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A
Meeting
we
are
very
busy
today
we
have
a
busy
agenda
and
I
just
want
to
let
everyone
know
that
if
you're
interested
in
testifying
there's
a
sign
up
sheet,
I
am
going
to
be
trying
to
consolidate
the
testimony.
So
if
you
are
here
with
a
group
and
you're,
basically
testifying
on
the
same
issue,
if
you
can
find
a
spokesperson,
that
would
be
helpful.
A
F
G
A
I
am
here
we
have
a
quorum
established
and
are
ready
to
do
business,
so
we
will
jump
right
in.
I
know
that
we
have
some
folks
who
are
having
to
go
between
state
government
and
this
committee.
I
believe
senator
douglas-
has
a
bill
to
present
in
state
government
as
well,
so
we'll
go
ahead
and
take
up
senate
bill.
55,
welcome,
senator
douglas
and
please
introduce
yourself
for
the
record
and
your
guest
and
proceed.
H
Thank
you,
madam
chairman,
and
good
afternoon
to
the
committee.
I'm
senator
douglas
district
22
jessamine
county,
as
well
as
garrett,
county
and
part
of
fayette
county
with
me
today,
is
miss
shannon
smith
she's
with
the
american
heart
association,
and
she
is
here
to
help
answer
any
questions
that
you
all
may
come
up
with.
H
H
H
So
if
we
talk
about
a
primary
stroke
center,
we
want
you
to
know
that
you're
talking
about
a
particular
category
and
not
just
a
general
term,
we've
also
added
a
thrombectomy
capable
center.
As
now
one
of
the
four
categories
of
stroke
centers.
Why
thrombectomy,
capable,
because
again
different
hospitals
offer
different
levels
of
care.
H
It
has
always
been
thought
that,
well,
our
hospitals
offer
the
same
levels
of
care
and
I
assure
you
they
do
not
early
in
my
career
as
a
physician,
I
worked
as
an
emergency
room
physician
and
it
was
pretty
scary,
some
of
the
things
that
came
into
my
emergency
rooms
that
should
have
gone
to
other
centers
motion
on
the
bill.
Second,.
A
E
E
A
A
Okay,
next,
we
will
take
up.
Actually
you
know
what
I
think
while
we
have
a
quorum
and-
and
we
have
members
going
back
and
forth,
I'd
like
to
go
ahead
and
consider
the
regs
that
we
have.
Everyone
should
have
received
all
of
the
links
to
the
regs,
and
I
would
just
like
to
to
consider
those
reviewed.
A
Are
there
any
questions
from
the
committee
all
right?
We
have
a
motion
in
a
second
all
in
favor
of
accepting
the
regs
all.
B
A
Okay,
thank
you
all
right.
Next,
we
will,
I
see
senator
alvarado
in
the
back
of
the
room,
and
so
we
will
go
ahead
and
take
up
senate
joint
resolution.
72.
C
Thank
you
all
for
considering
resolution
72,
it's
fairly
self-explanatory
for
those
of
you
who
may
or
may
not
be
aware.
We
had
an
opportunity
to
have
a
severe
mental
illness
task
force
this
past
year.
I
heard
a
lot
of
very
good
testimony
from
dozens
of
individuals
and
institutions
who
are
trying
to
find
ways
to
help
better
deliver
care
to
people
with
severe
mental
illness.
This
is
a
product
of
that
task.
Force
had
several
recommendations.
A
J
E
K
L
Thank
you
senator
alvarado.
Thank
you
so
much
for
this
resolution
and,
as
you
mentioned,
the
smi
task
force,
I
that
was
the
place
to
be
during
the
interim.
We've
done
such
really
amazing
work
that
we've
seen
come
out
of
that
and
we
had
almost
an
entire
meeting
devoted
to
the
problem
of
supported
housing
for
people
with
smi
and
how
the
lack
of
supportive
housing
takes
a
toll
not
just
on
individuals
and
their
families
and
their
loved
ones,
but
entire
communities.
A
A
A
H
B
M
Thank
you,
chairman,
mosher
and
committee.
Today,
I
bring
to
you
senate
bill
10.
senate
bill
10
addresses
several
statutory
issues
that
I
believe
could
be
holding
back
nurse
availability
in
kentucky.
M
We've
been
very
intentional
with
this
bill
over
the
last
several
weeks,
we've
welcomed
input
from
every
angle
and
all
interested
partners
have
listened
and
to
and
we've
listened
to
them
and
they've
offered
suggestions
and
changes.
We've
received
valuable
input
from
kentucky
board
nursing
our
all
of
our
nursing
schools,
hospitals
and
long-term
care
providers.
M
First
of
all,
senate
bill
10
improves
the
process
for
out
of
state
and
foreign
trained
nurses
to
practice
in
kentucky
without
compromising
our
standard
of
care.
The
idea
of
these
changes
are
to
allow
qualified
nurses
to
get
to
work
in
kentucky
faster
and
to
remove
any
red
tape
that
could
possibly
be
slowing
down
their
licensure.
M
The
second
thing
that
it
does
is
send
bill.
10
improves
access
to
nursing
programs
by
removing
enrollment
limitations
placed
upon
our
nursing
programs
once
again
without
compromising
the
quality
of
education
and
training
provided
by
our
nursing
programs.
If
the
criteria
is
met
for
them,
these
programs
are
able
to
self-determine
the
size
of
their
enrollment
every
year.
M
The
third
thing
senate
bill
10
does
is
make
updates
to
the
kentucky
board
of
nursing's
membership
by
adding
term
limitations,
changing
it
to
12
years.
It
adds
geographic
requirements,
so
it's
going
to
require
at
least
two
representatives
from
each
congressional
district,
and
it
also
adds
senate
confirmation
to
these
appointees.
I
I
I
A
Thank
you.
We
have
a
motion
and
a
second
on
the
bill,
and
I
just
want
to
personally
thank
you
for
this,
like
you
said,
very
practical
legislation
in
addressing
our
immediate
crisis,
with
the
health
care
worker
and
certainly
nursing
shortage,
and
thank
you
miss
wiseman
for
being
here.
I
appreciate
the
addition
with
the
committee
sub.
We
do
have
a
question
from
representative
wilner.
L
L
I
I
continue
thank
you,
I'm
really
concerned
about
this,
and
you
know
and,
as
you
know,
I
used
to
work
for
the
biological
association
as
a
psychologist,
I
know
that
none
of
the
mental
health
licensing
boards
have
this
requirement
and
it
worries
me
that
we're
you
know
political
appointments.
L
There
are
political
appointments
to
these
boards,
but
having
another
layer
of
politics
involved
and
and
getting
people
on
these
boards
really
concerns
me
a
lot,
and
I
guess,
since
we
have
a
committee
sub
anyway,
and
this
isn't,
you
know
going
through
clean,
would
would
you
be
willing
to
look
at
an
amendment
and
to
you
know,
consider
an
amendment
that
gets
rid
of
that
just
that
provision
and
changes
nothing.
I.
M
I
probably
would
not,
but
of
course
it's
in
the
house's
hands
and
y'all
can
amend.
However,
you
need
to
and
want
to,
but
you
know
one
of
our
focuses
was
elevating.
Nurses
practicing
nurses,
voices
in
the
commonwealth,
and
that's
probably
one
of
the
reasons
that
we
decided
to
put
the
confirmation
on
there
is
to
assure
that
the
balance
in
the
board
remains
working,
nurses
focused
and
not,
it
doesn't
get
heavy
again
top
heavy
again
with
nurse
educators
and
things
of
that
nature.
