►
From YouTube: House Insurance Committee- April 6, 2021
Description
House Insurance Committee- April 6, 2021
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
E
A
C
A
C
A
Let's
go
with
the
first
one
you
spoke
of,
I
think
6147.
Yes,
yes,
and
do
I
have
a
motion.
We
have
a
motion
and
second,
all
in
favor
any
opposed
mo.
The
amendment
goes
on
the
bill
and
now
then
we're
going
to
the
second
one
66
66
35.
Yes,
okay,
you
have
a
motion
in
a
second
on
both
bills.
Do
we
yes,
yeah,
yes,
and
now
that
we're
going
to
roll
both
of
those
amendments?
A
C
C
I
actually
never
received
that
mri
and
what
had
happened
was
is
that
the
insurance
company
was
asking
for
additional
information
from
my
doctor,
for
whatever
reason
my
doctor
did
not
get
that
request
and
it
pended
so
after
three
times
of
scheduling
this
and
taking
time
off
work,
etc.
I
asked
my
insurance
company
if
there's
any
reason
why
I
did
not
realize
that
there
was
information,
additional
information
being
requested
from
my
doctor,
and
the
response
was
well
we
didn't
have
to,
and
I
didn't
think
that
was
exactly
right
and
said.
C
I
said
well,
I've
got
a
solution.
I'm
going
to
file
some
legislation
that
requires,
when
there's
information,
additional
information
requested
in
a
prior
authorization
setting
that
that
additional
information
that
request
has
to
be
provided
to
the
patient.
So
I
have
worked
with
the
providers.
I've
also
worked
with
the
insurance
companies,
and
the
amendment
that
we
put
on
the
bill
at
first
is
the
result
of
that
that
work
to
require
either
a
provider
or
an
insurance
company
to
provide
within
five
days
notice
that
additional
information
has
been
requested
from
either
or
so.
C
A
G
G
G
Section
3
addresses,
spread
pricing
and
rebate
retention.
Spread
pricing
occurs
when
a
pbm
charges
a
health
plan
more
for
a
certain
drug
than
it
reimburses
the
pharmacy
dispensing
the
drug
artificially
inflating
the
cost.
This
practice
results
in
higher
costs
to
the
consumer,
while
allowing
pbms
to
divert
fees
for
profit.
It
is
most
common
with
cheaper
generic
drugs.
G
G
G
This
provision
states
the
pbm,
has
a
responsibility
to
report.
Any
entitlement
benefit
percentage
to
both
the
plan
and
covered
person
that
either
are
entitled
to
this
section
of
the
bill
will
remove
the
opaqueness
within
the
pbm
system
by
freeing
up
data
to
provide
accurate
information
to
patients
at
the
point
of
care,
empowering
discussions
and
decisions
about
medications
a
patient
can
afford
and
what
it
is
going
to
cost.
F
Thank
you,
madam
chairman.
We
do
have
an
amendment
that
we
need
to
attach.
I
have
a
code:
zero,
zero,
five,
six
one,
eight.
We
have
a
motion
and
a
second
I
thank
you.
I
would
assume
that
the
bill
that
you
described
includes
this
amendment.
Yes,
it
does
okay,
so
members,
you
have
heard
about
the
amendment,
let
us
and
we
have
a
motion
in
a
second,
let's
vote
on
attaching
amendment
5618
to
house
bill
1398,
all
those
in
favor,
please
say
opposed.
F
F
G
Mr
chairman
of
members,
ashley
reed
division
of
tenncare.
I
will
be
speaking
on
section
5
of
the
amended
bill.
This
language
requires
tenncare
or
its
pba
to
report
real
time,
cost
benefit
and
coverage
data
in
a
format
by
the
requesting
party
to
the
enrollee,
enrollee's
healthcare
provider
or
enrollee's
authorized
representative.
There
are
no
restrictions
on
the
number
of
times.
G
Data
can
be
requested
upon
granting
authorization
and
there
are
no
restrictions
on
a
third
party's
use
of
data
beyond
the
authorized
representative
near
real-time
data
output
on
this
scale
is
currently
unavailable
and
out
of
scope
for
tenncare
or
our
pba's
current
system
offerings.
We
also
need
to
ensure
that
we
follow
hipaa
guidelines.
G
F
G
D
Thank
you,
speaker
and
committee
for
having
me
today.
