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From YouTube: Senate Standing Committee on Banking and Insurance
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A
C
The
health
insurance
industry
and
dr
alvarado
is
right
he's
more
my
doctor
than
he's
my
senator,
because
he
has
helped
me
through
a
lot
of
times
and
I
do
appreciate
him.
I
really
do
only
thing
I
don't
like
now,
I'm
sleeping
with
the
enemy
now,
because
he's
going
to
be
up
here
with
us.
So
with
all
that
said,
every
time
you
know
we
talk
about,
can't
pay
insurance.
C
C
The
yang
yang
for
their
for
their
drugs,
but
the
insurance
companies
has
that
fault
in
this
too,
and
I'm
saying
all
this
to
say,
I
if
the
pharmaceutical
companies
are
part
of
the
nonprofit,
then
they're
paying
in
a
little
money
to
make
sure
that
they're
not
on
medicaid
and
with
knowing
that,
if
they're
on
medicaid
they're
going
to
get
nothing
back
later,
but
if
they
got
health
insurance,
they
know
they're
going
to
get
back
10
times
more
or
six
times
more
than
on
medicaid.
C
Now
that's
one
of
the
fears
the
insurance
companies
has
expressed
to
me
now,
medic
under
the
health
insurance
side
of
it.
The
insurance
companies
caused
a
lot
of
our
problems
too
by
by
refusing
to
pay
you
and
by
refusing
to
do
things
it's
just
this
morning,
my
daughter
called
me
crying
fact:
I've
got
a
little
fourth
grader.
That
needs
to
be
on,
and
I
don't
agree
with
a
lot
of
this
needs
to
be
on
adhd
medicine.
C
She
can't
concentrate
over
a
minute
or
two,
and
then
she
loses
it
and
she's
on
virtual
school.
So
today,
the
doctor
that
I've
known
since
she
was
a
child
said
can't
get
her
medicine
because
the
health
insurance
has
refused
it.
So
we've
caused
a
lot
of
our
own
problems,
and
I
understand
why
you're
doing
your
bills,
I
really
do
it's
a
catch-22.
C
What
we're
doing
is
you're
protecting
them.
I
understand
they're
going
to
come
back
and
say
dr
alvarado
is
the
reason
we
went
up.
Our
rick
girdler's
reason
we
went
up
or
the
senate
of
kentucky
has
recently
went
up
and-
and
I
don't
know
where
it's
going
to
end
kovids
caused
a
lot
of
it.
You
know
they're
allowed
to
the
more
chaos
they
cause
anyway.
A
So
a
couple
things
there
and
thank
you
for
those
comments.
I
greatly
appreciate
them
in
kentucky
alone.
Our
goal
is
to
make
sure
that
we
don't
have
people
going
on
to
medicaid
if
they
can
stay
on
their
commercial
insurance
and
during
since
covid
alone,
kentucky's
medicaid
population,
just
from
march
to
april,
has
grown
seven
percent,
also
to
keep
in
mind
that
the
pharmaceutical
companies
do
have
an
opportunity
to
work
with
the
state's
pbm
and
negotiate
their
rates
and
the
drugs
that
they
will
put
on
the
formulary.
A
So
as
a
non-profit,
we
receive
a
variety
of
donations,
simply
to
be
able
to
help
people
stay
on
their
insurance
and
be
able
to
get
the
treatments
that
they
need,
so
that
we
can
avoid
er
visits,
lower
the
cost
of
health
care
and
avoid
people
from
going
on
to
kentucky's
medicaid
roles.
Our
goals,
I
think,
are
all
aligned
in
terms
of
just
giving
people
the
access
to
the
care
that
they
need.
A
D
So-
and
I
appreciate
that,
I
don't
consider
myself
part
of
the
enemy
here,
I
it's
everybody
on
this
committee
allies
and
friends,
but
I'll
tell
you
one
thing
that
I
propose
to
insurance
companies
with
regards
to
pharmaceuticals
and
some
of
these
costs
of
treatment
that
there
always
seems
to
be
a
negotiation
behind
closed
doors
that
people
see
what
I've
told
a
lot
of
the
insurance
companies
is
what
they
need
to
start.
