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Description
This is the seventh meeting of the 2021-2022 Interim. Please see the agenda and "Work Session Document" for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
A
The
legislative
commission
established
a
committee
to
conduct
an
interim
study
concerning
the
costs
of
prescription
drugs.
As
the
read
as
directed
by
senate
bill
276,
which
was
passed
during
the
2019
legislative
session,
the
committee
was
comprised
of
six
legislators,
three
from
the
senate
and
three
from
the
assembly.
A
A
A
The
second
bdr
from
the
interim
study
became
senate
bill
201,
but
it
did
not
be
become
law
last
session.
It
passed
standard
health
and
human
services
and
was
amended
to
allow
licensing
fees
of
pharmaceutical
sales
representatives
to
cover
the
cost
of
licensure
and
regulation
and
for
the
purposes
of
the
prescription
drug
transparency
program
with
dhhs.
A
The
third
bill
senate
bill
380,
passed
last
session
after
being
significantly
amended,
sb
380,
built
on
legislation
concerning
transparency
of
asthma
and
diabetes,
prescription
drugs
from
the
2017
and
2019
legislative
session.
It
removed
the
existing
requirement
that
dhhs
compiles
a
list
of
essential
asthma
drugs.
A
There
are
some
other
reporting
requirements,
but
you
will
hear
more
details
details
during
a
dhhs
presentation
under
agenda
item
number
10
today
of
note.
The
introduced
version
of
sp
380
required
manufacturers,
wholesalers
and
pharmacy
benefit
managers
to
register
with
the
department.
A
A
A
B
Thank
you
so
much,
mr
ashton.
Does
anyone
have
any
questions
for
him
at
this
time?
See
none
here
and
none
in
las
vegas.
I
think
we'll
go
ahead
and
proceed
to
the
next
presentation.
So,
let's
move
on
to
agenda
item
10,
which
is
the
implementation
update
on
nevada
legislation
related
to
pharmaceutical
drug
pricing,
transparency
pursuant
to
senate
bill
380..
B
Our
presenters
today
are
miss
linda
fox,
who
is
the
pharmacist's
drug
transparency
program
manager
at
dhhs,
and
we
have
jessica
gerhard.
Who
is
a
management
analyst
in
dhs?
We
also
have
just
for
transparency
sake
for
the
members
after
they're
done
presenting.
We
also
have
dr
capuro,
who
presented
earlier
dr
beth
slamowicz
and
david
olson,
who
could
answer
any
questions
that
may
arise
so
miss
linda
and
jessica.
Please
proceed
when
you
guys
are
both
ready.
C
C
This
required
dhhs
to
provide
a
list
of
essential
diabetes
drugs,
as
well
as
a
list
of
those
drugs
that
experienced
a
substantial
price
increase.
In
the
past
two
years,
manufacturers
of
these
drugs
were
required
to
submit
information
regarding
drug
costs
and
for
drugs.
That
experiences
significant
increase.
The
reasons
for
those
increases
pbms
pharmacy
benefit
managers
also
had
to
report
certain
information
manufacturers
had
to
identify
pharmaceutical
sales.
Reps
and
sales
reps
had
to
submit
an
annual
report
regarding
their
activity.
C
So
that
was
2017
in
19
asthma
medications
were
added
to
the
essential
drug
lists,
but
they
were
repealed
the
following
legislative
session.
So
what
happened
in
21
the
asthma
drugs
were
removed.
However,
they
were
replaced
by
a
different
group
of
drugs,
which
was
essentially
all
drugs
as
long
as
it
met
a
certain
price
increase
criteria.
C
So
it
was
drugs
over
forty
dollars
that
increased
ten
percent
in
one
year
or
twenty
percent
in
two
years,
but
it
was
a
drug,
it
could
be
any
drug,
it
didn't
have
to
be
an
asthma
drug
or
any
other
particular
kind
of
drug
and
diabetes
remained
as
well.
C
C
C
The
penalties
paid
over
time
have
decreased
because
these
entities
have
increased
adherence
and
they
in
general
they
report
what
they're
required
to
report
so
the
first
year
of
the
program,
there
were
no
fines,
it
was.
It
was
a
free
year
until
it
allowed
people
to
learn
how
to
report
to
the
program
in
2019.
C
There
were
about
a
million
dollars
in
fines
in
20.
It
was
about
250,
000
and
interesting.
It
was
not
any
of
the
same
companies
so
19
and
20.
It
was
completely
different
companies
that
were
fined
in
2021.
There
were
no
fines
at
all
collected
this
year.
At
this
point
there
is
one
fine,
that's
being
administered.
It
is
being
appealed.
C
So
before
I
kind
of
go
over
what
happened
this
year
with
reporting,
I
wanted
to
briefly
explain
the
drug
list
that
we
that
we
make
so
there's
four
lists,
four
lists
that
are
published
in
february.
The
first
one
is
really
for
consumers.
It's
a
simplified
brand
generic
list.
C
The
second
list
is
a
list
of
essential
drugs
that
are
used
for
diabetes.
