►
From YouTube: 09/09/2020 - Committee to Conduct an Interim Study Concerning the Costs of Prescription Drugs
Description
This is the fourth and final meeting of the 2019-2020 Interim and the Committee's work session. Please see agenda for details.
For agenda and additional meeting information:https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
A
We
have
scheduled
and
rescheduled
this
meeting
a
number
of
times
as
a
result
of
all
of
the
busy
work
we
had
over
the
summer
and
to
get
to
this
point
where
we
can
deliver
good
work
nevadans
across
the
state
is
something
I'm
really
proud
of
and
that
every
committee
member
should
be
proud
of
before
we
get
started.
Today,
though,
we
need
to
go
ahead
and
take
roll,
so
we
could,
please
call
the
role
to
make
sure
we're
all
present.
C
D
D
D
A
I'm
sorry
I
I'm
mute
is
a
funny
thing
these
days
and
I
appreciate
broadcast
services
for
your
help.
The
first
item
on
our
agenda
today
before
we
move
into
our
work
session,
is
public
comment
and
then
we'll
hear
from
miss
nancy
bruin
from
the
gwin
center
and
then
we'll
move
into
our
work
session.
If
we
could
open
the
line
for
public
comment.
E
F
Hi
good
morning
this
is
maya
holmes.
It's
m-a-y-a-h-o-l-m-e-s,
I'm
the
healthcare
research
manager
for
the
culinary
health
fund,
and
I
really
want
to
thank
chairwoman
concella
and
the
committee
members
and
committee
staff
for
their
work
to
address
the
high
cost
of
prescription
drugs.
I'm
here
on
behalf
of
the
culinary
health
fund.
As
a
non-profit
self-funded
health
plan,
we
provide
health
benefits
to
members
of
the
culinary
workers
union
and
their
dependents.
A
critical
priority
for
us
is
to
ensure
nevadans
have
a
healthcare
market
that
provides
universal
access
to
quality
and
affordable
healthcare,
including
prescription
drugs.
F
We
support
the
recommendations
outlined
in
the
work
session
document
and
want
to
ask
the
committee
to
consider
a
few
refinements.
These
recommendations,
if
enacted,
will
increase
the
state's
purchasing
power
to
secure
prescription
drugs
at
a
reasonable
cost,
which
is
essential
as
a
result
of
copen
19's
financial,
financial
impact
on
the
state
economy
and
budget.
These
measures
will
provide
light
into
the
black
box
of
prescription
drug
pricing
by
requiring
transparency
and
reporting
from
all
market
participants
in
the
drug
supply
chain.
F
Policy
makers
will
be
able
to
see
each
participant's
role
in
drug
prices
and
where
the
cost
drivers
are
occurring,
transparency
reporting
will
focus
on
prescription
drugs
that
are
the
top
spending
drivers.
This
reporting
will
ensure
policy
makers
and
the
state
can
make
data-driven
decisions.
It
will
also
end
the
constant
finger-pointing
of
who
is
to
blame
for
the
unrelenting
increases
in
prescription
drug
prices.
F
These
measures
will
increase
pharmacy
benefit
manager,
accountability
by
ensuring
pbm
practices
are
transparent
and
are
not
driving
up
costs
for
plans
and
their
participants.
We
have
a
few
recommendations.
We
hope
the
committee
will
consider
first
regarding
the
purchasing
coalition
recommendation.
We
hope
a
bill
could
include
a
pathway
for
private
payers
to
participate.
This
type
of
inclusion
will
increase
the
state's
purchasing
power
and
allow
more
nevadans
to
benefit
from
lower
drug
prices.
F
F
Earlier
this
year,
the
trump
administration
withdrew
its
proposal
to
only
permit
rebates
and
medicare
at
the
point
of
sale
over
concerns.
It
would
raise
premiums
for
seniors.
The
congressional
budget
office
determined
the
proposed
rule
would
cost
the
federal
government
177
billion
dollars
over
10
years.
F
F
Okay,
that
prices
are
affordable,
it
makes
prices
worse
and
we
are
left
with
bigger
problems
and
fewer
ways
to
approach
them.
State
statute
should
not
further
enable
the
bad
behavior
of
this
industry.
Thank
you.
E
E
E
E
C
Good
morning
committee,
my
name
is
khan
pham
k-h-a-n-h-p-h-a-m
and
I
am
with
the
nevada
pharmacist
association.
So
I
have
a
little
comment
about
licensing
pharmaceutical
representative.
It
would
only
create
more
bureaucracy
when
they
are
already
the
most
regulated
industry,
while
the
pbms
are
still
unregulated.
C
Creating
this
licensing
requirement
will
increase
the
drug
costs,
restricting
patient
access
to
care
and
the
drug
they
needed.
I
have
worked
side
by
side
with
physicians
throughout
the
years
and
have
witnessed
such
relief
when
the
patient
receives
sample
from
medication
to
try
before
the
doctor
can
decide
which
medication
is
best
for
their
care
without
extra
cost
to
them.
The
patient,
with
limited
income,
senior
patients
who
can
no
longer
drive
and
those
patients
who
live
in
rural
areas
will
be
affected
negatively.
C
C
E
E
H
Begin
good
morning,
madam
chair
members
of
the
committee
for
the
record,
my
name
is:
barry
gold,
b-a-r-r-y
g-o-l-d.
I
am
the
director
of
government
relations
for
aarp,
nevada,
aarp
nevada,
thanks
the
committee
and
chairwoman
canfella
for
their
hard
work
on
lowering
the
cost
of
prescription
drugs.
It
is
something
that
affects
everyone,
especially
during
these
difficult
times.
We
need
to
find
way
to
lower
the
cost
of
prescription
drugs.
As
I've
said
before,
life-saving
drugs
do
not
work
if
you
cannot
afford
to
take
them.
Aarps
looked
at
the
recommendations,
and
I
think
this
is
a
great
start.
H
I
think
there's
a
lot
of
things
we
can
do,
but
we
need
to
continue
to
fight
against
rxgreed
and
lower
the
cost
of
prescription
drugs
for
everyone.
I
will
comment
on.
One
of
the
previous
callers
talking
about
rebates
being
sent
back
to
consumers
is
a
very
good
thought.
However,
there
is
a
possibility
that.
H
Up
costing
seniors
more
money,
I
mean
costing
the
medicare
program
more
money
and
that
has
to
be
looked
at
very
carefully
other
things
in
the
recommendations.
The
group
purchasing
other
things
like
that
are
absolutely
need
to
be
looked
at,
but
you
need
to
look
at
any
unintended
consequences
of
what
we
are
doing.
I
think
the
transparency
of
pricing
that
nevada
has
already
started
has
been
a
model
that
other
other
states
have
used
and
benefited
from.
So
I
think
we
are
often
off
to
a
good
start.
We
need
to
continue
doing
this.
H
We
appreciate
what
the
committee
is
doing
and
what
will
be
happening
in
the
legislature
and
aarp
on
behalf
of
our
345
000
members
across
the
state
look
forward
to
during
the
session
and
before
working
with
the
committee
and
the
legislators
and
all
the
stakeholders
and
lowering
the
cost
of
prescription
drugs
for
all
nevada
families.