So
that
was
as
my
thought
process.
M
L
One
one
quick
follow-up.
If
I
may
quick
very
quick,
thank
you
for
the
response.
I
appreciate
it.
I
just
wonder
what
would
happen
if
there
was
a
vacancy
on
the
board
and
there
needed
to
be
an
appointment
made
when
the
legislature
is
not
in
session,
which
is
of
course
most
of
the
year.
So
would
they
have
to
wait
10
months.
M
J
Thank
you,
jennifer
representative
marzian
wanted
to
send
a
special
hello
to
you.
I
wanted
to
ask
you
all
to
quantify
these
solutions
for
us.
As
best
you
can
we
hear
about
the
nursing
shortage,
if
you
would
tell
us
again
how
how
large
that
shortage
is,
and
then
if
there
are
educated,
guesses
or
projections
over
one
year
or
five
years,
for
you
know
welcoming
nurses
from
other
states.
What
will
that
bring
us
welcoming
nurses
from
other
countries.
M
I've
seen
numbers
just
in
the
last
few
months
talking
about
this
and
having
folks
visit
in
my
office,
expecting
you
know:
12
000
to
16
000
nurses,
shortage,
practicing,
nurses,
lpns
rns,
and
things
of
that
nature.
That's
that's
the
number
that
I
have
been
told
coming
right
now
to
be
honest
with
you
that
what
started
me
down
this
road
was
several
months.
I
got
a
a
call
from
somebody
that
manages
a
long,
long
term
care
facility.
M
I
Sure-
and
I
can
speak
the
numbers
that
I
don't
have
them
right
here
in
front
of
me,
because
I
wasn't
prepared
to
speak
on
those
numbers
today,
but
they're
the
same
numbers
that
you've
heard
from
the
kentucky
nurses.
A
I
I'll
get
closer.
The
numbers
that
I
would
speak
to
regarding
the
nursing
shortage
are
the
same
numbers
coming
out
of
the
kentucky
nurses
association
related
to
licensure.
What
what
I
was
focusing
on,
like
he
said
to
make
a
strong
board
focused
on
practicing
nurses
and
not
getting
heavy
in
the
education
aspects
of
it.
Our
licensure
has
tremendously
changed
number
wise
over
the
past
22
years,
which
is
the
last
time
that
our
board
composition
was
addressed
in
statute
at
that
time.
I
Nurses
in
this
state
is
very
important,
and
I
can
tell
you
the
nursing
shortage
is
real,
while
there's
no
shortage
of
nurse
anethesis
in
this
state,
I
see
firsthand
when
I'm
at
work
looking
at
operating
rooms
that
can't
function
or
surgeries
that
can't
go
on,
because
there
is
not
the
nursing
manpower
to
hold
those
patients.
I
You
know
for
an
elective
procedure,
that's
the
way.
I
see
it
in
my
specialty,
but
but
I
think
this
is
great
moving
forward,
creating
a
board.
That's
in
that's
representative
of
the
current
number
of
licensees
and
those
are
actually
practicing.
N
J
Thank
you
all
yeah
sure
I
I
just
think
we
we
need
to
have
projections
right,
removing
that
student
enrollment
cap
is
that
going
to
get
us
a
couple
hundred
nurses
or
a
couple
thousand,
and
if
we
could
have
projections
on
each
of
these
components
we
would
know
if
we're
gonna
wait
for
this
to
work
or,
if
we're
still
looking
for
solutions
yeah.
I.
M
Mean
I
think
the
biggest
issue
is
just
getting
folks
engaged
back
in
nursing.
I
mean
that's
the
first
step
this
taking
the
the
caps
off
is
maybe
something
that
may
help
two
or
three
years
down
the
road,
but
right
now
I
think
we
just
got
to
get
encourage
folks
to
get
back
in
the
nursing
field
and
get
our
classes
filled
up
as
much
as
possible.
I
And
I
don't
have
those
numbers,
those
are,
I
think
those
have
been
discussed
several
times
so
far.
This
session
from
the
kentucky
nurses,
association,
they're
really
leading
you
know
in
the
whole
team,
kentucky
task
force.
They
have
all
those
numbers
and
they're
being
discussed,
but
I
personally
do
not
have
those
numbers
in
front
of
me
as
far
as
projections.
Okay,
thank
you.
A
Okay,
thank
you,
representative
burch.
Did
you
have
a
question.
H
H
C
O
K
Quick
comment,
yes,
thank
you.
I
vote.
I
and
I
appreciate
miss
wiseman,
come
to
me
and
keep
me
up
to
date
for
past
about
a
month
or
so
and
really
get
educated
me
on
this,
and
I
appreciate
you
working
with
the
senator
and
senator
thank
you
working
with
her
and
expanding
this
and
appreciate
y'all's
effort
and
hope
this
really
comes
through
fruition
abode.
I.
K
A
A
Yes,
plea.
Thank
you.
Yes,
we've
got
you
representative,
tate
just
had
to
run
out.
Okay,
we'll
get
her
recorded
votes
on
other
bills.
Later,
okay,
senate
bill
10,
as
amended
by
the
committee,
passes
with
favorable
expression.
The
same
should
pass
on
the
house.
Thank
you
very
much
for
bringing
this
and
congratulations.
M
A
Governor
will
you
pull
your
microphone
a
little
closer
and
make
sure
that
it's
on?
Thank
you
is
the
light
on.
Yes,.
F
F
F
Chair
moser
and
members
of
the
committee
physicians,
assistants
are
a
significant
part
of
kentucky's
healthcare
delivery
system
and
all
aspects
of
patient
care.
Physician
assistants
in
kentucky
continue
to
value
their
role
in
the
physician-led
team
model
and
consistently
work
with
the
kentucky
medical
association
and
other
stakeholders
to
find
ways
to
improve
patient
care
and
lower
the
administrative
burden
on
health
care
providers
house
bill
336
reflects
the
result
of
some
of
that
work.
The
goal
is
to
simply
update
a
few
components
of
the
licensure
statute
to
better
reflect
modern
standards
of
practice.
F
L
A
We
do
we
have
any
questions
from
the
committee.
All
right
see.
None
secretary,
please
take
the
rule
representative,
bentley.
B
Representative
bowling
representative
bray,
yes,
representative,
birch,
yes,
representative,
dotson,
yes,
representative,
elliott,
representative
fleming,
aye,
representative,
fraser,
gordon,
yes,
representative,
marzian,
representative,
gibbons,
prunty,
yes,
representative,
rayburn,
yes,
representative,
raymond,
yes,
representative,
riley,
representative,
sharp
aye,
representative,
sheldon,.
E
Q
A
Mosher,
yes,
ma'am,
okay,
representative
tate,
would
you
like
to
record
some
votes.
A
F
A
Thank
you,
madam
chair,
thank
you
committee
for
giving
us
the
opportunity
to
discuss
this
really
important
piece
of
legislation
house
bill
573.
I
am
representative
kim
mosher
of
the
64th
district
for
the
record
and
I'll
allow
my
guests.
A
Okay,
thank
you.
So
much
all
right,
573
addresses
the
healthcare
worker
shortage
and
establishes
a
much
needed
recruitment
and
retention
tool
for
program
for
healthcare
workers
in
rural
and
underserved
areas.
In
kentucky
immediate,
it
immediately
addresses
the
access
to
care
issue
and
health
care
worker
shortage
with
a
long-term
solution.
A
This
will
again
aid
in
recruitment
and
retention
of
our
health
care
professionals
and
keep
them
in
kentucky.