My
name
is
renee
williams,
clark
and
I'm
the
chief
pharmacy
officer
at
tenncare
and
I'm
a
pharmacist
by
trade
and
have
over
12
years
experience
in
pharmacy
benefits
management,
six
of
those
being
primarily
in
the
medicaid
space,
and
to
address
your
question
about
whether
or
not
the
value
from
a
tenn
care
perspective.
D
We
definitely
believe
that
patients
should
have
information
and
access
information
and
that's
why
we
monitor
and
maintain
24-hour
call
centers
for
them
to
access
information
at
any
given
time
that
they'd
like
to
reach
out
and
find
out
status
about
their
their
claims,
they're,
also
information
about
what's
covered
and
how
it's
covered,
including
step
therapy
quantity
limits
readily
available
online
and
accessible
and
updated
as
frequently
as
monthly
and
anytime.
A
change
occurs
to
the
program,
and
then
members
are
also
made
aware
at
the
time
say,
for
instance,
for
prescription
benefits
that
there
is
a
rejection.
D
So
they
receive
letters
now
as
it
is.
With
regard
to
section
5,
there
is
the
requirement
of
both
real-time
infrastructure
and
exchange
of
data
does
come
at
a
premium,
because
claims
are
constantly
being
sent
to
these
vendors
to
process
and
to
give
you
a,
for
instance,
on
the
pharmacy
side
of
the
house.
D
The
system
in
and
of
itself
is
built
as
a
as
in
modules
and
those
modules
and
build
outs,
and
each
of
them
have
their
own
contained
space
that
have
to
be
secured
and
monitored
by
it.
Personnel
and
security
personnel
on
both
sides
of
the
space,
constant
updates,
as
you
can
imagine,
because
it
is
healthcare
and
protected
information,
and
so
connectivity
has
to
then
be
built
essentially
between
those
two
entities
or
parties.
D
Exchanging
the
information
and
secure
connections
have
to
be
built
and
maintained
in
order
to
do
that,
there's
also
the
the
point
at
which
the
output-
that's
just
talked
about
a
lot
about
input.
There's
the
output,
the
section
five
indicates
that
the
format
would
be
the
chosen
format
of
the
entity,
individual
or
personnel
requesting
it,
and
so
that
and
of
itself
also
poses
a
complex
nuanced
specialty
management
and
handling
to
be
able
to
output
in
multiple
formats
at
any.
Given
time.
F
D
Yes,
those
systems
are
for
protecting
privacy
and
in
place
on
a
weekly
basis,
sometimes
daily
basis,
but
when
we
talk
about
real
time,
we're
talking
about
a
claim
for
pharmacy
transaction
goes
through
in
less
than
a
second
and
so
transferring
that
data.
Each
time
a
claim
goes
through
across
the
state
for
any
given
member
at
any
given
time
does
become
a
more
complex
process.
E
E
E
I
get
it
I'm
with
you,
I'm
going
to
be
strongly
supporting
the
bill,
and
I'm
going
to
strongly
encourage
you
all
to
work
with
our
finance
committee
to
find
a
way
to
make
this
happen,
and
thank
you
for
showing
us
yet
again
why
all
payers
claims
database
is
needed
in
our
state,
not
just
for
tracking
prescriptions,
but
also
to
have
tennessee-centric
data
that's
available
in
in
in
a
way
that
can
be
manipulated
and
protected
on
an
ongoing
basis.
So,
thank
you,
mr
chairman.
Thank
you.
C
F
B
Good
morning,
mr
chairman,
members
of
the
committee,
my
name
is
michael
power,
I'm
with
the
pharmaceutical
care
management
association.
We're
thankful
for
the
opportunity
to
be
here
today
to
speak
to
you
on
what
is
a
very
important
topic
as
it
relates
to
the
pharmacy
benefit.
Unfortunately,
we
are
here
in
opposition
to
house
bill
1398
in
its
current
form.
Now,
before
I
get
into
just
a
couple
of
our
key
issues,
I
just
wanted
to
give
you
a
quick
background
on
pbms
and
in
our
role
in
the
drug
supply
chain.
B
We
originally
were
started
in
1970
1980s
to
process
drug
claims.
Drug
claims
have
risen
substantially
over
the
years.