It
has
its
own
set
of
reporting
lists.
Three
and
four
are
drugs
ahead.
Significant
price
increases
so
list
three
is
diabetes
drugs
with
a
significant
price
increase
list.
Four
is
all
the
other
drugs
I
mentioned
that
are
over
forty
dollars
that
have
a
price
increase.
Three
and
four
are
different
lists
because
they
have
different
criteria,
and
I
think
that's
all
I'll
say
about
this.
C
So
pharmaceutical
sales
reps
are
required
to
register
with
the
program
and
report
any
activity
over
ten
dollars
per
recipient
or
one
hundred
dollars
in
aggregate.
You
can
see
there
the
results
of
this
year,
so
266
thousand
reports
submitted
over
5000
active
reps
in
this
state.
More
than
1700
had
reportable
activity,
3.4
million
dollars,
total
reported
in
compensation
is
much
more
than
last
year.
C
Last
year
was
a
little
over
2
million
and
I
think
probably
some
of
that
is
because
of
covid,
but
it
does,
it
does
go
up
each
year
fairly.
Significantly
pharmacy
benefit
managers
are
required
to
report
certain
information
regarding
drugs
on
nevada
lists,
2
and
4.
C
There
was
some
inconsistency
in
the
reporting
that
made
it
difficult
for
me
to
aggregate
and
some
of
it.
This
is
the
first
year
we
required
pbms
to
drill
down
to
an
ndc
number,
and
some
of
them
had
difficulty
with
that,
so
the
the
ones
that
I
could
collect
information
from,
I
did.
C
In
addition,
it's
difficult
for
us
to
tell
which
pbms
need
to
report
to
us
with
manufacturers.
It's
very
straightforward.
I
have
a
database
I
use
who
made
the
drug
did
the
price
increase.
C
C
C
Okay,
so
I
had
the
highlights
here
of
the
report
this
year
over
a
thousand
unique
ndcs
for
essential
diabetic
drugs.
So
those
are
not
drugs
that
necessarily
hadn't
increased.
Those
are
just
drugs
that
are
used
for
diabetes
of
those
drugs.
151
did
have
a
significant
price
increase
on
list.
Four,
the
over
40
list.
There
were
about
180
ndcs.
C
I
think
when
sb
380
was
becoming
law
like
there
was
no
good
way
to
tell
how
many
drugs
would
be
drawn
in
by
that
net,
the
over
40
and
the
10
20
percent,
but
it
ended
up
with
a
180
mdcs
which,
in
my
opinion,
is
not
a
very
high
number.
C
C
C
C
C
So
I
wanted
to
review
what
was
reported
over
the
past
five
years
and
that's
how
long
this
program
has
been
in
existence.
255
drugs
in
dc's,
unique
ndc's,
appeared
on
the
essential
diabetes
drug
list,
with
significant
increase
over
five
years.
C
So
since
the
beginning
of
the
program
we've
seen,
the
same
manufacturers
and
drugs
repeatedly
show
up
on
these
lists.
So
67
drugs
appeared
all
five
years.
So
that
means
that
each
year
of
the
program
they
had
a
significant
price
increase
and
27
drugs
appeared
four
out
of
those
five
years.
C
The
average
annual
price
increase
for
a
drug
on
the
essential
diabetes
drug
list
with
an
increase
was
seven
and
a
half
percent,
and
the
average
total
price
increase
from
this
list
over
the
five
years
was
27.8
percent
and
over
the
years
the
average
increase
in
price
per
medication
has
trended
down.
While
the
number
of
medications
which
experienced
a
price
increase
have
increased.
C
So
I
went
through
that
very
quickly.
That's
that's
all
that
I
have
for
my
presentation,
but
I'm
happy
to
answer
questions.
B
Thank
you
so
much
members
do
we
have
any
questions
regarding
this
presentation.
D
D
D
C
C
Actually,
I
think
we
missed
a
slide
as
well.
I
had
a
manufacturer's
slide.
I
don't.
I
don't
think
we
saw
that
a
lot
of
the
reports
regarding
essential
drugs
had
no
information
because
they
didn't
increase
in
price.
So
we
have
this
really
big
group
of
essential
diabetes,
drugs
and
those
manufacturers
did
report.
But
the
answer
quite
often
was
there
was
no
increase
and
I
I
don't
know
how
much
value
there
is
in
that
report.
C
I
think
we
had
79
reports
and
only
13
had
usable
information,
so
I
think
a
focus
more
on
things
that
did
increase
would
be
of
more
value
rather
than
just
because
you're,
this
kind
of
drug
you're,
an
essential
diabetes
drug
and
if
we
wanted,
if
we
wanted
to
draw
more
medications
in
because,
like
I
mentioned
180
drugs
was
all
we
drew
in
with
the
over
40..
C
C
Also,
a
high
launch
price
that
we
don't
do
anything
with
launch
price.
We
only
do
what
I
discussed
here.
A
high
launch
price,
but
some
states
do
that.
