Morgan Sauer with Baptist Health and the Alzheimer's
Representative Julie Mayberry
Unverified
0:42
Association. You may proceed. Okay, 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 each session we have recommendations. This is actually one of those recommendations. We had a presentation back in July of 23 that told us that there's a new drug that's available,
approved by the FDA, to not 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,
Dr. Wei and Dr. Azar, and you are getting this 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 U.S. 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. As you can see in the presentation that Dr. Azar gave this committee, this is not a a medication that you just walk in, there's very few who actually will qualify. The main thing is
you have to be diagnosed early. The earlier the diagnosis, the better, and you will hear from some folks here in a little bit who can give you 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 happy to take some questions from you. Mr.
David Cook
Unverified
3:13
Members, thank you for the opportunity to speak on 1055, House Bill 1055.
This legislation is about access to care for
our state employees and those public servants who served this state and given their life on behalf of service to this state. The Alzheimer's Association contends that this decision to rather take the treatment should happen in clinicians' offices by physicians and not be permanently denied by bureaucrats. This ensures that state employees have the same level of access that Arkansans who participate in the state Medicaid program and those veterans who can't access these treatments.
It's not about spending more. It's about spending smarter. What we do know is that delayed care leads to more expensive late-stage interventions like long-term care and emergency care. Prior to 2023, physicians had very limited tools in their toolbox to treat behaviors associated with Alzheimer's disease or dementia, but 2023 was a landmark year, as the FDA did give approval to its first drug, 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 some of the proteins being present in the body up to 20 years before a patient can become symptomatic. And so these treatments, while they are not a cure, what they do promise is to give patients more time, more time to participate in life, more time to watch grandchildren grow up and graduate, more time to be with family, and more time to plan for the future. And it's 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 important to understand these are different than what doctors have had in the past. 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. And so, again, at the end of the day, this bill is just about access, creating access for our state employees to make sure that these decisions happen in doctor's offices where we think they're most appropriate.
Speaker 21
5:35
Your turn. Members of the committee, thank you for letting me speak today. I'm
Speaker 22
5:44
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. 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 neural degeneration, 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. UAMS is our fine academic institution with incredible reputation and integrity. The UAMS 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. 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 is 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 specialized imaging. Most people have to leave the state to go get that because we don't have 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. 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 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 I 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 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 people who serve our state the same access to this medication as patients on Medicare, Medicaid,
Speaker 21
11:37
through the VA, Aetna, Centene. I'm certainly happy to take any questions that you might have. Thank you for
your testimony. We do have some questions. Representative Dalby, you are first to be recognized for
Representative Carol Dalby
Unverified
11:56
a question. Thank you, Mr. Chair. Representative Mayberry, I apologize. I was late getting in here because I was over in the Senate. So I missed the first part of your presentation. Was there any mention, and I've read the projected cost,
and this is $90,000 a patient, evidently, for this treatment. What is your proposal, and how is the state going to pay for this? And I apologize. You may have covered that, and I
just didn't hear it. And I think I'm sympathetic, but at the same time, I think we have to also weigh what's going to be the cost to the state. And I have really a two-part question, so
that's the first part. And the second part, I'm sorry I didn't catch everybody's name,
But it sounds like that this is a covered drug with other insurance companies, and I would be curious as to if there was a rise in premiums for having to cover such an expensive treatment. And we all understand why it might be because it's somewhat experimental. But could you kind of address those? And once again, I apologize if I missed that part. I did
Representative Julie Mayberry
Unverified
13:12
not talk about cost. Obviously, that's a question to talk about. Let me back up, and I will repeat that this is covered by, this came out of the Alzheimer's
Disease and Dementia Advisory Committee that meets here almost quarterly. I co-chair it. Clint Penzo is my Senate chair on it. We've had many discussions in those committees on this particular medicine and all that. We did ask all the insurance companies in the state of Arkansas. Centene covers it. United Healthcare covers it. The U.S. Veterans Health Administration covers it. Medicare and Medicaid cover it. So our state is already covering it through Medicaid.
I believe that our state employees and our public school employees should have the same benefits that our Medicaid patients currently have. This medication is expensive, but I would say that it's not $90,000 a patient. I'm going to let David Cook from the Alzheimer's
Association kind of share more of what those dollars are, if that's okay. Representative
David Cook
Unverified
14:20
Dalby, Siegel put out two fiscal impacts on this bill.
The first showed that it was a negligible impact to the state budget. EBD disagreed with those findings and then produced theirs. Based on what we're seeing in terms of claims data and the criteria that Dr. Sauer just mentioned, the scope of patients who would qualify who are currently covered by EBD is very small. The Alzheimer's Association, let me 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 and so the Alzheimer's Association in our initial analysis contacted the Arkansas Administrative Statewide Information System and the public school network and what we discovered based on the participants in the the state plans of those aged 55 to 64 an estimated 26,310 Arkansans if we apply the Mayo Clinic's risk rate of 0.11 percent we We conservatively expected around 29 individuals to develop early cognitive decline in this
pool, whereas EBD suggests there would be -- I know there's currently 120 on behavior modification drugs. We're not seeing the rate of utilization that they forecast. So the association looked at real claims data, and specifically we looked at Indiana. It's apples to oranges, but it's kind of giving you a perspective, and we looked specifically at their Medicaid claims data and just to give you perspective you know Indiana has 357,600 enrollees between the ages of 45 and 64 on their state Medicaid population in 2023 only eight of
those people qualified for treatment which is 0.002 percent of that population so the association contains that because 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 data we see across the country, at the most, and it's a high estimate on our part, 29 people of the 26,000 would
actually qualify for something if you catch it at the right stage.
Representative Carol Dalby
Unverified
16:47
Once someone starts this treatment, are they on it for
Speaker 21
16:55
the rest of their life? No, ma'am, they certainly are not. This medication is only to
Speaker 22
17:00
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 time will move forward, and when people move into moderate or severe Alzheimer's disease, which is tested by doing what we call neurocognitive testing,
when those scores reach a certain point,
Speaker 39
17:29
then this medication is discontinued. Representative Sargaard? I'm sorry. Additionally, I
Speaker 22
17:33
wanted to bring a point that Mr. Cook brought up. While there were 120 people that were found to be on behavioral modifying medications, 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 for the behavioral-modifying drugs. So the behavioral-modifying drugs are also used in multiple other disorders, such as multi-infarct dementia, vascular dementia, and Lewy-bodied 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 the struck.
Representative Kenneth B. Ferguson
Unverified
18:27
Thank you. Representative Ferguson, recognize for a question? Well, I do have one.
Speaker 42
18:40
I think that was Representative Allen who was raising
Representative Jon S. Eubanks
Unverified
18:45
his hand. But since you called me, I'm going to ask my question. Well, your name was on the list. I want to be clear. Go ahead,
Representative Kenneth B. Ferguson
Unverified
18:52
Representative. Let me ask this question this way. Allow me just a little latitude.
I've got a friend who's a veteran. 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 physical impact statement, Siegel doesn't say very much, but I think EBD does, and it says somewhere between $2 million to $4 million. I think you're looking at it, too. So is it $2 million to $4 million estimated cost, not savings?
Representative Julie Mayberry
Unverified
20:06
Correct? Correct. We would argue with that cost, as David has pointed out, that we don't think
it would be that amount. But, yes, that is
Representative Kenneth B. Ferguson
Unverified
20:18
correct. That is the cost. Does not consider the savings. Okay, okay, okay. And
then going back to my friend who's a veteran. So let's get back. I know you said that the VA covers this medicine. But only a, what's the qualification, just briefly, to be eligible for it?
Speaker 21
20:44
So the qualifications are that you have to have what's either diagnosed by neuropsychiatric testing
Speaker 22
20:50
as mild cognitive impairment or pre-Alzheimer or pre-dementia for 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's limited 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 four 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. Then it resolves by definition. And if it doesn't resolve, then that is actually considered a stroke. Okay. Okay. That answers another question
Representative Kenneth B. Ferguson
Unverified
21:58
I have because I've got an in-law that kind of fits that profile. But he,
too, is a veteran, and he's, too, receiving some help. Thank you. Thank you, Mr. Chair. Representative Leitman, you
Representative Jack Ladyman
Unverified
22:13
recognize for a question. Thank you, Mr. Chairman. Well, Mr. Cook and Representative Mayberry, I know you all work on this.
David, I know you work on it every day, and you really want to improve treatment for these folks, and it's a big problem. And I have actually followed these drugs for years through the testing process, the different levels, because I thought, you know, we have nothing, as you said, doctor, to help these folks, nothing. And I thought 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, what are other states? You mentioned Indiana, but are other states doing what you all are asking us to
David Cook
Unverified
23:03
do? Sure. Yes, Illinois enacted legislation in 2023. I know there's pending legislation in Georgia, but this is kind of our initial ways.
