ALC-Employee Benefits Division Oversight Subcommittee

I OK, Adam B, uh. Mr. Grant Wallace, you won't come to the table. OK And I think you understand, uh, What we do if you just introduce yourself and then you'll be uh recognized to present B1 unless you have any other comments before that. Good morning, Grant Wallace, director Employee Benefits division, and I've learned not to make any additional comments than necessary. Um, item. Be one and forgive me, I'm gonna pull up y'all's documents just to make sure we're talking about the same thing. So yes, this is the uh pharmacy formulary recommendations for December. Oh, you will see we're doing some re-teering, uh, for the first two drugs we're adding some quantity limits for the next 2. And then we are adding one new drug on item 235. With um. Some step therapies, um, PAs and quantity limits and then the remaining drugs we are excluding at this time their new drugs, and we're excluding them from the formulary, uh, until further efficacy uh studies come through. With that, I'd be glad to answer any questions. OK, members, uh, this is item B1. Is there anybody that has any questions on the formulary recommendations. Anyone, Senator Stubblefield, do you reckon that, sir? Thank you, Mr. Chairman. Uh, Grant, one of those studies come where they supposed to be finished? Well, we generally review these like on every 6 months it's kind of a, not, not a hard and fast rule, but we try to look at them, uh, when they're new to market about every 6 months and just kind of keep up with them, getting additional time for clinical trials to come through FDA studies, those kinds of things, so, um, we do have that regular cadence that, but there's no hard and fast. that this particular drug is going to be done on this particular time period. All right, thank you, Mr. Chairman. Yes, sir. Thank you, Senator. Anyone else on B1? OK, seeing none, do I have a motion? I have a motion and I have a 2nd all in favor say aye. Any opposed like sign, that motion will carry. All right, we'll go to B2, uh, Mr. Wallace, B2, these are the medical drug. Again, these are drugs that are administered in a clinical setting, um, not from a pharmacy, uh, this is in coordination with um. Health advantage in admission. This is B1B1B, sorry, yeah, so members we're looking at B1B, you heard me say something wrong. B1B is where we'll be. I'm sorry, Mr. Wallace. Go ahead. Uh, so with that, uh, when you see no EBRX restriction, that just means that we would cover either what the label or what health advantages criteria would be. Uh, then you'll see some exclusions or if you see cover with a PA that's where EBRX does have some additional criteria beyond what, uh, health advantage would have or what would, um, the label might necessarily say at this point, um, so with that, I'd be glad to answer any questions. Oh, excuse me, there are 2 that we are removing from formulary because they are no longer in production. Or those zone here? Yes sir. There's about middle of the page, the Ifragen and to GC sorry exclude right yep. OK, this is B1B. Senator Stubblefield, you recognized, sir. uh, why is this one drug no longer valuable generic? Sanderson, uh. Right, that the, um, they're not manufacturing that one. So it no longer manufactured. OK. Thank you, Mr. Chairman. Yes, sir. Senator Irving. You reckon that? Hold on just a second. You should be on now. Thank you, sir. Um, so you are going to mail the letters to the impacted members of the ones that are excluded, um, It says prefer the biosimilar and the generic available. Um, and I, and I mean, they're very costly. I see that. However, Um I suppose what I, I guess my question would be then, did they have any alternative to be able to try to get back to this medication that was probably prescribed to them by their physician. Right, there is always an appeal process, uh, and if we put on here excluded there is an appeal process. OK, because sometimes those, those, the biosimilar may just not work for that patient or the generic may not work and. We do understand that and there are, there is some strategy of excluding them just to kind of force a step therapy process, uh, for somebody that may be new, uh, to that condition and new to taking these types of drugs, but if there is somebody that is an existing patient that has tried it and wants to appeal because they have a history of it with effectiveness, they can do that. We review those, um, I, I don't want to paint myself in a corner, but most likely I have tended to allow that, uh, exception. To occur, uh, if there is a, a long standing use of that particular drug. Yeah, and I, and I think it's important that there the timeliness of that because for some things, it may not be that big of a deal if they're, you know, transitioning from one medicine to another, but for some people it can be kind of an emergent situation. We've got to get them back to the medication that's working because of resistance that may have been built up. I don't know, there's all kinds of different variations. So I just wanted to just make sure we mindful of that. Thank you, sir. Thank you, Mr. Chair. Yes, thank you, Senator Irvin. OK, again, we're on B1B. You want to have any other questions? OK, do