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From YouTube: Interim Joint Committee on Health Services (9-27-23)
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A
I'm
not
sure
how
much
time
we'll
be
able
to
vote
each
one
of
these,
so
we
may
have
to
Institute
a
hard
stop
on
some
things.
So
I
hope
you
folks
are
understanding
that
appreciate
it
we'll
entertain
as
many
questions
possibly
can,
but
if
we
can't
get
to
everyone,
we
certainly
encourage
you
to
follow
up
with
the
speakers
we
have
today.
C
A
D
A
We
had
some
very
robust
discussion
last
year
on
this
very
subject
and
many
many
remember
Representative
Steve
Shelton's
bill
which
did
pass
the
house
but
for
a
reason,
didn't
make
it
through
the
Senate,
but
this
is
something
that
certainly
has
a
lot
of
national
in-state
attention
and
implications.
So
that's
what
we're
addressing
this
subject
this
morning
and
for
our
first
presentation
this
morning,
I'll
turn
the
mic
over
to
my
esteem,
co-chair
representative
Moser,
to
introduce
our
first
speaker.
F
I
think
actually
I
think
I
see
delegate
rohrbach
so
I'd
like
to
just
welcome
everyone
this
morning
and
thank
you
for
being
here
and
certainly
want
to
thank
delegate
rohrbeck
Dr
Matt
rohrback,
who
is
between
patients
joining
us
today
to
talk
about
some
laws
that
they've
passed
in
West
Virginia
around
PBM
reforms,
so
my
eyes
are
not
as
good
as
they
used
to
be
I.
Think!
That's,
that's
you
Matt!
Are
you
on
I
think
you
need
to
unmute
yourself.
G
G
You
for
having
me
and
I've
been
graciously
asked
by
representative
Moser
to
give
you
an
update
on
some
of
the
things
that
we've
done
in
West
Virginia
in
regards
to
pbms
I'm,
not
the
most
computer
savvy
person,
so
I'm
not
sure
I
can
share
my
screen,
but
I
think
you
have
the
copies
of
the
slides
in
front
of
you
and
I
thought.
I'd
start
back
with
some
of
the
PBM
bills
that
we've
done
and
they
will
be
made
available
to
your
committee.
G
G
relating
to
Pharmacy
Audits,
and
this
bill
was
otherwise
known
as
the
pharmacy
audit
Integrity
Act
did
several
things.
It
really
defined
the
terms
and
the
conditions
and
the
procedures
of
how
a
pharmacy
got
audited.
So
it
made
it
fair,
both
ways
it
limited
access
to
who
may
gain
the
data
from
the
pharmacy
and
prohibits
the
auditing
institution
from
being
solely
compensated
based
on
the
amount
they
recouped
or
claimed
by
the
pharmacy.
G
In
other
words,
we
didn't
say
we
didn't
want
the
pharmacies
to
be
audited
by
people
that
were
just
going
to
come
in
there
and
frivolously
find
things
to
just
claw
money
back.
The
pharmacy
has
at
least
30
days
to
respond
to
a
report.
If
they
don't
get
a
fair
hearing,
then
it
goes
in
front
of
the
office
of
the
insurance
commissioner
and
it
also
prohibited
clawbacks,
based
on
simply
an
overpayment
due
to
a
clerical
error.
G
So
it
also,
if
there's
any
Criminal,
Intent
or
fraud,
then
this
code
does
not
apply.
The
other
thing
that
it
did
that's
important
is
we
required
Pharmacy
benefit
managers
and
the
auditing
entities
both
to
register
with
the
insurance
commission,
meaning
we
now
had
a
way
to
track
who's,
doing
the
tracking,
so
that
was
2017..
G
G
If
they
told
a
patient
look,
don't
pay
your
co-pay
just
buy
it
for
the
four
dollars
cash
and
be
done
with
it,
and
a
lot
of
Pharmacists
had
to
sign
agreements
with
their
pharmacies.
They
couldn't
do
that
or
they
could
be
penalized.
So
we
did
away
with
that.
In
addition,
it
also
passed
the
law
that
the
pharmacist
was
prohibited
from
collecting
a
copay
that
was
larger
than
what
they
could
do,
just
sold
it
to
them
outright
for
cash,
meaning
that
actually
the
PDM
was
making
money.
G
If
the
patient
was
charged,
the
traditional
co-paid
for
that
plan,
2019
Senate
bill
489..
G
Now
this
one
did
a
lot.
The
pharmacy
audit
Integrity
Act
this
bill.
We
went
from
registration
to
licensure
for
pbms,
so
they
were
now
required
to
submit
reports
to
the
insurance.
Commissioner,
it
also
protected
340b
pharmacies
from
any
practices
that
would
limit
their
access
to
340b
programs.
G
It
prescribed
specific
criteria
for
the
auditing
entity
to
follow,
so
we
did
some
of
that
in
17.
We
really
went
further
in
19
and
it
really
put
some
fairly
stringent
rules
about
clawbacks
or
recruitments
involving
dispensed
products.
So
again
we
we
did
away.
You
know
if
there's
willful
misrepresentation
or
intentional
fraud.
None
of
this
applies,
but
otherwise
you
know
it
all
applies.
Then
it
had
to
be
an
actual
overpayment
to
claw
it
back.
G
So
the
other
thing
that
we
did
in
that
bill
was
the
applicant
must
demonstrate
Network
adequacy,
meaning
that
a
PBM
Network
cannot
be
all
mail
order.
They
have
to
have
a
mix
of
mail
order
and
physical
stores,
meaning
they
had
to
work
with
the
local
pharmacies
to
provide
Network
adequacy
for
people
that
wanted
to
get
their
prescriptions
quicker.
They
wanted
to
use
their
local
pharmacist.
G
So
there's
no
proprietary
information
from
the
PBM
getting
out
so
before
you,
but
it
does
go
to
the
insurance
commissioner
and
they
have
the
ability
to
get
that
under
statute.
It
also
again
tightened
the
rules
about.
It
prohibits
a
PBM
from
engaging
in
specific
reimbursement
practices
that
would
limit
Pharmacy's
ability
to
participate
in
340b
there's
also
something
in
there
about
public
and
employees
insurance
agency,
which
kind
of
specific
to
West,
Virginia
and
I,
don't
I
doubt
any
of
much
of
that
would
apply
to
the
Commonwealth.
G
G
So
again,
we're
leveling
the
playing
field
for
the
to
try
to
help
the
local
pharmacists
they
are
also.
The
PBM
is
prohibited
from
reimbursing
an
affiliate
more
than
it
reimburses
another
Pharmacy,
meaning
that
you've
got
to
keep
it
fair
to.
If
the
local
pharmacist
wants
to
participate,
then
they
can
another
thing
that
that
bill
did
was
basically
made
an
any
willing
provider
and
those
of
you
that
are
in
medicine,
kind
of
know
how
that
works
in
regards
to
Medicare
and
Medicaid,
but
it
gave
a
local
pharmacy
if
they'll
participate
under
the
reimbursement
model.
G
That's
set
up
in
the
bill.
It
gave
them
access
to
participate
now,
if
they,
if
they
say
we
can't
do
this
for
10.49
a
script
fee,
then
then
they
can
certainly
not
participate,
but
it
gave
them
a
mechanism
to
participate.
So
the
other
important
thing
that
that
bill
did
was,
if
there's
a
rebate,
then
the
consumer
gets
that
rebate
back
at
the
point
of
service.
G
Those
rebates
flow
back
to
the
PBM.
Now
under
this
law-
and
this
is
the
key
part
of
the
law-
those
rebates
now
go
to
the
consumer
at
the
point
of
service.
So
if
there's
a
50
rebate,
the
consumer
gets
that.
So
that
has
really
worked
very
well
and
despite
what
you'll
hear,
we
haven't
seen
any
changes
in
the
cost
of
insurance.
G
D
G
They
Exempted
especially
drugs.
Well,
we
actually
put
a
definition
of
what
is
especially
drug
and
it
means
a
drug
used
to
treat
a
chronic
or
complex
or
rare
medical
condition
and
requiring
special
handling
or
Administration
provider
care
coordination
or
patient
education.
That
cannot,
and
that's
the
key
word
that
cannot
be
provided
by
a
non-specialty
pharmacy
or
pharmacist,
meaning
that
you
can't
just
take
everything
and
pull
it
back
in
and
declare
it
especially
Farmers
or
especially
drug.
So
none
of
this
applies,
so
we
really
put
some
limits
and
fair
limits.
G
There
are
some
things
that
that
are
certainly
specially
drugs,
but
we
really
put
some
limits
and
some
definitions,
because
before
the
PBM
got
to
make
the
definition
so
now
in
code
we
have
what
is
the
definition
of
a
specialty,
drug
and
I
think
that's
the
key
part
of
that
one
and
then
lastly,
but
I
forgot
that
back
in
2019,
we
did
you
don't
have
a
slide
about
that,
but
I
will
certainly
get
you
a
copy
of
this
bill.
It's
house
bill
2770.
G
and
what
that
did
was.
Basically,
it's
called
a
cost
accumulator
provision
which,
if
a
patient
goes
to
get
a
script
filled
and
they
have
access
to
someone
else,
be
it
the
manufacturer,
Foundation
someone
paying
part
of
their
co-pay
well
before
they
weren't
getting
credit
from
all
the
insurers
from
that
bill
or
from
from
that
payment
towards
their
deductibles.
Even
though
the
insurance
company
didn't
pay
it.
So
let's
say
they
had
a
thousand
dollar
specialty
drug
and
they
say
they
had
a
reimbursement
that
was
going
to
pay
800
of
it.
G
G
I
think
that
we've
done
in
West,
Virginia
and
I
doubt
that
we're
unique
a
lot
of
states
have
done
varying
aspects
of
this,
but
to
try
to
put
some
fairness
back
in
the
system
to
try
to
help
your
patients
control
the
cost
and
also
to
help
keep
some
local
pharmacists
in
business
and
yet
not
I
mean
we
haven't
outlawed
pbms
or
anything
like
that.
They
perform
a
service,
but
to
put
some
fairness
between
them
and
the
local
pharmacist.
So
with
that,
that's
those
are
the
bills
that
that
we've
certainly
done
in
West
Virginia.
A
Thank
you
appreciate
that
information
done
greatly
and
I
think
it's
interesting
that
your
legislature
has
had
to
devote
so
much
time
to
these
particular
issues
with
pbms
and
I.
Think
in
theory,
they're
designed
to
supposedly
reduce
the
cost
of
health
care,
but
I'm
having
a
hard
time
connecting
the
dots
and
of
your
presentation,
you
gave
us
a
lot
of
great
information.