The
program
will
be
established
within
the
uk
center
for
excellence
and
for
rural
health.
Alongside
an
existing
federal
program,
the
mission
of
the
center
for
excellence
in
rural
health
shall
be
to
improve
the
health
of
all
rural
kentuckians
and
the
improvement
of
the
health
care
systems
through
education,
research
and
service.
This
is
very
much
in
keeping
with
what
we
are
trying
to
do
here.
A
This
program
would
supplement
the
the
federal
funding
by
accepting
state
dollars
grants
and
private
donations
motion.
L
Thank
you,
madam
chair.
I'm
just
full
of
questions
today,
just
wanted
to
so
you
mentioned
rural
and
under.
A
F
Do
do
assessments
to
see
where
the
folks
that
come
to
us
for
aid
with
financial
matches
for
their
state
loans
that
they
have
when
they
come
out
which
they're
really
high
in
debt,
and
we
do
look
at
those
areas.
It
doesn't
matter
if
it
is
urban
or
if
it
is
rural.
If
it
is
a
needed
area,
they
are,
we
are
obligated
to
help
them.
Thank.
H
H
H
F
A
And
I
would
just
add
that
when
we
are
able
to
recruit
and
retain
through
a
loan
forgiveness
program,
some
of
our
health
care
workers,
especially-
and
this
incidentally,
adds
to
the
list
of
health
care,
worker
worker
professionals
or
health
care
professionals
who
are
currently
eligible
for
scholarships.
This
expands
this,
so
it's
not
just
doctors,
it's
nurses,
aprns
dentists,
therapists
and
audiologists,
ophthalmologists
and
so
forth.
F
A
Okay,
well,
thank
you
very
much
for
that
question
or
comment.
I,
incidentally,
have
a
whole
list
of
information
from
the
the
osteopathic
school
of
medicine,
college
of
medicine,
college
of
osteopathic
medicine
in
pikeville,
and
they
do
outline
some
of
the
barriers
that
they
face
and
they
identify
scholarships
as
very
helpful,
and
I
mean
there's
a
yeah,
I'm
happy
to
share
this
with
you,
but
they
do
kind
of
outline
some
of
their
their
situation
and
they
would
be
included
in
this.
F
A
I
have
the
the
applicants
who
applied
for
this
scholarship
and
loan
forgiveness
program
and
there
were
19
md's
ndos
who
did
not
get
a
loan
repayment
simply
because
the
they
well,
they
did
not
meet
the
eligibility
or
probably
the
funding
wasn't
available,
and
so
this
would
expand
that
and-
and
this
you
know,
just
expands
the
reach
of
this
program
and
it's
completely
dependent
upon
the
funds
that
are
in
this
trust.
H
I
do
understand
these
and
I
wrestle
with
this
thing
for
over
30
years,
when
these
people
get
jobs
and
get
their
profession
perfected
they're
going
to
move
where
the
money
is
now
in
the
rural
areas,
where
they
roll
up
the
sidewalks
at
six
o'clock
at
night.
The
schools
are
not
good
or
they're
poor,
and
how
do
you
keep
them
there
in
that
area,
because
we're
going
to
be
wrestling
this
problem
again,
30
years
from
now
and
there'll,
be
people
sitting
on
both
sides
of
this
organist.
H
But
there
has
to
be
something
that
you
know
some
people
that
live
there
and
grew
up.
There
will
stay
there
in
most
cases,
but
in
most
cases,
when
somebody
finishes
medical,
school
or
nursing
school,
they
may
go
to
work
there
for
a
while,
because
you
got
an
incentive
to
keep
them
there,
but
once
that
time
is
up
they're
going
to
move,
there
has
to
be
something
more
to
keep
them
there.
A
I
I
don't
disagree
that
we
need
economic
development
in
across
all
of
our
commonwealth
and
certainly
when
a
physician
or
an
aprn
takes
up
practice
in
a
rural
area,
they
become
an
employer,
and
so
those
are
jobs
that
were
not
available.
Otherwise,
and
so
you
know
this
is
a
piece
of
a
very
big
puzzle.
A
A
F
A
Right
now
it's
an
annual
two
million
dollar
appropriation
and
you
know
I
certainly
would
expect
that
if
we
completely
solve
our
health
care
worker
shortage,
that
we
wouldn't
need
this
anymore.
So
I'd
love
to
work
ourselves
out
of
this
job.
C
F
F
I
F
J
F
G
I
want
to
reiterate
what
representative
bray
said:
schools
in
rural
kentucky
do
an
excellent
job,
I'll
vote.
Yes,.
K
F
L
F
A
F
A
Thank
you,
and
also
online.
We
have
dr
shanna
babilonis
with
us,
who
has
very
graciously
agreed
to
be
with
us
to
help
explain
what
we
are
doing
here
and
I
just
want
to
especially
thank
you
for
allowing
me
to
interrupt
your
maternity
leave,
and
I
want
to
congratulate
you
on
the
birth
of
your
daughter,
dr
babilonis.
Thank
you
for
being
with
us.
Thank
you
so
much.
A
A
I
have
had
this
bill
before
you
previously,
and
the
purpose
is
to
advance
the
study
of
marijuana
and
cannabis
derivatives
for
the
treatment
of
certain
medical
conditions,
as
recommended
by
by
the
board
of
directors.
The
board
will
be
made
up
of
stakeholders,
health
care
professionals
and
researchers
in
one
organized
center.
A
This
board,
this
research
center
will
care
carefully
review
and
monitor
current
and
future
literature,
establish
and
increase
clinical
trials
and
study
the
outcomes
of
states
with
marijuana
programs,
the
increase
in
clinical
trials
and
the
ex
expediting
expediting.
I
can
say
this
of
research
in
kentucky,
for
the
treatment
of
certain
medical
conditions
is
of
utmost
importance
when
we're
talking
about
cannabis,
derivatives,
uk
and-
and
my
guests
can
better
explain
this,
but
uk
does
already
have
research.
A
H
Thank
you,
representative
moser.
We
appreciate
you
bringing
this
bill
again,
as,
as
you
indicated
for
the
record,
I
think
this
is
our
third
time
with
this
bill.
We
appreciate
it.
It's
obviously
a
research
center
that
will
be
multi
multi-disciplinary
across
campus
and
with
that
I'm
going
to
let
dr
babylonis
say
a
few
words
about
this
bill.
Thank
you.
S
S
We
have
those
right
now,
but
we're
limited
it's
a
bottleneck
because
those
processes
to
obtain
all
those
regulatory
permissions
are
very
burdensome,
and
so,
if,
if
we
would
get
a
center
with
focused
individuals
who
are
all
working
towards
the
same
goal,
we
could
expand
the
number
of
people
who
have
those
regulatory
permissions.
We
could
expand
the
amount
of
research
that
we
do
and
we
could
really
make
a
difference.
I
think,
to
try
to
figure
out
what
conditions
can
we
treat
with
medical
cannabis.
F
C
J
Thank
you.
Might
this
hamper
the
legislature's
ability
to
approve
medicinal
marijuana
prior
to
research
conducted.
A
Here,
there's
nothing
in
this
legislation
that
would
preclude
or
hamper
the
efforts
of
a
medicinal
marijuana
program
being
implemented.
In
fact,
there's
language
in
this
bill
that
says
that
should
should
kentucky
implement
a
medical
marijuana
program.
That
individuals
who
apply
for
a
medical
card
in
that
program
would
also
be
eligible
or
be
given
the
opportunity
to
participate
in
research,
so
no
they
can
co-exist.
A
I
you
know.