It's 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 where that's at right now. Thank you,
Representative Lighteman. Representative Richardson, you're recognized. Representative Johnson, you're recognized. Thank you, Mr. Chairman,
Representative Lee Johnson
Unverified
23:44
and thank you for the testimony. 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 broadly just saying drugs, right? So not specific to this drug, or is that correct? Yes, sir, that's correct. And so, maybe this is more of a question for EBD, but I'm just curious about the process to make sure providers are following these narrow criteria and that we're 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, I have a 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 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. That's not an 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? I'm going to speak
Speaker 22
25:32
a little bit to that. When you look at other programs that provide this medication, one requirement is that people do have to have a specialized scan.
Speaker 21
25:42
I should have mentioned this when answering your question, a specialized scan showing that the target of the medication is actually actively present. Who requires
Representative Lee Johnson
Unverified
25:52
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
requirements? I'm going to speak to the medicine
Speaker 22
26:03
part of it. I'll let him speak to the legislative part of it. When you look at all the other entities like Centene, all of those who do this, they pretty much follow Medicare guidelines.
In general, in medicine, when Medicare comes down with something, they usually are the most stringent and have put the most research into it. And companies, instead of reinventing the wheel, they follow Medicare's guidelines for this. And so when you look at those, like if you go to Aetna and look and see what Aetna did, you have to have a specialized type of doctor. So neurologists, geriatricians, behavioral neurologists are limited to prescribing this. Additionally, you have to have both the patient and the physician register
with a nationally approved registry. ALSnet is one of those 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 are in place for inappropriate prescribing. And does this bill require
Representative Lee Johnson
Unverified
27:06
those same guardrails? Yes, sir. If
David Cook
Unverified
27:09
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 EBD some flexibility that they can't be more restrictive than the label. But the label does require, again, the presence of amyloid, which is an extensive test, and, of course, the registry requirements as well. And physicians across the state are following the appropriate use recommendations. that were put out in place, I believe, in early 2024 by a panel of physicians from across the country. Does this allow
Representative Lee Johnson
Unverified
27:45
them to seek a power authorization?
David Cook
Unverified
27:49
Sure. We spoke extensively about the step therapy piece. For these particular treatments, there is no step therapy. The only option to have step therapy in place for EBD was to put a patient on Aerosept or another behavior mod because these are a unique type of treatment. So we suggest there is no step therapy unless it's behavior modification drugs. I would argue that
Representative Lee Johnson
Unverified
28:12
step therapy and prior authorization are two different things. I mean, prior authorization is an approval. Step therapy is, you know, fail-first therapy.
Yeah. And I didn't know if this bill allowed for prior authorization. Because, you know, the members of the committee are very familiar with my stance on prior authorization, right? I have a pretty strong opinion about that in general. But when we did the go-kart legislation, I very specifically carved out pharmacy benefits because I recognized 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 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 and medical board to decide where those drugs, where that line is drawn. And so my question would be, does this allow them to seek a prior
David Cook
Unverified
29:13
authorization? I apologize. I misunderstood your question. You referenced step therapy earlier. But there's nothing in this legislation that restricts them from doing prior authorization as long as their procedures are not more restrictive than the FDA label, which is where we ended up. Okay, thank you. Does that help?
Speaker 65
29:28
Yeah, thank you. Representative Allen, very nice
Representative Fred Allen
Unverified
29:33
for a question. Thank you. I appreciate what you're all trying to do. I'm very sympathetic because my mom died from Alzheimer's. But I do have just a question or two. When you all talk about the administering of the drug, you say it's done intravenously. So will every hospital be able to do this, or do we have designated sites in the state
Speaker 21
30:02
Unfortunately, at this point, it is limited to designated sites. And that's another issue I have with the way that the data was collected on impact. Right now, very few institutions are actually registering and are administering this drug. And
Speaker 22
30:17
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, 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 opinion, an undue burden on them as compared to people who
Representative Fred Allen
Unverified
30:51
live in urban centers. What sites do we have here in the state of Arkansas
David Cook
Unverified
30:59
right now that can administer this drug? Currently, UAMS, Conway Neurology, is online as a provider.
There's a physician in Perigold. Not Perigold. It's Northwest Arkansas. I can't really start with a P. Perigold. That's prescribing. And we're seeing more and more clinics come online. But like he said, access is really limited right now. I can get a more exhaustive list for you, but those are the ones I can think of on the top of my head. Prairie Grove. Again,
Representative Fred Allen
Unverified
31:31
I appreciate you all. I have a couple more questions, but I'll get back in the queue.
Representative Dwight Tosh
Unverified
31:36
Thank you so much. Representative Tosh, you're ready to ask for a question. Thank you, Mr. Chair. I want to go back to just help me to understand. Representative Johnson brought up a good point. And 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 PPC would be able,
and I guess he or she would have to make a referral to a neurologist or how would
Speaker 73
32:13
that work? I'm just trying to understand it. If you go to
Speaker 21
32:19
your primary care physician, the first step would, if doing it efficiently, would probably set you up for neurocognitive testing
Speaker 22
32:27
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 six to eight months to get an appointment with one of those. Geriatricians do tend to have a little bit faster time. And so then they would evaluate you and start the process of going through the testing, either
Representative Lee Johnson
Unverified
32:58
the specialized imaging testing or
Representative Dwight Tosh
Unverified
33:00
the spinal tap. Okay, 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 15, 20 minutes.
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 that the protocol, is that the process that we'd have to take? And I can just see where it may not be obvious to your primary care physician that you've got this early stages. If it's
Representative Julie Mayberry
Unverified
33:40
okay, I'd like to just kind of bring this up
because 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. And so it's sitting there. I hope we can get it passed tomorrow. But that is a key to all of this is early testing. Very much a key, and we want to make sure that that's covered as well.
Representative Dwight Tosh
Unverified
34:08
Okay, thank you. And one last question, and David, this is for you.
Is it Alzheimer's or Alzheimer's? How do you pronounce that?
I struggle with that every day, Robert. Help me out a little bit. I've already pronounced it in here this morning. First, I thought somebody a while ago said old-timers, and I think they were saying Alzheimer's, but anyway, so
David Cook
Unverified
34:34
which one is it? I'm just curious. The discovering physician's last name
Speaker 1
34:39
was Alzheimer's with a Z in 1906, Dr. Alzheimer's. Thank you for clearing that up. Yes, sir. Any other questions, committee?
Representative Richard McGrew
Unverified
34:47
Representative McGurk. Thank you, Chairman. A couple of questions. It says in here that in addition to these treatments, there are new treatments that will be required, mandated by AVD because of this. So could you talk on them just here? Also, what is the cost to the patient now, if they were to take it? I was wondering. I'm curious to know the
David Cook
Unverified
35:16
cost of this treatment itself. Representative McGrew, you'll hear testimony today from a retired educator kind of talk about his out-of-pocket cost
and also a patient whose
family was denied access to this treatment, their cash price negotiated with the drug company was $5,000 a month in terms of a cash price. And can you repeat your first question again? I
Representative Richard McGrew
Unverified
35:39
apologize. My first question is in the sheet we have here. It says that this bill would
David Cook
Unverified
35:47
mandate EBD to begin covering some other treatments. Sure. So the EBD, the paragraph you referenced, they are discussing, or they're referencing, excuse me,
Likimbi, which is one that's been widely prescribed here in Arkansas.
There was a second drug approved by the FDA in the same class called Casunla. Denanimab is its clinical name. That was approved in 2024. We do expect that to start hitting the market sometime. If I told you, just be a guess. But we're hoping to see that start being prescribed from what we're hearing from clinicians and researchers. There's a lot of excitement about Kisuma because of the way it's performed in its clinical trials in terms of its efficacy.
Representative Richard McGrew
Unverified
36:36
And given this treatment, how long does it, what are the end results? How long does it put the, decrease the effects of Alzheimer's
Representative Lee Johnson
Unverified
36:48
for how long? What's the outcome? Actually, at this time, Ed
Speaker 22
36:52
is looking to prolong things for several years. There also is post-market analysis that's happening. When you look at Medicare and Medicaid, you have to go into 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 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 heard that on Monday, and I'm still pretty disturbed by that. Thank you. I don't know if there's
Speaker 1
38:03
any more questions from the committee for these witnesses. Thank you for your testimony.
It appears we do have a couple of other folks signed up to speak for this bill. Lori Melton. Thank
Speaker 87
38:16
you for allowing me the opportunity to... See, I don't
Speaker 1
38:37
know the rules. No, you're good, but before you start, a couple things.
Introduce yourself for the record, and then if you can, be as, I'm not limiting you, but be as brief as you can, as you can
Speaker 95
38:53
see, we have a lot to do today. I totally get it. I've got a three-minute, I'll stick to it. My name is Lori Case Melton. I am a wife, mother, grandma, and I'm a banker. I'm a long-time, lifetime Arkansan. 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, our keys, our glasses? Do you ever have that flash, though? What if I have dementia? And then you laugh it off because, you know, you're busy. Well, in July, Gerald sent a text to our daughter, youngest daughter, saying, I can't wait for your wedding. Her wedding was two months before, and he had forgot walking her down the aisle. That was the final straw for me.