Considering
is
instead
of
saying
they're
going
to
negotiate
co-pays
and
things
for
the
patients
I'd.
D
Rather,
they
just
say
for
a
disease
state
we're
going
to
give
you
x
amount
of
dollars
of
permission
to
spend
towards
this
disease
state
and
then
say:
if
you
have
diabetes,
we're
going
to
cover
88.43,
that's
what
you
have
to
work
with
patient,
whatever
you
want
to
get
under
those
drugs
that
will
fit
underneath
that
cap
go
ahead
and
do
it
and
then
forces
that
patient
and
the
doctor
to
say:
okay,
we
got
88
and
43
cents
in
our
budget
per
month.
How
are
we
going
to
manage
this?
D
If
you
want
to
bring
pharmaceutical
costs
down,
they're
going
to
say
boy,
I
got
a
drug
that
cost
200
bucks
and
I've
only
got
88
and
43
they're
never
going
to
use
my
product.
I
better
bring
my
price
point
down,
so
I
can
fit
within
that
budgetary
amount
allowed
by
the
insurance
companies
and
you
take
it
out
of
the
hands
of
having
backdoor
negotiations
set
your
amount
that
you
want
to
spend
for
disease
states,
maybe
say
we're
going
to
limit
no
more
than
this
many
disease
states
together.
D
There's
this
full
amount
and
let
patients
use
that
as
a
budget,
let
them
and
their
doctors
figure
that
out
and
get
out
of
the
way
these
backdoor
negotiations.
I
think
that
would
be
a
much
better
way.
It
would
be
a
complete
sea
change
on
how
we
approach
insurance
when
it
comes
to
medications,
but
let
doctors
and
patients
call
the
shots,
give
them
a
budget
to
work
within
and
don't
negotiate
it
behind
the
scenes,
and
it
would
work
a
lot
easier.
E
Question
quickly
on
page
1
line
25,
it
does
state
that
under
you
know,
extent
permitted
by
federal
law.
All
health
benefit
plans
may
accept,
so
it's
not
a
mandate.
They
can
choose
not
to
go
this
route
if
they
so
choose
the
health
benefit
plans.
So
don't
interpret
this
as
a
mandate.
This
isn't.
I
can't
imagine
why
anybody
would
not
want
to
accept
a
premium
that
was
due,
but
you
know
there
are
some
people
you
give
them
a
dollar
for
99
cents
and
they'll
come
down
here
and
object
to
it.
B
Thank
you,
senator
buford.
You
all
can
stay
at
the
table,
but
the
opposition
is
on
it's
thomas
stevens,
with
the
executive
director
of
kentucky
association
of
health
plans.
If
you're
online,
mr
stevens,
you
can,
you
can
go
ahead
now.
F
Good
afternoon,
mr
chairman
and
members
of
the
committee,
it's
my
pleasure
to
be
here
today
for
the
first
time
on
behalf
of
the
kentucky
association
of
health
plans.
You
may
be
aware
we
are
the
trade
association
for
kentucky's
commercial
health
insurance
providers
and
managed
care
organizations.
F
In
this
subsidized
private
insurance
marketplace.
The
providers
can
bill
at
higher
rates.
What
happens
with
the
patient
one?
They
can
be
left
unknowingly
with
copays
deductibles
coinsurance
on
both
benefits
and
prescriptions.
These
patients
were
enrolled
in
medicaid.
These
would
be
covered
benefits,
of
course,
medicaid
reimburses
providers
at
a
lower
rate.
F
Transferring
what's
effectively
a
provider
bonus
onto
the
backs
of
kentucky's
commercial
insurance
market,
while
well
intended
in
many
respects,
will
lead
to
higher
premiums
for
kentucky's
employers,
employees
and
individual
policyholders
at
a
time
when
that
simply
can't
be
born.
So
on
behalf
of
khp,
we
urge
you
to
vote
no
on
sb44.