I
believe
that
the
way
that
some
states
mississippi
comes
to
mind
has
ruled
out
their
medicinal
marijuana
program
is
really
prudent
and
smart.
They
started
with
research
in
1964
through
the
cultivation
center
that
they
have,
and
in
fact
I
added
that
language
to
this
bill
to
have
the
center
apply
for
through
the
dea
or
nida
for
a
license
for
a
cultivation
center
in
kentucky.
A
J
Follow-Up,
please
go
ahead.
How
would
it
interact
with
federal
research.
S
I
can,
I
think
it
would
really
help
our
our
federal
grant
dollars.
So
I
get
grants
from
the
national
institute
on
drug
abuse,
and
so
that's
the
federal
research
that's
being
conducted
is
through
grantees
like
myself,
and
so
I
think
that
this
would
give
us
a
huge
opportunity
to
apply
for
more
grants
and
get
more
grant
funding
in
kentucky.
F
F
I'm
going
to
briefly
explain
my
vote.
You
have
the
cart
and
the
horse.
I
think
this
is
the
horse.
So
thank
you
vote.
Yes,.
T
M
F
M
E
Okay,
if
we'll
get
started
here,
we're
obviously
going
to
be
here
the
name
of
our
house
bill
457,
it's
related
to
pharmacy
and
pharmacy
services.
I
do
want
to
mention
briefly
how
the
sub
changes
and
we'll
adopt
that
sub,
because
I
think
the
fact
that
the
sub
has
changed.
E
A
And
yes,
thank
you
for
starting
with
the
committee
sub,
just
go
ahead
and
explain
any
changes
and.
E
Appreciate
that
and
proceed
and
and
we'll
move
I've
scratched
a
lot
of
it.
I
know
how
much
time
we
have,
but
but
but
we'll
get
going
here
in
the
sub.
We
really
took
away
all
pricing
language
when
it
came
to
pricing
thresholds,
and
that
was
some
of
the
issue.
E
Dispensing
fees
came
out,
the
nadac
floor,
language
came
out,
pass-through
pricing
requirement
came
out.
Even
there
was
some
mention
in
one
of
the
fiscal
notes,
early
fiscal
notes
that
the
the
benefit
management
advisory
council
for
pharmacy
would
cost
a
little
money.
We
took
it
out
because
we
already
have
a
tax
council,
so
we
thought
that
would
be
okay
and
then
we
added
some
psal
language
that
would
require
fiduciary
duty
to
pharmacies
to
match
the
fiduciary
duty
that
pbm's
owed
to
to
insure.
E
So
those
are
the
things
that
that
I
believe
will
address
a
lot
of
what
any
opposition
would
have
as
far
as
worry
about
the
cost
of
of
this-
and
this
is
truly
about
consumers
and
we'll
move
forward.
Let
me
say
just
a
couple,
quick
things
and
then
kathy's
going
to
read
two
or
three
minutes
and
then
I'll
highlight
some
stuff
and
we
will
be
ready
for
questions.
We've
got
about
15
to
20
entire
organizations
over
the
last
three
years
are
supporting
this
bill
and
continue
to
support.
E
Today
you
have
a
list
of
them,
probably
in
your
folder.
This
has
been
three
years
of
a
collaboration.
That
is
it's
just
everybody.
Working
together,
we
even
had
an
informal
work
group
this
last
summer,
that
involved
several
representatives,
several
senators
again
just
to
get
to
this
to
this
bill.
I
do
want
to
say
I'm
a
legislator,
I'm
a
pharmacist.
E
I
serve
as
a
division,
ceo
for
a
very
large
self-insured
company,
with
several
thousand
employees,
so
I'm
very
sensitive
to
that
issue,
and
how
this
could
affect
that.
E
I'm
convinced
I'm
doing
what's
right
for
every
single
one
of
those
and
unfortunately
I
am
also
a
consumer
as
of
late
with
some
issues
that
you
get
health
issues.
So
I
feel
like
this
addresses
all
four
and
I'm
very
proud
of
this
bill.
All
of
you
all
have
watched
this
thing
evolve
over
the
last
few
years.
E
I
appreciate
everybody's
support.
I
do
plan
to
continue
working
with
those
four
and
and
maybe
some
in
opposition
today
beyond
this
and
look
forward
to
move
together
and
at
this
I'm
going
to
relinquish
it
to
miss
kathy
hannah
president
of
kpha
good
afternoon.
D
And
thank
you,
chairman
moser,
and
what's
it
on
I'm
good
now,
okay,
thank
you,
general
manager
and
committee
members
for
allowing
me
to
speak
with
you
today
again.
My
name
is
kathy
hanna
and
I'm
here
today,
as
the
president
of
the
kentucky
pharmacy
association
to
speak
on
behalf
of
kentucky
pharmacists
across
all
practice
areas
and
for
the
patients
and
communities
we
serve
the
three
largest
pharmacy
benefit
managers
or
pbms
control,
just
under
80
percent
of
the
market,
and
have
talented
record
profits
over
the
past
several
years.
D
D
I'm
here
today
to
ask
you
to
vote
in
favor
of
house
bill
457,
which
would
address
mail
order,
mandates
and
ensure
kentuckians
have
safe,
reliable
access
to
the
brick
and
mortar
community
pharmacy
of
their
choice.
House
bill
457
protects
a
critical
component
of
kentucky's
health
healthcare
infrastructure,
the
community
pharmacist.
D
This
is
particularly
true
in
rural
communities
where
pharmacists
are
most
are
often
the
most
direct
and
trusted
provider
contact
for
many
individuals
and
families.
A
recent
study
that
was
conducted
by
the
public
policy
polling
indicated
that
84
of
respondents
do
not
support
patient
steering
or
mandatory
malware
practices.
D
Unfortunately,
the
services,
local
pharmacists,
provide
remain
under
constant
threat
from
the
harmful
actions
of
major
players
in
the
health
care
system.
Most
notably
pharmacy
benefit
managers,
also
known
as
pbms
pbms,
pay
a
significant
role
in
deciding
how
kentuckians
access
and
how
much
they
pay
for
medications
at
the
pharmacy
counter.
D
Furthermore,
house
bill
457
provides
additional
protections
for
self-insured
employers
by
requiring
pabms
to
act
as
fiduciaries
and
represent
the
best
financial
interest
of
our
kentucky
employers
as
frontline
healthcare
providers.
Pharmacists
are
all
too
familiar
with
the
problems
that
pbms
are
creating
for
our
patients.
D
I
personally
have
witnessed
countless
situations
where
patients
and
their
caregivers
have
been
negatively
impacted
by
pbm
market
practices,
which
often
require
or
incentivize
patients
to
utilize
mail
order
or
a
pbm
owned
or
affiliated
pharmacy.
I
would
guess,
if
you
ask
the
pharmacist
in
your
individual
communities,
they
would
tell
you
the
same.
D
These
market
practices
rob
patients
of
their
ability
to
choose
where
they
receive
care
and
compromise
patient
safety.
When
medications
are
not
shipped
in
a
timely
or
safe
manner
or
a
patient
is
deprived
of
the
services
they
need
pharmacy
benefit
managers
and
the
harmful
practices
they
use
to
generate
profits.
Put
community
pharmacies
at
risk.
D
Every
time
a
local
pharmacy
is
forced
to
shut
its
doors.
It
is
not
only
the
patients
that
pharmacy
service
serves.
It
not
only
hurts
the
patients
that
pharmacy
serves,
but
it
hurts
the
overall
community
often
times
in
our
most
vulnerable
rural
areas.