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. Our insurance wouldn't let us go out of state to have the scan so he had not one but two spinal taps and then we got the most dreaded news that we've ever received
Gerald has early onset Alzheimer's he was 62 at the time still working and we were planning our retirement days
Speaker 97
40:31
together I would rather have been told he had
Speaker 95
40:36
cancer because you see my mom had Alzheimer's just like all of you have 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 changing making our life plans all we had to do was wait on our insurance approval 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 happy 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
Speaker 95
42:24
a job. No one even asked me how much money I made, so we never dreamed that 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, okay, 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 pension that he worked so hard to earn for. We can wait till he's 65. 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 and 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 call multiple times a day. I make lists of what he's supposed to do. I answer 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 here, 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 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 of knowing it would be different if we were simply given what we were paid for.
And I'm here to remind you that this could be happening to you right now. So
Speaker 101
45:00
I thank you for your time and I welcome any questions. Thank you for your testimony.
I don't see any questions, but we appreciate your testimony today. We
have two more people sign up to speak for. It looks like Cheryl and Steve Daniels.
Good morning. Just introduce yourselves for the record, and you can proceed with your
Representative Robin Lundstrum
Unverified
45:49
testimony. Okay. I'm Cheryl Daniels. I'm Steve's wife, and I'm here because this summer he was diagnosed with Alzheimer's. I'm also here because I come from a family of teachers. I was a teacher myself. I'm retired after 36 years of
Speaker 105
46:05
teaching special education. Loved every minute of it.
Representative Robin Lundstrum
Unverified
46:12
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. 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 give me information.
I'm not a real studious person after retirement, 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 sugar-coated 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 is working. After about the third infusion, I thought, you know, is this possible that it's working? and I wish that you could go with us to the treatment center, see the people that are there. There are not many of them, but hear their stories, hear the health care workers' stories that finally there's something to be done. 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
Steve Daniels
Unverified
47:59
my husband. My name is, excuse me, I've been sitting there for a while. My name is Steve Daniels. I coached and
taught school and was an athletic administrator, athletic director, assistant principal for 38 years, state of Arkansas, North Little Rock and Conway, representing Tavallon. I used to watch you play basketball at Little Rock Central. I was good.
And you were real good. That just shows you how well this drug is working because I remember
watching you shoot that basketball over there when North Little Rock would play Central. My mother, I've come from a family of educators as well, my mother was the secretary for Mr. Burnett, 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.
And I would never have dreamed that I'd be sitting here in front of a bunch of legislators at the state capitol talking to you today. But needless to say, I'm a little nervous about this, and probably some of you are looking at me thinking, okay, this guy's got Alzheimer's. I'm going to see how he's going to act about all of this, so I'll do my best. But after, I love my job. I met my wife there, and when I was diagnosed six years after I'd retired, I'm 67,
I didn't know much about it, and I couldn't see because of the poll back there who said they couldn't pronounce Alzheimer's, and I don't know who it was because I couldn't see you. I still don't know how to pronounce it. I did the same thing. I called it Alzheimer's and still do. But I just watched an aunt 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 I knew there wasn't anything that you could do about it at that time.
And I, you know, some of you asked some questions about what's that. I can just tell you what I went through and what I'm going through and how it happens. I was having some headaches and went to my primary care physician, Dr. Throneberry, there in Conway. And because I was an athlete and had concussions like all of us in life, brought you when you were growing up as a kid, he wanted to do an MRI just to check some things to see what it was all about. And so that's why I went in for the MRI. And I guess I just really
got lucky when he found this stuff. And when I had the MRI, came out of that, 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 okay. He wasn't too concerned about that. But he said, I'd like to send you to the neurologist here in Conway, Dr. Timothy Frealdhoven, and have him take a look at this MRI. And so I went to see Dr. Frealdhoven, and he mentioned something about amyloid plaques, which I knew absolutely nothing about. 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, those types of things, blood tests. So I went through a variety of tests and discussions with him, but he was very excited about a new drug that was coming out. And for this one, for me, it 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 knew there was, and I knew what lay in store for me because I'd seen what happened when you get this,
as a lot of you have witnessed that has gone on in your lives. But I listened to him, and he was excited. And he also discussed the side effects of this drug with me, which were pretty serious and a little scary. So we talked about this and 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 asked all three of those guys, which I trusted, they were 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 said resounding yes, without a doubt. And when I was asked if anybody discussed those side effects with me, I said, yeah. 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 after that i really don't have any problems haven't had any problems with it i do think clearer than i did i have i was asked uh in fact representative mayberry asked me said do you think you could go back to work and i i absolutely do i don't have the step that i had back back in my day but uh i i promise you
i could go back into my job and do it effectively 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 it 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 extend my life extend my life a little longer than what i what i would have had and I'm going to wrap this up
Speaker 73
54:30
I've had the most wonderful wife I've got two unbelievable children
Steve Daniels
Unverified
54:51
I've got two beautiful granddaughters and I'd like to be able to see
and 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 and God bless you thank you and I'm
Speaker 1
55:33
we appreciate your testimony thank you so much for coming I don't see anyone else signed up is there anyone else who wants to speak for this bill there's no one signed up is
there anyone who wants to speak against this bill there's no one signed up But this does affect EBD. I believe we need to hear from EBD on this matter. So if someone from EBD
could go then to the table. Sir, just introduce yourself, who
Speaker 113
56:05
you're with, and just give us your perspective on this
Representative Fred Allen
Unverified
56:09
matter if you don't mind, sir. Grant Wallace, Director of the Employee Benefits Division. 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. 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. 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 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 is a dramatic shift in the medication spend. The other concern that we have with this is the medical costs that come around that. You have to take five MRIs or you have to have five 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 write 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, and 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. If we say, new to market, which is the drugs that have come out within the last six 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 six months and we'll re-review it.
Or let's give it a year and we'll re-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 and 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 cost and fiduciary responsibilities that we have.
So with that, I'd be glad to answer any
Representative Fred Allen
Unverified
1:01:54
questions. 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 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 would show the savings that comes here. Thank
Representative Carol Dalby
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1:02:30
you. Representative Dahl, I'll be recognized for your question. Thank you, Mr. Chair. Grant, is there anything in the policies and procedures of your department that keeps y'all from
Speaker 124
1:02:43
adopting these drugs without this bill? I mean, can you
Speaker 125
1:02:48
do it without this bill? Absolutely. I could do it
Representative Fred Allen
Unverified
1:02:52
tomorrow if the data and everything was there that led to that being the best decision for the plan.
Representative Carol Dalby
Unverified
1:02:58
So your department has the ability to do this now? Yes, ma'am. Okay, thank
Chair
Unverified
1:03:08
you. Representative Richard, do you recognize for your question?
Representative R. Scott Richardson
Unverified
1:03:14
Thank you. What is the average cost or contribution from an individual into a plan
that may, let's say I'm an individual 65 years old, he's been contributing, We find out, what's that individual contribution into the plan?
Representative Fred Allen
Unverified
1:03:33
That's a great question that I don't have off the top of my head. Do you know? So I'd say our average monthly premium is probably between all of the plans, active, retired, all of that. You're probably going to land the average somewhere in the mid-100s that somebody's doing on a monthly basis for their insurance premium. Okay. And how long are people normally
Representative R. Scott Richardson
Unverified
1:03:55
contributing to the plan? Right. So if you look at kind of the
Speaker 125
1:04:01
averages that we have on a state employee,
Representative Fred Allen
Unverified
1:04:05
I think our average state employee has about 10 and a half years of service, somewhere in that range. Okay.
Chair
Unverified
1:04:12
Okay. Thank you. Any other questions from the committee?
Representative Sonia Eubanks Barker
Unverified
1:04:19
Representative Aki, you're recognized. Thank you. Thank you, Grant. I think we're all exceptionally sympathetic to the job that you have none of us probably would want. 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 without this medication. The long-term care costs, the emergency room visits, the car crashes that happen. 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. When 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 in my experience of being audited is that a prior authorization on the front end is basically a pre-audit. You're basically making them prove the necessity. Having health care 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 is an option to help give you the opportunity to curb the bad actors while still providing access. And we would need, obviously, health advantage to say that that's something
Speaker 125
1:05:43
that they can put forward. Absolutely. I'll ask the question and see if that's even possible within
Representative Fred Allen
Unverified
1:05:48
their system. Okay, thank you. And I would say, you know, I know there's been some comparison to Medicaid and Medicare covering this, but keep in mind those programs automatically have a mandated rebate. 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 onto 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 your question. Thank you. Maybe my question is relevant, maybe not irrelevant to what we're talking about. But 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 talking with Representative Mayberry, 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. These are things that we have been doing analysis, and I've expressed, I'm not surprising her by anything that I'm saying today. These are concerns that I've routinely expressed around the way the bill was drafted. 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. Did it come as fast as it should have? I think we did it the best that we could, but we're only one piece of that puzzle and that work. All right. Any other questions from the committee?