Thank
you
for
the
time.
E
G
Good
morning,
good
morning,
my
name
is
carmilla
gabson,
that's
c-a-r-n-e-l-l-a-g-a-d-s-e-n,
I'm
reading
on
behalf
of
lourdes
esparza.
My
name
is
lourdes
esparza
and
my
grandmother,
who
has
no
medical
insurance
lives
with
me
here
in
las
vegas
nevada.
My
grandmother
has
diabetes
and
high
blood
pressure,
not
having
medical
insurance
to
pay
for
medication
is
expensive
when
paying
out
of
pocket
and
she
needs
insulin
to
survive
and
lantus
is
the
insulin
that
she
needs
it's
patented
and
there
are
no
generics
for
it.
G
This
means
that
the
drug
company
can
charge
as
much
as
they
want
and
they
do.
We
do
use
goodrx
for
discount
medications
and,
yes,
there
is
a
discount,
but
it's
not
enough
when
an
insulin
pin
costs
us
90
every
20
days
in
order
to
cover
a
month's
supply,
we
have
to
purchase
two
insulin,
pens
and
that's
180
dollars
a
month
in
the
past,
when
the
insulin
cost
was
double
or
triple,
we
simply
couldn't
afford
it.
G
My
mother,
who
takes
the
same
insulin,
had
to
share
her
insulin
with
my
grandmother,
giving
herself
at
times
lower
dosages,
so
she
could
have
enough
to
share
with
my
grandmother
putting
her
life
at
risk
because
the
medication
was
too
expensive
to
purchase
and,
like
my
grandmother,
there
are
many
people
in
this
state
who
share
insulin
because
they
cannot
afford
to
purchase
their
own.
Many
others
purchase
insulin
from
those
who
have
extra.
At
one
point,
we
also
did
that
they
risked
their
lives
to
survive.
G
While
the
drug
companies
make
massive
profit,
we
pay
close
to
three
hundred
dollars,
monthly
for
medications
and
glucose
test
strips.
I
work
two
jobs
and
it's
stressful,
knowing
that
there
might
be
months
where
we
won't
be
able
to
afford
medications
again,
because
our
cost
of
living
keeps
increasing
yearly.
G
No
one
in
this
great
state
should
have
to
go
through
what
we
have
gone
through,
sharing
insulin
or
purchasing
insulin
from
someone
you
don't
know,
because
medications
are
too
expensive.
It's
time
we
put
people
first
and
profit.
Second,
I
ask
you
all
today
to
put
the
lives
of
nevadans
first,
we
do
deserve
better.
Thank
you.
For
your
time,
lord
vispersa,
thank
you
to
the
committee
once
again,
carmilla
gadza
and
reading
on
behalf
of
lord
of
esparza.
Thank.
E
J
J
J
Thirdly,
cap
consumer
co-pays
for
any
one
prescription
or
specialty
drugs
to
a
certain
price,
for
example
a
maximum
of
150
for
one
month's
supply
and
finally
prohibits
spread
pricing
pass
rebates
down
to
patients,
because
that's
what
we're
trying
to
do
spread
pricing
occurs
when
a
health
plan
provider,
contacts
with
a
pharmacy
benefit
manager
to
manage
prescription
drug
benefits
and
the
pbm
keeps
a
portion
of
the
amount
paid
by
the
health
plans
for
prescription
drugs.
Instead
of
passing
the
full
payments
on
to
patients
or
the
health
plan
provider,
thank.
E
E
E
K
We
would
like
to
thank
chair
kinsella
and
the
members
of
the
committee
for
reviewing
possible
legislation
proposals
to
help
reduce
barriers
to
affording
prescriptions
in
nevada.
The
nevada
chapter
of
the
national
hemophilia
foundation
represents
500
patients
living
in
nevada
affected
by
bleeding
disorders.
Affordability
of
prescriptions
is
of
utmost
concern
to
our
patients
as
a
treatment
for
bleeding
disorders
can
be
exorbitantly
expensive.
It
are
required
to
live
a
pain-free
productive
life.
K
The
intent
of
the
recommendation
is
to
ban
the
practice
of
not
allowing
third
party
payments
or
supplements
like
those
from
a
patient
advocacy
foundation
or
other
patient
assistant
sources
towards
a
patient's
out-of-pocket
cost
calculations.
Accumulator
adjustment
programs
may
result
in
higher
cost
to
the
pair
when
rolled
out
as
a
one-size-fits-all
solution.
This
one-size-fits-all
approach
is
short-sighted
when
applying
the
same
ideology
to
life-saving
specialty
medications
that
have
no
generic
alternative.
K
With
an
average
annual
household
income
of
58
000
americans
rely
on
co-pay
assistance
programs
as
their
sole
means
of
accessing
life-saving
treatments.
Many
states
have
addressed
legislation
to
ban
accumulator
adjustment
policies
and
legislation
has
passed
in
virginia
west,
virginia
and
arizona.
Health
insurance
plans,
pharmacy
benefit
managers
and
employers
are
all
implementing
practices
that
prevent
co-pay
assistance.
That
may
be
available
for
high-cost
specialty
medications
from
counting
toward
a
patient
member's
deductible
or
maximum
out-of-pocket
expenses.
K
I'm
deeply
concerned
about
the
accumulator
adjuster
practice
and
the
risks
that
they
pose
to
many
patients
with
chronic
and
rare
conditions,
and
ask
you
to
prevent
this
practice
by
nevada
health
plans
and
allow
patients
to
continue
to
access
all
resources
available
to
them
to
meet
their
out-of-pocket
costs.
As
you
contemplate
legislation
on
this
topic,
I
want
to
provide
you
with
a
good
background
on
the
issue
and
service
of
resource
to
you.
K
E
L
L
We're
not
addressing
key
items
to
create
true
transparency.
The
national
drug
acquisition
cost
nadc
is
a
real
number,
unlike
wholesale
acquisition
costs
derived
from
real
invoices
or
real
costs.
Income
compiled
from
an
independent
contractor
for
cms
black,
on
the
other
hand,
is
commonly
calculated
from
a
multiplier
using
average
wholesale
price,
which
is
an
inflated
number
created
by
the
manufacturer.
To
increase
revenue.
L
Creating
regulations
using
whack
pricing
points
will
create
some.
The
same
system
using
unknown
costs
will
allow
the
pharmacy
benefit.
Managers
to
use
a
shell
game
costs
continue
increasing,
pushing
patients
into
the
donut
hole,
limiting
the
access
to
drugs
and
raising
prices
for
patients
and
payers.
L
You
will
also
limit
access
to
care
allowing
pbms
to
eliminate
competition,
because
a
conflict
of
interest
that
they
have
pvms
must
not
only
have
a
fiduciary
responsibility
to
the
payer.
They
must
have
a
fiduciary
responsibility
to
the
provider.
Pvms
cannot
continue
to
reimburse
claims
below
cost
to
the
competition.