D
Just
that
all
members
should
have
before
them
also
a
financial
impact
statement
that
says
that
it's
not
expected
to
materially
increase
administrative
expense
of
insurers
and
it's
not
expected
to
maturely
increase
the
total
cost
of
health
care
in
the
commonwealth.
So
I
think
the
assessment
determines
that
it
wouldn't
do
that.
A
If
I
may
respectfully,
disagree
with
a
few
of
the
statements
is
that
we
operate
under
an
oig
opinion,
so
it
is
very
highly
regulated
and
not
everybody
can
go
and
open
a
non-profit
charity
in
order
to
do
this.
Secondly,
we
are
not
allowed
by
law
to
steer
a
patient
to
any
specific
health
insurance
plan.
A
B
We
have
a
motion
and
a
second
already
on
the
bill.
If
there's
nothing
else
to
be
said,
I
think
I'll
have
the
secretary.
Please
call
the
role.
E
If
I
vote
on
explain
my
vote
quickly,
I
think
any
time
that
we
can
prevent
someone
from
going
on
to
the
medicaid
system.
We
should
do
everything
possible
because
once
they
are
on
medicaid,
you
may
never
get
them
off
and
they
may
desire
not
to
go
to
work
to
keep
the
insurance
based
on
the
fact
that
the
other
side
is
too
expensive,
so
certainly
support
this
highly.
Thank
you.
B
C
C
Because
I
I
understand
where
the
health
plans
are
coming
from,
I
understand
where
dr
alvarado
and
you
are
coming
from.
I
really
do
and
I
hate
it
so
and
if
it
makes
you
feel
any
better
senator
alvarado
I'm
planning
on
voting
yes
for
senate
bill
45,
so
that
that'll
get
us
even
right
all
right,
but
this
one
I'm
going
to
pass
on
all
that
means
is
he's,
got
to
get
up
on
the
floor
and
sell
it,
and
you
ever
heard
him
speak
good
salesman.
So
thank
you.
B
Aye
just
to
make
this
known,
senator
mcgarvey
is
a
yes
and
so,
but
you're
gonna
have
to
you
can't
get
on
consent,
because
your
friend
rick
gerdler
was
a
pass.
So
just
that's.
D
B
C
All
right,
you
see,
I'm
a
sympathy.
Man
you
get
here.
B
D
Bill
45
is
next.
Thank
you,
mr
chairman,
and
thank
you
members
for
the
vote
on
44.
senate
bill
45
is
along
the
same
themes.
This
is
a
patient
protection
bill.
That's
going
to
help
kentuckians
afford
their
medications,
and
I
raised
this
important
issue
as
both
a
legislator
and
as
a
practicing
physician,
I'm
also
joined
today
by
joey
clousing
who's,
the
co-founder
of
cure
cf
he's
online
and
dr
ben
mudd
from
the
kentucky
pharmacists
association
is
also
online.
D
They
join
more
than
20
advocacy
groups
like
the
american
cancer
society,
hemophilia
foundation,
the
kentucky
medical
association,
the
arthritis
foundation.
I
think
the
american
diabetes
council
all
who
want
to
ensure
that
individuals
suffering
from
chronic
conditions
have
access
to
the
medications
they
need
and
senate
bill.
45
addresses
a
growing
problem,
which
is
a
new
insurance
company
practice
called
the
copay
accumulator
adjustment,
that's
leading
to
increase
and
often
surprising,
out-of-pocket
costs
for
kentuckians
when
they
visit
the
pharmacy
as
out-of-pocket
costs
have
increased
deadly
of
the
years.
D
Many
patients,
especially
those
with
chronic
conditions,
have
come
to
rely
on
copay
financial
assistance
programs
to
afford
their
medicines.
However,
many
insurance
companies
are
refusing
to
apply
the
value
of
payments
made
through
copay
assistance
programs
to
patients,
annual
deductibles
and
it's
hurting
kentuckians.
D
This
would
be
like
somebody
in
front
of
you
in
a
drive-through
at
mcdonald's
or
at
starbucks,
paying
for
your
meal
or
your
coffee
only
to
have
the
fast
food
person
there.