Seeing none, thank you, Mr. Walsh, for your testimony. Representative Mayberry. You're recognized, closed for
Representative Julie Mayberry
Unverified
1:08:14
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 session so we could iron out even more things, but here we are. 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 two to four million, but 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 this was a hard one for him, and I appreciate working with him. Thank
David Cook
Unverified
1:10:12
you, members, for your time. I'll be brief. Just wanted to add to Coach Daniel's testimony. He is retired from the school teacher's
retirement system. He does have Medicare, so CMS is picking up the bulk of that, but his Advantage
plan, he chose to stay with the state, 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 three times, but each time he was denied just on the Advantage plan piece. And so we just appreciate you stepping 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 i got a motion to pass representative richardson although are any discussion on the motion seeing none all those in favor say aye aye all those opposed say no congratulations representative maybury your bill is passed
moving right along we have representative moore presenting house bill 1150 if you would please go to the end of the table recognize yourself and you may present your bill
Representative Kendra Moore
Unverified
1:11:32
thank you mr chair and if i could have a couple members from the audience come up to help and speak in favor of the bill
absolutely if you would please Please go to the end of the table, recognize yourself, and you may
Representative Mark Perry
Unverified
1:11:46
proceed. Thank you, Mr. Chair. Members of the committee, Jeremiah Moore, House District 61.
House Bill 1150 is unique, and I had full two pages of comments prepared, but I'm just going to speak from the heart, if you will. I represent parts of five counties, 127 miles from top to bottom for District 61. I represent possibly more pharmacies than any other state rep in the state. It used to be 12, now it's down to about 10. Pharmacy benefit managers for far too long have been able to reimburse their competitors
while they reimburse themselves. I'll give you an example of why this could be seen as predatory 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 Mountaineer, that's Georgia's, Sanderson Farms. If they were able to set 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. The FTC reports over the past year have been quite damning in nature. 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 in 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. One thing you know about me is that I'm pretty up front, 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. I'll be up front. But what really irks me, what really gets on my nerves as a legislator, representing 30,000 people back home, are 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 taxpayer and
patients' money. People ask me, "Why are you running this bill?" Did the Pharmacy Association bring you this bill? I can tell you with the fact, this is an original idea from
Representative Kendra Moore
Unverified
1:14:55
yours truly. Zach Smith, a good friend of mine who
Representative Mark Perry
Unverified
1:15:01
happened to be in my wedding, right over there, has 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 patients and the taxpayers of Arkansas. And with that, I'm open for questions.
Well, first off, right quick, we need those at the end of the table that joined you to recognize themselves and identify themselves
Speaker 150
1:15:35
for the record. John Vinson, CEO of the Arkansas Pharmacists Association.
Speaker 151
1:15:40
Brittany Sanders, current president of the Arkansas Pharmacists Association and co-owner of the pharmacy at Wellington.
Thank you. Questions from committee, Jay Richardson, you're recognized for your question. Thank you, Mr.
Representative R. Scott Richardson
Unverified
1:15:55
Chair. Representative, 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 that this legislation will not only lead to pharmacy closures, but disrupt specialty and mail order pharmacy services. Can you speak to that? Yes.
Speaker 150
1:16:16
So, is that okay? John Vinson, CEO of the
Speaker 156
1:16:19
Arkansas Pharmacy Association. So 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, U.S. Federal Trade Commission, and two separate reports in the last six months,
Axios News, Columbus Dispatch, to his point that shows the higher prices that are being paid at pharmacies owned by PBMs versus the lower prices in 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 Board of 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 in all 75 counties and then there are also up to 670 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 or 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, All Care Pharmacy. I know CARTA and All Care are 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 prescriptions, and they should be able to access them locally at better prices with this legislation. And if I
Representative Kendra Moore
Unverified
1:18:51
can follow up with that, I've run the maps.
Representative Mark Perry
Unverified
1:18:55
There is the furthest PBM-owned pharmacy from a non-PBM-owned pharmacy in the entire state of Arkansas is two miles. There will be no pharmacy deserts. Two miles is the
furthest distance. All right. Representative Dolby,
Representative Carol Dalby
Unverified
1:19:15
you're recognized for your question. Thank you, Mr. Chair. Representative Morris, I read your legislation. It appears to me that we're turning over the rulemaking authority to the pharmacy board.
And can you explain why we would not have the rulemaking authority remain with the legislature and ALC as we do on everything else I can think of? But it appears that we're turning that legislative authority over. Can you speak to that for me, please? It's my understanding that their rules
Representative Kendra Moore
Unverified
1:19:50
will still have to be approved by ALC. And I don't
Representative Carol Dalby
Unverified
1:19:54
see that anywhere. Can you point that out?
And I apologize. And I've read it a number of
Speaker 156
1:20:03
times, but I can answer. Do you mind if I answer? So 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 into 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 my understanding is they still have that ability to promulgate rules if needed to happen. But for the sake of implementing this particular bill, That would be supported
Representative Carol Dalby
Unverified
1:20:49
by current statute. And is the makeup of the Board of Pharmacy all independent
Speaker 156
1:20:55
pharmacists? That's a good question. So the Board of Pharmacy has eight members that make decisions, and only two of those eight members are what I would consider independent pharmacists.
One of them is a true independent pharmacist that has a single store. The other one is part of 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 or licensed pharmacists, including a senior member that's over 60 years of age that is on the board serving. One more.
Representative Carol Dalby
Unverified
1:21:36
And just switching topics, but I can't help but go to this when I think of it because I put on my other hat. How does this bill not conflict with, you know, an organization or even a person's right to contract, and how does it not conflict with the Commerce Clause in the U.S. Constitution?
Speaker 156
1:22:09
I want to represent a more answer in addition to me. But at the first week of session when this bill was filed, it reminded 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 looked at this. AG Tim Griffin is supportive of this legislation.
He was at the press conference that we held 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 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 he can defend if it
Representative Carol Dalby
Unverified
1:23:11
was challenged. One more question, if I can, for Representative Moore.
And my concern, and I understand the PBM. I've been in the legislature long enough and know 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 a sawmill and a lumberyard and they're setting the prices for everybody around them.
And 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 that is a concern, not just in this area, but in all areas of commerce. And it just seems like we start down that slope, then somebody else has a beef with something else, then we've set that precedent that we can then tell people how they can operate their business.
Representative Kendra Moore
Unverified
1:24:26
Can you speak to that, Representative Moore? Thank you, Representative Dalby. I'll just be the first to
Representative Mark Perry
Unverified
1:24:35
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. So regarding somebody growing trees and having a sawmill and a lumber company, there's nothing wrong with that. Regarding Tyson Foods 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 the committee? Representative Eves, recognize for your question. We've been
Representative Les D. Eaves
Unverified
1:25:18
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 causing some of the problems that our local pharmacies are seeing?
Speaker 168
1:25:31
That would be a good question for Brittany.
Speaker 151
1:25:35
Brittany, would you mind? Sure, I can try to answer that. 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. 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're enrolled in that network or they can decline and we're out of network and unable to
Representative Les D. Eaves
Unverified
1:25:58
serve those patients. So those organizations don't have anything to do with how much you're reimbursed?
Speaker 151
1:26:04
They cannot negotiate the contracts. They hold the
Representative Les D. Eaves
Unverified
1:26:08
contracts. Does the Pharmacy Association receive any money from PSAOs? Yeah, we
Speaker 156
1:26:16
do not receive any money from PSAOs. Thanks for that question. 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. Any other
questions from the committee? Representative Leitman, you're recognized. Thank you, Mr. Chairman.
Representative Jack Ladyman
Unverified
1:26:52
The question that Representative Dalby asked, I'm going to relate to that. 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 fair. But, you know, we have things called monopolies, and we have to be aware of that as well. But if you've got a company that'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. With the research you've done, have you run across any other industry like this
where they set the prices basically for the whole industry? Thank
Representative Kendra Moore
Unverified
1:27:42
you, Representative Lehmann, and to answer that question quite bluntly, no. There may be other industries that exist
Representative Mark Perry
Unverified
1:27:47
in this similar scenario, but to my knowledge, PBM's pharmacy, this is the only instance where that happens. Any other questions from the committee? Representative Perry, you
recognize for your question. Thank you, Mr. Chairman.
So I listened to previous discussions talking about brick-and-mortar. So 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 over. What kind of impact would that be? Loss of
Speaker 174
1:28:47
jobs, the communities. Can you kind of touch on that?