we have a motion to approve this? I have a motion. Do I have a second, have a second. We have a motion to 2. All in favor say aye. Any opposes like sign seeing none of that motion will also carry. OK, now we'll go to B2. All right, this is a contract for Catalyze Health. This will be the administration of a spousal incentive health reimbursement program. Uh, we touched on this, uh, historically around we would like to, this is something new, but we would like to try, uh, this program out where if we have an employee whose spouse has group coverage. offered through their employer, we would actually, uh, pay the difference between them shifting over to their employer plan and what that increased premium would be. So for instance, if it's uh individual and they're insured at $100 but to move their spouse over, it becomes $200. We would cover that $100 difference. So what this does it similar to the MAPD plan, it would put a cap on the liability that we at EBD have, we would know a known dollar amount in order to care, uh, to cover that that member. Um, but this also does shift long term liability away from our plan because we are a self-funded plan, so we are incurring at 100% of the claims that that member may incur during their time period with us, um, with that, I'd be glad to answer any questions that you all may have on this. OK, members, you've heard the presentation. Any questions on this? 2 year contract. This will be a 3-year contract, and the reason we did that is because, uh, just understanding the first year is gonna be a lot of education and uptick. Then, uh, we would have a. Year 2 and year 3 to really study the effectiveness and the utilization of this. You take this through the state board of Finance before they come to us. That's already, that, that's already been, OK. All right. Any, any questions in regards to this? OK, do I have an emotion? They have a motion approved. We have a 2nd. All in favor say aye. And he oppose seeing no that motion will also carry. Alright, Mr. Wallace, we'll go to, uh, B3. OK, what you have before you is the EBD recommendation for the state employer match. Um, this is what the state would match per budgeted position for every state employee. It's uh 660 is our proposal for plan year or calendar year 2025. Be glad to answer any questions. OK, members, uh, you've heard this presentation, uh, that this is actually just, we, I think we all, we all knew what the amounts were gonna be. We're actually just complying with statute here just to be, yes sir, this has already been calculated into the rates and everything that were set for 2025. So we, we knew this. So we have a motion, we have a second, all in favor say aye. Any pose? OK, that'll carry All right. Do you have anything else, Mr. Wallace? No, sir. Merry Christmas. Yes, Merry Christmas to you. All right, at this time, what we're gonna have is a presentation, uh, uh. From Patrick Klein. He's our consultant, of course with Segal Group. Hey Patrick, how are you, sir? Doing good. How can you hear me? Yes, sir. So you're, you're gonna be recognized to, uh, present this. If you would just go ahead and, uh, uh, introduce yourselves so we'll have it on the record. OK. Patrick Klein with Siegel. OK. And you're recognized to begin, uh, your presentation on this fiscal impact. Sure. And does, just so I'm aware, does everyone have a copy of the Documents that were prepared, OK. Yes, sir, and uh I guess the first one, do you have on a C1, 12, and 3? Do you have them that way? I don't, I don't, but you could just tell me which one, which order you want me to go, and I'm happy to. OK, the first one is, uh, the title on is United Healthcare MAPD rate. Increase Sure. OK. And members for you, for you, of course, that's gonna be C1. Right. So, so, uh, United Healthcare came back. There's been some changes with the Medicare program. Um, and so they came back with a rate increase of $45 in total for 2025, and then that increases the, let's see, $105 for both the state and the public school MAPD plans. So the current subsidy split, the retirees pay 10% and then the plan picks up 90%. So, uh, the calculations. It's pretty simple. It's really the rate increase, which would be in the first year, $40.50 per retiree per month times the number of current. Uh, enrolled retirees. And so, We're looking at total dollars for the, the plan on the ASC side for 2025, we're looking at a $4.3 million dollar increase. For PSE, uh, 3.5, and then if you combine the two plans together, it's 7.8. Moving on to 2026, where that, we have a even a greater increase versus the baseline, those numbers. End up at 10 million for ASC 8.2 for PSE and 18.2 in total. Is that all you have on C1? Yeah, OK. All right, members, you've heard this, uh, again, we're on C1. Senator Boyd, you have some questions. I, I think I just have one simple straightforward question if you yes sir Mr. Klein, uh, Senator Boyd here in Arkansas, just we're seeing rate increases. I just want to make sure that you're aware of the Wall Street Journal articles that have come out about concerns about some. Practices in UnitedHealthcare. I'm not saying they happen. I'm just saying there are some articles out there and had an opportunity to discuss with