Pbms
are
quick
to
dismiss
local
pharmacy
closures
and
say
kentucky
pharmacists
are
doing
fine.
D
In
my
role,
as
vice
president
of
professional
affairs
for
american
pharmacy
services
corporation
and
as
a
practicing
pharmacist,
I
speak
with
and
work
with
pharmacists
across
kentucky
every
day
I
can
tell
you
that
pharmacies
are
struggling
in
the
past
month.
I
personally
know
of
four
kentucky
community
pharmacies
that
closed
that's
in
the
past
month,
leaving
two
communities
with
no
local
pharmacy
and
forcing
patients
to
either
travel
farther
or
switch
to
a
mail-order
pharmacy
that
lacks
the
one-on-one
interaction,
which
is
critical
to
ensure
optimum
care.
D
E
Very
good-
and
thank
you
very
much
for
that,
and
I'm
going
to
just
briefly
do
some
highlights
of
the
bill
and
then
we'll
take
some
questions.
If
dr
bentley
wants
to
jump
in
too,
we
can
do
that
or
representative
bentley
or
both
right
house
bill
457
will
prohibit
pharmacy
benefit
managers
from
requiring
patients
to
use
male
order.
They
can
still
use
mail
order.
Just
can't
require
them
to
use
mail
order
which
are
often
owned
and
affiliated
by
the
pbm
itself.
E
It
it
requires
pharmacy
requirements
to
be
imposed
equally
on
all
insurers
in
the
same
benefit
category.
We
can
get
deeper
into
these
weeds
if
you
want,
but
let's
I'll
go
down
the
line
here.
It
establishes
contracting
requirements
for
pharmacy
benefit
manager,
contracts
with
pharmacies
or
pharmacists,
and
there's
been
quite
a
bit
of
overreach
in
the
in
these.
What
we
would
call
adhesive
type
contracts
in
the
in
the
in
the
law
industry,
the
I'm
sure
they'll
straighten
me
out
on
that
in
a
minute,
but
they're,
basically
taking
or
leaving
contracts
there
needs
to
be.
E
There
needs
to
be
some
some
flexibility
there.
I'm
not
sure
this
bill
will
provide
at
all,
but
it
addresses
it.
This
includes
the
pro
the
prohibition
of
retroactive
denials
of
pharmacy
claims
after
adjudication
when
you
come
to
the
to
the
register
and
you
pay
your
medicine
for
your
medicine.
That
should
be
the
final
cost
and
everybody
here
should
know
what
the
final
cost
is,
including
the
person
selling
it
to
you.
But
unfortunately,
several
months
later,
these
guys
have
a
habit
of
coming
through
and
clawing
back
thousands
and
thousands
and
thousands
of
dollars.
E
So
and
some
of
that
is
part
d
federal.
You
know
federal
medicare.
Some
of
it
is
different
types
of
fees
and
again
I
can
get
into
the
weeds
at
some
point
if
they
want
to,
but
that's
we'll
leave
it
at
that.
It
prohibits
pharmacy
benefit
managers
from
basing
reimbursement
for
a
prescription,
drug
on
outcomes,
scores
and
matrix.
I'm
absolutely
in
the
surface.
You
would
think
I
can't
believe
they
wouldn't
want
that.
The
scores
and
matrix
that
were
put
together
when
all
this
came
out
several
years
ago
seemed
like
a
good
idea.
E
But
what
we've
seen
now
is
those
metrics
actually
have
no
nothing
to
do
with
with
these
dispensing
habits
and-
and
we
found
out-
and
they
told
us
that
if
we
did
these
outcomes-
and
I
want
to
believe
that
they
started
out
with
five
they've
changed
them
three
or
four
times
that
that
there
would
be
no
additional
fees,
the
idea
would
be.
If
you
do
good,
you
wouldn't
have
any
fees.
F
A
C
Most
people
don't
know
my
background,
but
I've
been
past.
President
of
the
high
farms
association.
I
was
on
the
board
of
directors
of
united
drugs
in
phoenix
arizona
which
had
2
400,
independent
pharmacies
and
I've
had
31
years
in
high
high
university
teaching,
pre-nursing
and
teaching
pharmacology.
C
A
Thank
you
very
much
at
this
point.
We
have
some
folks
who
have
signed
up
to
speak
and
I
will
invite
folks
who
are
here
in
person
if
you
could
just
come
to
the
table
together,
and
I
will
give
you
about
the
same
amount
of
time
that
these
folks
had
just
in
fairness,
but
keep
in
mind
that
we
do
have
a
motion
and
a
second
so
and
then
we
also
have
online
mindy
farnsley,
who
you
all
can
include
in
the
discussion.
A
O
Thank
you,
madam
chair
good
afternoon.
Members
of
the
committee,
I'm
frank
is.
O
Now
it
is
thank
you,
madam
chair
members
of
the
committee,
I'm
frank
gemly
with
the
kentucky
association
of
manufacturers,
I'll
briefly
express
our
concerns
about
the
bill,
and
we
appreciate
the
opportunity
to
to
appear
before
you.
Our
message
is
very
basic.
This
is
not
the
time
to
increase
health
care
costs
on
kentucky
manufacturers
and
other
kentucky
businesses.
O
O
Now
I
have
not
been
privy
to
the
committee
sub
or
the
fiscal
note
for
it,
but
our
message
is
that
in
these
extraordinary
times,
with
inflation,
now
at
7.9
percent
with
prescription
drugs
already
up
an
average
of
6.6
percent
across
the
country,
with
the
effects
of
the
pandemic
still
obvious
to
the
economy,
with
the
ongoing
workforce
crisis
and
with
the
effects
that
are
just
now
beginning
to
be
felt
from
the
war
in
europe.
O
O
Q
One
is
it's
very,
very
difficult
to
include
all
the
material
terms
of
a
contract
in
legislation,
it's
hard
to
predict
what
a
contract
should
provide
and
that
can
oftentimes
lead
to
confusion
among
the
contracting
parties
as
to
what's
permitted.
What's
not
permitted,
it
can
actually
hamper
the
contractual
relationship.
Creating
inefficiencies.
Q
Second
point
is
legislation
is
static,
but
the
economy
society
is
dynamic
and
fluid,
and
it's
very
difficult
to
predict
what
innovations
will
occur.
What
best
practices
will
emerge?
What
other
changes
in
the
relationship
will
develop
over
time,
and
so
where
the
goal
may
be
to
create
certainty
and
finality
with
in
terms
of
defining
the
contractual
relationship,
the
permitted
contractual
relationship
between
the
parties.
Q
The
reality
is
that,
through
whether
it's
technological
change
through
changes
in
best
practices,
change
in
society
ethos
maurice,
this
legislation
really
does
limit
the
ability
to
use
tools,
financial
inducements,
other
and
other
tools
to
to
drive
innovation,
to
drive
best
practices,
to
drive
accountability,
and
you
could
have
the
perverse
result
of
actually
eliminating
the
ability
to
pass
costs,
efficiencies,
cost
reductions
onto
people
who
pay
health
insurance
premiums
who
pay
pharmacy
costs.
So
I
just
caution
the
committee
that
take
a
hard
look
at
the
section
of
the
legislation.
Q
It
sets
out
in
very
detailed
terms
the
permitted
parameters
of
the
contractual
relationship
between
pbms
and
pharmacists
and
ask
yourself:
are
we
actually
creating
a
perverse
incentive
to
drive
in
the
future
best
practices,
accountability,
innovation
within
that
contractual
relationship?