L
The
larger
pbms
are
vertically
integrated
from
the
drug
development
to
the
end
user.
Pvms
have
developed
maximum
allowable
mac
price
lists
and
use
multiple
lists
for
plans
with
different
pricing
and
should
not
be
allowed
to
use.
These
erisa
has
been
used
to
preempt
the
state
laws,
but
there
are
over
60
pbms
and
you
can
contract
with
one
that
allows
the
price
based
on
that
act
or
federal
upper
limit.
L
You
must
know
that
the
cost
you
must
know
the
cost
in
order
to
control
the
charges,
costs
need
to
be
based
on
a
real
number
and
known
data.
Other
states
have
passed
legislation,
pbm
is
challenged
in
court
and
it's
still
pending
pvms
continue
to
state
that
they
are
saving
money,
but
the
costs
continue
to
go
up
and
they
pay
huge
fines.
You
look
at
florida,
medicaid
or
tennessee,
where
blue
cross
and
blue
shield
over
build
and
they
have
their
own
integrated.
L
A
Terrific
thank
you
so
much
broadcast
services
for
making
sure
that
in
this
and
every
meeting
we're
able
to
hear
from
the
public,
we
will
have
another
round
of
public
comment
at
the
end
of
the
meeting.
So
if
folks
are
watching
and
want
to
make
comment
at
the
end
of
our
meeting,
you
may
do
so
by
calling
669,
900
6833
and
then
entering
the
meeting
id
number,
which
is.
A
A
A
Now
we
will
go
through
our
meeting
agenda
and
I
want
to
remind
folks
that
we
may
take
things
out
of
order,
but
it
seems
to
me
like
today
we
will
get
through
our
business
in
the
order
that
it's
listed
on
the
agenda
and
the
first
thing
on
deck
is
voting
on
the
minutes
from
our
last
meeting
and
we'll
use
a
roll
call
vote
to
approve
the
minutes.
Are
there
any
questions
about
the
minutes?
From
the
last
meeting
from
members
of
the
committee.
A
J
A
It
was
not
an
addition
to
mr
ashton,
maybe
you
could
help
fill
in
here
on
senator
hardy's
question.
B
Thank
you,
chair,
consella,
so
item
b,
which
is
on
the
work
section
document,
is
something
that
we
have
not
considered
in
one
of
the
previous
meetings.
So
we
will
talk
about
it
during
the
work
session
in
a
little
bit
more
detail.
I
hope
this
helps,
but
it
was
not
considered
before
in
any
of
the
meetings
we
had.
Okay,.
A
D
D
D
A
Yes,
and
I
believe
with
that,
the
motion
passes
and
the
minutes
from
the
last
meeting
are
approved.
Thank
you,
mr
ashton.
We'll
move
down
the
agenda
to
our
next
item.
We
have
with
us
today,
one
of,
in
my
opinion,
the
most
bright
and
brilliant
nevadans
miss
nancy
bruhn,
who
leads
the
kenny
guinn
center
for
policy
priorities.
The
center
has
put
together
a
report
that
I
think
is
timely
and
necessary
for
this
committee
to
hear
we'll
have
about
15
minutes
for
miss
broon
to
present
and
then
we'll
take
questions
for
about
five
minutes.
N
Good
morning,
chairwoman,
concella
and
members
of
the
committee,
dr
nancy
brune
guinn
center
for
the
record.
Thank
you
for
the
opportunity
to
be
here
before
you
today
and
present
our
report.
So
just
really
briefly,
last
week
we
released
our
report
and
I
will
start
sharing
my.
N
N
N
Titled,
the
impact
of
covid19
on
communities
of
color
in
nevada
and
the
motivation
for
the
report
was
twofold.
First,
we've
seen
many
national
reports
indicating
that
people
of
color
are
disproportionately
affected
by
cova
19.,
so
we
wanted
to
see
if
those
trends
held
up
here
in
nevada
and
what
it
looked
like.
Secondly,
there's
been
a
lot
of
discussion
about
the
health
impacts
of
coven
19
and
we
wanted
to
start
to
look
at
the
economic
impacts
here
in
nevada
of
copenhagen.
D
I'm
sorry
this
is
wakanda
carter
from
broadcasting
production
service.
Your
powerpoint
is
not
being
shown.
Can
you
cancel
your
sharing,
share,
screen
and
reshare
it
again.
C
N
N
So
we
found
that
the
latinos
in
nevada
account
for
a
greater
share
of
confirmed,
coveted
19
cases.
As
of
the
end
of
august,
when
we
published
the
report,
there
have
been
about
67
670
cases
of
covet
in
nevada
and,
as
we
see
here,
the
incident
rate
of
cobia
19
varies
across
racial
and
ethnic
groups
here
in
nevada.
N
N
N
Cases
we
also
found
that
african
americans
have
the
highest
hospitalization
rate
or
the
highest
coven
19
related
hospitalization
rate
in
clark
county.
We
don't
have
statewide
data,
so
we
only
looked
at
clark
county
but,
as
you
see
here,
the
statewide
hospitalization
rate
for
african-americans
is
almost
217
hospitalizations
per
100
000
population
for
whites.
It
is
120
hospitalizations
per
100
000
population,
so
the
rate
for
african
americans
all
is
almost
twice
of
that
of
white.
N
We
also
see
that
covet.
19
mortality
rates
are
higher
for
asian
americans
and
african
americans
relative
to
their
share
of
the
population
about
the
at
the
end
of
august.
There
are
about
1250
coven
19
deaths
here
in
nevada,
asians
account
for
12
percent
of
deaths,
but
represent
only
about
10
of
our
population,
and
african
americans
account
for
12
percent
of
deaths,
even
though
they
represent
only
about
nine
percent
of
the
population
again.
So
as
we
see
that
the
mortality
rates
for
these
two
groups
is
higher
relative
to
their
share
of
population.
N
We
also
see
that
african-americans
suffer
from
the
highest
cardiovascular
death
rate
here
in
nevada.
What's
interesting
is
that
whites
and
american
indians
actually
have
the
highest
incidence
prevalence
of
cardiovascular
disease,
but
african
americans
have
the
highest
cardiovascular
death
rate
here
in
nevada.
N
But
despite
its
efforts,
nevada
is
still
ranked
seventh
in
the
country
in
the
uninsurance
rate,
and
we
see
from
this
graph
that
there's
variation
in
who
has
health
insurance.
So
right
now
we
about
11
of
our
population
does
not
have
health
insurance
for
asians
and
whites.
That
number
is
actually
lower.
That's
about
they've
about,
for
their
rate,
is
nine
percent,
which
is
at
the
national
average.
When
we
start
demographic
groups,
the
number
increases
dramatically
so
about
22
percent
of
american
indians.
Don't
have
health
insurance
and
about
20
of
latinos.