Representative Kendra Moore
Unverified
1:28:56
Thank you, Representative Perry. The actual cost of
Representative Mark Perry
Unverified
1:29:01
divesting or contracting out, I cannot speak to that. They have valuable assets in which they could sell and spend off and make profitable.
But the real 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 and be in a position to pay yourself higher than your competitor. This is not about free and fair markets, and I would emphasis the word fair, which this market is so obviously not. Thank you.
Does that answer your question? Yeah, kind of. But so besides eliminating competition, what else would this
Speaker 156
1:29:56
bill do? You mind if I answer? Okay. So in terms of the jobs question, I just would remind or educate for those of you who 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 in the reduction. There are about $5 billion, somewhere between $2 billion and $5 billion of prescriptions that are being forced to out-of-state mail or pharmacies at 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,
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 the patient didn't choose. So hopefully that answers your questions. Thank you, man. Representative Richardson, I recognize for your
Chair
Unverified
1:31:21
question. Thank you. So if I heard you
Representative R. Scott Richardson
Unverified
1:31:27
correctly, you said that the PS, I'm going to get the acronyms all screwed up,
the organization doesn't negotiate for you. Correct. 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 contracts to ensure that
he's being paid an adequate amount. Is that common practice or no?
Speaker 151
1:31:55
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 willing to accept any negotiation on our behalf okay maybe some other we have more
Representative R. Scott Richardson
Unverified
1:32:13
speakers they can speak to nobody else is speaking or signed up to speak okay thank you at representative original we do have
people you know that will be speaking for and against this i know what you're referring to any other questions from the committee representative mccullum you recognize
Representative Austin McCollum
Unverified
1:32:32
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 policy making authority as it's granted to by the board in this bill and as a lawmaker i know we do it a lot but i like to legislate and so just kind of understanding where this is
Speaker 156
1:33:00
going to go. Sure, on the, on the, back to the question about
rulemaking again, my understanding is the board can promulgate rules if they need to and shall 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 or pushback we had were 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 to the emergency room or hospital if they cannot fill a medicine? And in conversations with the hospitals who had the most concerns about that, 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 the that's where we landed is bill sponsors pharmacists association hospital association car tie and other partners that looked at it it's best way i know to answer
Representative Austin McCollum
Unverified
1:34:11
it can you uh maybe would you give me some
encouragement and give me a little more talk a little more about maybe guardrails that exist to prevent the idea of like a board effectively creating new law
Speaker 156
1:34:27
out of this? Sure 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 is 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 hard to get or a patient's unable to receive them based on their benefit design or the type of drug. There's the ability to give those oversights and to, 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 second largest retailer in the world who is also permitted in Arkansas, is not affiliated with PBM, Walgreens, the 25 specialty pharmacies I was talking about earlier, URAC accredited, 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 of Pharmacy and the community has the
Representative Kendra Moore
Unverified
1:35:51
ability to meet those needs. Representative Cullum, I totally understand your concern and your assurance is that this is not a
Representative Mark Perry
Unverified
1:35:59
broad ability to create broad rules that may or may not apply to unforeseen circumstances. This gives them the ability to make sure that patients have access to care and to those life-saving medications that they need. Okay. Representative Ferguson, you're recognized for your question. I'm sorry. Well, you can go ahead and
Chair
Unverified
1:36:27
we'll get to McGrew here in a second. Alright, thank you. Hey, I want to go back
Representative Kenneth B. Ferguson
Unverified
1:36:32
to Representative Richardson's question about, here again, POS or PSA. Oh, whatever it is. I've got a couple of pharmacies in my district that were negotiating with PBMs. And it appears that at some point it was 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 saying that's the case?
You said something similar to that. I would
Speaker 156
1:37:09
comment, too, and I know you're asking Dr. Sanders, so go ahead, Dr. Sanders. Yes,
Speaker 151
1:37:15
so that is the case. I mean, it comes to a point whether they accept. I have not seen them accept any red lines to a contract, but it comes to a point where it's take it or leave it. There's no further negotiation, but I have
Representative Kenneth B. Ferguson
Unverified
1:37:31
not had any success. In my last question, the reason 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. It had something to do with some negotiation. Would this have been with the PBM or with the insurance, with the... It could be
Speaker 156
1:37:59
any and all of 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 are supportive of that to happen for the insurance commissioner to be able to better enforce the laws and protect systems.
Representative Kenneth B. Ferguson
Unverified
1:38:50
I asked that question because the pharmacy said it had something to do with the contract, and I end up having to get it from Walgreens. Okay, well, thank
Chair
Unverified
1:38:59
you. Thank you. Thank you, Mr. Chair. Representative McGrew, you're recognized for your question. Thank you, Mr.
Representative Richard McGrew
Unverified
1:39:08
Chairman. I have been getting several calls from pharmacies in my district,
all of them explaining what you are, that PBMs sets the price at which they can charge, and it's going to take them out of business. In fact, one called me yesterday and said that this bill don't pounce. I will be out of business by the end of the year. So it's unbelievable to me that one organization can set the prices of their competition. I don't know how we ever got here to begin with, but can you tell me what you forecast seeing? If this bill doesn't pass, because we've already said so many small pharmacies have went out of business,
and I would assume that in my world, in my career business, if my competition had the ability to set my prices, pretty soon all of us small businesses 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 a picture for me of what you see is going to happen in the next year
Speaker 156
1:40:04
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 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 nation is watching. There are other states that have introduced similar legislation. Senator Josh Hawley of Missouri just put forward national legislation at 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 one in ten in arkansas there are 350 approximate independent owned pharmacies that similar type of of rate i would expect here and we've had six 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 in the entire world, is now selling to private equity, and who knows what's going to happen
Speaker 204
1:41:36
with them. It's bleak without intervention from the legislature, so thank you for
considering it. Representative Eubanks, you're recognized for your question. thank you
Representative Jon S. Eubanks
Unverified
1:41:47
mr chair i'm sympathetic to the uh what you're trying to do here uh did you say it was approximately 35
pharmacies across the state that might close so i mean yeah yeah i think that's
Speaker 156
1:42:00
reasonable 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 contract they did not contract yes that would be worst case scenario within the state yes sir
Representative Jon S. Eubanks
Unverified
1:42:24
i guess i'm wondering how this bill would it's going to affect the reimbursement rates
the independents are receiving right now i mean i can see we can we can limit the pbm-owned 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, 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.
But anyway, how is this going to
Representative Mark Perry
Unverified
1:43:09
change, the reimbursement rates for the rest of the pharmacies? Thank you, Representative Eubanks. It's a very good question. The first thing I'll say is that this is not a bill about reimbursement. This is a bill about fair practice. A lot of people may get it confused with setting the full record straight, but this is merely a step in the right direction. It will help because they won't be able to steer patients towards their own pharmacies.
But a good friend of mine who has a pharmacy in DeWitt, Arkansas, he's had to turn patients away because he couldn't afford to fill their prescription. He said, you've got to go to Walmart because I'm losing money on this. Last summer, he used to hire summer help, not pharmacy techs, just high school kids, college kids. He couldn't afford to hire them. Dewitt, Arkansas. You tell me if there's
Representative Kendra Moore
Unverified
1:44:05
a CVS going to go and Dewitt, and I'm going to tell you no.
Speaker 156
1:44:13
I would add, too, if you can't, if the person that's setting your prices 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 Dalby, I recognize for
Representative Carol Dalby
Unverified
1:44:43
your question. Thank you, Mr. Chair, and I appreciate the conversation.
And I'm not pro-PBMs, but what's going to happen in my town is I'm going to lose one of my three pharmacies, and then that's going to be it. And so I only have three pharmacies. I don't have any independents. I'm going to lose that. That business is going to go across the state line. We're going to lose the tax dollars, and so, you know, just say, oh, it's only, you know, only 35 or only going to do that.
It's going to have real specific consequences for my area, and, you know, so I guess my question is, you know, What am I going to 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, are that. But that's what's going to happen. So my question is, how do I answer my constituents that are going to lose a pharmacy in my town?
Speaker 156
1:45:58
I would say there's at least one person in the room that did own a pharmacy, and 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'd come up here and testify, that are 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 there are 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 those gaps with the new legislation that was passed this
Representative Carol Dalby
Unverified
1:46:42
session. Well, I appreciate that comment, but once again, I know what's going to happen in my town. And all of that's going to go to another state. So, thank
you. Thank you, Representative Dalby. Any other questions from the
Representative Jack Ladyman
Unverified
1:46:57
committee? Representative Leiteman, you're recognized. Thank you, Mr. Chairman. This might be a do you agree question, but since this is brought up as a local issue,
in my district I have, I think, six private small pharmacies. I have five large pharmacies, Walmarts and those kind of people, and I have one pharmacy, large pharmacy, that would be affected, closed, whatever, sold with this bill. So, I mean, we're like a miniature, I mean, this is a hot spot, okay? 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 these people that work at this one pharmacy, they've got nine other options. And as you mentioned, Representative, there may be people that open pharmacies. And here's the problem I see. 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 first state in the nation that passed that bill. Now many other states have passed that. But that bill does not say that 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 they say, you know, 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 make no money, and they can appeal. But this is a small pharmacy that has four people working there. They can't appeal 100 of these things a day. I see the pharmacist shaking their 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,
But I believe it's a good step in the right direction. Do you
Speaker 1
1:49:23
agree? I agree. Thank you for that. Representative, we are in the question phase, so let's try to limit it to questions. At this point, we will have discussion later.