A
I
sponsored
and
Senate
Bill
68
last
session
that
dealt
with
rebates
at
the
point
of
sale
and
the
immediate
pushback
I
received
was
it's
going
to
cost
employers
millions
of
dollars,
because
social
rebates
are
used
to
reduce
the
cost
of
health
care
premiums.
But
you're
saying
that
has
not
been
the
case
in
West
Virginia.
Is
that
correct?
We've.
G
Yeah
yeah
big
time-
and
you
know
the
it's
going
to
be
hard
to
track
and
you
know
have
to
add
computer
systems
and
all
that,
but
we
just
haven't
seen
that
it's
the
patients
have
liked
it
so
far.
It
hasn't
really
changed
cost.
But
it's
again
it's
leveled
the
playing
field,
so
the
patient
who's
paying
the
bill
gets
the
rebate.
If.
G
A
Was
a
practicing
physician?
You
certainly
know
that
the
administrative
cost
of
Health
Care
is
ridiculously
high
and
we're
about
double
what
other
industrialized
nations
spend
on
the
administration
of
Health,
Care
and
I
know.
This
is
a
kind
of
a
tough
question,
but
do
you
really
think
that
pbms
bring
value
to
the
Health
Care
delivery
system.
G
G
They,
okay,
I,
think
all
these
bills
and
and
certainly
I,
know,
delegate
Moser
and
I've
set
through
a
number
of
talks
at
various
meetings
that
we've
attended,
I
I
every
state
is
struggling
with
this
and
if
you
go
back
and
look
historically
and
we've
got
this
data
that
I
can
share
as
well.
If
you
really
go
back
and
the
best
data
that
I've
got
is
from
our
employees
plan,
the
percentage
of
our
total
spend
over
the
last
10
to
15
years.
G
That's
based
on
you
know:
total
dollars
expended
hospitals,
Physician
Services,
the
rest
of
it
have
been
reasonably
stable.
The
pharmaceutical
costs
have
more
than
doubled.
Now.
Some
of
that
is
higher
cost
medication.
There's
no
doubt
about
it.
So
the
manufacturers
are
part
of
the
equation,
but
I
think
pbms
are
part
of
the
equation
too.
So
I
think
every
state
that
the
more
I
talk
to
people
and
all
the
states
and
territories
we're
all
struggling
with
the
same
problem.
G
Yeah
there's
no
question
about
it,
but
we're
you
know
we're
trying
to
do
it
in
a
fair
fashion,
because,
okay,
our
employee
plan,
we
we
use
a
PBM,
so
I'm
sure
the
common
one
I
think
you
guys
may
or
may
not
still
use
a
PBM,
but
some
States
territories
have
done
away
with
pbms
as
they're
managers,
but
we're
all
trying
to
get
a
handle
on
these
costs
and
I.
Do
think
that
some
of
the
administrative
costs
have
come
under
question
and
do
they
really
and
they
certainly
they
have
not
kept
the
cost
down
because
consistently.
G
There's
a
percent
of
the
cost
of
Health
Care
spend
pbm's
as
they've
skyrocketed
the
cost
of
Skyrocket
as
a
percent
of
our
health
care
spend.
So
that's
where
I
think
we're
all
struggling
and
I
think
the
Commonwealth
of
Kentucky's
in
the
same
boat
as
as
state
of
West
Virginia
and
and
we're
trying
to
figure
out
ways
to
to
bend
that
curve
back
down.
A
F
Thank
you,
Mr
chair,
thank
you
for
your
presentation,
thanks
again
for
being
here,
and
thank
you
also
for
making
me
an
honorary
delegate
you're,
my
good
friend
so
I'll
be
a
delegate.
Today
we
have
here
in
Kentucky,
worked
on
several
of
these
issues
and
some
have
passed
some
haven't.
We
actually
were
able
to
go
from
six
pbms
with
every
MCO
kind
of
having
their
own
PBM
Pharmacy
benefit
manager
to
a
single
PBM
and
Have
Not
only
shown
through
data-driven
information
that
this
is
successful.
F
F
We.
We
also
passed
the
copay
accumulator
bill
in
2021,
but
you're
a
little
ahead
of
us.
So
are
you
seeing
any
what
what
sort
of
data
are
you
seeing
from
that
or
are
patients.
G
Or
your
patients
will
love
it
and
again
it's
just
it's
fairness.
If,
if
they
walked
in
with
a
thousand
dollar
bill,
whether
they
paid
the
thousand
dollars
or
the
thousand
dollars
was
were
those
that
money
was
paid,
it
really
doesn't
matter
who
paid
it
because
the
insurance
company
didn't
pay
it
so
whether
it
was
a
rebate
or
a
manufacturer's
discount
or
whatever
giving
the
patients
credit
for
that
has
been
wobbly
popular
among
patients
and
honestly,
we're
talking
about
patients
here
in
large
part
that
are
on
expensive
medications.
G
D
G
And,
and
so
these
these
are
our
patients
that
tend
to
run
up
the
highest
health
care
bills
and,
in
large
part,
this
has
helped
them.
So
anything
we
can
do
to
help
our
sickest
constituents
with
their
health
care
costs
has
been
a
good
thing.
So
we've
we've
really
heard
nothing
but
positive
comments
from
that
bill.
Yeah.
F
I
think
it's
a
great
thing
and
I
really
appreciate
your
sharing.
All
of
your
information,
we're
going
to
have
to
compare
notes
with
some
of
the
work
that
we've
already
done
and
and
we've
had
some
pretty
big
PBM
reform
bills
and
it
sounds
like
you've
kind
of
parceled
out
some
of
the
pieces
that
we
had
in
one
bill.
F
So
you
know
I,
think
that
we'll
likely
hear
from
representative
Bentley,
who
is
also
on
he's
our
our
expert
pharmacist,
but
a
quick
question
about
the
340b
protections
that
you
put
in
place
because
I
see
340b
as
EI
understand
what
it
is,
but
it's
growing
and
growing.
So
what
sort
of
protections
did
you
put
in
place?
Well,.
G
That
the
PBM
couldn't
discriminate
unfairly
against
a
340b
pharmacy
or
provider.
Now
I
do
agree
that
that
whole
program
is
kind
of
being
looked
at
by
the
federal
government,
because
it,
it
probably
has
gotten
out
of
control
and
I,
was
reading
something.
Recently,
one
of
the
major
medical
institutions
in
the
country
has
800
outlets
now
all
around
the
country
for
their
patients
to
get
their
biologics,
so
it
that's,
probably
not
what
this
law
was
ever
intended
for
now.
G
I
do
know
that
the
federal
government
is
taking
a
very
serious
look
at
that
program,
but
all
we
can
do
is
deal
within
a
structure
that
340b
operate
Center
and
we
just
want
it
kept
Fair
between
340,
B's
and
non-340bs.
Now,
at
some
point
in
time,
if
changes
are
made
to
the
federal
level
that
then
we'll
we'll
adapt
it,
as
will
you
I
mean
because
it
is
a
federal
program,
but
we
just
didn't
want
any
unfair
competition
to
go
on
between
non-340b
and
340b
pharmacies.
As
far
as
how.
F
H
G
D
G
Not
so
again,
those
are
the
institutions
that
tend
to
deal
with
our
most
vulnerable
patient
populations.
So
all
what
we're
asking
is
that
they
be
dealt
with
fairly
under
the
same
rules
and
regulations
that
the
non-340b
institutions
are
and
if
there
are
340b
institution
and
that
had
to
be
recognized
as
such.
So
that's
bad,
but
it's
all
driven
off
of
a
percent
of
Medicaid.
A
G
And
it's
been
a
pleasure
to
work
with
that,
and
you
know
representative
Bentley
and
I
were
at
a
meeting
not
long
ago
and
I
know
a
number
of
people
on
your
committees.
So
again.
D
G
D
A
A
blessed
day,
it
has
been
brought
to
my
attention
very
graciously
that
I
got
ahead
of
myself
on
our
agenda.
We
need
the
approval
of
the
minutes
which
were
previously
distributed.
So
any
questions
comments
if
not
entertain.
Emotions
motion
Motion
in
a
second
all's
in
favor
vote,
I
in
the
opposition
all
right.
Thank
you.
Our
next
presenter
on
Pharmacy
benefit
manager.
Reform
is
Miss.
Sally
West
has
sort
of
come
forward.
I
Thank
you,
Mr
chair,
I'm,
Sally,
West
I'm,
the
director
of
government
relations
for
Walgreens
and
I
cover
the
state
of
Kentucky.
So
thank
you
very
much
for
having
me
here
today.
I
really
appreciate
this
opportunity
to
testify
before
you,
and
this
is
such
an
important
topic
and
I
think
at
the
outset.
I
want
to
say
if
I
leave
you
with
one
takeaway,
it's
that
if
Walgreens
a
company
with
almost
9
000
stores
nationwide,
is
feeling
the
squeeze
on
reimbursement.
I
So
today,
I'd
like
to
take
you
through
I'd,
like
to
take
you
through
sort
of
a
summary
of
what
retail
pharmacies
are
and
then
walk
you
through
the
practice
of
Pharmacy
benefit
managers
as
it
relates
to
our
reimbursement
and
if
it's
okay
with
the
committee
I,
will
refer
to
Pharmacy
benefit
managers
as
pbms
throughout
my
presentation.
I
So
also
at
the
outset,
I'd
like
for
you
to
know
that
Walgreens
does
not
own
or
operate
a
PBM
and
I
feel
that
gives
us
some
some
of
a
more
analytical
view
of
how
they
function
with
regards
to
Pharmacy
reimbursement.
So
to
begin
with,
pharmacies
are
the
most
accessible
health
care
provider
throughout
the
United
States.
There's
a
pharmacy
located
within
five
miles
of
almost
90
percent
of
Americans,
with
almost
50
percent
of
Americans
living
within
one
mile
of
a
pharmacy.
I
They
provide
testing
and
treatment
for
minor
acute
illnesses
like
flu
and
strep
throat
and,
of
course,
they
counsel
their
patients
on
proper
adherence
to
their
medications.
During
the
height
of
the
Cova
pandemic,
pharmacies
were
open
for
business.
We
were
still
caring
for
our
patients
and
during
natural
disasters.
Pharmacies
are
at
the
scene,
delivering
medications
to
patients
and
shelters
and
helping
to
deliver
first
aid.
I
I
I
So,
while
the
front
end
sails
only
make
up
about
25
percent
of
our
business,
they
account
for
50
of
our
net
earnings,
with
all
that,
a
three
percent
ROI
leaves
very
little
room
for
any
unforeseen
difficulty
like
a
market
downturn
or
a
diminishing
Pharmacy
reimbursement
rate,
and
so
it
is
Little
Wonder.