Some
states
charge
fees
for
participating,
not
just
to
find.
D
I
I
guess
one
of
the
things
I'm
asking
is:
we
took
a
snapshot
of
one
area
of
drugs
and
their
charges
versus
the
whole
spectrum
of
medications
and
their
charges,
and,
to
wit,
I
read
in
the
wall
street
journal,
for
instance,
that
they
looked
at
everything
and
the
drug
prices
have
gone
up.
One
point
something
percent
in
total,
so
it
it
seems
to
me
a
company
may
have
said.
Okay,
we
can
do
something
for
one
group
of
medicines
as
opposed
to
all
groups
of
medicines.
D
B
And
senator
hardy
that
I
might
be
able
to
chime
in
on
that.
The
questions
that
I
would
defer
to
our
presenters
would
probably
more
entail
at
as
to
the
updates
of
the
work
that
the
transparency
program
is
establishing
since
funding
it
from
the
last
session
any
regards
to
policies
on
what
we
use
with
that
data
or
any
recommendations
that
come
out
of
that
would
be
in
the
purview
of
this
committee,
whether
it's
in
our
bdr
allocations
that
we
receive
per
nrs
or
that's.
B
I
guess
that's
a
discussion
between
all
of
us
as
to
what
we
want
to
do
with.
I
guess
the
main
important
thing
is
to
gain
transparency
so
that
all
stakeholders
have
the
availability
of
that
data
and
information
to
make
determinations
as
to
what
we
want
to
prioritize.
So
it's
not
really
a
question
for
them,
that's
more
for
us
so
and
I'm
happy
to
chat
offline.
If
that's
something
that
you're
interested
in
and
I'm
sure
chair,
peters,
shares
that
same
sentiment.
B
D
B
Great
yep,
thank
you,
chair
peters.
Did
you
have
a
question.
E
Yes,
thank
you.
I
think
you
highlight
really
the
point
of
this.
This
activity,
which
was
to
start
with
start
with
a
baseline
of
what
does
the
data
look
like
and
then
really
drive
into
what
it?
What
what
do
we?
What
do
we
have
access
to?
What
do
we
need
access
to
and
how
do
we
get
to
a
place
where
patients
are
the
most
protected?
E
At
least
that's
what
I
see
in
this
data,
and
it's
not
unusual
when
you're
assessing
data
to
take
a
a
glance
at
it,
so
that
you
can
kind
of
stuff
out
trends,
and
then
you
take
a
you,
take
an
analytical
approach
to
how
to
move
forward
with
that
data
in
the
future.
I
have
a
question,
though,
related
to
your
breakdown
or
the
reported
breakdown
of
costs
for
each
medication
that
was
or
medication
that
was
provided
on.
As
this.
F
E
Your
review
of
data
collected
slide
slide
12..
They
were
required
to
specify
drug
costs
to
consumers
through
a
cost
breakdown.
The
breakdown
included,
production,
administration,
profit,
prescription
assistance,
co-pay
cards
and
rebates,
and
then
there
is
a
statement
here.
The
most
common
explanation
reported
for
drug
cost
increases
on
the
essential
drug
report
was
research
and
development.
E
C
It
is
actually
a
different
report,
so
there's
two
different
places.
These
things
are
reported
and
one
is
the
essential
drug
report
versus
the
report
where
there
was
a
an
increase.
E
I
want
to
ask
that
that
staff
follow
up
with
you
and
get
those
reports
and
distribute
those
out
to
us,
because
I'd
like
to
see
those,
but
I'd
also
like
to
know
where
they're,
where
the
the
drug
companies
are
putting
that
cost
for
research
and
development.
Is
that
a
part
of
the
production
cost
or
is
that
a
part
of
their
profit,
their
their
profits,
because
that
changes
the
interpretation
of
the
data
and
where
those
investments
are
going
back
into
the
product?
E
I
think
that's
real.
That
was
really
about
the
most
important
question
I
had
to
ask
today.
I
like
we'll,
have
follow-up
questions
for
you,
mrs
fox,
on
what
this
data
looks
like
and
some
of
your
suggestions
for
how
to
move
forward.
In
the
data
analysis.
I
think
that
this
is
important
work
being
done.
Transparency
in
medicine
is
something
that
we're
trying
to
tackle
all
over
the
place.
E
Any
entity
in
the
medical
industry
will
tell
you
that
somebody
is
not
showing
us
everything,
and
so
what
we're
doing
here
is
important,
but
we
need
to
continue
moving
forward
with
some
kind
of
goal,
as
I
think
the
senator
was
getting
at.
Thank
you
by
share.
B
Thank
you
so
much
chair,
peters,
any
other
questions
from
committee
members.
B
I
don't
seem
to
see
any
so.
Thank
you
so
much
for
this
presentation
item.
I'm
sure
we'll
have
more
discussion
as
to
how
we
can
financially
sustain
this
program
in
the
future
and
what
we
can
do
to
support
it,
but
I'm
sure
there's
a
lot
of
other
things
that
we
can
cover.