I
think
in
2020
in
the
united
states
we
process
over
4.6
billion
drug
claims
across
this
country
we
have
270
million
americans
who
receive
their
pharmacy
benefit
through
a
pharmacy
benefit
manager
and
1.2
million
of
those
folks
reside
here
in
the
state
of
tennessee.
B
B
It
is
unclear
to
us
where,
specifically
in
that,
in
this
piece
of
legislation
that
you
talk
about,
rebates,
rebates
are
used
or
by
the
pbm,
and
also
the
plan
sponsor
to
to
two
things.
One.
The
plan
sponsor
can
choose
to
pass
those
rebates
on
to
their
employees
or
they
can
use
those
rebates
to
reduce
their
monthly
premiums,
helping
reduce
their
cost
of
their
health
insurance,
and
so
you
know,
there's
two
two
tools
at
pvms
or
the
employer
or
the
contract
the
client
uses
with
those
with
those
tools.
B
B
The
legislation
currently
in
section
3
when
we
talk
about
reimbursement
to
the
pharmacy,
the
language
in
there
actually
says
actual
costs,
which
I
think
is
something
we
could
be
okay
with,
but
the
problem
and
implementation.
There
would
be
that
for
us
to
comply
with
this
state
law,
if
it
actually
does
say
actual
cost
like
it
does
today,
we
would
have
to
require
that
the
independent
pharmacy
or
pharmacist
provide
all
of
their
invoicing
data,
including
rebates,
coupons
or
any
off
invoice
discounts.
B
They
receive
either
from
the
manufacturer
wholesaler
or
their
psao,
and
so
we
would
have
to
get
all
that
information.
So
we
could
comply
with
this
law
section
four,
we're
not
really
sure
if
there's
anything
new
there,
but
you
know
we're
okay,
with
sharing
that
information
section
five
most
of
this
information,
not
all,
but
most
of
this
information
is
already
readily
available
to
the
beneficiary
pbms
use.
B
Sorry,
I'm
lost
my
place
here,
but
there's
secure
scripts
as
well
as
rxhub
to
help
convey
these
benefits
and,
what's
going
on
in
the
pharmacy
benefits
space
to
the
consumer,
and
so
the
three
largest
pbms
already
participate
in
these
programs
today,
and
so
a
lot
of
this
information
that
we're
looking
to
address
in
section
five
is
already
readily
available
to
the
consumer
and
just
real
quickly,
I'm
probably
running
out
of
time.
So
in
closing,
you
know
as
the
entity
that
would
be
regulated
under
house
bill.
1398
there
are.
B
There
are
some
issues
and
some
gaps
and
we
feel
like
it
would
be
somewhat
challenging
for
us
to
actually
implement
this
law
in
reality,
due
to
some
of
the
lack
of
clarity
and
some
of
the
definitions
missing
from
the
legislation,
we
ultimately
also
feel
that
this
legislation
will
drive
up
costs
not
only
to
the
businesses
of
the
state
but
to
your
citizens.
You
know
we
a
lot
of
these
plan
decisions
that
you're
looking
to
regulate
here
will,
in
fact
increase
costs
to
the
citizens
of
the
state.
H
Mr
chairman
trey
moore,
on
behalf
of
pcma,
I
just
wanted
to
touch
briefly
on
the
amendment
that's
before
you,
which,
which
alters
the
bill
as
followed
in
two
very
specific
and
significant
ways.
In
our
opinion,
dealing
with
section
two
and
section
three,
the
the
original
bill
in
both
sections
two
and
sections
three
just
applied
to
pharmacy
benefit
managers,
which
would
would
be
us.
The
amendment
now
applies
section
2
and
section
3
to
a
to
a
pbm
or
a
covered
entity.
H
I
think
we
need
to
just
a
brief
discussion
on
federal
law,
called
the
employee,
retirement
income,
security
act
or
orisa
as
it's
as
it's
known,
I'll
read
you
just
sort
of
a
brief
explanation
that
I've
pulled
from
the
ncsl
website,
which
I
think
sort
of
encapsulates
it
with
regard
to
section
two
that
deals
with
any
willing
pharmacy
law
so
and
it
deals
with
the
erisa
federal
preemption.
So,
as
with
most
state
regulation
of
insurance,
any
willing
pharmacy
laws
generally
apply
only
to
state
regulated
policies,
especially
fully
funded
insurance.