Representative Mark Perry
Unverified
1:49:34
Any further questions? Anyone? Representative Perry. Thank you, Mr. Chairman. So you mentioned earlier that you would be able to direct the patients to another pharmacy on that side of it, that if one closed, if you have a lack of accessibility or demand?
Speaker 178
1:49:53
I'm sorry, could you clarify about the
Representative Mark Perry
Unverified
1:49:58
question? I just want to make sure I understand it. So if a pharmacy closes, you would be able to allocate, pick up the... Oh, yeah, good question. And where would you do that? How would you
Speaker 156
1:50:11
direct those people to another pharmacy? So a couple of things. One, yeah, they're physicians and prescribers for sure, but also the language in the amendment asked for and worked with with the Arkansas Hospital Association and also with Arkansas Children's Hospital and UAMS
in that policymaking 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 prescriber. 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 pharmacies that are going to open because of Senate Bill 58 and also the fair competition that we talked about earlier, that this bill would create, that we would have
Representative Mark Perry
Unverified
1:51:12
the capacity in this state to meet the needs. Would that go against Act 922 of 2021 where it makes
Speaker 151
1:51:33
I'm going to have to go ahead. I'm not familiar with the act that you referred to steering since they're not owned by that company they're not steering to themselves they're not steering to something that they're owned if cvs 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 providing that information so they're not steering to
Speaker 156
1:52:00
something that they own and i wouldn't characterize and i wouldn't characterize this me personally that particular act 922 which is house bill 1852
I wouldn't necessarily characterize that one as a steering bill per se. It was a delivery standards bill for pharmacies that use common mail carriers and the rule-making process of how you provide those prescriptions to patients. 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 Board of Pharmacy to protect patients.
Chair
Unverified
1:52:43
Okay, thank you. Representative Richardson, you recognize for a question. Thank
Representative R. Scott Richardson
Unverified
1:52:48
you, Mr. Speaker. The PSCs, how many of those are there?
There are six PSAOs in the state of
Arkansas. Okay, and if I heard you correctly earlier, you said that you guys aren't associated, did I hear that
Speaker 156
1:53:06
correctly, you guys aren't associated with them? The association doesn't receive any funding from PSAOs. There are companies, just to clarify, to representatives, 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 align rx out of oklahoma um there's one called pharmacy first which is merging with align rx out of oklahoma to become one company as we speak there is uh cardinals is leader net that's affiliated with the company called cardinal that you may be be familiar with. There's one called Elevate and there's one called Health Mart Atlas. And those
last three do have some ownership ties or fully owned and wholly owned by wholesalers, Cardinal Sincora, Marisource Bergen, and McKesson. The other three are mostly independent or partially owned. And one of them, I think, was partially owned. Okay. Thank you. Thank you. Any other
Speaker 220
1:54:16
Questions? Where's the launch term? First of all,
Representative Robin Lundstrum
Unverified
1:54:24
thank you for bringing this bill. 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. And it concerns me, the small-town pharmacists, if they can't survive, and you've even got Walmart and Harps concerned, 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.
Is that what the goal is on this, just have everybody mail-in and then we can
Speaker 211
1:55:06
just close all our brick and mortars?
Speaker 156
1:55:09
I would say that if you read the Federal Trade Commission report on drugs that are more than $1,000 that are defined as specialty, it was staggering that 70% are being filled by three pharmacies owned by BBMs. 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 competition and bring down prices and bring back access locally past this bill.
Representative R. Scott Richardson
Unverified
1:55:33
That's a great question. Thank you. Any other questions? Yes. You said there were
Speaker 156
1:55:42
three pharmacies that owned all. What are those? So they're OptumRx, which is part of UnitedHealthcare, CVS, which is part of CVS Health and Aetna. Thank you. And then Cigna, which is ExpressGrips PBM, which is also a credo. In the FTC report, there was fill in $225 billion worth of specialty drugs in just those three in the United States.
Speaker 1
1:56:03
Okay. Seeing no other questions, we thank you for
your testimony. 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. Zook. Just introduce yourself for the record and have your guest introduce himself, and you can proceed with your testimony.
Speaker 227
1:56:35
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. And then I'd like Mike to talk about some of the more technical issues around this process. My comments are going to focus on the effect on the Arkansas business climate.
Before we start, would you have your guest introduce himself,
Mike Castleberry
Unverified
1:56:57
please? Thank you, Mr. Chairman. I'm Mike Castleberry. I'm with Consociate representing self-funded employers here in the state. Thank you. Proceed,
Speaker 227
1:57:05
please. Thank you. My comments are going to focus on the effect of this bill on the overall business climate.
I've got members on both sides, or maybe on all four sides of this issue. This is not just a quarter with two sides to it. It's a complex issue. But I want to make some comments about the theoretical impact 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'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 or 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 price list 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 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 patient protection or lower costs.
Hundreds of thousands of Arkansans, through free market competition, choose to fill their prescriptions at a pharmacy owned by a PBM. Perhaps they like the convenience of mail order or 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 divest, putting about 600 hard-working 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 economy. Thank you for your time, and I'd invite Mike to make comments for you as well. Thank you, Mr. Chairman. Thank you,
Mike Castleberry
Unverified
2:01:58
everybody on the committee, for letting me come speak with you today. Again, my name is Mike Castleberry. I
Mike Casselberry
Unverified
2:02:04
represent self-funded employers around the state.
So for those of you who 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. And I can tell you, from my employers from northeast Arkansas to southwest Arkansas, one thing in common they all have is they can't afford any more. 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 five of your 25 pharmacies, we think fewer choices is going to rise prices. 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. This is a big deal. A lot of people, this is the most cost-effective way that my employers can pay for medication is through mail order. Absolutely. And probably the first phone call y'all are going to get from your constituents is someone who's on a specialty drug that'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, where you may pay $5 or $10 or $50 for your drug, they actually share it in coinsurance. So 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 going to 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? We've heard 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 told the Ford dealership how much the car is going to cost. What they sell it for is their choice. So my employers are to the point where they are scared of every single piece of legislation that could add cost
to their plan. 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 going to give you a renewal a year from now, right? They're going to 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 were 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 cost. 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, when they came to give you your new rates the next year, they said, okay, 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 where my employers come from. They're so worried about continuing regulation that's going to add the cost to their health
point. 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 can only take so much to your bottom line and you give it back to your employee. Most employers would tell you after salary, it's benefits, right? That's their single largest cost 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 our employer just says, I just can't do it anymore. You know, we just won't be in business because I can't afford the health care.
and I'll be happy to take any questions Mr. Chairman Thank you, there are numerous
Representative Mark Perry
Unverified
2:05:57
legislators who have some questions, we're going to start with Representative Perry Thank you Mr. Chairman, I appreciate it Mr. Casperry, I understand the insurance side of it, Mr. Vincent made a comment that this would prevent like the OptumRx Express Scripts, those wouldn't be able to sell or in the state?
Mike Casselberry
Unverified
2:06:18
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 this market, which you would almost force to go to a brick-and-mortar, right? Yeah. Where the cost is
Representative Mark Perry
Unverified
2:06:32
definitely going to be more. And being in Jacksonville, we have Little Rock Air Force Base, and they do all of their mail order through Express Scripts. So this would do that. I know a lot of my clients use Express Scripts. an OctomRx, so this would eliminate that, and they would have to pick a different option.
Mike Casselberry
Unverified
2:06:52
Yes, sir, that's my understanding. Okay. 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 get your prescription moved, 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 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 Blademan,
Representative Jack Ladyman
Unverified
2:07:20
you're next. Thank you, Mr. Chairman. Mr. Casper, you said a couple things that I can't agree with you on.
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 set the manufacturers set the selling price. So when I was chair of public health, we had numerous calls with manufacturers, PBMs, and pharmacies about trying to figure out this thing, okay? 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 you disagree with that? No, sir. I agree with you in
Speaker 234
2:08:15
principle about how the process works, but I'm talking about where the price starts from. I agree with you on
Mike Castleberry
Unverified
2:08:21
that. Eli Lilly makes a 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?
Representative Jack Ladyman
Unverified
2:08:30
They try to get a better price. So we agree on the selling price at the manufacturer level, but the PBM sets the price for the pharmacies. The pharmacy does not set the price. Let me move on. You say it will kill mail order. As I said, I worked for the largest 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 have people looking at that all the time.