N
Don't
have
health
insurance,
as
we
reported
in
a
report
we
did
last
year
in
2019,
looking
at
the
uninsured
population
here
in
nevada,
we
found
that,
while
our
population,
the
latino
population,
represents
about
30
percent
of
our
state's
overall
population
or
sorry
36,
it
accounts
for
60
of
the
uninsured
population,
and
one
of
the
factors
for
that
is
the
fact
that
we
have
a
large,
an
immigrant
population,
so
about
27
percent
of
the
uninsured
nevadans
lacked
coverage
due
to
immigration
status.
N
N
A
recent
report
by
the
kaiser
family
foundation
also
looks
at
access
to
employer-sponsored
health
insurance.
About
almost
two-thirds
of
whites
have
access
to
employer-sponsored
health
insurance.
The
number
drops
dramatically
when
you
look
at
other
groups,
so
about
48
percent
of
latinos
have
access
to
employers,
funds
health
insurance,
about
42
of
african
americans
have
access
to
employer-sponsored
health
insurance,
and
so,
as
we
know,
you
know
thinking
about
health
insurance
and
access
to
health
insurance
as
it
relates
to
covid.
N
And
so
what
this
means
is
that
low
folks
are
communities
of
color.
People
of
color
are
often
in
low-wage
jobs,
they're,
coupled
with
job
losses.
Right
now
we
know,
there's
been
a
backlog
of
in
the
unemployment,
unemployment,
insurance,
our
state
unemployment,
insurance
and
deter,
and
so
it's
created
real
cash
flow
constraints
in
many
households
of
color,
and
so
subsequently
many
of
our
people
of
color.
Our
households
of
color
may
face
challenges
paying
for
rent.
N
We
spend
a
lot
of
time
talking
about
the
eviction
risk
crisis,
seeking
medical
attention
or
paying
for
prescription
drugs.
At
this
point
in
time,
I'm
gonna
leave
with
this.
This
last
slide.
I
should
have
retitled
it.
N
Eviction
filings
and
eviction
rates
started
to
pick
upwards,
and
so
the
the
takeaway
is
that,
even
when
it
seems
that
our
economy
is
recovering
and
we're
moving
forward,
we
do
see
almost
a
lagged
effect
in
some
of
the
the
I
guess
challenges
faced
by
some
households.
In
being
part
of
that
recovery-
and
so
it's
just
the
takeaway-
is
that
our
decision
makers
need
to
think
about
both
short-term
strategy,
but
also
long-term
strategies,
because
this
show
this
chart
shows
that
recovery,
you
know,
is
there's
a
lagged
effect
with
the
recovery.
N
We
do
see
again
that
in
2015,
the
victims
and
eviction
filings
start
to
come
down
again,
but
we
just
want
our
decision
makers.
Mindful
of
that
and
then
finally
just
a
couple
of
recommendations,
we
have
about
12
recommendations
in
the
report.
I
think
the
one
that
is
relevant
for
this
committee
is
that
we
found
that
many
states,
in
the
midst
of
obit,
19
and
and
acknowledging
the
fact
that
proven
19
has
disproportionately
affected
people
of
color
have
launched
task
forces
looking
at
health
equity
issues.
N
So
as
it
relates
to
the
charge
of
this
committee,
one
of
the
recommendations
would
be
to
share
the
recommendations
that
come
out
of
the
interim
committee
with
the
office
of
minority
health
and
equity,
so
that
they
can
review
them
through
the
equity
lens
and
maybe
add
or
share
their
input,
so
that
I
will
conclude
my
presentation
and
see
if
there
are
any
questions.
Thank
you.
A
Thank
you,
miss
broon
questions
from
the
committee.
A
I
Thank
you
and
thank
you
very
much
for
this
presentation.
I
found
myself
picking
up
my
phone
and
taking
pictures
of
some
of
the
slides
because
they
were
just
quite
startling
and-
and
I
I
really
appreciate
having
this
information
just
so
easy
to
understand,
and
I
think
that's
something
that
we
can
can
take
out
to
the
folks
that
we
meet
with
and
and
it
just
it's.
You
made
it
very
easy
to
advocate
on
on
behalf
of
those
folks.
So
thank
you
for
the
presentation.
J
J
J
Get
to
somebody
who
needs
help
now,
as
opposed
to
down
the
corporate
path
that
we
seem
to
be
looking
at
instead
of
how
to
get
to
the
person
who
needs
a
short-term
strategy.
Do
you
do
you
have
specific
short-term
strategies
that
you're
looking
at
or
how
do
you
see
the
strategies
that
we've
put
on
our
work
session?
N
N
I
am
not
a
legislator,
but
you
know
just
probably
12
to
18
months,
potentially
I'm
not
sure
in
our
report.
We
do
have
some
short-term
strategies
which
speak
to
expanding
and
making
available
free
testing
free
treatment,
especially
for
our
front
line
industry
workers,
which
include
folks
who
work
in
the
grocery
stores,
building
cleaning
services.
Many
of
them
don't
have
insurance
and
don't
have
access
to
employer-sponsored
insurance
and
so
those
sorts
of
short-term
strategies,
I
think,
will
go
a
long
way
to
helping
those
folks
with
the
greatest
need
our
most
horrible
communities.
A
And
I
would
extend
my
gratitude
to
you,
miss
bruin
and
to
everyone
at
the
guinn
center
who
worked
so
hard
on
this
report.
We
know
that
the
effects
of
the
pandemic
on
our
health
care
system
as
a
whole,
but
especially
on
our
vulnerable
community
communities,
is
going
to
be
with
us
for
a
long
time
and
it's
my
opinion
that
the
pandemic
has
not
made
our
health
care
system
worse.
Rather,
it
has
exposed
the
inequities
that
were
already
there.
A
N
Thank
you,
chairwoman,
council,
and
I
will
plan
to
see
that
we
are
working
on
a
follow-on
report
which
is
looking
at
covid19
and
the
impact
of
coba
19
on
our
general
healthcare
infrastructure.
So
we
look
forward
to
sharing
the
results
of
that
report
with
you
at
the
appropriate
time.
Thank
you.
Thank
you
all
for
your
work
and
service.
A
Terrific
and
with
that,
we
will
go
ahead
and
move
into
our
work
session.
Now
there
are
four
items
that
have
been
agendized,
there's
a
fifth
item
that
will
be
added
to
the
top
of
the
work
session.
That
is
a
recommendation
that
was
presented
in,
I
believe,
our
third
meeting,
though
time
is
fuzzy
in
the
time
of
covid,
and
so,
mr
ashton,
I
will
turn
it
over
to
you
to
walk
us
through
all
five
items.
B
Thank
you,
chair
consella,
for
the
record,
patrick
ashton,
with
the
research
division
of
the
legislative
council.
Borough
brief
the
disclaimer
before
I
start
with
the
work
session
as
staff
of
the
legislative
council
bureau,
I
can
neither
support
nor
oppose
any
proposals
that
have
come
before
the
legislature,
including
those
you
will
discuss
today
before
we
address
specific
recommendations
for
consideration.
I
will
briefly
talk
about
the
committee's
options
for
action
today.
B
Also,
as
chair
khan
seller
just
mentioned,
I
will
inform
you
verbally
about
an
additional
recommendation
that
was
added
to
the
work
session
today.