The
community
pharmacies
in
every
part
of
the
country
are
closing
up
shop.
I
So
how
are
pharmacies
reimbursed
in
order
to
have
access
to
patients?
Pharmacies
contract
with
Pharmacy
benefit
managers
in
both
the
commercial
market
and
the
Medicaid
space?
It's
important
to
understand
that
pbms
do
actually
add
value.
They
can
pull
volume
across
health
plans
in
order
to
negotiate
better
rates
from
the
manufacturer.
I
They
administer
an
adjudicate
prescription,
drug
claims
and
they
provide
plans
with
information
on
the
quality
and
efficacy
of
prescription
drugs.
There
are
currently
over
60
pbms
in
the
United
States.
The
three
largest
pbms
are
Caremark
Express,
Scripts
and
OptumRx,
and
they
control
80
percent
of
the
market
and
notably,
they
each
have
their
own
Pharmacy.
I
So
how
do
pbms
make
money,
and
this
should
not
be
considered
an
exhaustive
list,
but
these
are
some
of
the
ways
that
they
make
money
so,
first
and
foremost,
and
I
believe
that
the
delegate
touched
on
this
previously
but
rebates
so
pbms
negotiate
with
drug
manufacturers
for
product
placement
on
their
formulary
manufacturers,
provide
pbms
with
rebates
for
favorable,
formulary
placement
and
historically
would
keep
the
entirety
of
that
rebate.
Neither
the
health
plan
nor
the
patient
would
see
any
of
that
money
more
recently
with
the
passage
of
state
laws.
I
This
practice
is
starting
to
change
slowly
and
state
by
state.
Many
states
now
require
the
pbms
to
pass
the
rebate
on
to
the
health
plan
or
back
to
the
patient,
but
because
the
system
isn't
entirely
transparent,
it's
hard
to
be
certain
if
a
hundred
percent
of
the
rebate
is
being
passed
through,
another
common
practice
of
pbms
is
called
Pharmacy
spread.
I
I
Administrative
fees,
pbms
do
administer
plans
and
they
do
adjudicate
claims
and
they
should
receive
fair
market
compensation
for
that.
Administrative
fees
are
paid
by
the
pharmacy
for
Network
participation
by
the
health
plan
for
plan
Administration
and
by
the
manufacturers
for
formulary
access,
there's
another
very,
very
complicated
thing
called
direct
and
indirect
remuneration,
otherwise
known
as
dir
fees.
I
I
Originally
dir
fees
were
used
in
Medicare
Part
D
plans
as
a
way
for
CMS
to
ensure
that
the
true
cost
of
the
drug,
minus
any
rebate
or
other
discount
was
what
they
were
paying
more
recently.
Dir
fees
have
been
used
as
a
way
for
pbms
to
extract
clawbacks
from
pharmacies
for
arbitrary
and
opaque
performance
metrics,
and
this
is
especially
Troublesome
in
the
Specialty
Pharmacy
space,
where
patients
may
have
to
change
medications
multiple
times
before
they
find
the
regimen
that
works
for
them.
I
So,
firstly
I'd
like
to
say
that
you
should
consider
prohibiting
clawbacks,
so
that
pharmacies
have
certainty
that
they're
not
going
to
receive
a
surprise
Bill
months
after
dispensing
a
prescription
for
which
a
claim
was
already
adjudicated,
prohibit
mandatory
mail
order
so
that
patients
can
receive
their
medications
in
a
timely
manner
from
their
trusted.
A
Thank
you.
We
will
open
up
the
questions
appreciate.
Your
presentation
was
a
very
interesting
thought,
provoking
I
think
that
was
interesting,
that
you
think
pbms
do
bring
value
to
the
healthcare
delivery
system.
I
guess
where
the
push
pull
is,
is
at
what
cost
so
I
guess
that's
what
we
have
to
Grapple
with,
but
I
appreciate
your
opinion
on
whether
they
bring
value
to
the
system
or
not.
A
You
also
mentioned
about
the
whack-a-mole.
It
seems
like
we
do
that
a
lot
at
least
lately,
so
you
suggesting
that
we
don't
have
like
an
Omnibus
Bill
to
address
all
these,
but
we
should
try
to
address
them
individually.
Is
just
the
opposite?
Yes,
okay,
misunderstood
you!
Okay,
thank
you
because
yeah
that's
yeah,
I'd
like
to
do
it
all
one
time.
Thank
you
represent
Dodson.
You
have
a
question
comment.
J
J
I
Mr
chair:
well,
maybe
we
missed
the
boat
on
the
PBM,
Market
I,
don't
know.
I
I
believe
I'd
like
to
believe
this
decision
was
made
well
before
I
joined
Walgreens,
but
I'd
like
to
believe
that
perhaps
it's
because
it's
an
inherent
conflict
of
interest.
K
L
Give
a
real
you
know
we're
hearing
from
you
from
Walgreens,
which
is
a
large
business
and
CVS
is
a
large
business.
Can
you
speak
to
the
mom
and
pop
pharmacies
that
we
see
in
more
rural
counties
in
Kentucky
and
how
PBS
pbms
would
affect
them?
I
The
small
mom
and
pop
pharmacies
do
not
have
the
advantage
of
having
the
large
front-end
sales
right.
So
when
I
mentioned
previously,
how
only
25
percent
of
our
sales
are
only
25
of
what
we
sell
is
at
the
front
end.
It
makes
up
50
percent
of
our
net
profit,
while
75
percent
of
our
sales
are
Pharmacy
but
make
up
50
of
the
profit.
A
H
Alex
off
sorry,
I
actually
think
that
reforming
pbms
in
the
state
is
one
of
the
basic
things
we
can
do
for
consumer
protection
I
as
a
physician
and
a
patient
have
spent
literally
days
days
with
my
PBM
trying
to
get
prescriptions
approved
for
my
family
and
and
I'm
an
informed
consumer.
Who
knows
how
to
argue
this?
If
you
are
not,
it
is
at
this
point.
Hopeless
and
pharmacists
in
the
community
are
essential.
They
protect
patients.
H
It
is
a
patient
care
issue,
it
is
not
people
think
oh
you're,
just
dispensing
pills,
you're,
just
counting
to
30
you're,
counting
to
30.
absolutely
unequivocally.
That
is
not
the
case.
Pharmacists
are
there
to
protect
patients,
they
need
to
be
accessible,
they
need
to
be
on
the
front
line
of
medication
delivery
and
not
locked
behind
literally
days
and
days
of
phone
calls
until
you
can
get
to
a
pharmacist,
and
all
they
can
do
is
apologize
for
the
system
within
which
they
are
now
working.
H
I
And-
and
this
goes
back
also
to
the
other
question
previously-
one
of
the
advantages
I
think
that
that
Walgreens
does
have
is
pharmacy
technicians
and
and
having
the
the
payroll
to
hire
numerous
pharmacy
technicians
who
do
work
behind
the
scenes
to
address
those
issues.
So
we
have
a
whole
claims
adjudication
system.
I
We
have
a
whole
system
that
works
with
insurers
with
pbms,
to
get
medications
approved
for
a
patient
to
work
through
prior
authorization
and
and
so
I
would
say
that
that
we
do
have
an
advantage
in
that.
But
you
are
absolutely
correct.
I
I
You
are
absolutely
correct
and
you
have
to
be
informed
and
most
patients.
Unfortunately,
don't
have
the
time
that
it
takes
to
be
that
informed
at
that
level.
A
Thank
you
really
appreciate
it.
We
have
two
final
questions
in
the
queue
one
will
be
within
this
room,
then
representative
Bentley
will
be
doing
remotely,
but
we'll
go
first
with
representative
bratcher.
A
C
C
Self-Insured
employers
were
falsely
told
that
PBM
reformed
from
last
session
would
cause
premiums
to
go
up.
Well,
we
see
the
West
Virginia
they
didn't
happen.
One
point
to
make
for
sure
is
that
to
know
that
340b
is
a
federal
program
and
any
reform
up
to
now
has
avoided
interfering
with
that
program
and
rightfully
so.
The
340b
program
needs
attention,
but
does
not
be
need
to
be
combined
with
a
PBM
reform
that
we're
talking
about
today.
C
Now,
after
you
make
the
comment
about
the
state
employees
comments,
actually
the
house
bill
that
made
its
our
house
would
have
still
providing
the
same
competition
and
would
have
just
made
the
PM
satisfy
the
same
list
of
criteria
we
use
for
Kentucky
Medicaid.
It
calls
that
record
1.5
billion
in
rebates
and
a
decrease
in
millions
and
costs
for
Kentucky
taxpayers.
C
We
continue
to
let
our
self-insured
employers
get
totally
overcharged
if
it's
great
enough
for
Kentucky
Medicaid,
why
can't
we
protect
our
consumers?
And
my
last
thing
is
make
sure
we
point
out
that
our
40
50
page
Bill,
House
Bill
447,
that
passed
would
address
everything
that
Walgreens
lady
suggested.
Thank
you.
Mr
Speaker.
A
A
A
A
N
N
It's
an
important
issue
for
the
purposes
of
patient
health
and
safety.
Some
of
what
I'm
going
to
say
to
you
will
seem
very
obvious.
You
know
hospitals
and
health
insurance
companies
each
exist
for
particular
purposes.
The
hospitals
exist
because.
N
We're
trying
to
treat
patients
to
restore
their
health
to
preserve
their
health,
to
bring
new
life
into
the
world,
and
that's
our
real
mission
is
taking
care
of
patients
there's
a
second
mission
for
the
insurance
company
and
that
is
to
serve
their
shareholders
and
that's
a
good
Mission.
There's
nothing
inherently
wrong
with
that
mission.
N
We
need
them
to
take
care
of
covering
our
patients,
because
Health
Care
is
expensive.
There's
no
getting
around
it,
because
hospitals
require
lots
of
infrastructure.
We
pay
some
of
the
most
well-trained
professionals
in
our
society
and
we
use
some
of
the
most
expensive
and
sophisticated
equipment
in
order
to
try
and
produce
the
good
outcomes
that
we
all
want
for
our
patients.
N
The
insurance
company
is
motivated
differently
notice,
I
didn't
say,
wrongly,
it's
just
motivated
differently.
The
motivation
for
the
insurance
company
is
to
make
sure
they're
getting
a
return
for
their
investors
and
that's
a
good
thing.
We're
all
investors,
if
you're,
if
you're
on
the
state
payroll
you're
invested,
and
so
that's
a
good
thing
and
we
like
to
see
our
people
employed,
we
like
to
see
businesses
that
are
growing
and
thriving.