When
you
show
up,
say,
hey
we're
going
to
charge
you
as
well,
it's
just
not
right
and
as
a
physician,
I
find
practices
like
these
concerning-
and
I
know,
we've
all
heard
from
the
insurance
companies
about
making
sure
that
patients
have
skin
in
the
game
when
it
comes
to
the
cost
of
health
care,
and
we
do
need
to
be
good
health
care
shoppers.
D
I
agree
and
I've
got
a
bill
for
health
care
transparency
that
everyone
seems
to
oppose
these
days,
but
it
would
allow
patients
to
be
able
to
shop
for
their
health
care
more
easily,
but
this
practice
goes
too
far
and
it
punishes
patients
through
unexpected
additional
costs.
Studies
show
that
when
a
patient's
share
of
prescription
costs
become
too
high,
they
often
skip
doses
or
they
stop
taking
their
medicines
all
together,
leading
to
even
higher
medical
costs
down
the
road
in
terms
of
hospitalizations
er
visits
and
long-term
health
issues.
D
Unfortunately,
this
is
another
example
of
a
barrier
that
interferes
with
the
all-important
patient-provider
relationship
where
all
treatment
options
should
be
decided
and
we've
all
seen
in
their
letters
that
we've
got
from
the
insurance
companies
this
week
that
have
a
very
complicated
explanation,
but
I'll
make
it
very
short
and
sweet.
The
copay
accumulator
program
doesn't
help
patients
with
chronic
conditions.
It
only
costs
them
more
to
receive
the
medicines
that
they
actually
need
and
when
a
patient
uses
a
copay
assistance
program,
it's
no
different
than
any
normal
transaction
at
a
pharmacy
counter.
D
The
insurance
company
still
gets
paid.
The
pharmacist
is
still
reimbursed.
The
patients
still
get
their
medicines
and
is
closer
to
meeting
their
annual
deductible
to
me,
that's
a
win-win-win
and
it
should
be
for
all
of
us
in
this
committee
as
well,
and
let
me
give
you
an
example:
if
you
went
to
a
restaurant
with
a
friend
and
they
were
there
and
said,
hey
look
I'll
pay
for
you.
D
I
got
a
gift
card
for
christmas,
I'll
pay
for
your
dinner
and
they
offer
that
as
payment
for
your
meal
and
as
you're
getting
ready
to
leave
the
restaurant
says,
we
haven't
gotten
your
payment
yet
for
your
meal.
You
know
that's
what
the
copay
accumulator
program
basically
does
is
saying
someone's
willing
to
pay
it
for
you
and
they're,
saying
we're
gonna
we're
gonna
charge
you
again
and
charge
a
double
senate
bill.
D
45
will
put
an
end
to
this
unfair
insurance
practice
and
ensure
that
patients
aren't
hit
with
unexpected
bills
when
they
pick
up
their
medicines
and
despite
what
you've
heard
this
past
week
from
some
of
these
letters
from
our
insurance
partners
senate
bill
45
will
not
push
patients
to
brand
name
drugs.
This
bill
is
only
applicable
when
there
is
no
generic
available.
Believe
me,
as
a
doctor,
I
can
assure
you,
when
I
write
patients
medications,
I'm
incentivized,
to
write
for
generic
medicines.
D
My
quality
measures
from
medicare
and
from
other
agencies
are
based
on
how
many
generics
I
write.
I
get
reports
that
compare
me
to
other
providers
to
say
how
many
genetics
are.
You
writing.
I
think.
Maybe
I
can
count
on
my
hand
in
25
years
of
practice
how
many
times
I've
told
the
patient.
You
must
take
a
brand
name
over
a
generic
we've
been
incentivized
for
that,
and
we
continue
to
be
incentivized
for
that,
so
insurance
companies
are
not
harmed.