H
What
they
mean
by
that
is
your
individual
market
and
your
small
group
fully
insured
market
and
do
not
apply
to
self-funded
insurance
plans
such
as
those
offered
by
largest
by
the
largest
employers.
Erisa,
creates
rules
and
standards
for
employers
who
choose
to
offer
pensions
and
health
benefits
to
employees.
Erisa
prevents
states
from
imposing
conditions
on
such
erisa
protected
health
insurance
plans,
and
this
is
known
as
preemption
of
state
laws.
H
So
when
we
talk
about
a
self-insured
plan,
we're
talking
about
an
employer
and
it
doesn't
have
to
be
a
large
employer,
although
traditionally
they
were
your
larger
employers
because
they
had
the
capital
to
do
so,
but
you
actually
are
seeing
a
lot
more.
Smaller
employers
move
to
a
self-funded
market
using
stop-loss
insurance,
but
what
a
self-funded
plan
means
is
that
they
don't
actually
have
insurance,
there's
no
transfer
of
risk
to
the
health
carrier.
They
pay
dollar
for
dollar
every
claim
that
hits
their
employees
now
they
may
show
up
at
the
pharmacist.
H
With
a
you
know,
a
big
carrier,
an
insurance
card,
you
know
a
united
card
or
a
blue
cross
card
or
a
cigna
card.
I
don't
want
to
leave
any
of
the
map,
but
but
they
don't
actually
have
an
insurance
product.
What
that
carrier
is
doing
in
that
instance
is
acting
as
a
third
party
administrator
for
that
plan.
So
I
would
say
that
by
including
self-insured
in
this
amendment,
that
is
a
market
change
from
the
policies
of
this
state
that
we've
had
for
a
long
time.
H
There's
questions
like
I
said
over
whether
federal
law
would
even
allow
it.
I
think,
if
that's
our
intent,
then
we
need
to
make
it
clear
on
the
record.
If
it's
not
our
intent,
then
I
think
we,
it
would
make
sense
to
to
also
clarify
that
we
do
not
intend
on
on
including
erisa
plans
in
the
in
the
ending
willing
pharmacy
provision,
as
well
as
the
section
3
of
the
bill
with
the
reimbursement
issues.
But
I'm
happy
to
answer
any
questions.
I
would
final
thought
two.
H
I
So
pbms
took
over
in
in
the
70s
and
80s,
and
you
know
just
a
history
prior
to
that
are
our
drugs
in
the
united
states
cost
we're
a
similar
cost
to
the
rest
of
the
world.
Then
then,
pbm
stepped
in
and
drug
prices
started
skyrocketing
in
the
90s
we've
seen
drug
prices
triple
continue
to
see.
You
know
drug
prices
skyrocket,
so
so,
besides,
besides
seeing
skyrocketing
drug
prices
since
your
existence,
what
good
have
you
actually
done?
I
H
Thank
you.
Thank
you,
representative.
What
I
would
say
is
that
the
order
of
that
statement
might
be
a
little
different
right
in
that
pbms
existed
before
the
rising
cost
of
drugs
and
in
their
traditional
role
process
claims.
I
think,
once
you
saw
list
prices
from
drug
manufacturers
start
to
skyrocket,
employers,
plan
sponsors,
government,
medicaid
programs,
look
to
pbms
to
pool
all
of
that
buying
power
to
help
fight,
help
curb
that
now
granted.
H
F
I
H
I
H
Thank
you,
mr
chairman.
One
key
distinction,
of
course,
is
that
other
countries,
at
the
federal
level
or
at
the
national
level,
set
their
own
prices
for
drugs,
and
so
obviously
we
don't
do
that
in
the
united
states.
We
have
to
buy
these
drugs,
employers
and
and
government
to
help
other
plan.
Sponsors
are
forced
to
buy
these
drugs
on
the
open
market.
They
don't
have
the
benefit
of
a
federal
government
that
is
setting
a
price
nationwide.
H
I
Yeah
that
that's
great
great
response,
I
mean,
I
agree,
I'd
love
to
see
us
set
prices
federally,
but
at
the
same
time,
once
again
you
guys,
you
know,
manage
the
drugs
of
this
country
and
and
we've
seen
them
skyrocket
under
under
your
watch
and
and
before
you
were
in
existence.
We
we
were
relatively
equal
to
those
countries
that
that
do
set
prices
and-
and
we
didn't
at
that
time
either
and
we
were
still
equal
to
them.