N
So
that's
all
good,
but
the
problem
comes
when
there's
this
inherent
natural
tension
between
the
insurance
companies
need
to
make
money
and
our
need
to
protect
the
health
and
safety
of
our
patients.
And
that's
where
you
come
in
kind
of
calling,
the
balls
and
Strikes
it's.
It's
really
the
role
of
government
to
call
those
kinds
of
balls
and
Strikes,
and
we
think
this
one
is
very
much
a
strike
again.
N
N
The
white
bagging
process
really
is
subject
to
a
number
of
stress
points
where
something
can
go
wrong.
That
could
cause
injury
to
the
patient
if
it
doesn't
adhere
strictly
to
the
refrigeration
protocols,
the
cold
storage
that
has
to
take
place
if
something
is
mailed
to
the
wrong
place.
If
it
shows
up
on
a
loading
dock
and
isn't
properly
received,
and
then
it's
infused
into
the
patient,
it
can
be
either
inefficacious
and
we
don't
know
that
we're
not
really
giving
the
patient
what
they
need,
or
it
can
outright
be
dangerous
to
the
patient.
N
So
the
other
potentials
there
are
are
concerning
a
little
less
so,
but
there's
potential
waste
of
very
expensive
medications
if
they've
been
damaged
along
the
way
and
can't
be
used,
because
the
last
thing
that
we
want
is
to
put
something:
that's
not
going
to
be
for
the
patient's
benefit
into
their
arm.
We
want
to
make
sure
that
what
they're
getting
is
going
to
be
safe.
N
The
patient
presents
what
their
treatment
plan
is,
is
going
to
be
devised
between
them
and
their
provider
and
they
determine
what
medications
are
needed.
Those
are
put
into
the
electronic
health
record
that
all
moves
forward
when
the
patient
then
presents
for
their
treatment
or
actually
right
before
that,
there
will
be
some
blood
tests
done
and
if
there
are
any
changes
that
need
to
be
made
in
the
medication,
the
hospital
pharmacy
will
make
those
changes
at
that
point
so
that
the
patient
is
sure
that
they're
getting
what
they
need
when
they
need
it.
N
N
The
drugs
are
shipped
via
mail
order
pharmacy
to
the
hospital
to
administer
and
they
go
through
alternative
or
sometimes
non-licensed
Distributors,
and
we're
always
concerned
that
we're
making
sure
that
we
meet
the
federal
drug
safety
laws
for
the
transport
of
drugs.
We
don't
have
any
way
of
knowing
that
that
has
taken
place
when
it's
being
shipped
from
a
mail
order,
place
medication
package
could
easily
be
misplaced
or
lost,
and
there's
just
no
guarantee
that
the
critical
Cold
Storage
requirements
have
been
followed
during
that
chain
of
custody
for
most
infusions.
N
The
patient
again
is
required
to
have
labs
done
immediately
before
treatment
with
white
bagging.
If
something
has
changed
in
the
labs
and
the
treatment
needs
to
be
changed
at
the
last
minute,
two
things
can
happen
either
that
dose
is
going
to
be
wasted
and
we've
thrown
away
medications
worth
tens
of
thousands
of
dollars
or
the
hospital
can
make
the
decision.
N
N
N
You
heard
a
little
bit
about
the
interplay
with
340b
and
how
many
Medicaid
patients
are
being
seen
and
most
of
our
hospitals
in
the
state
are
safety
net
providers
and
it's
their
mission
to
ensure
that
patients
are
going
to
be
treated
regardless
of
their
ability
to
pay.
So
if
you
take
the
safety
net
facility,
the
340b
covered
entity
out
of
the
equation.
N
The
hospital
has
now
lost
its
ability
to
use
that
program
to
pay
for
treatment,
and
so
the
patient
may
now
be
up
against
a
situation
where
they
can't
afford
their
treatment
and
that's
not
right.
We
don't
want
that
large
mail
order.
Pharmacy
simply
do
not
share
the
safety
net
mission
to
ensure
that
patients
can
afford
their
therapy
under
white
bagging
inventory,
control
costs
increase
for
providers
they're
going
to
bear
that
cost.
N
The
cost
of
intake
and
storage,
the
cost
of
equipment,
staff
facilities
and
the
risk
of
spoilage
all
fall
on
the
hospital,
and,
ultimately
that
can
have
an
imper
impact
that
is
adverse
on
access,
because
oncology
is
not
a
money
maker
for
hospitals.
Hospitals
offer
that
as
a
service,
they
make
the
money
on
elective
surgeries.
You've
heard
a
lot
over
the
last
couple
of
years
about
the
damage
that
was
done
when
elective
surgeries
were
shut
down
during
the
pandemic.
That's
really
what
we're
talking
about
here.
N
Oncology
is
not
a
revenue
raiser
for
the
hospital,
and
so
if
the
losses
are
too
great,
that
service
won't
continue.
So
next
slide.
Please.
The
bottom
line
is
that
white
bagging
really
is
a
threat
to
the
health
and
safety
of
the
patient
and
could
damage
access
to
treatment
in
a
lot
of
our
communities.
N
It's
a
concept,
that's
really
just
too
focused
on
the
insurer's
bottom
line.
It's
not
focused
on
the
Health
and
Welfare
of
the
patient
and
our
heart.
Our
hospitals
again
wouldn't
argue
that
it's
wrong
to
make
a
profit,
that's
a
good
thing,
and
we
want
them
to.
We
want
the
insurers
to
be
successful,
because
we
want
our
patients
to
have
that
good
coverage,
but
the
success
of
their
bottom
line
really
can't
come
at
the
expense
of
the
patient's
Health
and
Welfare.
N
You've
been
great
partners
with
the
provider
Community
as
I
often
say
to
you
individually
and
collectively.
Our
patients
and
your
constituents
are
the
same
people
and
we
all
are
seeking
a
good
outcome
for
them.
We
hope
to
continue
to
work
with
you
to
get
those
good
outcomes
thanks
again
for
having
us
and
I'm
happy
to
try
and
answer
questions.
If
I
can.
A
Thank
you
Jim
appreciate
your
presentations
as
always,
and
to
put
this
in
the
Reader's
Digest
version.
Our
concern
is
quality
of
care
going
to
sound
like
a
rhetorical
question,
but
if
there's
an
adverse
outcome
as
a
result
of
white
bagging
adverse
outcome
for
the
patient,
who's.
N
Going
to
be
responsible,
that
is
an
excellent
question,
because
it'll
be
unclear
and
I'm
sure
that
enterprising
attorneys
and
I
I,
don't
say
this
to
attack
attorneys,
because
I
am
one
but
I'm
sure
that
there
are
enterprising
attorneys.
Who
would
be
happy
to
sue
the
hospital,
the
pharmacy,
the
insurer,
everybody
along
the
chain
and,
unfortunately,
probably
the
the
least
Deep,
Pockets
and
I
know
everybody
thinks
the
hospitals
are
rich.
The
hospitals
themselves
pay
all
their
money
out
to
other
people.
They
don't
particularly
have
Deep
Pockets.
N
So
the
liability
question
is
certainly
a
good
one
and
one
that
could
easily
be
avoided.
If
we
stop
the
white
bagging
issue,
we'd
know
who
was
responsible
and
it's
fine
for
for
hospitals
to
be
responsible.
If
they
do
something
wrong.
You
know
it's
just
like
what
you
were
hearing
about
the
340b
program.
A
N
O
There
had
to
be
a
reason
that
started
the
white
bagging,
so
is
there
any
benefit
at
all,
I
mean
we've
heard
all
the
negatives
and
but
other
than
just
the.
You
know
some
of
the
obviously
advantages
to
the
bottom
line
that
we
were
talking
about,
but
is
there
a
benefit?
Are
there
any
exclusions?
Are
there
some
that
that
might
be
the
most
appropriate
path
to
take.
N
Not
that
I'm,
aware
of
the
the
the
insurance
company
like
I,
said
Has
Its
has
its
own
reasons
for
doing
it.
It's
not
for
the
benefit
of
our
patients
as
near
as
we
can
tell.
A
It's
not
about
the
money,
it's
about
the
money,
so
you
know
further
questions
or
comments.
Jim
appreciate
you
being
here
and
Donna
you
as
well,
and
thank
you
for
a
testimony
today.
Thanks.
A
A
M
P
He
wasn't
leaving
me
no,
so
there's
been
a
lot
of
talk
about
Senate
bill
50
already
this
morning,
but
I
know
we
have
a
lot
of
new
committee
members.
So
I
just
want
to
give
a
very
brief
description
of
what
Senate
bill
50
is
or
was
passed
in
2020
regular
session
of
the
general
assembly.
It
did
require
the
department
for
Medicaid
services
to
procure
a
single
Pharmacy
benefit
manager
for
the
entire
Managed
Care
population.
P
We
do
have
six
Managed
Care
organizations,
they
did
each
have
their
own
PBM,
Pharmacy
benefit
manager,
and
so
we've
gone
down
to
one
for
that
population.
We
do
still
have
a
fee
for
service
PBM
and
just
to
give
context
over
90
percent
of
our
population
is
in
Managed
Care,
the
10
percent,
that's
in
fee.
What
we
call
fee
for
service
is
that
a
long-term
care
in
1915
C
waiver
members.
They
are
the
developmentally
and
intellectually
developed,
intellectually
disabled
individuals
as
well
as
elderly,
who
may
need
home
and
community-based
services.
P
So
so
we
are
talking
about
the
large
part
of
Medicaid.
When
we
talk
about
the
single
PBM,
we
did
Implement
that
on
July
1
of
2021.
That
was
a
really
quick
implementation
in
terms
of
switching
a
pharmacy
benefit
manager.
So
we
did
it
in
about
six
months,
but
I,
think
and-
and
certainly
you
know
folks
could
come
to
the
table.
Maybe
that
would
say
otherwise
but
I
believe
it
was
a
very
smooth
transition.
P
So
you
know
in
terms
of
that
implementation
and
sense.
I
know
one
of
the
questions
asked
of
the
department
was
you
know
what
have
been
the
challenges
and,
to
be
honest
with
you,
we
have
not
seen
any
major
issues.
There
are,
you
know,
I
think,
with
any
process
and
with
any
system
there
there's
an
occasional
issue,
but
what's
important
is
how
that's
addressed
and
I
think
that
we
are
very
responsive.
P
So
in
this
model
the
department
Remains
the
oversight
and
the
responsibility
for
the
benefit,
so
we
dictate
what
the
benefit
is,
what
drugs
are
covered?
We
dictate
the
reimbursement
and
we
as
part
of
the
procurement.
You
know
we
were
able
to
set
the
the
per
member
per
month
so
that
administrative
fee
was
negotiated
and-
and
you
know,
part
of
that
open
procurement
process.