D
Take
the
word
of
the
20
plus
advocacy
groups
that
represent
the
kentuckians
that
are
affected
by
this
unfair
program
and
it's
the
people
who
have
the
most
skin
in
the
game
that
are
asked
to
continue
to
put
even
more
skin
in
the
game,
and
because
of
that,
I'm
going
to
ask
for
your
support
on
this
bill
today,
and
I
also
want
to
introduce
again
I
mentioned
him
earlier-
is
joey
clousing
who's
online
with
cure
cf,
mr
clousing,
if
you're
there.
If
you'd
like
to
introduce
yourself
for
the
record
and
begin
your
testimony.
H
H
Many
families
in
kentucky
be
impacted
by
the
copay
accumulator
luke
has
cystic
fibrosis
he's
13.
Now
he
has
24
years
left
to
live.
So
if
you
look
around
it's
your
committee,
many
of
you
are
probably
older
than
37..
If
you
had
cf
you'd
be
dead
right
now,
according
to
the
odds,
since
he's
been
diagnosed,
life
expectancy
has
increased
and
that's
only
because
of
new
drugs.
H
H
That's
one
drug
luke's
on
13
drugs
just
to
stay
alive.
This
isn't
you
know
a
cosmetic
drug.
This
isn't
to
lose
weight.
This
isn't
because
he
smokes.
This
is
because
of
high
blood
pressure.
This
is
because
god
made
him
that,
when
it's
way
he
was
born,
the
pharmaceutical
companies
provide
assistance
to
us
due
to
the
cost
of
the
drugs
that
are
vital
for
luke
and
others
with
cystic
fibrosis
and
other
rare
diseases
to
take,
and
I
use
that
word
vital
in
the
truest
sense,
the
truest
definition
of
vital.
H
A
few
years
ago,
the
insurance
company
changed
their
policy
and
decided
not
to
allow
copay
assistance
payments
received
from
the
pharmaceutical
company
to
account
towards
our
deductible.
Accordingly,
we
had
two
to
three
thousand
dollars
in
extra
expense
when
we
normally
hit
our
out-of-pocket
maximum
in
january
or
february
of
every
year.
This
is
not.
This
is
not
right.
H
What's
happening
here
is,
is
we've
got
to
get
patients
with
chronic
conditions,
medication's,
not
optional
or
temporary?
It's
a
permanent
situation,
they're
in
kentuckians,
much
like
luke,
should
not
have
to
choose
between
their
health
or
their
family's
financial
security.
That's
how
we
have
to
bring
senate
bill
45
to
passage
this
year.
H
H
You'll
often
hear-
and
you
may
hear
later
on-
that
it's
too
complicated
and
we
need
to
pass
this
or
push
this
down
to
line.
It's
not
too
complicated.
It's
very
simple:
they're
receiving
money
from
pharmacies
from
co-pay
assistance,
companies
and
cards.
They
should
go
toward
right,
deductible,
it's
a
payment
so
when
you
hear
too
complicated
later
on,
if
they
talk
about
that
think
about
luke
and
age
13,
and
also
when
13
year
old
was
cf
and
lastly,
I'll
close
with
this,
you
know
you
may
say:
well,
they
don't
have
skin
in
the
game.
H
So
if
someone
talks
about
skin
in
the
game
for
a
person
with
a
chronically
ill
child
or
chronically
ill
condition,
it's
disingenuous.
I
won't
get
to
speak
again.
Presumably
so
I
just
asked
for
you,
if
you
hear
from
other
folks
these
insurance
companies
like
anthem
who
spent
125
000
in
lobby
for
humana
122
000
for
united
healthcare,
121
272,
I've
spent
zero
zero
dollars
on
lobby,
I'm
a
cf
dad
of
a
child
with
a
life
expectancy
of
24
more
years.
H
So
I
ask
for
you
to
remember:
have
a
little
bell
go
off
your
head.
If
they
object
to
this
and
say:
oh
it's,
it's
too
complicated
or
it's
it's
it's
it's
not
fair
or
they
don't
have
skin
in
the
game.
Think
about
luke
and
the
others
with
life
expectancies
of
37
or
even
less.
Thank
you.