Mr. Wallace or whoever is appropriate, whether or not those activities might be happening in our state employee in public school employee retirement plans. Yes, I am aware of, of the articles. Uh, I mean, it's my understanding that the denial rates on the MAP for United Healthcare is about 1%, so. I'm not sure if everything that's coming out is. It is factual or not, but yeah, I mean, that's, it's definitely something we want to So just to clarify, I'm not specifically talking about the denial rates. That's a separate issue the Wall Street Journal reported on. I'm talking specifically about the situation where it was reported that some people had. Nurse practitioners come to their home, wind up with diagnoses that no physician or other, you know, um, Healthcare provider had diagnosed that they were not treated for, but there might have been as much as $50 billion in additional payments that ultimately the, you know, the members and the taxpayers paid for that, those were the, the two specifically that I was referring to. One came out with 50 billion and then another second article. Went down and narrowed it down to more of a, a 20 billion on a more specific issue. So if not, I'm happy to visit with you and, and share those with you. Thank you. OK, thanks. And thank you, Senator Boyd. Any other, any other discussion on, uh, C1. OK, we don't need any action on this, so we'll move to C2, uh. Patrick, yours, uh, will be. At the top it'll be the removal of uh specified budget for vacant positions. So that'll be the C2 for you all members. Yeah, so this would just impact the ASC plan, the state plan. So, currently the funding structure where it's a set dollar amount per uh budgeted position. And I guess there's a a decent amount of vacant position. So the request was, if we remove these vacant positions, what does that do to the funding. So I requested how many vacant positions are there and the number I got back was 5,071. So the math is pretty simple again, it's, it's really the funding amount times the vacant positions times 12, we assumed the funding for calendar year 2025 would increase to 660 and then increase at a 4% CPI from there, um. And when we do the multiplication times set 5,071. If we remove those positions, that would reduce funding to the ASC plan by 41 million in fiscal year 26, and then slowly increases, you know, 43 million and 44 million out in fiscal year 2028. OK. So, so by removing them by removing them, then what the state would have to do or the employee, they would have to pick that up, correct? That's. That's you need in your reserve or you'd have to find a way to, to compensate with, with another level of funding, members, if you all remember in budget hearings, this was we were talking about this over and over again, so this is kind of what all that relates to, so. Is there any, is there any questions in regards to this? OK, Senator Irvin. Thank you. So I, I wanna kind of just go through this because I think, you know, Initially at face value, it seems a little crazy to pay for health insurance benefits for a vacant position. Uh, or seems not to be fiscally responsible. Let's just say it that way. Um, and so it's been a long debate in the legislature about do we continue to do this practice or not, we understand that that contribution does help, I think, is from what you're reporting and correct me if I'm incorrect, that it can, it helps, it helps reduce the increased premiums for everybody else. Is that correct? Yeah, it could. I mean it would just create a $40 million gap in your Your revenue lines, so you'd have to, I mean, if you wanted to make that up, you'd have to come up with another source whether more employee er funding or more employee funding. And the other, the other thing to note is that you don't have any funding based on the number of retirees, you know, pre 65, post 65. So it's all coming from these These positions, which is Maybe a, you know, somewhat uncommon. So the way I think about it is maybe these extra vacant positions that you have, you're getting this additional funding. It's helping funds, uh, some of the retiree expenses in the program as well. OK, so, but instead of, I mean, so my understanding though is we have the funding, but we're actually purchasing that benefit. Is that correct? It's not just that we're putting the funding in. But are we actually purchasing a benefit? We're just, it's just it's we're just putting the funding there. We're not actually, we're not actually purchasing a benefit for a position that's not filled. Right, right, no, so these, yeah, your expenses are gonna be based off the people that are enrolled in the plan, so you wouldn't have any expenses for these, you know, 51. 