So
everyone
has
access
to
the
contract
that
we've
entered
into
with
men
impact.
They
can
see
the
terms
and
conditions
all
of
our
reimbursement.
P
Methodology
is
contained
in
our
regulation,
so
it's
open
to
everyone
to
be
able
to
understand
it
and
to
scrutinize
it
as
needed.
But
you
know
the
the
path
of
communication,
I,
think
between
providers,
the
PBM
and
and
the
department
is,
is
really
open
and
collaborative,
and
you
know
we
meet
regularly
with
the
pharmacy
associations.
P
We
also
know
that
medimpact
has
regular
meetings
with
the
pharmacies,
and
you
know
we're
not
aware
of
any
issues
or
challenges
with
trying
to
reach
someone
when
there's
when
there
is
a
problem
so
that
it
can
be
dealt
with.
So
in
terms
of
you
know
the
ask
around
well,
you
know:
is
there
anything
the
department
would
ask
for
for
changes
to
the
current
statute?
P
M
So
like,
like
she
said,
we've
heard
from
many
of
you
wanting
an
analysis
on
on
what
the
Senate
bill
50
looked
like.
So
let
me
just
set
the
stage
here
real
quick
on
how
we
did
this.
We
worked
with
our
actuary
milliman
to
come
up
with
a
calculation,
so
to
speak,
to
kind
of
estimate
what
our
less
spend
or
or
savings
you
should.
You
know
you
could
call
it
savings,
but
it's
it's
less
spend.
So,
first
of
all,
let's
just
look
in
the
time
periods
that
we
looked
at.
M
We
looked
at
time
periods
before
Senate
bill
50
went
into
implementation,
which
was
calendar
year,
18,
19
and
20.,
and
then
we
compared
that
to
the
two
years
County
year,
21
and
22
after
Senate
bill
50,
and
the
reason
why
we're
looking
at
calendar
years
is
that
is
the
time
period
of
our
MCO
contracts.
M
So
we
wanted
to
be
consistent
with
that,
the
we
evaluated
the
total
Managed
Care,
Pharmacy
cost
and
and
I,
provided
you
a
definition
there,
where
it's,
the
Managed
Care
organization's,
claim
expenditures,
plus
their
non-benefit
expenses
minus
any
estimated
rebates
that
would
equal
the
total
Pharmacy
cost
that
we
that
we're
showing
here
a
few
things
that
we
want
to
point
out
is
that
all
the
amounts,
including
the
rebates,
are
on
an
incurred
data
service
basis
when
we're
I
presented
last
week
to
the
BR
subcommittee.
M
But
it
review
subcommittee
that
you
know
in
a
budget
world,
you
look
at
data
payment,
the
payments
as
they
go
out
the
door,
but
in
this
situation
we
for
this
purpose.
We
wanted
to
look
at
date
of
service
basis,
which
is
when
it
was
incurred.
M
The
claims
benefit
non-uh
non-benefit
expenses,
the
claims
plus
their
non-benefit
expenses.
It
does
it
cause
or
underlie
the
the
future
capitation
payments
to
mcos
that
so,
when
you
see
an
increase
in
those
claims,
payments
and
and
things
you're
going
to
see
an
increase
in
the
future
in
the
cat
payments
that
which
we
capitation
payments,
which
we
process
on
a
monthly
basis-
and
then
the
last
thing
I
just
want
to
say,
is
the
340b
I
know.
It's
been
a
lot
of
comments
made
about
that
this
morning.
M
340B
is
a
discount
drug
program
in
which
pharmacy
rebates
are
not
eligible
for
so
that
and
title
21
chip,
which
is
our
children's
health
insurance
program.
M
Title
21
chip
is
not
eligible
for
rebates,
as
well
as
zero
paid
claims,
and
then
the
last
thing
that
before
we
go
into
the
to
the
heart
of
the
analysis,
is
the
per
member
per
month.
Amounts
were
adjusted
to
normalize
for
enrollment
mix,
changes
that
that
may
have
occurred,
and
it's
particularly
in
this
in
in
during
our
study,
was
particularly
around
the
covid-19
public
health
emergency.
As
you
know,
we
had
a
maintenance
of
effort
where
we
had
to
maintain
the
eligibles
on
the
on
the
book.
M
M
So
this
table
shows
you
that,
prior
to
Senate
bill
50,
the
annual
Total
pmpm
Trends
were
above
10
percent
as
a
as
Veronica
stated
earlier,
that
when
we
implemented
it
in
21,
so
therefore
you
can
see
in
County
years
19
and
20.
We
had
pmpm
trends
that
were
above
10
percent
and
I,
provided
you
a
couple
instances
why
that
is
the
case
claims
pmpms
per
member
per
month.
They
increased
5.7
percent
on
average,
between
2018
and
2020,
when
it
was
under
the
MCO
management.
M
Also,
the
rebate
per
member
per
month
declined
6.9
percent
in
that
same
time
period
and
that's
primarily
due
to
increased
340b
utilization,
which
I
just
stated.
340Bs
do
not
get
they're
not
eligible
for
rebates,
as
well
as
the
MCO
switching
to
newly
launched
generic
drugs
to
lower
the
rebates
that
that
comes
to
the
state.
It's
lowered
their
costs,
but
it
also
lowered
the
rebate
amounts
that
were
coming
to
us
in
calendar
year.
21
you'll
see
an
8.6
reduction.
This
is
due
to
rebates
outpacing
the
increase
in
Managed
Care
Organization
claim
expenditures.
M
The
rebates
that
we
look
at
we
Mac
rebates
are
maximized
after
implementation
of
the
single
preferred
drug
listing
and
reduction
would
have
been
larger
if
it
was
not
for
the
increase
in
340b
utilization.
Like
I
stated
calendar
year
22,
there
was
a
15.9
percent
increase
in
the
per
member
per
month
for
the
total
Pharmacy
cost,
but
that
is
increases
due
to
claims
expenditures
of
MCO,
claim
expenditures,
outpacing
the
increase
in
rebates
and
what
we
mean
by
that
there's,
a
timing
lag
in
which
the
claims
get
paid.
M
Then
we
invoice
for
the
rebate,
and
then
we
receive
the
rebate
a
lot
of
times.
We
will
invoice
for
the
rebate
the
quarter
after
in
which
the
that
claim
is
processed,
and
then
the
pharmaceutical
company
has
30
days
to
pay
us
to
reimburse
us
that
rebate.
So
you
can,
you
can
almost
see
from
if,
if
the
claim
was
was
paid
in
January,
we
probably
would
not
receive
that
rebate
until
sometime
in
May.
M
Representative
Bentley
kind
of
stole
my
thunder
earlier
and
what
I
was
wanting
to
provide
here
today.
We
provided
last
week
to
Senator
Douglas
and
representative
Bentley
last
week,
but
this
is
the
the
heart
of
the
analysis.
You'll
see
those
first,
three
columns
are
the
same
exact
information
that
was
on
the
previous
slide,
that
is
showing
our
actual
Pharmacy
pmpm
our
per
member
per
month
and
above
the
table,
I
provided
in
red.
M
The
formula
in
which
how
that
was
derived
one
thing
I
will
point
out
is
where
the
column
that
has
the
C
the
letter
C
the
letter
c
above
it.
That
is
an
estimated
Pharmacy
PM
PM,
that
we
worked
with
our
actuaries
to
determine
what
we
did
was.
We
said
what
happened
if
Senate
bill
50
did
not
go
into
to
effect.
What
would
our
pmpm
be
in
and
they
gave
us
a
range,
a
minimum
and
a
high
and
a
maximum,
and
what
you
see
here
is
an
average.
M
So
there
is
some
rounding
issues
that
if
you
multiply
that
out,
it's
not
gonna,
it's
not
gonna
match
up
to
the
dollar
amount,
that's
showing
there
in
in
column
d,
but
it's
for
instance
the
seventy
dollars
and
sixty
seven
cents
I.
Think
if
you
round
it
out,
it
was
seventy
dollars
and
6.655
or
0.665,
or
something
like
that,
so
that
that's
the
reason
why,
if
you
multiply
that
out,
follow
the
the
the
formula
at
the
top,
you
won't
match
it,
but
it
is.
It
is
close.
M
It's
all
due
to
rounding,
but
without
Senate
bill
50,
the
total
Pharmacy
expenditures
would
have
been
higher
in
Cal
in
the
county
years
21
and
22.
County
year
21
we
would
have
spent
172.5
million
more,
which
is
comes
out
to
34.5
million
in
state
funds,
so
a
savings
so
you've
heard
us
say
that
we've
we've
we've
had
a
savings
about
thirty
four
and
a
half
million.
That's
where
this
comes
from.
M
So
the
total
savings
which
includes
Federal
share
too,
is
172.5
million
in
21
and
110.2
million
in
22..
So,
over
the
over
the
two
years,
you're
looking
at
282
283
million
dollars,
I
will
turn
it
back
over
to
Veronica
here
in
a
second
but
I
just
want
to
say
he
mentioned
about
our
rebates.
Our
rebates
have
increased.
If
you
recall
back
in
state
fiscal
year
21,
it
was
800
Million.
M
Last
year,
State
fiscal
year
22
we
went
up
to
1.2
billion
1.25
billion
this
past
fiscal
year
fiscal
year,
23
that
we
just
closed
out.
We
we
did
increase
to
the
1.5
billion.
That
representative
Bentley
was
referring
to
earlier
in
his
comments.
So
we
have
seen
an
increase
in
rebates,
but
I
want
to
caution.
You
I
mentioned
that
the
payment
claims.
What
we're
doing
is.
We
are
maximizing
those
rebates,
which
means
we
may
switch
our
preferred
drug
listing
from
a
generic
to
a
more
a
brand
name,
drug
which
is
more
costly.
M
But
what
we're
doing
is
we're.
Looking
at
the
lower
net
cost
so
yeah
it
may
be
more
costly,
but
we
after
you
take
into
consideration
the
rebate.
It's
a
lower
net
cost
for
for
the
Medicaid
Program.
So
there
has
been
also
there's
been
a
significant
increase
in
our
high
cost
drugs.
There's
some
high
cost
drugs
coming
down
that
are
relatively
new
to
the
market
and
we've
seen
a
substantial
increase
in
in
the
utilization
of
those
drugs.
So
our
spend
is
going
up.
M
P
Thank
you.
We
wanted
to
a
question
we
received
last
week
in
budget
review
subcommittee,
was
around
340b
provider
claims
and
just
really
what
is
that
difference
that
we're
seeing
with
increased
utilization?