That's not an unusual thing to do. So 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 in medium size, they can change. We're talking about competition here. There is competition out there. Would you agree with me on that? Yes, sir. I definitely believe in competition. Absolutely.
Speaker 234
2:09:30
I think it should be fair and open, and everybody should be able to develop the program that they think is most effective
Mike Casselberry
Unverified
2:09:38
and that their employers want to buy, right? So I'm definitely in line with you when it comes to competition. My comment about mailware is it is the most cost-effective way. All my employers will show you and tell you this is a way it saves them as an employer and their employees money. So I'm just trying to be real life here, right? I agree with what you just said.
Representative Jack Ladyman
Unverified
2:09:59
I agree with that. But you would agree with me that this does not kill mail-order pharmacies? From reading of the legislation, there's going to be a lot of mail-order pharmacies
that will not be able to participate in this market. But there will be mail-order pharmacies still available.
Speaker 234
2:10:15
People can still get mail-order drugs. If you're a mail-order and you're a PBM, no, right? That's what the legislation says. So you're going to have to be a mail-order but
Mike Casselberry
Unverified
2:10:24
not a PBM, which means you're going to be brick and mortar. Right. I mean, I don't know of one, I guess is what I'm saying.
Speaker 234
2:10:29
I don't know of a mail-order company that has not attached themselves in this structure that we're discussing today. But if
Representative Jack Ladyman
Unverified
2:10:34
I want to buy mail-order drugs, I will still be able to do that, yes or no?
Speaker 234
2:10:39
Not the way I read it, no, sir. And maybe we'll get more clarification from others, but
Representative Jon S. Eubanks
Unverified
2:10:46
that's the way I understand it, sir. Yes, sir. Representative Eubanks, great answer for a question. Thank you, Mr. Chair. Mr. Zook, you were talking about vertical integration, and one of the companies you mentioned was Tyson, which I'm very familiar with. I think the difference here is Tyson has to still negotiate whatever their contracts with their vendors 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 they are reimbursing their company-owned pharmacies differently than what they are the independents, that puts them at a competitive advantage. So that's the 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 my problem with the vertical integration in this case is that they're controlling the in-market where the consumer... Maybe a better
Speaker 227
2:12:00
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 was in that business. 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 globally. There's no way for an independent to make a nickel in that business other than selling crackers and Cokes and now THC-infused seltzer or whatever the heck it is. Whatever the heck it is, they survive on these days. But that, I think, is more akin to what we're looking at here, where you've got the supplier of the product in several different aspects or different channels in the marketplace.
Representative Acker
Unverified
2:12:59
Representative Acker, you're recognized. Thank you, Mr. Chair. This will be for both of you. Either of you
Representative Sonia Eubanks Barker
Unverified
2:13:08
read the FTC report or the House Oversight Community 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 pharmacy? I'm not doing my questions here. Oh, okay, sorry. So my question is, when we read that and you speak about eliminating competition, eliminating competition is happening. That's what's happening. And what it sounds like to me when you're here advocating for employers
is 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 aren't aware of it either because their PBM doesn't allow them to engage in that,
to give choice. 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 the only way to 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 patients, charged them thousands of percent over, and you want that to continue.
Randy Zook, sir, you sat in this committee when we did 128 and acknowledge to Chairman Maddox that this is not a fair market. And we're here advocating that somehow they should
Speaker 226
2:14:49
be allowed to continue. I find that just... Well,
Speaker 227
2:14:52
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 live in Little Rock,
So I have a lot of choices for where I get. Today. Today, yeah, where I get my scripts. I drive by a now empty Walgreens, but I think that Walgreens, somebody acknowledged earlier, there were a lot of things that caused that to collapse, just bad business decisions, overexpansion, getting out over their skis, and they paid the price for it. That's what markets do to people who make bad decisions. So you're saying that all the pharmacies that have closed have
Representative Sonia Eubanks Barker
Unverified
2:15:29
made bad decisions to be where they're 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 the market's not fair in its current form, and this is before we
Speaker 244
2:15:43
regulate it. When you mention that AID has full authority... That one's
Representative Sonia Eubanks Barker
Unverified
2:15:46
going over my head. 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 AID revoke
Speaker 226
2:15:59
their license? That's a great question. They can. In
Speaker 139
2:16:03
fact, actually, today when we pass this bill, that license will be revoked.
There you go. So you're in support of revoking the license. Thank you for going on. No, thank you very much for that. Okay. And? Far
Speaker 1
2:16:26
from it. Let's see here. I believe that's all I have for the moment. Thank you. Okay. Seeing no other questions for these witnesses, thank you so much. Thank you for
your attention. okay we're going to continue to move down the sheet to speak for 1150 adam head is adam head in the room
go to the table sir introduce yourself who you are with and proceed with your testimony
Adam Head
Unverified
2:16:55
please good afternoon representative maddox members of the committee my name is adam head i am the President and CEO of CARTI. 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.
CARTI'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 lot of humility 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 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, They work hand-in-hand with our physicians to try to eliminate barriers in taking care of patients and very complicated drugs.
Very often, 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 a plan, an insurance plan, attached to a PBM that they don't really fully understand. And they never use drugs before they go to CAR TIE. 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 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 as a non-profit, like a lot of our health care 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 with a local community pharmacist, 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.
It uncomplicates things for patients and readily provides that access that right now with many PBMs and putting them in the middle of it, it complicates it. It unnecessarily complicates it and creates an undue burden on patients that we're taking care of every day. So, thank you. Thank you for your
Speaker 182
2:20:23
testimony. Questions? Okay. Representative Allen. Okay. Thank you, Mr.
Representative Fred Allen
Unverified
2:20:28
Chairman. Thank you, Mr. Head, for what you all are doing at Carti.
I was recently treated at Carti. 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. When you talk about specialty drugs, are you all able to get specialty drugs
Adam Head
Unverified
2:20:52
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 at our various sites all around the state among all our locations so yes we can access those
we can provide those to patients in-house and working hand-in-hand with our physicians our oncologist or
we can work with community pharmacies. Are some of the pharmaceutical companies restricting you all
Representative Fred Allen
Unverified
2:21:19
from selling their drugs? So through the through the PBMs we do
Adam Head
Unverified
2:21:26
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 cannot do that and say
well, according to this right here, you're actually going to have to get that mailed in. And there's such fear that 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 going to have to get something that's going to be mailed in from out of state to me.
So it's really important for us. It's our heartbeat as an organization to make that as easy as possible.
Chair
Unverified
2:22:26
Follow-up. I can relate to that because I'm a
Representative Fred Allen
Unverified
2:22:31
victim. It just recently happened to me. I had a 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 will not allow any pharmacists 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 city of Little Rock, but around the state of Arkansas. So I appreciate what you're doing, and I thank you for your services. I appreciate it, Representative Allen. Representative Baker, you recognize for a question. Thank you, Mr. Head.
Representative Sonia Eubanks Barker
Unverified
2:23:20
As you know, when you speak to those, 100% of my immediate family is suffering through cancer, 100% of my immediate family, myself included, use your services. And so I really appreciate the commitment you have and the access that you provide. Is Cartai a member of the Arkansas State Chamber of Commerce? Yes. Are you familiar with the op-ed that Randy Zook authored? And as a patient of yours, I found it a little insulting, but 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 and my wife a better experience than a mailbox? Yes. Were you consulted
Representative Acker
Unverified
2:24:04
at all before that op-ed was written? No. Thank you. Thank you. Any other questions?
Speaker 1
2:24:14
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 going to work until 1. I apologize for that, and then we're going to come back after and finish this up and hopefully finish some others up. So that's just the way we're going to have to do it.
Lynette Washington
Unverified
2:24:56
You may proceed. Good afternoon. Members of the committee, my name is Lynette Washington, and I am the Director of Pharmacy Practice at Acredo Health Group, and I'm testifying in opposition to House Bill 1150 and the impact it would have on current patients utilizing
Speaker 258
2:25:18
our pharmacy. Hi, I'm Ashley Ellis. I'm the District Leader for CVS Retail here in Arkansas.
Lynette Washington
Unverified
2:25:28
Thank you. You can proceed with your testimony. Okay. Acredo is an accredited, both URAC 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. Acredo has access to the widest list of these limited and sometime exclusive distribution drugs on the market.
Acredo's specialty-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's health and safety. Our clinical team is structured around condition-specific therapeutic resource centers,
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.
Specialty medications are typically very expensive, as you've already heard, and require complicated financial support to ensure patients have access to therapy. Acredo billing specialists help patients minimize significant out-of-pocket co-pays and co-insurance costs by helping them find manufactured co-pay assistance programs and foundational support programs for their prescriptions. The reimbursement specialty removes the claim filing burden from the patient by submitting claims directly to retail
and major medical insurance plans and co-pay assistance programs on the patient's behalf. Our 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 require 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, Acredo is their most practical option.