So
moving
on
from
this
presentation
item:
let's
go
to
agenda
item
11,
we're
close
to
the
end
of
this
meeting.
B
We
have
an
update
on
senate
bill
396,
which
authorizes
public
agencies
in
nevada
to
enter
into
agreements
with
private
entities
within
or
outside
of
the
state
for
the
purchase
of
pharmaceutical
or
medicare
services.
We
have
dr
beth
slamowicz,
who
is
a
senior
policy
advisor
on
pharmacy?
So
please
proceed
when
you're
ready.
G
All
right,
so
thank
you.
Vice
chair
donate
and
chair
peters
and
members
of
the
committee.
My
name
is
beth
slamotz.
I
am
the
senior
policy
advisor
on
pharmacy
for
the
department
of
health
and
human
services
and
I'm
going
to
give
a
brief
update
on
senate
bill
396
today.
G
So
mr
ashton
earlier
alluded
to
senate
bill
396
and
the
fact
that
that
particular
bill
authorized
a
public
agency
to
enter
into
an
agreement
with
another
public
agency
or
private
entity.
Basically
addressing
interstate
and
interest.
G
So,
as
part
of
the
passage
of
sb
396,
we,
the
state,
was
able
to
enter
recently
into
an
interstate
agreement
with
the
northwest
consortium.
This
agreement
was
announced
by
governor
sistelak
back
in
late
february.
We
recently
signed
the
agreement
in
may
and
we
are
in
the
process
of
moving
forward
to
initiate
some
projects
out
of
that
agreement.
That
was
signed
so
just
to
give
you
some
brief
background.
G
It
operates
through
an
administrator
by
the
name
of
moda
health,
and
then
it
also
has
a
pharmacy
benefit
administrator
by
the
name
of
navitus.
That's
contracted
with
it
different
types
of
items
that
the
consortium
operates
include
a
pharmacy
benefit
administrator,
a
discount
card
program.
They
also
operate
drug
vouchers,
workman's,
comp
and
also
recently
medicaid
prescription
drug
management.
G
G
They
operate
under
primary
principles,
which
are
for
public
sector
purchasers.
They
are
a
completely
and
fully
transparent
operation.
They
utilize
pass-through
pricing
for
pharmacies.
That
means
that
all
discounts
and
rebates
are
passed
through
to
the
pharmacy
counter
for
consumers,
100
of
all
manufacturer
rebates
and
fee
payments.
G
They
work
off
of
a
fixed
administration
fee
and,
most
importantly,
they
are
operated.
It
is
operated
by
states
for
states,
so
participation
from
other
states
increases
the
value
for
public
purchasers,
and
so
it
is
now
a
three-state
agreement
with
hopes
that
additional
states
will
join
in
the
future.
G
Although
sb
396
was
not
necessary
for
this
to
take
place,
I
wanted
to
kind
of
just
give
an
update
in
terms
of
what's
been
happening
within
the
state
in
terms
of
pooling
our
purchasing
power
and
utilizing
that
in
terms
of
the
payments
or
purchase
of
prescription
drugs.
So
this
is
just
a
really
brief
timeline.
G
Back
in
september
of
2019,
there
was
a
request
for
information
that
was
released.
Looking
at
solicitation
for
pharmacy
benefit
managers
for
the
fee
for
service
medicaid
population.
G
G
The
idea
was
that
both
of
those
programs
are
pairs
of
last
resort
and
they
also
utilize
rebate,
revenue
for
the
purchase
of
prescription
drugs,
and
so
it
wasn't
an
ideal
partnership
to
solicit
for
a
single
pbm
and
so
that
rfp
or
request
for
proposal
resulted
in
magellan,
medicaid
winning
that
proposal
and
they
just
recently
went
live
july
1st.
So
we're
just
in
the
beginning
stages.
A
couple
weeks
in.
G
Benefit
manager,
for
both
programs
mostly
was
to
obtain
comprehensive
services
for
both
programs.
The
state
of
nevada,
division
of
public
behavioral
health
hosts,
the
ryan
white,
hiv
and
aids
part
b
program,
and
then
the
department
of
health
care
financing
and
policy
is
where
the
fifa
service
medicaid
program
is
housed.
G
There
was
also
opportunity
for
flexibility
to
incorporate
technology
and
tools,
innovative
business
techniques,
hopefully
in
the
that
it
would
enhance
quality
of
care
under
the
pharmacy
benefit.
G
Some
of
the
items
forward,
thinking
with
both
programs
nmap,
has
a
medical
advisory
committee
and
medicaid
works
under
the
silver
state
scripps
board,
which
is
technically
either
pharmacy
and
therapeutics,
and
then
they
also
have
a
drug
utilization
review
board
that
manages
their
clinical
policy
and
so
being
able
to
combine.
The
programs
under
one
pbm
is
also
giving
us
the
opportunity
to
leverage
some
of
those
advisory
boards
to
make
sure
that
we
are
presenting
the
most
cost
effective,
as
well
as
clinically,
effective
and
appropriate
medications
to
the
population
of
nevada.