Because
that's
going
to
happen
if,
if,
if
we're,
increa
we're
seeing
overall
increased
utilization,
the
the
difference
between
what
the
340b
provider
gets
reimbursed
and
and
what
their
actual
cost
is
is
going
to
increase
as
well.
P
So
we
did
our
best
to
try
to
estimate
what
that
would
be
so
for
calendar
year
2020,
we,
you
know,
we
do
believe
that
at
340b
providers
retained
a
196
million
dollars
we're.
We
have
no
position
on
whether
that's
you
know
the
right
way
to
go,
and
we
are
also
monitoring.
P
A
B
A
It's
just.
P
One
more
slide
just
wanted
to
no
no
problem.
We
just
wanted
to.
Let
you
all
know
that
our
fee
for
service
Pharmacy
benefit
manager,
contract
was
coming
up
for
was
ending,
and
so
we
did
do
under
KRS
chapter
45.
A
procurement
request
for
a
proposal
and
Med
impact
was
the
successful
bidder
for
that.
We
are
currently
in
the
process
of
implementing
that
and
that
goes
live
on.
January,
1,
2024,
so
medimpact
will
be
the
PBM
for
both
managed
care
and
and
fee
for
service.
We
just
wanted
to
provide
that
information
to
you
all.
A
All
right,
thank
you
as
I'm
looking
around
the
room
majority
of
the
legislators
weren't
here
in
2019
when
this
subject
first
came
up
and
it
was
quite
contentious
and
one
of
the
things
Center
wise
for
his
leadership
on
this
particular
bill.
But
I
specifically
remember
when
we
talked
about
doing
this
going
from
six
pbms
to
one
the
prevailing
thought
was
it's
going
to
cost
her
Medicaid
program?
More
and
obviously
that's
not
the
case
so
very
pleased
to
hear
that
and
the
question
I
would
have
is
who's
watching
the
PBM.
Now.
P
So
so
Medicaid
and
we
also
there's
an
annual
performance
evaluation
that
is
prepared
so
that
we
can
make
sure
that
we
are
doing
our
due
diligence
to
ensure
that
it
is
operating
as
planned
and
within
the
requirements
we
have
again.
You
know
regular
audits
of
the
PBM
to
ensure
that
payments
are
being
made.
A
Questions
we're
going
to
hear
from
pill
plan,
Data,
Solutions
later
and
I
think
they're
going
to
share
a
very
positive
experience
with
our
employee
Kentucky
employee
health
plan.
It
looks
like
significant
savings,
but
I
know
that
one
is
100
and
it's
real
time.
So
I
was
wondering
if,
if
it's
working
for
our
employee
health
plan,
should
we
look
at
this
for
the
Medicaid
Program
as
well,
and
so
I
know,
let's
discussion,
we
have
to
have
further,
but
that's
what's
on
my
mind,
Senator
wise
did
you
have
a
common
question.
Q
Thank
you,
Mr
chairman
comment
in
a
couple
questions.
Thank
you
both
for
being
here.
Thank
you
for
the
help
and
the
implementation
everything
you've
done
chairman
and
co-chair.
Q
Thank
you
for
having
a
day
with
an
agenda
full
of
this
topic,
and
you
know
when
we
leave
here
as
legislators,
I
think
we're
all
going
to
look
back
at
impacts
that
we
had
on
the
Commonwealth
and
today's
a
great
day
for
the
Commonwealth
of
Kentucky
and
what
we're
seeing
with
the
savings
report
I
give
so
much
credit
to
my
Senate
leadership
and
house
leadership.
For
sticking
with
me
on
this
bill,
my
colleagues,
this
was
a
a
difficult
bill
at
the
time.
Many
members
here
were
not
present
and
I.
Q
Don't
think
I'll
ever
trust.
A
physical
note
again
I
hate
to
say
that,
but
it
was
any
time
it
seemed
like
to
kill
a
bill.
It's
here's,
the
physical
note
and
it
was
either
indeterminable
or
what
it
was
going
to
cost
the
state
and
and
I
think
leadership.
Q
For
sticking
with
me-
and
my
colleagues
I
want
to
thank
my
house,
colleagues
that
were
in
the
pharmacy
business
and
as
well
as
others
on
this
committee
and
testimony
because
Senate
bill
50,
truly
saved
jobs,
it
kept
a
lot
of
pharmacies
open
and
it
also
provided
transparency.
The
Black
Box
we
talked
about
and
for
taxpayers
of
Kentucky
it's
good.
A
couple
questions
I
do
have
is
specific
to
the
Savage
report
was
traditional
and
supplemental
drug
rebates
included
in
the
savings
report.
Q
It
was
okay.
Do
these
savings
also
include
the
elimination
of
spread
pricing.
M
Q
Okay,
last
two,
and
when
will
the
full
report
be
released
to
the
General
Public.
P
Our
understanding
it's
going
through
the
approval
process,
we
keep
checking
on
it
because
there's
a
lot
of
interest
in
it.
I
don't
have
a
formal
date,
but
we
keep
making
sure
that
it's
going
through
the
process
and
certainly
we'll
send
it
as
soon
as
possible.
Perfect.
Q
My
last
one
Mr
chairman
and
has
the
cabinet,
used
any
savings
from
Senate
bill
50.
P
So
I
I
do
know
that
secretary
Freelander
indicated
that
for
our
dental
vision
hearing
when
we
increase
services
to
adults
that
it
was
mentioned
that
we
do
have
savings
from
Senate
bill
50,
which
we've
obviously
shown
today
and-
and
that
has
allowed
you
know
that-
has
reduced.
We
have
a
budget,
and
so,
if
we're
not
spending
more
somewhere
else,
then
we
have
funds
available
to
do
things
with.
P
P
A
Thank
you
Central
wise
for
your
questions,
your
comments
and
your
leadership
on
this
bill.
Two
final
people
in
in
my
queue
and
then
we'll
move
on
versus
representative
Bentley,
again
remotely
I'm
sure
he's
wanting
to
apologize
to
Mr
Beckner
for
stealing
his
thunder
so
representative,
Bentley
you're
you're
up.
C
They
kind
of
miss
me
chairman,
on
the
last
thing
I'm
talking
about
the
white
bagging,
so
I
got
a
few
comments
about
that.
The
white
bagging
was
addressed
in
the
house
bill
that
died
in
Senate
last
session
and
we
talked
to
the
Kentucky
Hospital
Association
about
that
before
so
I
wanted
people
to
know
that
it
is
addressed
in
that
bill
and
was
addressed
in
that
bill.
C
C
Mr
muster
had
a
concern
on
the
PBM
reform
and
no
one
should
be
forced
to
use
a
PBM
owned
Pharmacy
and
the
hospital
should
be
able
to
treat
their
patients
according
to
their
expertise
that
expertise
takes
a
hit
when
they
have
to
get
their
medication
from
out
of
state
mail
order.
This
is
happening
to
hospitals
and
all
kentuckians,
so
we
need
to
stop
mandatory
mail
order
on
white
bagging,
and
that
was
in
the
bill
too.
C
C
C
We
hope
that
this
additional
rebate,
on
top
it
almost
300
million
we
saved
with
house
bill
50,
will
be
used
to
make
allow
us
to
maximize
rebates,
something
we
just
didn't
accomplish
prior
to
Senate
bill
50.
In
the
comments.
L
Thank
you
chair,
just
a
few
simple
questions
and
then
we'll,
let
you
guys
leave.
You
had
mentioned
on
Slide
Five,
the
increase
of
Pharmacy
costs
and
the
preference
of
brand
drugs
over
generic
drugs,
which
has
lowered
the
cost
for
the
Medicaid
Program.
Are
patients
getting
hit
with
a
difference
in
cost
for
out-of-pocket
with
those
brand
drugs,
as
opposed
to
generic
brands?
Oh.
P
L
One
other
really
quick
question
you
mentioned
on
Slide
Five,
also,
the
significant
increase
in
higher
cost
brand
drugs,
which
are
new
to
the
market.
What
drugs
in
particular,
are
you
talking
about?
That's
driven
this
significant
increase
in
cost.
P
P
There
is
a
lot
of
new
drugs
coming
out
for
that,
and
that
has
been
a
very
expensive
area.
There
is
also
gosh
I'm
linking
there's
there's
one
other
drug
class
and
I
apologize.
I,
don't
have
it
out
on
top
of
my
head,
but
I'm
completely
blanking
on
it,
so
I'm
happy
to
get
get
it
to
you,
but
so
the
the
but
the
primary
one
has
been
around
the
diabetes
treatment.
E
So
my
question
is:
if
Senate
bill
50
saved
Medicaid
around
283
million,
you
know
what
is
your
guess
as
to
what
PBM
reform
could
save
the
rest
of
Kentucky.
M
I,
don't
think
I
can
have
that
guess
without
knowing
the
the
increases
of
how
the
business
Works
I
know
how
Medicaid
works,
but
I'm
not
sure
how
that
would
I
can't
give
you
that
answer
today,
yeah.
P
I
would
say,
representative
Duvall,
you
know
a
lot
of
the
previous
speakers
talked
to
to
and
about
some
issues
that
are
not
related
to
Medicaid
anymore.
It's
in
a
bill
of
50
brought
enormous
transparency
to
the
process,
and
so
in
in
terms
of
you
know
what
could
be
next
for
us
to
save
money.
It's
it's
really
challenging
and
that
that's
because
Pharmacy
costs
are
Pharmacy
costs
and
we
go
out.
P
I
mean
we
do
have
a
rebate
pool
that
goes
out
and
negotiates
costs
for
us,
and
so
we
maximize
that,
to
the
extent
that
we
can
so
I
really
feel
like
it's.
A
lot
of
it
is
is
beyond
even
our
control,
but
we're
always
open
to
brilliant
ideas
so
and.
M
Like
Veronica
said
earlier,
we
don't
have
co-pays
in
Medicaid,
so
I'm
not
sure
how
that
would
transition
over
to
the
commercial
Market,
especially
given
the
fact
that
the
very
first
presenter
I
forget
his
name
doctor
from
West
Virginia
mentioned
about
giving
those
those
or
giving
that
back
to
the
to
the
consumer
or
something
we
wouldn't
have
that
here
in
Medicaid.
So
I
wouldn't
know
how
to
kind
of
estimate
that,
for
you.
E
And
I
know
that
my
predecessor,
Representative
Steve
Sheldon,
was
referenced
earlier.
It's
it's
actually
House
Bill
457
from
from
2022.
it's
about
a
40
50
page
bill.
That
I
think
addressed
many
of
the
concerns
that
was
brought
up
from
Miss
West
earlier.
So
thank
you.
F
You
Mr
chair,
thank
you
for
being
here.
It's
it's
always
good
to
hear
this
type
of
presentation
and
certainly
to
have
this
update
and
this
great
news
so
I'm
very
excited.