100 positions, but, but fiscally that money is just sitting there, right, to help offset. I mean, I'm thinking about, I mean, would it not be and I don't know, I'm asking questions here, but from a fiscal perspective, what if we put that money into a bucket that was gaining interest or utilizing that money always earmarked for the program so that you don't create that whole. But for it to just sit there and not make money doesn't make sense to me. I'm trying to figure out the best way to maximize our funding to continue to make sure that our premiums don't skyrocket for everybody else in the plan, but also trying to be fiscally responsible with the taxpayers' dollars and not just have the funding sit there and not creating an impact more than what it possibly or potentially could create. Does I don't. Yeah, I'll try to answer that. So the, the revenue that's generating this, this $41 million it is going into your fund and you do have some interest. Income that's coming from that fund, you know, we're not involved in, in how it's invested. I think it's more of a low interest kind of a cash basis. Um What you're getting the interest on, but it is getting some interest. It's not, I guess, just sitting there. OK OK, well, I appreciate it. I'm, I'm not 100% sure here, but I believe that whenever that just sits in our phone, then it flows through our treasury and then they're actually, uh, uh, that's the way that, that is happening. So. OK. Are there any other questions in in regards to this item? OK. I know there's a lot lit up, but I know it's not in regards to this. OK. All right, members, uh, that'll be, that will be the 2nd 1. Now we will go to the last one. And that's going to be emergency rule 128, uh, of course, that should be your last one that you have, Patrick. And members of this will be of course see C3. I, yeah, I want a preface before we get too far into everything that we, we have limits to data, we're, we're still waiting for complete data, so we, we did a lot of extrapolating on what we think the impact would be. But I think we need to, to go back and, and kind of finalize the analysis. Directionally, we're in the same place as some of the other firms that that have analyzed this. So I think, I think we feel good about Just ballpark where, where the number is, um, but I just wanted to put that out there. So the change that we're analyzing here is if EBD changed their pharmacy reimbursements to a NADA model plus 1% and include a $9 dispensing fee. And so our uh our estimate. Came in at $13 million or $12.7 million and that's total plan cost, so that would be split between uh the member and the plan. So it'd be a less liability on the plan after, after some of that is picked up by the member. OK. Representing Lord Law, do you have a question in regards to this one? I do, Mr. Chair. OK, you, sir, if you don't mind, I'm gonna go ahead and ask for a little bit of leniency because I need to build up to where I'm going, if that's OK. Yes sir So yesterday, And I think today we final approved a $660 on the state contribution side, and that's, that's not including the. 4% medical CPI. Is that correct? And maybe Grant would be better to be at the table, Mr. Chair. Yeah, Mr. Wallace, do you mind coming down? Of course, you've already been down once, but if you would recognize yourself, we'll have it on the record. Grant Wallace, director of employee benefits division. So am I right? Well, currently for 2024, it's 6:05, so going to 660, yes, there is some, uh, inflation that was balanced into that amount. Was it the full 4% medical CPI? 10%. Probably not. OK, so that would be 683 on top, uh, or 68625, I think on top of the 660. If you go 4%. So When we look at our trust fund or excess money, whatever you want to call it. The last 3 months we've came to you a lot on different changes that have been made by either the administration or legislatively, and you've had the common head nod, we can absorb it. We can absorb it. Well, the problem with that is when you start absorbing $12.7 million. It don't take long to eat up a $70 million surplus. And these are arbitrary numbers I'm throwing out, but you're looking at roughly 6 years and it's gone, correct? Yes, sir, and I, I would also, uh, as I understand it, when you're looking at these analysis and what has been presented to me, when you look at NADAC, it's a point in time. Um, and, and I know Patrick could probably get into this a little bit more with their methodology, but that NADA was would have been at that particular point in time, NADA could have gone up. Between now and then, or it could go down, um, it, it is highly fluctuating, but the likelihood of it going down in significant numbers, very rare, correct? Up is not very rare, correct, correct. So, my problem with all this is, is we keep nodding our head and saying yes, we can do this, and I understand you have a job and I understand you have a boss, and I understand how it works. But at some point we can't absorb any more. Where is that point at for us? For me personally, the point is when I don't have predictability in in the out years. OK, so how far exorbing this 12.7 or $13 million where does that leave you at in your out years? Where do we become negative and where do our constituents become to see a huge increase in insurance. And honestly, I can't tell you that because I don't know what the market's going to do. I, I don't know where this is one of those highly unknown values, Patrick. Can you answer that question? Yeah, the last report that we got from Melman, it showed there was about 180 million in reserve for 2024. And I think if we go up to the 660. That's what, that's what they were assuming. In 2025, there'd be a $53 million. gain or net income on the funds, so you're, in other words, your revenue is 53 million higher than your expenses. So you're even including all of these hits. OK, so including these hits, what does that look like in 2025. Yeah, so if you 40 million for the budgeted positions. 