So
I'll
just
leave
it
at
that
and
thank
you
responses.
B
E
Good
episode
smith.
Mr
thank
you,
mr
chairman.
I
know
that
there's
66,
but
there's
about
five
that
are
have
about
80
to
90
percent
of
the
market
share.
Is
that
a
fair
statement
and
of
those
four
or
five
that
have
89
percent
of
the
market
share?
Those
are
indeed
owned
by
insurance
companies.
Is
that
accurate
statement
that.
E
Okay-
and
one
thing
you
know
just
to
the
to
follow
up
on
the
comments
that
were
made
earlier
by
my
colleague,
you
know
in
other
countries.
The
reason
that
there
are
no
pbms
is
because
there's
no
insurance
companies,
because
the
government
owns
the
health
care
system.
We
have
there
are
socialized
medicine
and
so
just
to
set
that
into
the
record.
The
reason
that
there
are
no
pbms
in
another
country
is
because
it's
socialized
medicine,
which
we
find
in
this
country.
It
provides
less
care
but
relative
to
the
the
here
and
the
now.
E
In
my
office,
insurance
companies
on
pharmacy
benefit
managers
which
own
specialty
pharmacies,
which
own
other
things
and
we're
seeing
this
vertical
alignment
as
the
costs
go
up,
and
so
is
there
a
role
in
your
opinion
to
return
to
the
assignment
of
benefits
to
the
patient,
so
that
the
patient
pays,
the
patient
shops,
the
patient
demands
value,
the
patient
demands,
transparency
and
the
patient
demands
care.
Thank
you,
mr
chairman.
Thank
you.
B
Thank
you
for
the
question.
I
appreciate
that
so
you
sort
of
started
with
what's
going
on
in
other
countries
around
the
world
right
so
they're,
on
a
single-player
single-payer
system,
where
the
government
runs
healthcare
in
the
united
states
of
america.
We
took
a
different
approach
and
a
lot
of
companies
provide
healthcare
as
a
benefit
to
their
employees
that
they
don't
have
to
provide.
B
They
choose
to
provide
it
to
make
their
workplace
more
attractive
in
a
place
where
these
people
want
to
come
and
live
and
work,
and
they
they
fund
a
significant
portion
of
those
health
care
costs.
And
so
I
don't
think
it's
a
simple
question
of.
Should
we
just
eliminate
the
pvm.
The
pbm
is
a
tool
that
these
clients
use
to
develop
their
program
and
plans
to
benefit
their
employees
at
a
large
area
of
their
costs,
and
so
it
is.
It
is
a
challenging
question.
It's
unique.
B
E
Thank
you,
mr
chairman,
and
I
would
just
like
to
read
into
the
record.
We
hear
a
lot
about
expanding
and
moving
to
a
socialized
medicine
government
system,
but
what
we
have
heard
testimony
today-
and
I
hope
everyone
listening
in
the
public-
is
that
in
countries
where
there
is
socialized
medicine,
there's
no
free
market,
there's
no
competition
and
there's
a
closed
loop
and
it
does
away
with
private
insurance.
E
H
That
is
now
public
chapter
470
that
reads
in
part
a
covered
entity
being
an
insurance
company
or
pharmacy
benefits
manager
shall
not
engage
in
a
pattern
or
practice
of
reimbursing
pharmacies
or
pharmacists
in
this
state
less
than
the
amount
that
the
pharmacy
benefits
manager
reimburses.
A
pharmacy
benefit
manager
affiliate,
so
a
retail
or
especially
pharmacy
that
they
own
for
providing
the
same
drug
or
dispense.
So
there's
a
law
on
the
books.
Now
that
and
it
effectively
eliminates
any
temptation
to
sort
of
play
by
home,
rule
and
pay.
H
F
J
Thank
you,
mr
chair
members,
and,
and
we've
heard
the
explanation
from
the
sponsor
we've
heard
the
support
from
many
of
our
colleagues
in
the
in
the
room,
and
I
voted
in
favor
of
this
in
subcommittee.
Previously.
I
want
you
to
give
me
bottom
line
this
for
me
what
your
perceived
intent
of
the
legislation
is
and
where
you
perceive
that
we
can
do
a
better
job
in
in
working
in
working
in
this
system,
so
just
as
few
words
as
possible.