Just
recently,
I
will
do
so
before
we
consider
the
four
recommendations
in
the
work
session
document.
As
a
reminder,
the
committee
may
request
up
to
five
bill
draft
requests
to
amend
nrs.
B
You
may
accept,
modify,
reject
or
abstain
from
taking
action
on
any
of
the
recommendations
that
I
will
present
to
you
today.
Additionally,
the
committee
may
vote
to
pass
resolutions
to
highlight
a
certain
concern.
Issue
include
statements
in
the
committee's
final
report
and
send
letters
of
recommendation
or
support.
B
A
majority
of
four
votes
is
necessary
to
pass
any
measure
as
a
result
of
the
action
taken
during
today's
work
session.
I
will
draft
a
summary
of
recommendations
to
be
sent
to
the
legislative
commission
and
the
legislative
committee
on
health
care.
The
final
report
also
referred
to
as
the
bulletin
will
be
drafted
by
committee
staff
under
the
direction
of
the
chair
and
will
describe
the
activities
and
actions
of
this
body
during
the
interim.
A
B
Let's
begin
with
the
the
additional
recommendation,
so
committee
members,
we
we
have
this
additional
recommendation
that
you
do
not
find
in
the
work
session
document,
as
mentioned
before,
the
recommendation
is
to
require
that
at
least
half
of
the
health
plans
offered
by
providers
in
nevada
have
prescription
drug
coverage
from
the
first
day
with
no
deductibles
fixed
prescription
co-payment
allowing
patients
pay
a
flat
dollar
amount
per
prescription,
which
is
not
percentage
based
and
limit
co-payments
to
not
more
than
112
of
the
patient's
annual
out-of-pocket
spending
maximum,
and
this
is
a
recommendation
you
may
remember,
it
was
proposed
by
ms
ascher
isaac
from
farmer
during
the
february
28th
meeting
additional.
B
A
Thank
you,
mr
ashton,
and
I
know
this
is
new
to
the
work
section,
but
not
new
to
this
committee.
Questions
or
comments
on
this.
A
J
A
Yes,
yes,
I'm
sorry,
I'm
sorry!
I
forget
that
in
the
virtual
world
we
have
to
do
the
roll
call
vote.
My
apologies,
mr
mr
ashton.
It's
floor
is
yours
to
do
the
roll
call,
though
I
apologize.
D
D
D
A
A
And
so
the
motion
carries-
and
I
want
to
remind
the
public
and
those
watching
that,
while
these
are
votes
to
move
these
bdrs
into
the
session
committee,
members
are
not
bound
to
support
these
these
measures
in
session
and
that
until
we
see
final
bdr
language,
these
are
votes
in
favor
of
moving
these
ideas
forward
to
become
bill
draft
requests,
and
so
we
will
continue
to
fine-tune
them
to
ensure
that
we
get
the
policy
correct
and
the
language
is
correct,
like
we
would
any
other
bill,
and
with
that
we
will
move
to
the
next
item.
B
So
now
we
go
to
the
work
session
document
to
item
a
the
first
recommendation:
a
is
to
draft
a
bill
to
allow
the
establishment
of
intra
and
interstate
purchasing
coalitions
by
the
department
of
health
and
human
services.
In
short,
dhhs,
the
interstate
purchasing
coalition
may
consolidate
purchasing
power
from
any
state
agency
with
a
pharmacy
benefit
program.
In
a
purchasing
coalition,
the
state
may
also
form
a
new
or
join
an
existing
interstate
purchasing
coalition.
B
A
Thank
you,
mr
ashton,
and
we
had
a
presentation
from
our
I'm
sorry.
I
had
a
little
bit
of
an
echo
and
distracted,
but
we
had.
We
did
have
a
presentation
from
our
norton
the
northwest
purchasing
coalition,
to
talk
about
how
these
kinds
of
group
purchasing
agreements
can
work
in
practice
and
what
they
may
look
like,
and
with
that
I
would
accept
a
motion
to
accept
item
a
as
a
bill
draft
request
from
this
committee.
A
D
D
D
B
D
B
Thank
you,
chair
godzilla.
The
second
recommendation,
item
b
of
the
workstation
document
is
to
draft
a
bill
to
amend
statutes
related
to
the
reporting
of
pharmaceutical
sales
representatives
to
require
dhhs
to
license
representatives
who
are
operating
within
the
state,
and
this
recommendation
is
proposed
by
this
committee
chief
concealer.
A
Thank
you,
mr
ashton,
and
this
was
this
builds
on
current
statute.
Today,
all
pharmaceutical
sales
reps
have
to
report
a
series
of
transparency
measures
to
the
state
those
are
compiled
and
are
part
of
our
public
reports
on
everything
from
samples
that
are
left
behind
to
how
much
is
spent
by
wraps
on
things
like
food
for
doctor's
offices.
J
To
your
point
about
transparency
and
things,
I
looked
up
nrs439b
section
one
that
requires
manufacturers
required
to
provide
a
list
of
their
pharmaceutical
sales
representative
of
representatives
in
section
6,
sub
b.
So
I
appreciated
that
it
enhances
I'm
not
sure
that,
in
fact,
I
I
can't
go
to
the
point
where
I
have
to
add
another
layer
of
credentialing
and
licensing.
D
Measure-
okay-
sorry,
that's!
Okay!
Assembling
monk!
I
appreciate,
of
course
you
know
what
the
bill
is
trying
to
do.
I
just
want
to
say
on
the
record
that
I
have
a
lot
of
questions,
and
so
I
will
be
voting
yes
on
it,
but
I
am
not
committed
to
voting
to
it
in
this
session.
I
appreciate
you
and
you
know,
understanding,
and
I
just
wanted
to
have
that
on
the
record.
J
M
D
D
D
B
B
The
measure
expands
the
mentioned
statutes
to
expand
nrs439b635
and
439b640
to
require
the
manufacturer
of
any
prescription
truck
that
has
been
subject
to
a
price
increase
described
in
subsection
2
of
nrs439b630,
in
addition
to
essential
diabetes
and
as
my
medication
to
report
the
information
described
in
this
section,
so
it
would
expand
it
to
any
other
prescription
drugs
that
has
a
price
increase,
as
you
can
find
in
subsection.
2
of
ns439b630,
the
measure
number
2
requires
wholesale
truck
distributors
and
insurers
who
cover
prescription
drugs
to
report.
B
Nrs439B64645
that,
in
addition
to
information
about
essential
diabetes
and
asthma,
drugs
pbm
shall
report
the
information
for
prescription
drugs
described
in
subsection
1
of
section
5
that
you
find
on
page
15
of
the
model
legislation
under
item
4.
The
measure
adds
section
6
on
page
16
and
section
7
on
pages
16
and
17
of
the
model
legislation
which
require
the
reporting
entities
to
register
with
dhhs
and
to
be
subject
to
annual
assessments
by
dhhs
number
five.