10 million on the MAPD and, uh, yeah, so. I mean, the, the number I gave you for the NADA, that was PSE and ASC. So let's just split it and call it, you know, 7 million. So you're talking about 57 million, that is going to Kind of wipe out that net income and create a small net deficit. Um I, I think that's my point and thank you Patrick and Mr. Chair, I think I've made my point, but I, I think the one thing we got to remember is the legislature is anything we do affects this, and we have to be able to account for that or we're gonna be back in the same shape we were, I think it was 4 years ago, we passed the bill and had to come back in a special session and change it. It was a diabetes bill. Maybe it was 2 years ago, because we were looking at a huge impact to the plans. We have to make sure we're looking at this not as today, but is what it's gonna look like for the employees of this state, 5 years from now, 10 years from now, and how that affects them. And some of these hits are very significant when you're looking at a $13 million hit. So, thank you, Mr. Chair. Well, thank, thank you, Representative Wardlaw. It was a great explanation. I do want to say one thing, of course, with the, Rule 128, there's no surprise. I've been out front with where I'm gonna stand, but as devil's advocate for lack of a better word, I do want to say that We haven't been given the numbers in the rule that's been part of the contention, you know, whether or not we would raise it or what the insurance department would raise it to. So, you know, some of, some of this is some speculation, and we're basing it on testimony because we don't have any other. Options to do that, so I do want to put that out there, uh, again, everybody knows where I'm at on that, but again, I think it's fair that we do say that in here that we don't have the numbers, uh, but this has been what's been kind of testified to. So that's what we're having to, having to take. So, I believe Senator Dimay, I think you're next, sir. You're recognized. Thank you. And so my question is, is there any other instances with which the, uh, insurance department would come in and renegotiate your I guess, plan for any other providers. Let's just say that, you know, you're that that we're not paying a PT enough for the PTs across the board to be able to have access and so they decide. That they're not getting paid enough. I is there any instance in which the insurance department would come in and tell you, hey, look, you're gonna have to pay the PTs more. I'm not aware of any, but I've not, I've not been around long enough to have that experience to be honest, I mean, there's no one else that's getting inside your contract or the insurance department doesn't come into your contract and say this is a good plan or black. I mean, we're doing it here, right? In some ways we're helping dictate what the parameters are for what you're going to go out in price. In the market, right? And so I mean I guess my question would be because everyone says, well, we don't know if rates will go up or down or what's going to happen because we don't have the data, we don't have the data, we don't have the data, and it gets said over and over and over again. And so even you sitting here, you can't say really one way or the other or the consultants can't say one way or the other what's going to happen because no one has the data and no one knows what's fair and reasonable because that has yet to be defined. Would it not be beneficial to have that information gathered? And then have a, a bigger conversation about what fair and reasonable is for pharmacies. As manager of a plan, yes, to be able to have some predictability in what I would need to do for rate setting and all of those activities wouldn't you think your position of wanting to have that data, then come back to the table and have a bigger discussion about what's fair and reasonable is, is probably shared by all plan administrators that they would rather, you know, having worked through the contracts, having to, you know, had hired a PBM with all the many things that happen. Would they rather not get all the information then come back and have a bigger discussion, just like you would. I would have to believe so. Thank you. Thank you, Senator, uh, Senator Irvin, I believe you're next. Thank you. Patrick, I In your actuarial world, I think one thing that, um, Mr. Wallace said regarding NADAC was that it was a point in time. So that's my understanding it's, it's fluctuating, correct? So, so you picked, I think you picked these two numbers based on what's been testified to, but my, but if there's no cap. And there is no cap. What, what typically in your world do you use in order to look at inflation. Uh, what, what number is that? And is there any type of predictability within the NAAC structure or within the dispensing fee that we said $9 but if there's no cap, what, what would in your world you would use as a way to to predict without a cap on something, what that