G
Also,
the
effort
was
to
reduce
administrative
burdens
on
both
providers
and
beneficiaries,
control
the
growth
of
the
pharmacy
benefit
expenditure.
That's
been
a
common
conversation
on
both
the
federal
and
state
level
and
nationally
reducing
those
expenditures
to
the
state
as
they
tend
as
they
continue
to
push
healthcare
costs
forward.
G
There
are
folks
in
both
programs
that
both
benefit
from
the
medication
assistance
hiv
program,
as
well
as
with
medicaid
and
so
being
able
to
have
that
data
in
one
place
and
be
able
to
combine
the
access
to
that
data,
hopefully,
will
yield
positive
results
and
last
consolidating
the
pbm
contracts
and
services
across
the
state
programs,
in
the
hopes
of
reducing
some
of
the
administrative
burden,
but
also
reducing
the
contract
costs
which
we
were
able
to
do
significantly.
G
And
lastly,
I
want
to
add
just
because
it
was
brought
up
under
public
comment
at
the
beginning
of
this
meeting.
As
part
of
this
solicitation
and
implementation,
nevada
did
join
the
national
medicaid
pooling
initiative,
otherwise
known
as
nmpi
and
as
stated
earlier,
it
is
a
multi-state
purchasing
pool
there
are
roughly
about,
I
believe,
14
states
in
it
now,
but
medicaid
does
have
the
silver
state
scripps
board,
which
still
determines
placement
of
the
of
the
preferred
drug
list.
G
G
B
Thank
you
so
much
dr
samuel.
Do
we
have
any
questions
not
here,
mr.
D
D
Vice
chair,
thank
you,
mr
page.
Seven.
Fourth
bullet
point
from
the
bottom:
reduce
administration,
administrative
burdens
on
providers
and
beneficiaries.
I
understand
the
concept
that
we're
doing
ultimately
to
save
money
and
pool
and
do
all
of
those
kinds
of
things.
My
I
suspect
the
managed
care
organizations
are
interested.
Does
that
mean
that
the
managed
care
organization
does
not
have
to
include
a
pharmacy
benefit
if
they're
under
this
program,
or
are
they
still
on
the
hook
for
providing
the
pharmacy
benefit?
G
Implementation,
so
thank
you
senator
hardy
for
the
question,
so
just
for
clarification,
the
solicitation
that
took
place
in
the
implementation
was
for
pharmacy
benefit
management
services
strictly
for
the
fee
for
service
medicaid
population,
as
well
as
the
nevada
for
the
medication
assistance
program
for
ryan.
G
The
managed
care
organizations
separate
they
manage
their
own
pharmacy
benefit
each
one
of
them
and
they
each
contract
with
their
own
pharmacy
benefit
manager.
So
this
solicitation
did
not
include
knowledge
care.
The
pharmacy
benefit
has
not
been
carved
out.
This
was
strictly
a
presentation
for
the
brief
population.
Pharmacy
benefit.
B
I
don't
think
I
see
any
so
we'll
go
ahead
and
close
this
agenda
item.
Thank
you
so
much
dr
zlamowicz
for
presenting
okay.
We
have
reached.
The
final
presentation
item
is
item
number
12
on
the
agenda,
which
is
the
final
update
on
the
kovid
19
health
crisis
interim
study
pursuant
to
senate
bill
209.
B
I
am
the
presenter
for
the
item,
so
I'm
gonna
go
over
if
it's
okay
with
all
the
members,
I'm
gonna
go
over
a
few
of
the
documents
that
are
online
and
I'll
walk
through
some
of
the
background
information
and
the
recommendations
and
then,
if
there
are
any
other
further
questions,
I'm
happy
to
entertain
them
or
have
a
committee
staff
address
them
as
well.
So
again,
I
am
senator
freeman
donate
representing
senate
desert
10.
B
This
roundtable
focused
more
on
a
conversation
that
is
always
left
behind
with
kobe
19,
which
is
a
public
health
workforce
not
to
be
confused
with
the
healthcare
workforce.
B
We
always
talk
about
nurses,
doctors,
but
there's
also
the
public
health
workforce
that
contributes
to
the
response,
and
so
the
stakeholders
that
were
involved
received
questions
in
a
similar
respect
on
what
the
public
health
infrastructure
looks
like
how
we
can
improve
the
workforce
in
general
and
to
consider
the
creation
of
a
public
health
service
corps,
and
on
pages
one
and
two
of
the
handout
that
you
have.
B
You
will
find
a
summary
of
the
discussion,
along
with
the
priority
areas
that
were
identified
by
the
stakeholders
in
policy
recommendations,
and
I
want
to
highlight
a
few
of
them
for
your
attention.
Priority
areas
for
public
health
infrastructure
are
one
non-categorical,
flexible,
public
health
funding.
B
Similarly,
stakeholders
identified
funding
as
the
greatest
need
to
strengthen
the
public
health
workforce,
followed
by
providing
more
incentives
for
a
public
health
career.