I
want
to
go
just
I.
Have
a
quick
comment,
maybe
about
the
340b
program.
I
think
you
know
it
might
be
new
to
a
lot
of
folks
and
and
it's
a
very
complex
issues,
so
I
I'm
I'm,
very
interested
in
what's
going
on
on
a
federal
level,
I
want
to
see
kind
of
what
they're
what
they're
looking
at.
F
When,
when
we
go
to
the
slide
six
I
guess
you
say
that-
and
this
is
just
generally
what
340b
does
it
covers
the
covered
entities,
so
that
would
be
hospitals
or
other
providers
or
contracted
pharmacies,
retain
the
margin
between
the
acquisition
cost,
so
the
negotiated
rate
and
the
the
reimbursement
from
the
single
PBM
and
we're
seeing
the
cost
the
margin
growing
the
cost
growing
in
those
MCO
expenditures,
so
I
I'm
concerned
I,
guess
about
you,
know
the
340b
program
in
that
and
I
am
still
learning
I've
done
hours
and
hours
on
this,
and
it's
still
really
complex,
but
I
believe
that
it
it
started
out
following
patience
and
now
it
now
there
are
covered
facilities,
and
so
we've
expanded
it
to
a
whole
group
of
people
who
might
not
be
those
High
need
or
low-income
patients
for
whom
this
was
enacted.
F
And
so
that's
my
concern.
I
I,
don't
know
that
we
really
know
where
this
we
use.
The
word
spread,
and
this
is
a
spread.
We
don't
know
where
this
spread
is
going.
It's
it's
charity
work
I,
know
that
charity
hospitals
rely
out
on
on
it
a
lot
small
pharmacies
and
I.
F
Just
I
don't
know,
I,
don't
know
if
it's
a
if
it's
a
good
thing
or
a
bad
thing,
so
I
you
know,
I
I
know
we
could
do
a
whole
day
on
340b
and
we're
not,
but
I
just
think
it's
important
that
we
keep
looking
at
this
not
to
throw
it
out.
Everyone
who
uses
it
gets
nervous
when
I
talk
about
it
but
yeah
just
to
to
understand
it.
Maybe
thank
you.
A
I
thought
just
came
to
mind
before
you
leave
the
table.
You
know
with
a
little
bit
too
pragmatic
for
my
own
good,
but
if
we
go
from
six
pbms
to
one
we
save
money.
Do
you
think
there's
any
potential
to
save
money
if
we
had
fewer
mcos
rhetorical
question,
thank
you
for
your
presentation
today.
I
appreciate
you
being
here.
Thank
you.
A
Next
we're
going
to
hear
from
our
Pharmacy
payment
Integrity
for
the
employee,
Kentucky
employee
health
plan,
which
I've
referenced
earlier
representatives
are
here.
R
K
R
Well,
good
morning,
again,
chairman
Meredith
and
co-chair
Moser
like
to
thank
you
on
behalf
of
HDs
for
inviting
us
here
to
speak
at
the
Joint
Committee
on
Health
Services.
It's
obvious
after
sitting
through
a
number
of
sessions
this
morning.
That
Kentucky
has
done
an
incredible
amount
forward
on
reform,
but
I'd
like
to
call
out
specifically
the
members
of
the
general
assembly
for
their
leadership,
their
vision
and
tenacity
to
enact
legislation
to
implement
a
pharmacy
payment
Integrity
program.
In
addition
to
reform,
to
safeguard
the
taxpayers
of
the
great
Commonwealth
of
Kentucky.
R
Hds
won
that
competitive
procurement,
and
then
we
began
our
work
in
January
of
this
year.
So
I'd
like
to
talk
a
little
bit
more
specifically
on
what
that
exactly
means
and
what
that
requires
us
to
do
so,
unlike
some
of
the
other
traditional
things
that
are
done
for
payment,
Integrity
HDs
monitors,
100
percent
of
the
claims
that
are
adjudicated
through
the
PBM.
R
R
Lastly,
and
importantly,
the
legislation
limits
the
compensation
of
HDs
to
a
fraction
of
the
total
savings
we
generate,
thereby
guaranteeing
that
our
service
is
a
good
value
for
the
Commonwealth
I'd,
be
remiss
to
not
thank
retired,
now
retired
commissioner
Sharon
Burton
and
Deputy
Commissioner
Chris
chamness.
Their
leadership,
alongside
of
us
at
the
table
with
their
PBM,
has
been
instrumental
in
bringing
the
General
assembly's
Vision
to
Life
by
empowering
HDs
to
deploy
our
payment
Integrity
Solutions
on
behalf
of
kehp.
They
have
truly
been
great
partners.
R
This
is
done
post
adjudication,
so
it
doesn't
interfere
with
a
patient
acquiring
their
prescription,
but
prepayment
before
you
write
the
check
to
the
PBM
hds's
approach
is
far
superior
to
some
of
the
other
things
that
you
heard.
A
PBM
audit
is
the
accepted,
but
Antiquated
form
of
looking
back
for
payment
integrity.
R
We
review
every
claim,
as
I
mentioned
by
the
payer,
rather
than
a
sampling
of
claims
that
are
done
in
an
audit
when
we
review
through
claim
scan
in
near
real
time.
This
allows
us
to
uncover
the
errors
and
pursue
savings
immediately
in
an
audit
that
is
done
three
to
five
months
post
the
entire
year,
so
you're
15
months
in
the
rear
view
mirror
to
18
months
in
the
rear
view
mirror
before
you
determine
any
errors
by
the
PBM
in
a
normal
audit.
R
We
also
identify
other
founding
findings
that
allow
us
to
inform
kehp
in
this
case
of
contractual
items
that
need
to
be
modified
or
amended
along
the
way
for
more
favorable
outcomes
for
future
transactions.
In
other
words,
for
our
clients,
like
kehp,
we
make
sense
of
what
the
PBM
is
doing
and
explain
how
the
PBM
is
performing
real
time.
R
Lastly,
I'd
just
like
to
mention
again
think
about
what
we
do
in
cyber
security.
We
don't
do
cyber
security
once
a
year
and
then
hope
that
that's
reflective
of
what's
been
going
on
the
entire
year,
but
rather
we
Monitor
and
have
surveillance
throughout
the
year.
That
is
the
basis
for
what
HDs
does
year
round.
We
monitor
continuously,
we
fix
we
recover
and
then
we
continue
to
monitor
so
I'll
stop
there
and
I'll
turn
things
over
for
some
findings
that
we
will
share
with
you
from
the
first
half
of
23.
S
So
the
first
substantial
finding
I'd
like
to
present
to
you
all
today
was
an
error
that
we
discovered
with
the
application
of
the
contractual
prescription,
claims
payment
logic
to
90
90
day
supplies
of
medications
in
the
first
half
of
2023.
This
error
was
found
to
account
for
just
about
268
thousand
dollars
worth
of
overpayments.
S
S
We
knew
we
needed
to
look
back
further,
so
we
partnered
with
our
contact
our
partners
at
KP,
our
our
leadership
team
at
khp
and
we've
collaborated
with
them
and
the
khp
contracted
entity,
and
we
believe
that
we've
identified
that
this
air
began
at
the
beginning
of
2023
and
that
that
time
period
of
the
air
from
1-1
of
2022
or
sorry
2022
to
August
of
2023,
when
the
error
was
corrected,
would
account
for
just
south
of
a
million
dollars
of
recoveries
for
kehb.
S
Another
error
that
we
discovered
was
in
relation
to
the
specialty
medications
not
being
priced
according
to
the
contractual
discounts.
Several
specific
medications
have
line
item
discounts
in
the
khp
contract,
so
this
era
accounted
for
about
ninety
thousand
dollars
worth
of
overpayments
in
the
first
quarter
of
2023
or
360
000
savings
for
the
calendar
year
of
2023
to
the
plan
the
full
details
of
that.
Finding
the
examples
there
can
be
located
on
page
eight
of
that
same
Quarter,
Two
report.
S
The
third
example
was
an
error
we
found
with
the
insulin
co-pays
exceeding
State
mandated
maximums.
So
as
you're
all
I'm
sure
you're
aware
the
Kentucky
Legislature
passed
House
Bill
95
requiring
a
cap
on
insulin,
co-payments.
The
applications
of
these
limits
was
being
incorrectly
applied
to
claims
and
patients
were
overcharged
for
their
medications.
S
By
way
of
this,
finding
about
seventeen
thousand
dollars
in
copays
was
returned
to
patients
for
the
first
six
months
of
2023.
and.
D
S
S
K
Well,
first
of
all,
I
just
wanted
to
reiterate
our
our
thanks
and
gratefulness
for
the
opportunity
to
be
here
today,
as
well
as
to
really
help
serve
khp
and
the
taxpayers
of
of
Kentucky.
We're
really
proud
of
our
work
and
we're
very
much
committed
to
the
General
assembly's
Vision
that
we
have
undertaken
as
well
to
deliver
transparency
in
the
area
of
Pharmacy
spend
on
behalf
of
the
taxpayers
here
in
Kentucky.
K
A
C
Yes,
sir,
did
the
HDs
did
they
give
Kentucky
an
opportunity
to
carve
out
the
pbn.
R
R
Yeah
sure
I'll
try
to
answer
that
succinctly.
So
the
system
is
agnostic.
We
we
will.
We
have
worked
with
multiple
pbms
within
Medicaid,
and
we've
worked
with
single
pbms
in
Medicaid,
and
the
the
error
rate
won't
change.
If
you
have
one
single
PBM,
some
of
the
things
that
were
talked
about
about
having
a
single
PBM
and
the
advantages
are
very
much
true.
R
C
R
So
we
have
no
affiliation
with
any
PBM
whatsoever
about
80
percent
of
our
business,
as
you
would
expect
for
our
clients
reside
within
the
three
largest
pbms,
that's
de
facto,
because
of
the
amount
of
business
they
have.
We
have
worked
with
other
what
people
might
call
more
transparent,
pbms
like
medimpact
or
navitus
and
others.
There
are.
You
know
57
Beyond,
The,
Big
Three,
and
so
we
have
worked
with
them
all,
but
we
have
no
affiliation
with
any
of
them.
C
R
I
think
indeed,
if
I
could
just
add
one
more
comment:
Mr
chairman,
according
to
Mr
Chan
this
yesterday,
you
are
running
a
process
in
the
kehp
sector
for
an
RFP
for
PBM.
So
there
will
be
a
process
ran
by
not
HDs,
but
another
company
that
will
allow
multiple
pbms
to
bid
on
the
kehp
business.
A
Gentlemen,
thank
you
and
folks.