inflationary, um, effect would be as you actual. ri ly looked at this and helped plan for future years. Yeah, I think it's, it's quite a challenge when we're talking about Uh, reimbursement structure that we're not really sure what it's gonna look like or where it's gonna go down the line. Honestly, we don't have a lot of plans that utilize this type of reimbursement model, so I haven't, I personally haven't. been faced with that challenge on trying to figure out, um, What it's gonna look like down, down the line, we, you know, we project out trends on future pharmacy claims and rebates and all that, but, you know, getting into the, what NADA's gonna look like. I haven't been involved with. OK, but is there any type of uh inflationary indicator for pharmacy dispensing fees. Is that, does that exist? Or I can, I can take that back and ask our pharmacy team. OK. I, I would like to know that because If you don't mind, I'd like to know that information and see like if it's tied to any kind of, uh, CPI consumer price index of a certain percentage or, or if it even exists for that specific, um, quantity. If you don't mind getting that, I would, I mean, typically, you know, we're going to do an RFP with a vendor, a PBM and they're gonna disclose what they're dispensing fees are over those 3 years. So, I mean, I guess It's all negotiable. But, but I, I will take that question back and just see, you know, big picture, what the expectation is in the future, what recent trends have been, so we should have that information. OK. Thank you. Yeah, you're, you're actually set to, uh, uh, provide testimony before the rule of subcommittee tomorrow and you're gonna have your pharmacy guy then. Is that correct? That's right. If, if you all, but just don't mind having that with that question comes up so that it can be answered and uh, you know, we have some historical data. Sure, all right, thank you, sir. Senator Johnson, is that you that's owner, oh, Senator Boyd, I'm sorry, I couldn't see down there. Center boy, you're recognized, sir. Thank you, Mr. Chair. Uh, I have a few questions. I hope you'll allow me a little bit of leeway here. So, First of all, You indicated that this is not complete, uh, that you needed more data or would like more data, is that, could you confirm that for the record, please, one more time. Yeah, so you stop right there, yeah, that's all I needed is that, yeah. OK, it's Arkansas. We accept that, um, mail order and specialty were seemed to be excluded and based on some real world experience I have, that seems like those might be a cost driver more than some lisinopril or atorvastatin at the local community pharmacy. Could you kind of walk me down that road about why all of a sudden those don't seem to be in there. It's my understanding that they're not eligible for the NADA pricing. So they could just charge anything then. I mean, help me understand what from your view, what, what do we need to direct the insurance commissioner to, to look at with mail order or, or whatever else. I mean, I, I'm just like NADAC is a public number. Why wouldn't they be eligible for NADAC pricing. I mean. I mean, I've seen some examples where in the EBD plan. Mail order was paid a significantly higher price for the same drug than than other pharmacies, so why would we not want to look at that in this study. I mean, you're, you're, you have a contract with the PBM where that's gonna outline. Uh, but, but you say there's a contract, but does it? Can they not, can Novitus not change the price on any given day, multiple times a day if they want to in those contracts. They have pricing guarantees. Guarantees to who? to you or? To the plan, but not to the pharmacy, right? So they guarantee some kind of pricing to the plan, but not to the pharmacy, is that correct? Uh, are you shaking your head? Can you say yes? OK, I heard the yes again, so the other thing is that I've noticed in EBD is some national chains seem to be paid more per prescription. And I'm not talking about a nickel or a quarter that might explain some efficiency. I'm talking $20.25 dollars, something that I would consider more significant of an out of pocket cost to an EBD, an employee who has to, to walk in there to the to that pharmacy and. Pay a higher rate and then if they're not having to do that, then the, the rest of the plan is subsidizing that through premiums, so are you aware if there are national clawbacks, so our national chains being paid more because that money is being clawed back. At a later date. Yeah, I, I think I might have to take some of these questions back. Our pharmacy team member wasn't able to join today, so I, yeah, I don't want to give you an answer that I'm Speculating on. OK, so this final question, Mr. Chair. So can you give me a legitimate reason. Why A pharmacy located inside or outside of Arkansas would be paid a significantly more Amount of money than another pharmacy and by significant, I'm not talking about a nickel. I'm not talking about anything, you know, a $1 or less. Can you give me a good reason why that would happen and. Did you account for the fact that this might actually levelize prices when you, you came in here. Or when you made this report that some prices might actually