I
know
we
need
to
move
on
in
and
forgive
me.
J
H
I
guess
in
response
I
mean,
I
think
the
intent
is
what
the
sponsor
is
has
read.
I
mean
I,
we
don't
disagree,
I
guess
on
the
intent.
I
think
our
disagreements
might
be
in
what
the
intent
is
versus
the
language
of
the
bill
and
creating
a
whole
new
framework
of
laws
that
sort
of
do
the
same
thing
as
laws
that
are
currently
on
the
books.
H
I
think
we're
sort
of
creating
a
two
different
sections
of
the
code
with
this
bill,
where,
instead
of
working
within
the
existing
laws,
that
already,
for
instance,
say
that
we
have
to
treat
independent
pharmacies
the
same
that
we
have
to
pay
them
the
same,
that
we
have
to
let
them
in
the
network
if
they
want
to
be
in
the
network.
That
is
all
existing
law.
H
F
Discussion
can
get
very
long,
but
remembering
the
basics,
if
we
will
one
part
of
this
legislation,
is
discrimination
against
340b
entities.
Those
are
entities
that
receive
help
from
the
government
to
purchase
medications
and
drugs
for
the
those
who
cannot
afford.
I
think
that's
a
noble
cause
in
that
situation.
Why
would
you
have
any
objection
to
that.
H
H
Well,
I
I
guess
my
only
response
to
that.
Mr
chairman
would
be
that
we're
neutral,
because
it
we
think
it
basically
codifies
current
practice.
No,
we
we
do
have
reluctance
anytime.
You
set
a
price
control
in
statute
and
set
a
price
floor,
but
but
it's
our
understanding
that
most
of
our
members
are
already
paying
at
that
price
floor
or
reimbursing
of
that
price
floor.
So
we
that's
why
we
haven't
had
an
issue
with
it.
F
H
Well,
I
guess
it
would
be
our
understanding
of
the
existing
law
that
we
can't.
We
can't
offer
them
a
better
price.
We
can't
we
can't
offer
another
pharmacy,
a
better
price
under
the
existing
laws
of
the
state.
So
to
the
extent
that
there
is
steering
going
on,
I
guess
it
would
just
depend
on
how
you
define
steering.
Do
you
send
is
it?
Is
advertising
steering
hey,
come
to
you
know,
publix
and
and
and
fill
your
pharmacies.
F
This
depends
on
how
you
interpret
steering
reminds
me
of
a
famous
phrase
which
says
it
depends
on
what
the
the
meaning
of
the
word
is
is
exactly
going
on
to
the
next
point
about
paying
pharmacies
below
their
acquisition
cost
doesn't
seem.
Fair
public
does
not
like
it.
We
to
us
it's
fairly
clear
and
obvious,
and
it
costs
pharmacists
who
serve
small
communities
and
towns.
That
really
should
not
exist.
Are
you
agreeable
to
that.
B
Real
quick,
I
mean
just
so
the
way
the
language
reads
in
section
3c
of
the
legislation
right
now
and
the
substitute
that
you
all
have
before
you,
it
actually
says
reimburse
them
at
their
actual
costs,
and
so
I
do
think
that'll
present
some
challenges.
There
are
some.
You
know
national
average
drug
acquisition
programs
out
there
that
have
for
the
average
cost
and
what's
what's
important
to
know
when
we
talk
about
spread
pricing
in
particular
in
this
section,
is
that
there
are
some
drugs
where
the
independent
pharmacists
we
reimburse
them.
B
We
we
actually
lose
money
when
we
reimburse
them,
and
so
it
is
sort
of
a
it
is
a
seesaw.
If
you
will,
there
are
some
drugs
that
they
do
get
reimbursed
below
what
maybe
their
acquisition
costs
are,
but
there
are
others
where
they
get
maybe
reimbursed
two
three
four
ten
times
their
acquisition
cost.
So
there
is,
it
is
a
back
and
forth.
F
H
I
guess
the
only
thing
I
would
add
to
that
is
on
aggregate,
and
this
comes
from
the
independent
pharmacist,
national
national
trade
association.
They
publish
an
annual
report
every
year
and
on
on
in
their
latest
one
on
aggregate.
They
have
about
a
22
to
23
percent
margin
on
the
drugs
that
they
sell.
K
K
It's
also
part
of
the
reason
that
we
lose
sight
of
cost
that
goes
for
drugs,
medical
care,
auto
insurance.