I'm
happy
to
answer
any
questions
at
this
time
or
later
on.
D
I
I
Our
community
pharmacists
play
an
essential
role
in
our
healthcare
system,
providing
consistent
care
and
individualized
care
to
our
patients
across
the
state.
You
know
one
of
the
roles
that
that
a
pharmacist
has
is
helping
patients
navigate
chronic
conditions,
including
complex
health
insurance
matters.
I
You
know,
I
went
to
pharmacy
school
to
learn
about
conditions
and
how
to
treat
them,
but
one
of
the
hardest
jobs
of
working
as
a
pharmacist
is
helping.
Patients
find
ways
to
pay
for
their
medications,
and
these
copay
cards
are
our
way
to
help
patients
manage
out-of-pocket
costs,
making
those
costs
more
predictable
and
manageable
each
year
it
seems
like
out-of-pocket
costs
and
deductibles
they
they
go
up
every
year
and
just
making
these
options
available
for
kentuckians
more
important
like
they
had
mentioned.
I
I
I
I
They
have
a
a
maximum,
so
they'll
only
pay
a
hundred
dollars
or
150.
So
if
the
patient's
on
a
high
deductible
plan,
they're
still
going
to
have
a
significant
out-of-pocket
cost
for
that
medication,
so
it's
not
wiping
their
responsibility
away
completely.
From
my
experience
very
rarely
is
there
a
zero
copay
card
that
I've
seen.
I
It
should
be
known
that
you
know
that
the
pharmacy-
it
is
a
secondary
claim
and
the
pharmacy
really
doesn't
have
a
lot
to
gain
from
this.
In
addition
to
the
money
that
the
copay
card
would
give
us
that
the
processor
usually
pays
a
dollar
or
two
processing
fee
on
top
of
the
claim
which
long
story,
but
that's
not
all
profit
like
there's,
there's
costs
associated
with
submitting
a
claim
to
an
insurance
company.
I
So
you
know
I
ask
that
you
support
this.
This
legislation,
I
think,
as
a
pharmacist.
You
know
I've
spent
a
lot
of
time,
helping
patients
and-
and
if
we
don't,
if
we
don't
pass
this
and
allow
these
these
dollars
to
go
towards
the
out-of-pocket
max
and
deductibles
for
patients,
we're
going
to
see
more
issues
with
adherence
where
patients
are
skipping
doses
or
stopping
their
medications
all
together,
and
I
think
it
was
very
important
that
it
was
noted
that
you
know
ultimately,
if
patients
can't
afford
medications
and
their
can
health
conditions
continue
to
get
worse.
I
B
D
You,
mr
chairman,
just
on
the
sub,
I
was
going
to
bring
that
up.
So
thank
you
for,
for
that
is
on
page
three.
The
only
change
is
under
on
line
12.
We
added
what
it
says
by
another
insured
by
another
person
for
a
prescription
drug.
We
wanted
to
make
sure
that
was
clear,
that
this
is
for
medications
and
it
couldn't
be
interpreted
to
be
broader.
So
thank
you
for
bringing
that
up
thanks.
B
Mr
mudd
appreciate
your
testimony
as
well
there
on
on
that
issue.
Do
you
have
another
person.
B
All
right
at
this
time,
okay,
I'm
sorry,
a
senator
parrot
has
a
question.
Turn
your
microphone
on
center
parrot,
senator
parrot
turn
your
sender.
B
You
thanks.
We
do
have
some
folks
that
would
like
to
talk
on
the
other
side
of
the
bill.
I
I
know
we've
already
heard
from
thomas
stevens
and
he's
online
and
also
connor
rose
so
thomas.
If
mr
stevens,
if
you
want
to
make
a
statement
or
if
mr
rose
has
a
statement
first
or
both
of
you
I'll,
let
you
do
that
now.
J
J
Pcma
respectfully
opposes
senate
bill
45,
as
it
eliminates
an
important
tool
used
by
plan
sponsors
to
contain
the
ever
increasing
cost
of
prescription
drugs
and
providing
those
benefits.