This
could
be
done
through
loan
repayment
programs,
more
diversity
in
the
field
and
evaluating
and
building
on
the
workforce
pipeline.
B
It
was
also
intriguing
to
learn
that
stakeholders
recommended
support
for
public
health
workforce
pipeline
by
investing
in
outreach
through
in
k-12.
For
example,
youth
could
be
introduced
to
and
engaged
in,
public
health
careers
through
the
nevada
department
of
education's
career
and
technical
education
programs
throughout
the
state,
by
adding
an
emphasis
on
public
health
careers.
B
Many
stakeholders
also
recommended
the
creation
of
a
public
health
service
corps,
and
such
a
service
corps
could
repay
the
educational
loan
debt
of
public
health
professionals
in
exchange
for
their
service
at
the
local
health
department
across
the
state.
We
have
similar
programs
for
physicians,
and
so
there
is
a
conversation
about
extending
that
to
folks
that
work
in
public
health
and
finally,
the
last
round
table
that
we
had
was
held
on
july
12
of
this
year.
B
This
roundtable
engaged
conversations
on
policy
recommendations
for
health,
equity
issues
and
populations
that
were
disproportionately
affected
by
the
covet-19
crisis.
In
this
particular
round
table,
we
discussed
affected
populations
such
as
children,
attending
child
care
and
k-12
racial
and
ethnic
minorities,
vulnerable
populations
served
by
local
and
state
social
services
and
individuals
in
the
criminal
justice
system.
B
B
For
instance,
limited
early
intervention
services
during
the
first
two
years
of
the
pandemic
led
to
spikes
in
behavior
on
social
issues
in
schools
in
the
primary
grades
that
could
not
be
adequately
addressed
due
to
shortcomings.
In
the
current
system
number
three
health
disparities:
stakeholders
reported
that
across
nevada
communities
with
racial
and
ethnic
minorities
had
higher
rates
of
co
of
health
conditions
and
chronic
diseases.
B
The
coca-19
pandemic
exacerbated
these
health
disparities.
For
example,
access
to
vaccines
was
more
difficult
for
these
communities
and
their
rate
of
severe
illness
and
death
from
cover
19
was
disproportionately
higher
compared
to
other
counterparts
and
a
interesting
conversation
that
also
came
up
was
with
regards
to
food
security.
B
B
They
mentioned
that
they're
still
experiencing
some
challenges
now
due
to
inflation,
which
of
course
was
could
be
contributed
to
the
coven
19
pandemic
and
then
the
last
the
most
important
thing
that
came
from
all
this
is
the
conversation
on
workforce.
You
know,
I
think
in
general.
Yes,
we
recognized
the
need
for
a
public
health
workforce,
but
the
coveted
19
pandemic
led
to
shortages
across
the
whole
entire
system,
whether
it
was
in
criminal
justice,
education,
social
services
sectors.
B
For
instance,
stakeholders
reported
vacancy
rates
ranging
from
18
to
40
due
to
burnout,
lack
of
competitive
salaries
and
increased
workload,
and
the
recruitment
of
new
staff
is
also
a
challenge.
For
example,
a
training
academy
for
new
correctional
officers
had
to
be
cancelled
because
of
the
lack
of
applicants,
and
I
think
it's
clear
that
the
community
also
faces
severe
shortages
of
personal
care,
service
providers
and
child
care
providers
and
then,
in
terms
of
policy
recommendations
that
were
delivered
from
this
roundtable
stakeholders
recommended
to
invest
in
the
primary
prevention
of
chronic
diseases
to
improve
health
care
outcomes.
B
Some
stakeholders
recognize
the
need
to
address
information
gaps
and
misinformation
amongst
non-english
speakers,
which
would
require
us
to
invest
in
health,
literacy
efforts
and
then
the
last
and
final
thing
is
that
the
state
should
focus
on
emergency
preparedness.
The
example
used
by
stakeholders
was
an
increase
in
planning
for
crises
in
food
security
and
food
delivery,
but
this
could
be
applied
to
many
other
sectors,
including
improved
access
for
vaccines
for
populations
facing
health
disparities,
child
care
options
for
frontline
workers
or
crises
planning
for
crucial
economic,
supportive
services,
such
as
snap,
food
stamps
and
unemployment
benefits.
B
So
that
concludes
the
report.
For
the
third
and
final
roundtable
discussion,
the
committee
staff
are
in
the
process
of
preparing
a
final
report.
That's
going
to
detail
all
of
this
more
comprehensively
and
eventually
it'll
lead
to
bdr
recommendations
that
we
could
either
choose
as
a
committee
to
introduce
ourselves
or
if
there
are
any
members
that
would
like
to
introduce
them
themselves
as
part
of
their
allocation.
That's
also
an
option.
H
Well,
thank
you
for
that
and
that's
a
lot
of
effort
and
time
and
thought
that
has
gone
have
gone
into
it.
So
thank
you
very
much
for
everybody's
effort
and
all
those
roundtable
discussions
moving
forward
as
senator
doc.