You
know
any
number
of
things,
because
it's
no
longer,
in
our
view,
on
a
regular
basis
and
as
consumers,
if
you
don't
see
it,
it's
already
been
taken
out
of
your
check
the
money
to
pay
for
it.
Now
you
don't
really
care
that
much
with
spreading
the
risk
to
everyone.
K
How
do
we
get
with?
And
I
guess
maybe
I
know
the
answer-
I'm
trying
to
ask:
how
do
we
get
people
more
aware
of
what
the
actual
price
of
these
drugs
are
before
they
go
shopping
for
them
from
that
commercial
that
they
saw
or
that
special
that's
running
in
the
pharmacy
window,
or
is
it
just
flat
out
that
the
consumer,
at
the
end
of
the
day,
if
they
don't
have
eyes
on
it,
nothing's
going
to
change?
B
Mr
powers,
thank
you,
mr
chairman,
so
you
know
every
every
year,
when
you
renew
your
health
insurance
plan,
you
get
it.
You
get
to
plan
documents
that
describe
the
benefit,
including
your
health,
insurance
and
then
your
drug
benefit,
and
then
there
are
tools
I
mean,
like
I
mentioned
in
my
testimony,
the
three
largest
pbms
you
have
rxhub,
which
is
actually
an
app
you
can
put
on
your
phone
and
you
can
go
through
and
search
these
things
as
well,
and
then
there
is,
you
know
there
are
oftentimes.
B
When
I
go
to
the
doctor,
I'm
often
told
what
my
prescription
is
and
they
remind
me
that
hey
this
one
may
be
expensive.
You
know
when
my
wife
was
most
recently
pregnant.
She
had
a
lot
of
nausea
and
the
nausea
medicine
that
she
needed.
I
mean
the
doctor
told
us
right
away
that
this
one's
going
to
be
expensive,
and
so
there
is
those
opportunities
of
communication,
and-
and
you
know
it
is
sometimes
you
do
have
to
do
some.
You
have
to
be
your
best
advocate
right.
C
Thank
you
very
much
chairman.
I
don't
know
this
question
can
be
answered
right
now,
but
just
a
thought
for
discussion
as
we
move
through
this.
While
I'm
complete
agreement
with
my
colleague
timo
wright,
who
brought
out,
I
believe
the
free
market
system
is
the
best
way
to
control
prices.
I
think
we
all.
We
all
believe
that
my
question
is
since
healthcare
is
such
a
convoluted
and
complicated
issue
that
we've
done
to
ourselves
over
the
last
couple
generations.
C
Is
there
anything
out
there
that
would
prevent
the
free
market
from
protecting
the
consumer?
I'm
a
big
supporter
of
the
independent
pharmacist,
but
is
there
any
control
out
there
that
would
allow
the
free
market
to
to
work
the
way
it
should
work
in
this
issue?
Do
you
have
any
thoughts
or
comments
on
that.
H
Thank
you,
mr
chairman,
mr
moore,
so
I
guess,
when
you
talk
about
the
free
market
and,
most
importantly,
how
a
free
market
may
drive
down
drive
down
costs,
but
also
improve
quality?
Like
you
see
in
many
sectors,
the
key
there
is
competition
right
and
I
think
where
healthcare
lacks
in
many
cases,
is
either
federal
or
state
regulation
that
actually
hinders
the
competition
within
the
marketplace.
H
Now.
Some
of
that
is
just
you
know,
a
pure
policy
tradeoff
that
legislatures
determine,
for
instance,
and
any
willing
pharmacy
law
that
is
currently
on
the
books
that
that
requires
the
person
paying
for
the
drug
to
do
business
with
anybody
that
wants
to
do
business
with
them,
regardless,
whether
or
not
they
want
to
do
business
with
that
entity
right
and
at
the
federal
level
you
don't
have
competition
or
what
we
would
say.
You
don't
have
as
much
competition
in
the
prescription,
drug
manufacturing
business
because
of
patent
laws
and
fda
exclusivity
rights
that
manufacturers
enjoy.
H
They
get
a
pure
monopoly
for
five,
seven
twelve
years
under
under
federal
law
with
no
competition,
and
they
know
that
they're
not
gonna
have
competition
for
five
seven
twelve
years.