Thank
you,
madam
chair
members
of
the
committee.
R
Thank
you,
madam
chair
member
of
the
committee,
I'm
rusty
kress
here
on
behalf
of
america's
health
insurance
plans.
Many
of
the
elements
that
are
part
of
house
bill
457
have
been
introduced
in
other
states,
but
never,
I
won't
say,
never,
but
very
rarely
in
an
omnibus
bill.
R
So
even
though
we
have
concerns
throughout
the
bill
just
for
the
sake
of
time,
we'll
limit
them
to
two
one
of
them
deals
with
the
concept
of
the
elimination
of
the
practice
of
white,
bagging
and
connor
will
go
into
much
greater
detail
on
that
topic,
but
in
essence
it's
the
use
of
specialty
pharmacies
for
drugs
that
are
administered
in
a
clinical
setting,
not
pills
or
anything
like
that.
It's
the
drugs
that
you
get
infusions
or
things
like
that.
R
R
R
P
Good
afternoon,
madam
chair
members
of
the
committee,
my
name
is:
connor
rose,
I'm
with
the
pharmaceutical
care
management
association,
we're
the
national
trade
representing
pharmacy
benefit
managers.
Our
members,
our
members,
administer
prescription
drug
benefits
for
more
than
three
million
kentuckians
who
receive
their
health
coverage
through
their
employer,
the
medicaid
medicare
and
the
individual
market.
We
work
with
employers
to
help
design
benefits
that
employers
are
able
to
provide
their
employees
with
affordable
access
to
prescription
drugs.
P
I
would
like
to
note
we
are
the
only
entity
in
the
supply
chain
whose
goal
is
to
lower
and
drive
down
the
cost
of
those
prescription,
drugs
and
again
to
make
them
as
accessible
and
affordable
as
possible.
We've
heard
from
the
business
community
that
they
are
concerned
about
the
cost
increases
associated
with
this
bill.
P
I
haven't
had
the
most
time
to
go
through
that
committee
sub
in
detail,
but
I
do
know
of
a
few
provisions
that
I'd
like
to
point
out
that,
on
its
face,
are
cost
increases
and
again
limit
the
flexibility
that
employers
should
have
in
designing
their
benefits.
But
before
I
get
into
that,
I
would
like
to
first
note
that
if
you
recall
in
2020
the
general
assembly
passed
senate
bill
50,
which
changed
the
way
that
the
kentucky
medicaid's
program
used
a
pbm
to
administer,
prescription
drug
benefits
in
that
process.
P
In
that
case,
rather,
the
state
exercised
its
ability
and
the
flexibility
to
contract
in
a
way
that
best
fits
the
state's
needs
and
medicaid
enrollees
needs.
However,
house
bill,
457
strips
every
tool
away
from
employers
and
the
flexibility
that
the
state
itself
used
in
2020
and
those
tools
that
are
being
stripped
away
across
the
board
demonstrably
reduce
costs
again
just
to
point
out
a
few
parts
of
the
bill,
as
russia
mentioned
something
known
as
white
bagging.
So
this
deals
with
drugs
that
are
administered
in
a
clinician's
office
in
a
hospital.
P
These
are
very
high-priced
drugs
and
typically
a
hospital's
pharmacy
will
provide
that
from
their
own
inventory
known
as
buy
and
bill.
However,
hospitals
are
also
marking
up
these
drugs
astronomically,
on
average,
probably
about
250
percent
pbm.
Specialty
pharmacies
can
dispense
those
same
drugs
to
the
provider's
office
for
administration,
for
the
patients
at
a
cheaper
rate,
and
so
employers
adopt
these
policies
and
support
these
policies
and
want
these
policies
because
they
lead
to
lower
costs.
P
Secondly,
I'd
like
to
provide
an
example
of
what
the
words
in
the
bill
mean
in
practice,
so
this
legislation
prohibits
any
incentivizing
of
mail
order,
pharmacies
or
lower
cost
channels.
So
let's
say
I'm
an
employer
I
have
300
employees,
say
half
of
which
are
on
statins
for
bad
cholesterol,
that
maintenance
drug
can
be
provided
through
a
mail
service
pharmacy
at
a
significantly
cheaper
price
than
a
retail
pharmacy.
P
If
I'm
an
employer
paying
upwards
of
80
percent
of
the
total
cost
of
care,
I
want
to
incentivize
my
employees
to
use
the
lower
cost
channel
to
obtain
their
prescription
drugs.
This
would
be
prohibited
under
this
bill.
This
bill
prohibits
our
our
members,
our
companies
from
offering
lower
prices
to
employers
to
provide
benefits
to
their
employees.
P
I
would
also
like
to
note
that
the
state
employee
health
plan
is
not
included
in
this
bill
and
not
subject
to
any
of
these
costly
provisions
for
a
reason.
Secondly,
I
would
also
like
to
point
out
that
if
you
look
at
the
definition
of
pbm
in
the
bill,
it
says
if
a
pbm
is
contracted
with
a
hospital
that
has
a
pharmacy
and
is
self-insured.
They
are
exempt
from
everything
in
the
bill
and
they
wouldn't
do
that
if
they
knew
it
wasn't
going
to
increase
costs,
and
it's
going
to
that's
all.
A
N
O
N
With
that
being
said,
we've
spent
many
hours
investigating
house
bill
457,
which
is
brought
before
you
today
and
in
our
expert
opinion,
this
proposed
piece
of
legislation
does
not
do
anything
to
address
the
cost
of
prescription
drugs.
In
fact,
it
does
the
opposite.
N
Not
only
do
we
think
it's
going
to
disrupt
the
current
health
insurance
market
and
have
a
negative
impact
on
the
cost
of
health
insurance
premiums
to
employers
and
consumers,
but
it'll
also
remove
critical
cost
containment
strategies
that
we
currently
use
to
implement
lowering
health
care
costs
for
employers.
N
In
fact,
one
major
carrier
in
kentucky
has
already
came
out
and
said
that
they're
estimating
a
six
percent
overall
increase
to
health
care
premiums.
If
this
legislation
is
passed
at
this
time
with
cost
increasing
everywhere
for
consumers
and
constituents
of
kentucky,
I
just
don't
think
that
this
is
the
time
to
pass
legislation.
N
That's
going
to
increase
health
insurance
premiums
any
further.
So,
on
behalf
of
the
kentucky
association
of
health
underwriters,
I
please
ask
that
you
oppose
this
bill,
as
it
will
negatively
impact
our
clients
and
restrict
the
tools
that
we
need
to
keep
our
health
insurance
costs
down
for
kentuckians.
A
Thank
you
very
much.
I
think
at
this
point
I
would
invite
representative
sheldon
back
to
the
table.
I
don't
know
if
you,
if
you
want
to
stay
nearby
for
questions,
we
do
have
a
few
questions
and
I
think
most
of
these
will
at
least
my
question
is
referring
to
cost
containment
and
providing
options
for
patients.
E
I
would
just
say
that
anecdotally,
you
can
pick
any
generic
drug.
You
want
to
and
decide
that
300
people
couldn't
get
that
drug
for
a
certain
price
and
come
up
with
some
assumption
that
the
entire
program
is
going
to
cost
more
and
that
that's
kind
of
just
doesn't
it
doesn't
hold
water.
I
mean
the
the
actual
truth
to
all
of
this
is
that
we
took
out
most
of
any
possible
pricing
issue.
So
I'm
going
to
say
there
are
a
lot
of
tools
that
go
in
I'm
a
self-insured
employer.