B
B
item
6
requires
dhhs
to
make
a
report
available
on
its
website
on
emerging
trends
and
prescription
drug
prices
and
conduct
an
annual
public
hearing
based
on
the
report
finding,
as
provided
in
subsection,
1
of
section
9
pages,
17
and
18
of
the
model
edge
installation
and
finally,
item
7
keeps
all
existing
definitions
in
statutes.
However,
when
adding
new
definitions
that
we
should
that
this
measure
would
require
to
use
or
to
the
extent
possible
of
existing
definitions
in
federal
law.
And
if
this
is
not
available,
then
to
use
the
definitions
provided
in
the
model
legislation.
B
So
this
recommendation
was
proposed
by
mr
barry,
gold
from
aarp
and
miss
bond
from
the
culinary
health
fund,
jack
and
stella.
A
Thank
you,
mr
ashton.
We
spent
some
time
thinking,
or
rather
legal
through
mr
robbins
helped
ask
some
pretty
pointed
questions
that
led
us
to
the
bdr
that
is
before
the
committee.
It
takes
the
model
language
from
the
national
from
nashville,
the
national
association
of
state
health
policy
and
crafts,
it
so
that
it
does
not
interfere
with
the
work
that
our
state
has
already
done
on
drug
transparency.
In
other
words,
there
is
nothing
new
for
diabetes,
drug
manufacturers
or
asthma
drug
manufacturers.
A
J
I
think
it's
so
all-encompassing.
I
I
have
a
right
off
the
bat.
I
have
a
challenge
with
the
first
proposal
of
any
and
every
drug
being
roped
into
this.
J
J
So,
as
I
read
439b
630,
the
percentage
increase
in
the
consumer
price
index
medical
care
component
during
immediately
preceding
calendar
year
or
twice
the
percentage
increase
of
the
consumer
price
index.
Medical
care
component
during
the
immediate
preceding
two
calendar
years
is
the
nrs
that
it
alludes
to
in
our
work
session
document.
A
That's
right,
correct,
and
so
it
would
be
any
and
on
drugs
that
meet
those
triggers.
So
not
just
so
it's
clear
on
the
record.
Senator
not
all
drugs
would
be
subject
to
these
transparency
requirements.
Only
those
that
have
a
significant
price
increase,
as
defined
by
the
triggers
in
nrs.
A
Any
other
any
other
discussion
before
we
call
for
a.
M
Motion
chair
cancel,
this
is
senator
reddy.
I
appreciate
the
clarification
I'm
maybe
not
as
disciplined
as
senator
hardy
is
always
going
to
the
statute
to
read
it.
So
I
appreciate
that
clarification.
M
I
think
that
that's
a
great
idea,
I
think
healthcare
cpi
makes
sense
as
a
marker
and
I'm
particularly
because
the
increase
in
healthcare
costs
has
been
significant,
and
so
that
means
that,
if
that
you
know
if
we're
going
up
by
10
12,
sometimes
a
year
if
the
drug
cost
has
gone
up
by
10
or
12,
I
think
we
should
be
looking
into
why.
I
think
we
want
to
know
more
information
about
that
and
so
to
me,
if
it's
good
enough
for
diabetes
drugs,
it's
good
enough
for
asthma
drugs.
M
A
Thank
you
senator
reddy,
and
I
would
add
that
this
is
directly
in
response
to
the
public
comment.
We've
heard
of
folks
with
chronic
conditions
that
are
not
diabetes,
that
are
not
asthma,
that
are
still
very
much
patients
who
are
suffering
because
of
unaffordable
drugs,
and
currently
we
don't
have
a
way
in
state
to
answer
the
question
of
why
the
price
on
those
drugs
has
increased
so
significantly.
D
Hi
I
too
I'm
gonna
vote,
yes,
I'm
out
of
the
committee,
but
I
do
want
to
make
sure
that
senator
hardy's
concerns
about
the
price
that
we
are
just
targeting,
those
that
increase
a
certain
amount.
So
I
just
wanted
to
put
that
on
the
record.
A
A
Okay
with
that,
mr
ashton,
if
you
would
please
take
the
roll
call
vote.
D
D
D
D
A
Yes,
with
that
the
motion
carries,
we
have
one
more
committee
and
then
we
have
completed
our
interim
study
work.
I'm
almost
sad
to
see
us
come
to
this
point,
but
we'll
happily
turn
it
over
to
mr
ashton.
B
Thank
you,
chair
concealer.
The
fourth
and
final
recommendation
in
the
workstation
document
is
to
draft
a
bill
to
immense
status
related
to
we
pbms
pharmacy
benefit
managers
to
first
require
pbms
who
are
operating
within
the
state
to
obtain
a
license
from
dhhs.
B
B
B
The
measure
would
require
a
pbm
to
allow
a
client
such
as
a
health
insurance
provider,
full
ordered
rights,
including,
but
not
limited
to
pharmacy
claims,
rebates
and
similar
information
needed
to
ensure
compliance
and,
finally,
number
four
to
establish
a
fiduciary
responsibility
for
a
pbm
to
a
third
party
payer.
The
benefit
of
the
payer
is
the
primary
and
sole
interest
of
the
fiduciary
and
any
conflict
with
that
role
must
be
disclosed
and
avoided.
B
So
that's
something
that
is
not
stated
in
the
work
session
document,
but
I
want
to
make
it
clear
on
the
record
and
all
these
proposals
were
recommended
by
ms
bond
from
the
culinary
health
fund.
However,
proposal
number
two
requires
rebates
to
be
passed
down
to
patients,
instead
of
passing
them
down
to
health
plan
providers.
B
A
Thank
you,
mr
ashton,
and
I
would
say
that
something
that's
important
to
me
as
we
finalize
the
work
of
this
committee
is
to
have
work
on
every
piece
of
the
drug
pricing
chain
and
with
transparency
and
changes
to
copays
and
changes
to
pharmaceutical
sales.
Reps
we've
addressed
a
number
of
different
pieces
and
there
is
some
transparency
requirement
as
part
of
the
previous
bdr
on
pharmacy
benefit
managers.
A
This
measure
creates
a
much
broader
set
of
requirements
on
pharmacy
benefit
managers
and
allows
us
to
examine
pretty
deeply
that
piece
of
the
drug
pricing
chain.
It's
an
entity,
it's
a
series
of
entities
that
I
think
are
important
to
look
at
holistically,
as
opposed
to
just
taking
one
piece
of
the
puzzle
at
a
time,
and
that's
why
this
bdr
is
so
broad
in
its
multiple
pieces.
B
That
also
here,
I
would
like
to
mention
on
director
that
this
licensing
would
also
authorize
dhhs
to
charge
a
fee
for
the
licensing
of
a
pharmaceutical
sales
representatives,
similar
to
what
we
are
discussing
right
now
under
item
d
for
pharmacy
benefit
managers
just
want
to
clarify
that
for
the
record.
Thank
you
check
on
seller.
J
I
think
the
discussion
on
pbms
needs
to
be
had.
I
recognize
that
there
is
revenue
that
has
to
be
raised
in
order
to
do
some
of
the
things
that
we're
looking
at,
so
I'm
supportive
of
the
concept
of
looking
at
the
pbms
and
how
we
can
do
it.