Hardy
had
had
brought
up
earlier
about.
Well,
what
do
we
do
with
this
information?
H
Now
and-
and
certainly
I
have
mentioned
a
couple
times
and-
and
I
understand
we're
going
to
look
at
it
in
a
work
session-
maybe
next
time
around
about
the
in
some
of
my
rural
counties
that
I'm
going
to
represent,
have
reached
out
about
the
enabling
them
to
have
a
health
district
that
are
not
continuous
or
touching
or
contact.
H
So
certainly,
we
can
actually
move
forward
and
suggest,
at
least
for
that,
one
that
that's
that
becomes
a
bdr,
because
that's
something
we
can
do
moving
forward
and
actually
glean
something
positive
with
all
that
work
that
you've
done
and-
and
I
think
that's
really-
you
know
we
have
so
many
studies
and
we
have
round
tables
and
we
have
discussions
and
presentations.
H
Thank
you
for
that
and
looking
forward
to
having
that
particular
bdr
go
forward
from
this
committee,
because
I
think
that
that
a
committee
bill
has
more
weight
and
more
chance
as
a
bipartisan
effort
to
go
forward
in
the
next.
In
the
next
session.
B
Yeah,
thank
you
so
much.
If
something
women
tell
us,
I
would
agree
yeah.
I
think
that
there
were
conversations
that
came
up
during
our
discussions
that
we
do
have
to
take
some
review
as
to
how
we
prepare
for
in
terms
of
emergency
preparedness
and
how
we
help
counties
and
local
jurisdictions
prepare
for
future
crises,
whether
it's
a
pandemic
or
a
wildfire
or
anything.
So
I
think
that
was
one
of
the
positives
that
we
had
and
you're
you
are
right.
It
does
allow
for
the
opportunity
for
collaboration.
B
So
hopefully
we
can,
I
think,
chair,
peters,
and
I
will
work
together
and
we'll
we'll
be
bringing
it
to
you
with
some
sort
of
recommendation
for
the
next
work
session.
If
there
any
do,
we
have
any
other
questions
for
anyone,
maybe
in
las
vegas.
E
Peters
chair,
I
just
want
to
extend
my
gratitude
to
you
and
staff
for
completing
this
task.
It
was
a
quite
a
heavy
lift,
including
a
lot
of
stakeholders
from
a
variety
of
areas
and
you've
done
a
wonderful
job
and
for
great
things,
feedback
from
the
folks
who
have
met
with
you
and-
and
I
think
that
dr
chad
has
nailed
it.
Our
goal
is
to
come
up
with
solutions
in
this
committee.
That's
what
we've
asked
every
person
who's
presented
in
this
committee
to
do.
You
have
a
problem
come
in
with
a
solution.
E
The
suggestion
may
not
be
what
sticks
at
the
end
of
the
day,
but
at
least
we
have
a
starting
point
to
start
building
with
our
brain
power
and
other
stakeholders
on
what
it
is
that
will
work
for
the
state
of
nevada
address
these
issues.
What
are
our
priority
issues?
Where
do
we
see
similarities
in
different
organizations
and
agencies,
and
how
can
we
leverage
those
dollars,
as
well
as
those
policies
and
practices?
B
Seeing
none
I'll
go
ahead
and
close
this
agenda
item
and
we
will
go
ahead
and
we've
reached
the
conclusion
of
this
meeting.
So
now
we
are
at
our
last
item,
which
is
public
comment.
We'll
start
with
public
comment
from
those
in
the
physical
locations.
It
doesn't
seem.
We
have
anyone
here
in
carson
city,
we'll
go
to
las
vegas
and
then
we
can
go
virtually
so
is
there
anyone
in
las
vegas
that
would
like
to?
B
G
E
F
The
nevada
tobacco
prevention
coalition
is
comprised
of
collaborating
public
health,
health
care
and
private
partner
organizations.
Our
mission
is
to
improve
the
health
of
all
nevadans
by
reducing
the
burden
of
tobacco
use
and
nicotine
addiction
mtpc
strongly
encourages
members
of
the
committee
to
consider
the
following
policy
recommendations
to
equitably
protect
the
health
of
all
nevadans.
F
We
recommend
should
include
increased
enforcement
and
accountability
for
tobacco
retailers
and
to
support
community
based
education,
including
id
checking
and
other
means.
We
thank
the
committee
for
your
work
and
for
your
consideration
of
these
this
information
and
the
documents
presented.
Thank
you.
I
Good
afternoon
this
is
maya
holmes,
I'm
the
healthcare
research
manager
for
the
culinary
health
fund,
and
I
want
to
thank
the
chair
of
the
vice
chair
and
the
committee
for
discussing
the
affordability
of
prescription
drugs.
Today
on
agenda
item
9,
we
were
very
active
in
the
interim
health
committee
study
concerning
the
cost
of
prescription
drugs
and
supported
some,
but
not
all
of
the
committee's
recommendations
for
the
2021
session.