As
you
know,
it
does
require
health
insurance
to
treat
all
manufactured
coupons
as
an
insurance
contribution
toward
their
deductible
in
overall
out-of-pocket
maximums,
unless
a
medically
appropriate
generic
equivalent
is
available.
J
And
to
that
point
I
would
note
that
there's
some
research
back
in
2014
they
looked
at
the
top
two
under
drugs
by
spending
and
found
that
51
of
those
drugs
that
were
coupon
had
no
generic
substitute.
They
may
have
had
an
alternative
competing
brand
that
achieved
the
same
outcome,
but
there
were
no
generic
substitutes
for
over
half
of
those.
I
would
like
to
also
emphasize
at
the
outset
of
my
testimony
that
pcma
does
not
oppose
true
means-tested
patient
assistance
programs
that
help
individuals
afford
their
prescription
drugs.
J
In
fact,
a
number
of
if
many
pbms
operate
savings
programs
focused
on
the
specialty
drug
space.
We
help
identify
and
facilitate
patients,
enrollment
in
need-based,
manufacture,
charitable
and
other
patient
assistance
programs,
and
I
think
it's
important
to
note
that
difference,
there's
a
difference
between
means-tested
patient
assistance
programs
and
then
co-pay
coupons,
which
are
targeted
marketing
initiatives
to
individuals
who
already
have
health
insurance.
J
J
And
you
know,
while
health
plans
pay
the
vast
amount
of
the
members
from
prescription
drug
costs.
Drug
manufacturers,
price
increases,
have
four
cell
plans
create
new
benefit
designs
that
keep
monthly
premiums
as
low
as
possible,
but
do
require
some
members
to
shoulder
more
of
the
cost
before
deductibles
are
met.
J
Drug
manufacturers
are
encouraging
patients
to
disregard
formularies
and
lower
costs,
or
prefer
to
alternative
brands
by
offering
coupons
to
help
patients
cover
that
higher
cost.
Again,
this
ultimately
steers
patients
away
from
cheaper
alternatives
and
towards
the
more
expensive
brand
drugs
with
the
less
favorable
placement
on
a
formulary,
and
I
would
just
like
to
provide
the
committee
with
a
few
facts
on
manufactured
coupons.
J
We
do
know
that
the
prices
for
drugs
with
manufactured
coupons
increase
faster
about
12
to
3
12
to
13
per
year
compared
to
non-coupon
drugs,
which
increases
about
seven
percent
per
year.
We
know
that
if
medicare's
ban
on
coupons
were
not
enforced,
cost
of
the
program
would
have
increased
10
48
billion
dollars
over
10
years.
J
J
They
decide
by
disallowing
the
manufacturer's
coupon
toward
the
patient's
out-of-pocket
maximum
deductible,
because
the
patient
hasn't
actually
incurred
that
cost
and
again
these
programs
help
plan
sponsors
mitigate
the
harmful
impact
of
manufacturing,
coupons
on
the
overall
cost
plan
cost
and
member
premiums
ensuring
that
the
patient
has
the
incentive
to
stay
on
the
formulary
and
use
the
plan
design
as
it
was
offered
by
the
sponsor,
and
again
I
mean
I
think,
it's
safe
to
say
that
manufacturing
coupons
do
decrease
costs
for
patients,
while
they
do
decrease
in
individuals.
F
Thank
you,
mr
chairman.
Obviously,
the
very
unenviable
task
of
following
up
on
mr
klausing's
testimony
as
well
as
senator
alvarado
and
mr
mudd.
F
The
rising
cost
of
prescription
drugs
is
a
concern
for
all
payers
and,
as
connor
noted,
sb45
is
narrowly
targeted
to
kentucky's
commercial
markets.
Of
course,
principal
reason
for
that
is
that
these
sorts
of
discount
cards
are
explicitly
banned
by
the
federal
government,
which
considers
them
to
be
a
kickback.