I
think
it's
a
bigger,
you
know
a
bigger
lift
than
we
can
do.
Obviously,
in
this
setting,
I
will
be
supportive
of
the
measure
reserving
every
which
way,
right
as
we
look
at
the
many
intricacies
of
this
bill
going
forward
in
the
session
to
vote.
D
Thank
you.
I
will
just
ditto
senator
hardy's
comments.
You
know,
I
agree,
there's
so
many
levels
in
trying
to
address
drug
pricing
and
you
know
we
need
to
take
a
deeper
dive
into
each
of
these,
and
so
you
know
I'll
vote,
yes
out
of
committee,
but
also
reserve
my
right
as
we
get
farther
into
how
this
and
other
bdrs
are
going
to
be
developed.
Thank.
A
You
understood,
and
I
would
encourage
all
members
we
received
some
pretty
extensive
public
comment
from
pcma,
which
is
a
pharmacy
benefit
manager
association
on
many
of
the
issues
that
are
within
this
builder
after
question,
I
would
make
sure
the
public
knows
that
those
will
be
taken
into
consideration
as
we
enter
the
drafting
phases
and
would
encourage
the
public
and
members
to
make
sure
that
they
also
are
familiar
with
those.
As
we
prepare
to
look
at.
A
Language
with
that,
if
there
is
a
motion
to
approve,
I
would
accept
it
now
move
to
approve
a
motion
from
senator
ratty.
M
I
D
D
A
Oh,
I'm
sorry,
yes,
and
with
that
the
motion
carries,
and
I
believe
mr
ashton,
that
concludes
our
work
session.
A
Great
and
with
that,
we'll
close
the
work
session
and
move
into
our
final
public
comment,
we'll
take
a
short
break
to
allow
broadcast
services
to
shift
into
public
comment
and
open
the
line.
A
M
Before
we
close
the
work
session,
can
I
just
make
a
comment
sure
so
I
just
wanted
to
take
this
minute.
I
know
we'll
go
into
public
comment,
but
specifically
on
the
work
session
and
the
work
that
was
just
completed.
I
just
wanted
to
take
this
moment
to
thank
you
and
vice
chair,
bilbray
axelrod,
for
your
work
on
this
committee.
M
I
know
that
there
are
a
group
of
recommendations
here
that
we've
heard
through
public
comment
that
some
some
stakeholders,
like
some
some
stakeholders,
like
others,
some
dislike
some,
some
just
like
others,
and
I
think
you
see
that
reflected
in
the
conversation
that
we've
had
today,
but
I
think
that
you
and
staff
have
done
a
lot
of
work
to
keep
the
patient
in
mind
and
to
make
sure
that
we
go
into
the
next
legislative
session,
with
a
wide
variety
of
proposals
that
do
look
across
all
the
different
players
within
the
process
of
setting
pricing
for
pharmaceutical
drugs,
and
that
allows
us
to
have
a
really
good,
robust,
meaningful
conversation
going
into
the
next
legislative
session.
M
So
I
just
wanted
to
thank
you
and
the
vice
chair
specifically,
mr
our
lcb
staff.
You
know
research
and
legal
just
to
patrick
and
eric
just
to
make
sure
that
we
recognize
that
it
was
a
bit
of
a
disjointed
interim
with
covid
and
special
sessions
getting
in
the
way,
but
the
work
product
that's
coming
out
provides
a
lot
of
good
meat
for
us
to
chew
on,
and
I
think
it's
good
work.
So
thank
you
to
everyone
who
put
time
and
energy
into
this.
J
Thank
you,
madam
chair.
I
appreciate
everyone
who
has
come
through
this
coveted
19
era
which
obviously
isn't
over,
but
how
we
were
able
to
have
so
many
people
give
testimony
and
I'm
I'm
grateful
for
the
winnowing
down
the
things
that
are
coming
out
of
committee,
recognizing
that
I'm
sure
that
there
will
be
other
opportunities
to
have
bdrs
come
forward
that
will
address
some
of
the
short-term
strategies
that
I
think
are
still
needed.
J
So
I
appreciate
the
ability
that
the
committee
had
to
come
with
some
kinds
of
consensuses
that
will
be
further
vetted,
so
I
look
forward
to
the
session
that
we'll
be
able
to
get
people
some
short
term
short-term
relief
and
look
long-term
at
some
other
strategies.
So
I
think
the
committee
was
able
to
do
some
things
during
the
era
that
hopefully
we
can
move
forward
with
all
of
these
discussions.
A
Thank
you
senator,
and
certainly
thank
you
to
all
of
the
committee
members
for
your
patience
and
grace
as
we
navigated
this
virtual
environment.
I
know
that
it's
challenging
at
times,
but
really
appreciate
all
the
work
that
we've
all
done
and
I'm
looking
forward
to
continuing
this
work
into
the
next
legislative
session,
which
some
days
feels
very
far
away,
but
is
actually
not
so
far
away
at
all
and
very
much
looking
forward
to
working
with
you.
A
All
with
that.
I
believe
broadcast
services
has
opened
the
line
for
public
comment
and
we'll
take
our
final
batch
of
public
comment.
E
G
Good
morning
my
name
is
carmela
gabson,
I'm
reading
on
behalf
of
rose
turner.
That's
r-o-s-e-t-u-r-n-e-r,
hello.
I
am
a
recent
non-hodgkin's
lymphoma
cancer
survivor.
I
knew
the
battle
of
health
care
from
dealing
with
my
mom
and
her
battle
with
cancer,
but
once
I
was
diagnosed,
I
discovered
the
many
challenges
for
myself.
I
had
six
rounds
of
chemotherapy
in
the
hospital
for
a
week
that
resulted
in
a
chemo
prescription
bill
and
a
hospital
stay
bill.
G
Chemo
comes
with
side
effects
that
require
treatment
with
costly
prescription
drugs.
Recently
I
went
to
go,
get
an
iron
infusion
that
made
me
go
into
anaphylactic
shock.
While
I
was
going
through
this,
my
nurses
were
busy
with
another
patient
and
they
didn't
notice
me,
and
I
tried
to
look
for
my
epipen,
but
because
I
haven't
been
able
to
afford
a
new
one.
The
epipen
that
I
did
have
was
expired.
G
The
copay
for
my
epipens
cost
fifty
dollars
and
I
had
to
choose
what
I
can
afford
to
get.
It's
a
shame
that
I
have
to
decide
between
medicine.
I
ended
up
having
a
heart
attack
that
day.
The
nurse
was
detracted
and
my
hands
were
so
swollen.
The
sad
thing
is
that
so
many
factors
could
have
prevented
it.
These
medications
are
life-saving
and
the
cost
is
killing
people.
G
G
E
H
Good
morning
my
name
is
bill
head
with
p-c-m-a-b-I-l-l-h-e-a-d
and
thank
you
for
the
opportunity
to
speak
this
morning
and
thank
you,
chair
kinsella
and
members
of
the
committee
very
much
appreciate
the
way
committee
has
conducted
this
business,
particularly
as
stated
earlier
in
these
trying
times.