My
apologies
to
representative
Ray,
Gordon
and
Frazier
in
roork.
We've
got
to
move
on.
This
gentleman
will
be
around
after
this
meeting.
If
you
want
to
follow
the
question
then,
but
I'm
sorry
to
not
be
able
to
entertain
your
question,
but
we
really
do
have
to
move
on
gentlemen.
Thank
you
for
being
here
today
and
appreciate
the
presentation
appreciate
the
work
you're
doing
for
our
Commonwealth.
A
Our
last
presentation
is
a
the
hearing
on
the
Community
Health
Services
block,
grant
and
substance
abuse,
Supreme
treatment
block
grant.
Those
folks
will
come
forward
and
I
use.
My
apologies,
but
you
know
we're
running
very
short
of
time.
So,
if
you
can
give
me
the
rears
digest
version,
I
would
greatly
appreciate
it
and,
while
they're
sitting
up
you
see
the
last
thing
that
we
have
is
reviews
some
administrative
regs
I
think
we
have
a
question
only
about
one
representative
Moser.
Would
you
like
to
talk
about
that?
One
briefly.
F
Yes,
thank
you
Mr
chair
I'm,
looking
at
902
Kar
055015,
and
that
is
the
proposal
to
add
the
drug
Tia
neptene
to
the
schedule.
1,
designation
and
I
I
would
like
to
defer
this
and
talk
about
it.
A
little
bit
in
my
brief
investigation,
I
I'm,
just
I'm
looking
at
this
I'm
trying
to
figure
out
why
this
is
being
placed
into
a
schedule,
one
designation,
it
looks
like
it
is
an
atypical,
tricyclic,
antidepressant
and
anxiolytic
I.
Don't
know
I
mean
everything
can
be
abused,
so
I'm
not
sure.
F
J
Yeah
Inspector
General
Adam
after
yeah
we'd
be
happy
to
defer
until
next
month.
That's
not
a.
T
And
I'm
Missy,
Runyan
and
I
am
the
block
grant
program
administrator
for
the
Department
for
Behavioral,
Health
and
I
am
not
a
lawyer.
So
we'll
try
to
go
through
this
fast
and
then
we
can
always
come
back.
If
you
have
questions
but
I'm
here
today
to
talk
about
the
mental
health
and
the
substance
use
block
grants
that
our
department
administers
samsa
is
the
Substance
Abuse
and
Mental
Health
Services
Administration,
and
that
is
who
we
receive.
Our
funding
from
you
can
go
ahead
every
other
year.
T
We
are
required
to
submit
a
very
large
application
that
is
combined.
So
it's
for
both
of
these
block
grants
and
then
we
are
required
to
submit
reporting
every
year,
so
these
are
stay
there
for
one.
Second,
these
are
two
separate
grants
that
are
non-competitive
but
they're,
very
restrictive,
so
they
have
specific
purposes
and
populations
that
they
must
serve,
and
so
okay,
let's
go
to
the
next
one.
T
For
both
of
these
block
grants,
you
can
only
carry
out
the
things
that
are
in
your
approved
plan,
which
is
what
we
call
the
application.
It
can
be
used
to
evaluate
programs
and
services
that
were
funding
and
for
planning
and
administering
educational
activities
related
to
those
services.
So
we
use
a
lot
of
funding
for
training
and
and
technical
assistance.
T
Four
purposes
are
the
overarching
purpose
for
both
of
these
block
grants
it's
to
fund
treatment
and
support
services
for
people
who
don't
have
insurance
or
for
people
who
go
in
and
out
of
having
insurance,
so
sometimes
they
have
it
and
then
they
lose
it
also
for
priority
treatment
and
services
that
demonstrate
success
in
in
outcomes
and
support
recovery
that
are
not
covered
by
Medicaid,
Medicare
or
private
insurance.
T
So
a
lot
of
our
funds
go
to
fund
those
Services
people
might
need,
but
not
have
coverage
for
also
to
fund
primary
prevention,
and
primary
prevention
is
trying-
and
this
is
for
substance
use.
It
is
trying
it's
it's
activities
that
are
targeted
to
try
to
keep
someone
from
developing
a
substance,
use
disorder
and
then
to
collect
performance
and
outcome
data
so
that
we
can
show
what
works.
What
doesn't
work
see
how
things
are
going?
T
This
is
a
big
overview
of
Air
2
Grant.
So
you
can
see
the
mental
health
is
on
one
side:
substance,
use
prevention,
treatment
and
Recovery
block
grant.
They
go
by
lots
of
names,
folks,
all
of
them
they
they
change
the
names
daily.
But
these
are
the
two
block
grants
that
we
administer
here
in
Kentucky.
Underneath
you'll
see
some
of
additional
supplemental
grants
that
were
given
over
the
last
few
years
that
are
connected
to
our
block
grants,
so
they
are
still
administered
through
the
block
grant
process,
but
they
are
different
funds
of
money.
T
And
then
just
to
go
into
a
little
bit
of
detail
about
each
one
for
the
mental
health
block
grant
of
all
of
these
are
community-based
Services
only
so
you
can't
use
these
funds
for
hospitals
or
those
kinds
of
things.
These
funds
are
only
for
adults
with
serious
mental
illness
or
children
with
serious
emotional
disability.
So
that's
our
two
target
populations
for
the
mental
health
block
grant.
10
percent
of
our
entire
allotment
must
be
used
to
work
with
first
episode
psychosis
programming.
T
T
T
For
children
with
SED
again,
this
is
the
definition,
the
same
type
of
thing
it's
based
on
disability
and
duration,
and
there
are
State
definitions
for
SMI
and
SED.
These
are
the
federal
ones.
So
all
the
states
have
to
at
least
meet
the
federal
definitions
which
we
do
and,
in
addition
to
Services,
we
can
use
funds
for
data
collection
outcomes,
reporting
other
support.
T
Just
an
outline
of
funding
for
the
mental
health
block
grant
this
top
amount
of
the
12
million
is
what
we
currently
have
allocated
and
we're
awaiting
allocations
for
24.
We
have
not
yet
received
those.
You
can
see
that
the
president's
proposed
budget
was
pretty
high,
but
we
don't
know
yet
what
we'll
get
for
24..
T
So
all
of
our
plan
is
based
on
the
23
amount,
and
you
will
see
some
of
our
maintenance
of
effort
requirements
and
set-asides
that
we
have
to
meet
for
substance
use
to
go
into
this
block
grant
just
a
little
bit
again.
It's
community-based
services
and
residential
treatment.
Centers
are
considered
Community
Based
I
always
get
that
question.
20
of
these
funds
must
be
set
aside
for
primary
prevention,
so
we're
trying
to
keep
people
from
having
substance
use
disorders.
T
We
also
have
to
Target
women
pregnant
women
with
substance
use
disorders
are
a
priority
population,
as
well
as
women
with
substance
use
disorders
who
have
dependent
children.
So
there's
certain
amounts
that
we
must
spend
on
those
two
categories
and
then
there's
also
maintenance
of
effort
requirements,
and
then
these
are
the
priority
populations,
for
this
grant
again
is
the
pregnant
women
and
the
women
with
substance
use
disorders
who
have
dependent
children,
persons
who
inject
drugs,
tuberculosis
services
for
people
who
are
substance,
use
disorder,
resurface
recipients.
T
If
we
were
a
designated
State,
we
would
be
required
to
fund
some
early
intervention
services
for
HIV
Kentucky
is
not
there's,
there
are
only
three
designated
States
Across,
the
Nation
and
Kentucky
is
not
one
of
those
and
then
Kentucky
picked
a
different
priority
population
that
is
not
required,
but
we
pick
service
members
veterans
and
their
families,
and
so
we
spend
some
of
these
block
grant
funds
to
support
those
people
with
substance,
use
and
co-occurring
mental
health
disorders
and
here's
the
funding
outline
for
this
grant.
Again
we
did
our
planning
based
on
the
23
amount.
T
Again,
we
can
just
flip
through
these
if
we
want,
but
this
is
an
outline
of
those
additional
funding
that
was
under
that
slide.
So
these
are
supplements
that
we
received,
through
the
covid-19
funds
and
I'm,
happy
to
answer
any
questions
about
that.
T
This
one
is
a
little
different
because
they
gave
us
little
tiny
bit
what
I
call
little
tiny
bits
of
money
to
help
our
providers
buy
things
like
PPE
equipment
and
things
like
that
testing
equipment
to
help
mitigate
covid-19,
so
those
are
what
those
funds
are
used
for
and
then
the
bipartisan
safer
communities
act.
You
may
hear
about
that
and
know
about
that.
So
we
are
getting
some
funds
through.
T
They
want
us
to
use
this
funding
to
support
adults
with
SMI
and
children
with
scg
regarding
those
emergencies
and
then
in
Kentucky
or
all
states
are
required
to
have
a
performance
indicator,
so
something
we're
measuring
for
each
of
the
required
populations
that
are
stipulated
through
samsa,
and
so,
if
you're
interested
these
are
our
they
are
set
for
a
two-year
period
of
time
and
so
you'll
see
the
top.
T
One
is
for
adults
with
SMI,
which
is
a
required
population,
and
so
we're
trying
to
help
keep
people
who
aren't
starting
out
in
Personal
Care
Homes,
and
then
they
go
to
the
to
the
psychiatric
hospital.
We
don't
want
them
to
then
end
up
in
a
personal
care
home
if
possible.
So
we're
measuring
that
and
then
you'll
see
others
for
SED.
T
First
episode
psychosis,
the
the
last
one
is
about
our
crisis
funds,
so
we
have
to
have
a
performance
indicator
for
that,
and
this
top
one
is
for
our
pregnant
women
and
women
with
dependent
children.
That's
our
performance
indicator.
They
are
expanding
some
plan
of
safe
care
sites
to
help
those
folks
access
services
that
are
effective.
T
We
are
doing
some
prevention
work.
We
are
monitoring
our
syringe
Services
programs
for
harm
reduction
purposes
and
we're
making
sure
that
everybody
that
sees
one
of
their
funded
providers
for
sud
service
are
appropriately
screened
for
tuberculosis
and
referred
to
Services.
If
they
need
them
and
that's
a
lot
I
know,
that's.
A
A
lot
it
is
a
lot.
You
did
an
excellent
job
and
you
don't
have
to
tell
me
the
attorney,
because
attorney
couldn't
cover
that
much
information,
it's
a
short
period
of
time,
but
I.
Thank
you
for
that
certainly
grants
that
would
be
a
great
benefit
to
our
Commonwealth,
and
this
requires
approval
from
this
committee.
We
do
it
by
voice
voters
or
a
motion
to
approve
motion
representative
Moser
second,
to
buy.