We
appreciate
that
the
committee's
work
is
being
revisited.
I
We
also
want
to
thank
dhhs
for
the
tremendous
work
they
are
doing.
Implementing
the
drug
purchasing
coalition
and
the
drug
price
transparency
reporting.
The
transparency
legislation
was
critical
to
start
shining,
a
light
into
the
black
box
of
drug
prices
and
their
unrelenting
price
increases.
So
the
public
can
really
just
start
tracking
what
is
happening
in
the
market
and
also
move
towards
developing
well-informed
policy
based
on
real
data.
I
I
It
is,
it
spends
incredible
sums
on
political
lobbying
to
protect
their
business
model
and
profits
and
prevent
meaningful
reform
to
address
their
out
of
control
and
unaffordable
prices,
manufacture,
prescription
drug
prices
are
egregious
and
out
of
control.
Just
this
past
tuesday,
the
non-pharma-funded
patient
advocacy
group
patients
for
affordable
drugs
released
a
report
that
the
median
price
for
a
new
prescription
drug
is
now
and
eighty
thousand
dollars
for
a
year's
supply.
That
is
up
from
two
thousand
dollars
in
two
thousand
eight,
it's
just
mind.
I
They
want
to
propose
price
caps
on
co-pays
eliminations
of
deductibles,
allowing
manufacturers
to
use
coupons
for
high-cost
brand
drugs
over
low-cost
generics
and
rebate
sharing
at
the
pharmacy
counter,
while
patients
absolutely
do
need
relief.
These
proposals
ignore
that
fundamental
price
problem,
which
is
that
they're,
it's
the
manufacturers
who
are
setting
the
prices
and
how
that
contributes
to
overall
health
care
costs.
I
As
a
non-profit
self-funded
health
plan,
we
cover
approximately
130
000
lives
in
southern
nevada.
Our
goal
is
to
ensure
a
health
care
market
that
provides
universal
access
to
quality,
affordable
health
care,
including
prescription
drugs.
Like
all
nevadans
are
perf.
Our
participants
are
struggling
with
inflation,
housing,
gas,
food
and
other
costs
on
health
care.
They,
like
all
nevadans,
need
solutions
that
meaningfully
reduce
not
exacerbate
our
health
care
costs
and
expending.
I
We
cannot
support
band-aid
legislation
that
fails
to
address
the
root
of
the
problem
and
allows
pharma
to
continue
to
price
gouge
and
drive
up
premiums
and
out-of-pocket
costs
for
everyone
again.
We're
really
very
appreciative
that
the
committee
is
discussing
these
issues
and
we
look
forward
to
participating
in
those
discussions
going
forward.
Thank
you.
H
Thank
you
co-chair
and
chair,
and
I
would
just
like
to
offer
before
we
close,
if
there's
no
other
phone
or
or
public
comments
that
if
I
might
just
suggest
that
moving
forward,
I
had
already
mentioned
that
we
as
one
of
our
bdrs
look
at
the
health
districts
not
having
to
be
counties
that
are
touching,
but
also.
I
would
suggest
that
perhaps
you
had
had
a
suggestion
about
funding.
We
already
have
a
source
of
funding
to
reimburse
rural
providers,
the
pas
that
have
come
like
to
my
clinic
and
myself.
H
I
was
paid,
you
know,
supported
through
med
school
by
my
county,
but
we
may
be
able
to
put
a
bill
in
because
again
I'm
about
solutions.
I
put
a
bill
in
that
just
ads
that
were
the
words
public
health
professionals
in
the
already
existing
statute
that
reimburses
under
that
for
physical
therapists
pas,
and
that
may
be
one
of
our
bills
that
we
use
just
to
add
that
work
that
profession,
underneath
that
litany
of
people,
because
we
have
social
workers
etc.
H
So
maybe
our
staff
can
look
into
that
if
it
would
be,
you
know
what
would
that
be?
A
simple
fix.
That's
something
we
may
actually
be
able
to
do,
and
then
the
third
thing
was
the
the
nursing
compact.
I
think
it
would
go
well
for
this
committee
to
look
at
that
as
one
of
our
bills,
but
not
just
for
the
nursing
compact.
I
think
it
was
mentioned
by
dr
packham
that
there
was
we've
only
signed
two
out
of
eight
of
the
possible
compacts.
H
B
Thank
you
so
much
assemblywoman
titus.
I
think
that's
something
that
we
can
probably
all
discuss
before.
We
prepare
for
the
next
work
session.
B
Chair
peter's
probably-
and
I
will
work
together
to
address
some
of
them,
so
hopefully
we
can
fix
some
of
those
changes,
yep
great
okay.
Now
that
we
have
are
there
any
other
comments
from
any
other
committee
members
at
this
time,
seeing
that
we
don't
have
any
more
public
comment
or
any
more
comments
from
the
committee
staff
or
the
committee
members.
I
just
want
to
thank
the
staff
for
helping
us
out
today.
It
was
a
pleasure
of
joining
you
all
in
carson
city
and
our
just
as
a
reminder.