E
I
I
have
set
at
the
table
with
previous
governors
with
one
of
the
men
sitting
at
this
table
and
talked
about
the
pbms
and
what
they
did
to
the
state.
Medicaid
this
bill
actually
does
a
lot
what
we
did
in
state
medicaid
and
what
we
saw
in
our
senate
bill
50
state
medicaid
last
year,
which
they
brought
it
up
was
we
saw
an
infusion
in
the
economy
in
kentucky
of
somewhere
around
150
million
dollars,
and
we,
after
talking
to
eric
friedland
secretary
friedlander
last
week,
they're
looking
at
a
net
positive
gain.
Now.
E
E
Pbms
are
just
going
to
be
forced
to
all
act,
the
same
way
they
just
won't
be
able
to,
and
by
the
way.
Let's
just
remember,
you
got
insurance
people
up
here
and
folks,
like
they're
being
talked
to
by
by
pcma.
Why
insurance
companies
own
the
pbms
y'all
do
aware
that
there's
there's
the
conflict
of
interest
is
absolutely
it's
total
vertically
integrated.
E
You
know,
and
I
won't
go
through
and
tell
you
which
one
owns
which,
but
they
know
75,
it's
all
insure,
so
who's
going
to
be
against
this
it'll
be
people
that
have
something
to
do
with
insurance.
That's
what
you've
heard
and
it'll
be
the
pbms,
which
is
these
guys.
I
fully
expected
that
this
is
what
I'm
saying:
patients
have
to
be
over
profits.
E
I
can
assure
you
we
fired
our
pbm
four
or
five
years
ago
and
we
put
another
one
in
and
we
simply
did
an
rfp
process
that
has
much
of
what
this
bill
has
in
it
and
we
save
two
million
dollars
our
first
year,
so
they
can
talk
all
they
want.
The
truth
is
I've
lived
it
I
see
it.
I
know
it.
This
is
the
truth
and
and
I'll.
T
There
is
not
the
security
of
the
prescription
drug
supply
chain
if
you're
using
white
bagging.
It
means
that
instead
of
the
patient
receiving
a
drug
they're
at
the
hospital
that
has
been
prepared,
specifically
for
the
patient,
it's
being
prepared
by
a
third
party
pharmacy
and
it's
being
shipped
by
somebody,
and
if
that
drug
then
lands
at
the
dock,
and
it's
not
immediately
put
into
cold
storage
the
way
it's
supposed
to
be.
If
we
don't
know
that
it's
there
and
that
gets
infused
into
a
patient
that
could
that
could
be
could
be
devastating.
T
It's
it's
a
case
of
when
you
talk
about
what
the
hospital
charges.
That's
a
very
alluring
thing
to
say
that
it's!
Oh,
it's
double
the
charges,
but
the
bottom
line
is
you
think
about
this.
Those
of
you
who
are
providers,
you
already
know
what's
charged,
isn't
what's
paid,
the
insurer
has
a
negotiated
rate
and
the
negotiated
rate
is
what
is
actually
paid
so
saying.
Oh,
it's
it's
an
exorbitant
charge.
Well,
you
know
that's
okay,
to
say
that,
but
what's
actually
being
paid
is
the
negotiated
rate.
T
E
Is
there
any
more
questions,
I'll
just
kind
of
leave
it
that
I
tried
to
hit?
We
could
talk
about
the
contract
issues
that
and
mr
brinkman.
I
want
to
make
sure
I'm
available
to
him
to
concern
all
those
contracts
we'll
work
through
that.
So
I
don't
know
that
I
need
to
speak
a
lot
to
that.
There's
some
other
things
said,
but
but
yes.
K
Actually,
I
believe
the
my
answer,
or
the
answer
was
conveyed
a
few
minutes
ago
about
the
white
backing
and
so
forth,
and
I've
always
focused
on
what's
best
for
the
patient
and
making
sure
they're
getting
the
best
quality
product,
but
also
at
the
least
expensive
price
question
is
and
and
I'm
sort
of
data
driven
when
it
comes
to
going
through
what
is
what
is
beneficial
to
the
to
the
to
the
patient,
and
I
hear
well
we're
going
to
save
costs
or
it's
going
to
increase
costs,
but
you
know
I
don't
I
don't
see,
I
don't
see
where
the
rubber
hits
the
road
in
terms
of
black
and
white
on
a
piece
of
paper
as
far
as
with
that
go
to
pro
forma.
K
That's
what
I
want.
I
haven't
heard
anything
other
than
what
mindy
said
about
six
percent
increase.
I
I
you
know:
okay,
it's
great,
but
I
haven't
y'all.
I
haven't
heard
or
haven't
received
any
information
to
help
justify
what
you're
saying,
because
I
hear
all
this
stuff.
So
if
you
could
comment
on
that,
I
would
appreciate
it
and
that-
and
I
do
appreciate
representative
sheldon
talking
with
the
contract,
because
secretary
bringman
brings
up
a
good
point
that
we
need
to
be
conscious
of
that.
P
K
Has
this
been
gone
through
an
independent
agency
to
go
through
and
audit
what
both
both
sides
are
saying.
P
K
K
F
Thank
you,
madam
chair
connor.
F
Do
pbms
have
buildings,
do
they
have
investment
in
product?
Do
they
what
what
service
do
pbms
actually
do?
There's
a
brick
and
mortar.
Besides
just
the
office
and
the
people
I'm
talking
about
the
pharmacists
have
the
buildings
they
invest
in
the
they
have
employees
they
have
product,
they
have
to
order
the
product.
What
service
literal
service
do
pbm
serve
or
provide
okay.
P
Well,
quite
a
few
actually
so
on
one
hand
we
admit
we
manage
and
administer
prescription
drug
benefits.
So
a
part
of
that
is
one.
We
negotiate
discounts
with
drug
makers.
They
set
the
price
of
the
drug.
We
were
able
to
negotiate
significant
discounts
off
of
those
prices.
Secondly,
we
manage
pharmacy
and
build
pharmacy
networks,
whether
that
pharmacy
network
is
narrow
or
broad
is
up
to
the
plan
sponsor
of
the
employer.
P
So,
yes,
I
would
say
we're
not
just
simply
we're
not
paper
pushers.
You
know
the
monopoly
man
in
the
back
of
the
room
laughing
pocketing.
All
this
money
we're
out
there
working
with
patients
making
sure
they
stay
adherent
to
drugs,
make
sure
they
can
afford
their
drugs
and
make
sure
that
they
can
go
to
pharmacies
providing
high
quality
care
at
affordable,
low
cost.
F
May
have
a
follow-up
question.
Yes,
I
I
understand
my
understanding
is
that
yeah,
you
do
the
negotiation
and
I
understand
why
the
kentucky
associates
might
be
concerned,
but
I
would
I
would
say,
manufacturers
probably
would
want
to
get
paid
for
the
product
they
produce
and
I
think
pharmacists
just
want
to
get
paid
for
the
service
they
provide.
F
I
have
had
this
is
an
issue
this
my
sixth
year
here
and
I've
heard
from
my
local
pharmacist,
many
of
them
about
to
go
under
because
of
their
issues
with
this,
and
I
I
quite
frankly
am
concerned
that,
with
all
the
things
you
took
out
representative
sheldon,
if
ron
paul's
going
to
be
satisfied
because
I've
heard
a
lot
of
issues,
he's
told
me
about
you
said
you
took
out
so
it
sounds
like
there's
still
more
work
to
be
done,
but
but
but
I
know,
my
independent
pharmacists
have
bought
the
buildings.
F
They've
employed,
the
people
they've
bought
the
product.