F
F
F
F
These
sorts
of
health
care
mandates
passed
by
the
general
assembly
contribute
to
higher
costs
that
are
most
felt
by
small
employers,
individual
payers
who
don't
have
the
resources
to
self-insure
and
after
what's
transpired,
with
particular
emphasis
on
kentucky's
small
businesses
in
the
last
year,
a
government
mandate
increasing
health
insurance
premiums,
isn't
the
right
answer
today.
Khp
strongly
opposes
sb45
and
ask
you
to
vote
against
it
today.
B
Your
questions,
thank
you.
Senator
alvarado
thank.
D
You,
mr
chairman,
very
briefly,
this
bill
has
nothing
to
do
with
increasing
insurance
premiums.
It's
all
about
helping
kentuckians.
If
health
plans
increase
premiums,
it's
only
to
protect
their
own
bottom
line.
So
I
know
we
mentioned
a
profitability
was
mentioned
here
about
pharmaceuticals.
I
don't
think
we
want
to
talk
about
the
profitability
of
our
insurance
companies
as
well.
We
want
them
to
be
viable,
but
there's
also
a
case
be
made
there
also
it
does.
It
does
not
include
medicaid
or
other
state
employee
health
plans,
because
the
state,
employee
health
plan
is
a
self-insured
plan.
D
D
So
you
do
the
math
here
how
about
how
that
is
in
the
line
the
states
of
west
virginia
virginia
arizona.
Georgia
illinois
have
moved
to
adopt
patient
protection
laws
like
this
regarding
copay
accumulated
adjustment
policies
and
there's
several
other
states
that
have
it
proposed
as
well.
Also,
if
you
look
at
the
fiscal
note
again,
I
think
it's
inconclusive
is
how
it's
as
written,
because
the
fiscal
amp
impact
could
be
a
dollar
18.
It
could
also
be
zero.
D
B
Comments,
I
have
a
motion
as
amended
by
this
committee
sub
by
senator
buford.
Do
I
have
a
second
second
by
senator
storm
I'll?
Ask
the
secretary:
please
call
the
roll.
E
I'd
like
to
explain
my
vote,
I
have
dealt
with
these
pbms
pharmaceutical
benefit
managers
and
I'm
my
doctor
tries
to
prescribe
lipitor.
So
I
end
up
getting
the
generic
and
I
try.
Of
course
I
get
prior
authorization.
I
give
it
to
the
lady
behind
the
scenes
of
the
doctor's
office.
E
She
spends
a
half
hour
to
45
minutes
on
hold
for
this
pbm
to
give
her
a
response.
So
after
45
minutes
I
go
on
and
head
for
the
drugstore
guess
what
nothing
nope
haven't
got
it
yet
call
back
tomorrow.
Nothing
haven't
got
it
yet
third
day,
maybe,
and
they
might,
they
might
turn
it
down.
What
has
that
cost
the
doctor?
E
B
C
I
fear
that
every
time
we
make
a
law
that
that
says,
the
insurance
company
has
to
pay
more,
and
I
understand
why
are
you
doing
it,
and
just
like
senator
buford
said
I
understand
all
that,
but
when
it
comes
down
to
the
long
run,
we
are
going
to
end
up
paying
more
now.
If
this
is
only
12
a
year,
you
know,
but
every
time,
every
time
you
go
to
the
gas
pumps
and
it's
12
a
year
12
a
year
12
a
year.
Eventually
it's
going
to
get
where
we're
going
to
be
on.
C
Thank
god.
I
hope
we
never
have
it,
but
it's
going
to
be
on
government-run
health
insurance.
You
don't
want
it
and
I
don't
want
it.
So
that's
my
biggest
fear
is
is:
is
that
we're
going
to
price
ourselves
out
of
business
and-
and
it
scares
me,
but
anyway
I
do
vote
yes
for
this.
I
do
agree
with
the
analogy
that,
oh
by
the
way,
you
said
when
you
go
eat
with
somebody,
you've
never
eaten
with
shickel
because
he
ain't
bought
yet
so
I
just
want
you
to
know
that
too.
So.
Thank
you.
B
B
I
think
we
have.
Our
businesses
concluded
motion
for
adjournment.