come down. Again, I'd, I'd like to, you know, take that back and, and we, we could address those questions tomorrow. So really we've released a report and we don't know the answers to some, some questions we just throw it out there so it might make some fake news. Thank you. OK, Senator Boyd, uh, for me as chair and of course with the importance of this rule, it seemed to me that you were asked a question about the non-complete data and, well, yes, but you Acted like that you wanted to expand, expound on that. Uh, I would ask you to do that at that time, this time just so we can have it on record. The first question, Patrick. Sure, yeah, so we requested the most recent data at the time was January through September of 2024, and we knew based on the NAPA control file that there was about 1.5 million claim line in the file and we received a million, so we, we basically got 2/3 of the complete data set, and we've been working through that with uh EBD and, and now Naviitus to try and get the full set. OK. So, basically, basically, you just didn't have the, uh, About 500,000. OK. All right, again, I just, uh, feel it's important that we all, all know what we're talking about here. All right. Is there anything else in regards to this? I'm sorry, Senator Dimay? Yes, sir. Yes, and, and it's just to kind of help educate me because I've been trying to learn as I go, um. On this rule 2118. The way that I'm kind of better understanding how pharmacies are paid, and I just wanna. Make sure I'm not off base here. It's kind of like a teeter totter, uh, some, some are paid or higher drug price. Uh, in a lower, uh, dispensing fee if a dispensing fee at all. Some are paid a greater dispensing fee and a lower drug price. Some pay a little bit of both, but at the end of the day, it's kind of like this. And so if we were to try to go to a When, when the pharmacies are talking about what they're getting paid being different, is it just on the drug cost or is it the dispensing fee or can you? Talk to me about. It should be on both. for us it's a both, but other plans may do it differently. Is that the way that I'm understanding this conversation. I think, I think there'd be variation across what's reimbursed. Across different plants as well. But it's up to the plan to determine, and I'm assuming that's part of an adequate or a network. Computation of how they pay pharmacies, right? Is it based on just strictly drug cost or? Uh, do we also factor in dispensing fee? Is that kind of how that that it's looked at or am I missing something there or no, that's, that's right. Yeah, that's, and, and so when we're talking about one pharmacy getting paid one amount for one drug and another pharmacy getting paid an amount, another just when they're making those because they've come before you, I think, when they're, when they're talking about those things, are they taking into account the dispensing fees too and how those are paid. Yeah, those are a part of the. That, that's part of what they're referring back with is the dispensing fee portion too. OK. All right, thank you. Senator Boyd, yes, sir. You're recognized. Thank you, Mr. Chair. Just one quick follow up to Senator Dismay's question. If the PBM can Change the price to the pharmacy at any moment in time of its choosing, how does it really matter? What the the formula is. I mean, whether it's this national chain, that national chain. I mean, we Why would it make sense? For the state of Arkansas to pay one pharmacy significantly more than others. I understand if it's a nickel, there might be some contracting efficiency, but when we're talking about $20.25 dollars, when you're talking about thousands of prescriptions, that adds up quickly, correct? So can you give me a good reason why we as a state of Arkansas would want that as potential policy. I, I appreciate that you're thinking about it, but it also reflects that there isn't really a good reason. Thank you. OK. Again, I think, uh, that you're already scheduled for tomorrow and you have some other, uh, experts from you again, members, this is our consultant that we use for the EBD program and they were requested to try to come up with some numbers specifically for that, uh, I don't believe that they actually knew that they were going to get all of these questions today as far as from the pharmacy side. So, but if you all will be ready and prepared tomorrow, uh, for Senator Boyd's question, Senator Irvin's Senator Dimas, and I know there's also been some House members that have, uh, told me they're gonna have some more. So. Just, let's be, let's be highly prepared for these, uh, this is just kind of a prelude of what you're gonna get, I'm sure. So, uh, Senator Irvin. Yes, ma'am. Yeah, on your, do y'all ever look at Medicaid programs for actuarial, the seagull. Look at those, we don't, yeah, we don't get involved in, in any Medicaid work. OK. OK, thank you. OK. Thank you. Anything else? All right, Patrick, we appreciate you being here. We'll see you tomorrow, uh, uh, Mr. Wallace, you didn't have anything else, obviously, so we appreciate you, uh, being down there. OK, members, uh, is there anything else that needs to come before us or needs to be discussed? See a nunne will consider it adjourned.