They've
got
a
lot
invested
and
I
just
think
people
ought
to
have
a
free
choice.
I
gave
up
my
choice
for
a
when
I
was
working
for
the
diocese.
We
could
have
had
mail
order
and
I
preferred
to
have
go
to
my
pharmacist
and
get
it
from
my
pharmacist.
So
I
appreciate
that
aspect
of
this
bill
so.
P
Well
to
that
point,
even
if
an
employer
or
plan
is
trying
to
incentivize
mail
through
lower
cost
sharing,
that's
gonna
be
a
lower
cost
employer.
You
still
have
the
option
to
go
to
a
retail
pharmacy,
whether
it's
a
chain
independent,
you
might,
you
might
pay
a
little
more
but
again,
the
employer
who's
in
health
plans
insurance
who
are
paying
upwards
of
80
of
the
total
cost
of
the
drug.
The
total
cost
of
care
need
to
incentivize
patients
and
individuals
to
go
to
low-cost
pharmacies.
P
E
If
I
could
comment
on
that,
any
willing
provider
law
has
been
around
for
20
years.
It
says
that
as
long
as
a
local
pharmacy
is
willing
to
pay
the
same
price
and
do
it
for
the
same
amount
that
they
should
be
allowed
to
participate
where
these
guys
came
up
with
the
incentives
was
when
they
looked
at
that
law
and
said:
oh,
we
can't
send
them
to
our
own
mail
order,
people.
We
can't
force
people
to
go
to
these
pharmacies
we
own,
so
we
can
make
more
money,
so
they've
created,
tiers
and
preferred
pharmacies.
E
Things
like
that.
That
is
where
that
came
from.
So
they
act
like
well.
We
incentivize
them
to
go
where
you're
doing
that
to
try
to
get
around
any
willing
provider
law.
We
are
absolutely
willing
to
do
it,
and
I've
heard
him
say
a
couple
of
times
that
kentucky
state
employees
that
they
were
included
in
this,
that
he
could
give
us
all
the
data
we
needed.
Well.
E
C
Yeah
when
you
talk
about
specialty
drugs,
I
went
to
university
of
kentucky
and
I
have
a
doctorate
in
pharmacy.
If
I
was
trained
well,
don't
you
think
I
could
do
a
specialty
drug
in
my
own
pharmacy?
C
C
J
Thank
you.
I
I
wanted
to
quibble
with
a
couple
of
things.
I
heard
there's
this
consistent
myth
that
we
love
our
health
insurance
plans
and
we'd
just
be
absolutely
heartbroken
if
we
left
it
for
something
better.
I
want
to
speak
for
just
the
every
man
and
say
that
is
not
the
case.
I
also
don't
like
to
hear
hear.
People
say
that
what's
good
for
employees
is
bad
for
employers
and
vice
versa,
when
we
know
that
what's
good
for
one
group
is
good
for
the
other.
J
R
J
Will
you
please
tell
me
the
health
insurance
companies
that
you
represent
in
their
profits
last
year.
R
A
Okay,
well,
thank
you.
I
I
just
want
to
make
a
quick
comment
and
I
appreciate
all
of
the
work
that
you've
done.
Representative
sheldon
representative
bentley,
everyone
involved.
I
know
that
this
is
a
big
issue.
A
The
committee
sub,
I
hope,
is
what
everyone
is
working
off
of
today,
because
it's
vastly
different
than
the
first
bill
that
was
proposed.
You
know
I.
I
have
a
few
concerns.
When
I
hear-
and
you
know
I
I've
visited
pbms,
I
understand
the
services,
but
you
know
the
cost
containment
and
limiting
limiting
options
for
patients
requiring
the
use
of
mail
order
and
requiring
the
use
of
pbm
owned
pharmacies
is
bothersome.
A
A
M
Ma'am
a
lot
of
these
points,
you
know
the
it's
going
to
drive
up
costs,
they've
been
talked
about
in
here
today,
and
some
of
them
debunked,
there's
there's
data
from
other
states
that
have
passed
sections
of
this
law
that
shows
that
the
cost
of
health
insurance
actually
fell
after
that.
So
there's
good
data
to
debunk
those
one
of
the
points
talked
about
that's
been
brought
up
again
is
the
contractual
relationship
between
two
private
parties.
M
It's
here's
your
contract,
sign
it
or
don't
we
don't
care
and
that's
it.
I
can
either
sign
it
and
sign
up.
There's
there's
three
companies
that
dominate
over
80
percent
of
the
market.
I
can
either
sign
it
and
have
a
part
of
that
80
percent
of
the
market,
or
I
can't
that's
it.
They
don't
care.
I'm
too
small.
There's.
M
P
So
independent
pharmacies,
we
understand
their
importance
in
kentucky.
I
am
born
and
raised
in
lexington
kentucky.
I
got
my
coveted
vaccine
at
independent
pharmacy
in
lexington.
We
understand
we
need
them
in
our
networks
for
rural
kentuckians,
that's
on
it.
They
are
also
not
negotiating.
It's
not
a
david
versus
goliath
scenario.
P
A
large
majority
about
80.
Some
odd
percent
of
independent
pharmacies
in
the
state
are
a
part
of
psals
who
negotiate
these
contracts
with
pbms
on
the
independent
pharmacies
behalf
those
psaos
are
owned
by
the
three
largest
drug
wholesalers,
and
you
want
to
talk
about
billions
representative
raymond.
Those
wholesalers
are
all
in
the
top
20
fortune
500
list.
So
it's
it's,
not
this
uneven
playing
field
that
the
picture
is
being
painted
and
again
these
independent
rural
pharmacies
are
very
important
to
our
networks.
P
A
H
Explain
my
vote.
I
had
some
circling.
H
I
appreciate
your
passion,
representative,
sheldon,
representative
bentley.
I
trust
you
fully
and
I
give
you
a
yes
thank
you.
G
Briefly
explain
my
vote.
I
think
all
of
us
in
here
want
lower
prescription
costs
for
the
citizens
of
kentucky.
I
think
many
of
us
are
concerned
about
the
squeeze
on
local
independent
pharmacies.
G
Secretary
brinkman
made
a
statement
earlier
and
I'm
not
pair
I'm
just
paraphrasing.
I'm
not
quote
that.
There's
many
steps
in
this
process
and
there
will
be
and
there's
also
many
steps
in
the
process
in
the
legislature
process
number
one
is
house
committee
we've
had
a
good
debate
on
here
we're
having
a
vote.
G
Then
there
will
be
discussion
before
it
becomes
a
vote
on
the
house
floor,
maybe
amendments,
maybe
not,
then
it
will
go
to
senate
committee
and
they
will
go
through
the
same
process
and
they
will
go
the
same
process
on
the
floor.
So
there's
going
to
be
many
steps
in
this
process
and
I'm
looking
forward
to
hearing
all
those.
My
vote
is
yes.
E
F
Tate,
I
briefly
explain
my
yes
vote,
please.
I
sincerely
appreciate
representative
sheldon
and
representative
bentley
bringing
this
before
us
and
as
they
have
both
alluded
to
we've
been.
They
have
been
working
on
this
since
2018
2019,
and
this
has
gone
through
three
iterations
and
again
I
would
just
like
to
give
a
resounding.
I
trust
you-
and
I
know
that
you
have
spent
many
hours
explaining
this
to
me,
so
I
appreciate
it.
Thank
you,
representative.
B
F
A
A
Right
see
no
further
business
to
be
come
before
the
committee,
and
I
see
people
walking
out.
We
are
adjourned.