So
thank
you
for
very
much
being
open
to
to
the
public.
H
I
won't
go
over
those
again
since
they
are
in
the
letter,
but
I
will
highlight
one
thing
that
we
did
not
include
our
in
our
letter
that
is
included
in
the
pbm
recommendation,
and
that
is
passing
on
rebates
to
patients
and
two
comments
on
that.
One
is
it's
it's
interesting.
It's
not
ironic!
That
farmer's
position
is
that
rebates
add
to
the
cost
of
drugs,
yet
their
proposal
is
not
to
eliminate
rebates,
but
simply
to
pass
them
on
to
the
consumer,
and
that's
very
appealing
in
a
sense.
H
That's
being
said,
it's
important
to
note
that
more
than
95
percent
on
average,
more
than
95
of
all
the
rebates
dollars
are
in
fact
passed
on
to
the
health
plan
and
getting
back
to
a
a
point
that
assembly
woman
monk
made
at
an
earlier
meeting,
and
I
was
unable
to
answer
at
the
time.
H
But
her
question
was:
why
is
it
so
challenging
or
difficult
to
pass
on
the
rebate
to
the
consumer
at
the
point
of
sale?
And
the
reason
is:
there's
not
a
rebate
at
a
point
of
sale,
the
dispensing
of
one
drug
or
100
drugs
won't
necessarily
trigger
any
rebate.
Rebates
are
reconciled
many
months,
and
sometimes
you
know
more
than
a
year
after
the
terms
of
the
rebate
agreement
between
the
pbm
and
the
manufacturer
are
met.
H
H
But
in
the
long
term,
what
if
the
rebate
is
never
passed
through
is
never
paid
by
the
manufacturer
to
the
pbm
and
or
to
the
health
plan.
Are
we
then
in
the
position
of
going
back
to
that
patient
and
asking
for
that
money
back?
H
I
just
want
everybody
to
think
through
the
logistics
of
that,
and
certainly
it's
hard
to
argue
with
the
appeal
of
you
know
giving
some
relief
to
the
patient
at
the
counter,
but
I
just
want
to
make
the
committee
aware
that
it
does
have
its
problems
and
I'll
conclude
with
that
and
again,
thank
you
for
the
opportunity
to
work
with
you
and
look
forward
to
working
with
you
throughout
the
rest
of
the
year
and
certainly
going
into
the
2021
session.
Thank
you
very
much.
E
H
H
H
E
E
E
E
F
Hi,
this
is
maya
holmes
again
from
the
culinary
health
fund
m-a-y-a-h-o-l-m-e-s.
I
just
wanted
to
put
on
the
record
regarding
the
fifth
proposal
from
the
pharmaceutical
industry,
and
I
also
just
wanted
to
really
thank
the
committee
and
the
staff
again
for
all
their
tremendous
work
on
such
an
important
issue.
But
regarding
the
fifth
proposal,
I
mean
we
share
the
desire
and
certainly
understand
the
desire
to
provide
immediate
relief
to
patients
dealing
with
high
costs,
but
that
needs
to
be
a
very
thoughtful
approach
and
we
don't
think
this
is.
F
We
need
to
remember
that
those
costs
from
you
know
putting
that
the
cost,
if
you
have
copay
counts
or
deductible
counts,
those
counts
are
simply
not
going
to
disappear.
Those
costs
are
going
to
show
up
in
higher
premiums
and
other
costs
that
patients
are
paying
and
those
costs.
Those
caps
are
not
going
to
help
the
uninsured
a
number
of
the
horrific
stories
we
heard
we
hear
about
in
the
press
of
people
not
being
able
to
afford
their
medications
and
of
the
uninsured
grandmother
we
heard
about
this
morning.
F
Those
provisions
will
not
help
those
patients.
Those
patients
are
still
going
to
face.
The
full
cash
price
charged
by
drug
companies-
and
so
those
are
just
some
of
the
reasons
why
addressing
the
issue
of
high
prices
of
drugs
is
so
essential.
In
looking
taking
this
long-term
approach,
the
high
prices
we
pay
for
prescription
drugs.
It
is
the
fundamental
problem
we
have
the
most
expensive
health
care
in
the
world,
not
because
we
use
more
health
care.
We
don't
not,
because
we
have
better
health
care.
We
don't
not,
because
we
have
better
outcomes,
we
don't.
F
It
is
because
we
pay
the
highest
prices
in
the
world
for
our
health
care
and
prescription.
Drugs
are
a
critical
driver
of
those
health
care
prices.
Research
has
shown
this
over
and
over
again.
Any
type
of
action
around
copays
and
deductibles
proposed
by
the
pharmaceutical
industry
must
be
extremely
targeted,
thoughtful
and
based
on
real
and
actual
data.
Otherwise
it
is
just
a
blank
check
to
the
pharmaceutical
industry
to
price
gouge
and
drive
up
health
care
costs
for
public
and
private
payers
and
patients.
F
In
a
time
of
extreme
fiscal
difficulty
for
the
state,
the
patient
protection
commission
is
proposing
a
bdr
for
an
all
player
claims
database
over
20
states.
Have
these
databases
and
they
provide
data
on
what
payers
and
patients
are
paying
for
drugs,
as
well
as
what
the
spending
trends
are
over
time.
Apcds,
coupled
with
the
drug
price
transparency
that
we
have,
and
that
is
being
proposed,
will
be
critical
to
providing
real
data
on
which
drugs
are
creating
the
most
affordability
challenges
for
patients
and
public
and
private
payers,
and
why
those
drugs
are
costing
so
much.
F
We
need
that
level
of
data
to
make
targeted,
thoughtful
and
evidence-based
policy
and
avoid
big
giveaways
to
the
pharmaceutical
industry
that
shields
them
from
the
effects
of
their
high
prices,
while
patients
and
public
and
private
payers
continue
to
face
higher
and
higher
health
care
and
drug
costs
far
outpacing
inflation
year
after
year.
Thank
you.
E
C
C
C
E
E
O
O
O
O
O
O
O
I
have
seen
older
clients
of
mine
in
my
last
job,
who
could
barely
afford
their
medication
to
people
rationing
medications
and
not
taking
them
properly.
We
cannot
continue
to
allow
the
pharmaceutical
industry
to
price
gouge
and
make
obscene
amounts
money
off
of
the
people
who
are
sick.
We
need
help.
O
E
E
E
A
It
would
not
be
a
zoom
meeting
if
there
weren't
someone
who
messed
up
the
mute
happy
to
take
the
charge
this
morning
with
that,
we
will
close
this
meeting
with
a
final
word
of
gratitude
to
all
of
our
broadcast
services
staff,
all
of
the
staff
that
has
supported
the
work
of
this
committee
and
with
an
especial
ounce
of
gratitude,
on
my
behalf
for
mr
patrick
ashton,
who
has
done
a
phenomenal
job
at
being
the
bumpers
on
this
bowling
lane
and
really
keeping
us
on
track
and
making
sure
that
we
get
our
work
done.