Additionally, infusions are often administered in the comfort of the patient's home with the support of an infusion nurse. Without Acredo, these patients would be required to travel to hospitals and infusion centers to receive their treatments, which is not the 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 potentially causing access to care issues and administration burden on patients and prescribers.
I urge you lawmakers to consider the serious consequences of this bill. Thank you for your
Speaker 258
2:29:30
time. Thank you again for the opportunity to speak today. Again, I'm Ashley Ellis, a district leader for CVS Pharmacy. I live in Greenbrier, and I am based out of Conway. As a pharmacy leader, my role is to support my pharmacy teams as they provide care directly for patients. I mentor pharmacists 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 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 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 my community. So I urge you legislators to vote no on this bill, and I'm happy to answer any questions. Thank you for your testimony.
Representative Richard McGrew
Unverified
2:32:43
questions. Orson McGurray, you're recognized. Thank you, Chairman. and you represent CVS,
I have got numerous emails 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 a lobbyist.
The one I called and checked on this morning was from Hot Springs Village. And when I explained what I'm calling for, they said, well, 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 ZVS. Can we call them and complain? I said, absolutely do. Integrity is very important to me. And when, if that information is coming through CVS, 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 as CVS, do you advocate for that? Have you been part of that? I don't know anything
Speaker 258
2:33:57
about that. And I do work for CVS Retail, but I'm here as a community pharmacist. Okay. Thank you. Thank you. Any other
questions for these witnesses? Thank you so much for your testimony.
Speaker 1
2:34:19
Next to speak for the bill is Brittany Butterfield. Okay. I don't
see anyone, so... How about Callie, I can't read the last name, Birch or Bunch? These are four.
We're looking for a four. Is there anyone who has signed up who would like to speak for this bill? And if you feel your side has been advocated for, you certainly do not have to testify. But anyone else would
like to speak for this bill? Okay. We're going to move back to the against. We have Russell Harper and Sharon Faust, I believe, would like to come to the table together.
If you would, just introduce yourselves for the record and
Speaker 267
2:35:35
proceed with your testimony, please. Yes, sir. Still, or I guess we're in the afternoon hour, so good afternoon, Mr. Chairman. Members of the committee, I'm Russell Harper. I'm an executive of government relations with Navidus Health Solutions. Navidus is a 100% pass-through PBM. 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 interest of our clients and others to provide top-quality customer service and improve patient health by partnering with Arkansas provider community, including locally operated pharmacies. It's an avidist belief that House Bill 1150, as I'm admitted, 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 going to outline these concerns in more detail. Thank
Speaker 269
2:36:39
you, Russell. Sharon Faust, Chief Pharmacy Officer for Navidus Health Solutions. Again, I thank you for letting me speak today 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 access reasons. 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 within hospice care, within mental health pharmacies, specialty pharmacy, retail community pharmacy, 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 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 patients earlier in the day, access matters. 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 UnitedHealthcare that owns providers.
We've got health systems that maybe own health plans and own their own specialty pharmacies that maybe direct right into their specialty pharmacy. It is a slippery slope, and it is occurring all over as we have vertical integration and, let's say, supply chain integration across a number of industries. The prevention of PBO and affiliated pharmacies will have a very great impact on Arkansas residents. We've heard the 30 number from Navitus' account.
It's actually more like 50 to 60. Because while we're focusing on the big three PBMs that exist in our industry, there's actually more than 100 PBMs in the pharmacy benefits industry. For example, Kroger has Kroger prescription plans. The 26 pharmacies of Kroger, nine of which are in Little Rock, will also be included as excluded pharmacies in this bill. We already talked about the 23 pharmacies of CVS,
But there's also specialty pharmacies within Arkansas that provide critical care. For example, Genoa, which is owned by Optum, has five mental health pharmacies in mental health facilities. Genoa is actually a pharmacy that I worked in 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, as it's directed to some of our most serious mental health conditions,
the schizophrenia and things like that. So specialized care and components for those members. A lot of this really creates disruption when we talk about eliminating these pharmacies. We talked about how 20 independent pharmacies may have been, say, run out of business in the last year, as it was stated. We're looking at greater than 60 in this. So one 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 drop my daughter off at gymnastics, I go hit the pharmacy, and I come back to pick her up. That disruption
Speaker 273
2:40:49
creates adherence issues within Arkansas residents.
Speaker 269
2:40:53
The other 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 talked before about the fair and reasonable pricing that the AID has access to, the anti-steering and the option and the choice, you're 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 for those members. 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 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, WAGOVI, weight loss drugs, direct to manufacturer with the NOVO program through Humana's insurance, or Humana's pharmacy, I should say.
Patients don't have the choice to go to those direct-to-consumer pharmacies if they're looking to shop the market. And that is 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 it will have a great impact if we limit PBM-affiliated or owned pharmacies in the state from providing care for patients.
I'll 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.
Representative Jon S. Eubanks
Unverified
2:43:24
Oh, I'm good. I'll start it off, sir. I can keep going,
Speaker 267
2:43:26
though, if you want me to. We would like to leave the committee with a list of impacted pharmacies that we'll have to close. Do I pass those out or somebody else? Staff will assist in that.
Speaker 1
2:43:37
Okay. Thank you. Thank you. Thank you for your testimony.
Thank you. Okay. As I said, we had numerous people who had signed up to speak for. Is there anyone else who would like to speak for this bill? Okay. Is there anyone else who would like to speak against this bill? Representative Moore, you're recognized to close for your bill. And member of staff is passing out the handout that was referenced.
Representative Kendra Moore
Unverified
2:44:15
Thank 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
Speaker 156
2:44:27
a few things there were comments that the prescription drug
yes sir i i don't want i hate to do this but i think we're just in the closing now so jeremy go ahead represent more you can close and then we can discuss
Representative Mark Perry
Unverified
2:44:45
there have been 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. The issue at hand is not vertical integration as it sits in typical normal business. There's nothing wrong with vertical integration unless you have the opportunity to set the prices for your competitors. I've got a list of 8,000 patients here in Arkansas that signed a petition asking us to vote in favor of this legislation. Just yesterday, I have a list
of three 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. 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 free and fair markets,
a vote for our patients and our taxpayers. Thank you. I'm close to
Speaker 113
2:46:39
the bill. President Baker, you're recognized. Okay. We have a motion
Speaker 103
2:46:50
at the proper time. Members, are there any discussion amongst the members? Representative
Representative Jack Ladyman
Unverified
2:46:55
Ladyman. Thank you, Mr. Chairman. Well, I mean, this is a very difficult, very complicated issue.
But to me, it basically boils down to the monopolizing an industry or 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 would be voting for the bill. I think we have to be the gatekeepers and take all this data and make a decision. Thank you, Mr. Chairman. Thank you. Further discussion from
the members? Seeing none, Representative Aker. you are recognized. I make a motion due pass. We have a motion due pass. Any further discussion on the motion? Seeing none, all in favor say aye. Aye. Any opposed say no. No.
The ayes have it. Congratulations to Rep. Moore, you've passed your bill. Members, we are going to break for lunch and we are going to come back 15 minutes upon adjournment and try to handle as many House bills as we can. Thank you. All right, I got to run. I got to baby down.
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 1
Speaker 2
Representative John Maddox Chair
Unverified
Representative Julie Mayberry
Unverified
Representative Lee Johnson
Unverified
David Cook
Unverified
Speaker 21
Speaker 22
Representative Carol Dalby
Unverified
Speaker 39
Representative Kenneth B. Ferguson
Unverified
Speaker 42
Representative Jon S. Eubanks
Unverified
Representative Jack Ladyman
Unverified
Speaker 65
Representative Fred Allen
Unverified
Speaker 67
Representative Dwight Tosh
Unverified
Speaker 73
Representative Richard McGrew
Unverified
Speaker 87
Speaker 95
Speaker 97
Speaker 96
Speaker 101
Representative Robin Lundstrum
Unverified
Speaker 105
Steve Daniels
Unverified
Speaker 112
Speaker 113
Representative Trey Steimel Chair
Unverified
Speaker 124
Speaker 125
Chair
Unverified
Representative R. Scott Richardson
Unverified
Representative Sonia Eubanks Barker
Unverified
Representative Kendra Moore
Unverified
Representative Mark Perry
Unverified
Speaker 150
Speaker 151
Speaker 156
Representative Les D. Eaves
Unverified
Speaker 168
Speaker 174
Representative Austin McCollum
Unverified
Speaker 204
Speaker 178
Speaker 213
Speaker 220
Speaker 211
Speaker 227
Mike Castleberry
Unverified
Mike Casselberry
Unverified
Speaker 234
Representative Acker
Unverified
Speaker 226
Speaker 244
Speaker 139
Adam Head
Unverified
Speaker 182
Lynette Washington
Unverified
Speaker 258
Speaker 262
Speaker 267
Speaker 269
Speaker 273
Speaker 103