They
also
have
the
ability
to
sort
of
extend
those
that
exclusivity
and
that
monopoly
by
tweaking
you
know,
let's
say
the
the
the
way
the
drug
is
delivered.
The
epipen
is
a
great
example
and
y'all
are
all
familiar
with.
H
C
Thank
you,
mr
chairman,
and
thank
you
all
for
coming
out
today.
Just
briefly,
and
I
don't
want
to
take
a
whole
lot
of
time.
But
could
you
talk
a
little
bit
more
about
the
rebate
system?
I've
never
really
understood
the
what
maybe,
what
the
original
intent
of
it
was
and
why
it
is
needed
when
we're
dealing
with,
and
you
don't
see
that
in
very
many
business
models,
and
so
I
just
wanted
to
get
a
get
a
handle
on
that.
H
H
Thank
you,
representative
powers,
for
that.
We
do
hear
a
lot
about
rebates
and
it's
talked
about
as
if
rebates
are
you
know,
ubiquitous
and
applied
to
every
drug
to
sort
of
set.
The
the
baseline
over
92
percent
of
the
drugs
that
are
filled
at
a
pharmacy
counter
are
going
to
be
generic
right.
So
that's
a
multi-sourced
drug
and
I
someone
would
have
to
point
to
me
a
situation
where
a
multi-source
drug
would
have
a
manufacturer
rebate.
I
think
where
rebates
come
into
play
are
more
with
brand
drugs
that
are
single
source
right.
H
So
just
the
manufacturer
is
making
that
specific
drug
and
there
may
not
be
any
competition
in
the
market
to
the
extent
that
there
are
competing
brands.
You
would
see
you
would
see
manufacturer
verse,
manufacturer
of
different
brands
negotiating
with
pbms
for
a
better
position
on
the
formulary
to
increase
their
sales
and
their
utilization.
H
We
are
buying
technically
buying
the
drugs
we're
paying
for
them
at
the
pharmacy
counter
and
our
reimbursement,
either
on
behalf
of
a
plan
sponsor
or
a
carrier,
is
going
to
the
pharmacy.
So
really
the
only
functional
way
for
the
manufacturer
to
discount,
specifically
to
us,
without
lowering
their
risk
without
lowering
their
list
prices,
which
they
seem
adversely
unwilling
to
do.
The
only
way
for
them
to
give
us
a
discount
is
to
bypass
that
supply
chain
and
to
give
us
a
rebate.
H
It
would
be
no
different
from
going
into
best,
buy
and
wanting
to
buy
a
new
samsung
tv
samsung
doesn't
want
to
lower
its
list
price,
but
they
may
offer
a
rebate
on
that
tv
when
you
walk
in
to
for
a
period
of
time
to
induce
you
into
buying
it,
but
but
it's
not
best
buy,
but
your
money's
going
to
best
buy
you're,
not
buying
that
from
samsung
directly.
So
that's
why
the
manufacturer
same
with
the.
H
C
H
Typically,
yeah
right
so
so
pbms
pool
all
of
these
covered
lives
together
from
different
carriers,
different
employers.
Then
they
go
to
the
manufacturer
and
they
say
you
know
we
can.
We
can
put
your
your
drug
in
a
preferred
position
on
the
on
the
formulary,
because
we
got
we
got
to
put
one
of
them
on
the
formula
right.
H
I
mean
we're
committed
to
providing
the
therapy,
and
you
know
if
that
drug
manufacturer
would
then
offer
discounts
based
on
how
many
basically
units
we
can
almost
guarantee
that
they're
going
to
sell
are
likely
to
sell
so
the
more
we
bring
to
the
table
as
far
as
potential
sales
utilization,
the
more
they're
going
to
discount,
but
it
is
going
to
be
discounted
retroactively
right.
It's
based
off
of
sales,
so
there
is
like
a
six
month
lag.
H
B
B
They
provide
them
to
the
state
government
and
they
also
provide
rebates
to
the
psal,
which
is
an
entity
that
has
been
formed
to
provide
independent
pharmacies
and
pharmacies
very
similar
services
to
a
pbm
and
those
entities
also
partner
with
us
for
their
drug
benefit.
So
there's
a
lot
of
rebates
in
the
system.
Okay,
thank
you,
jim
and.
F
B
Mr
thank
you
thank
you,
mr
chairman,
so
I
think
there's
you
know
we'd
be
willing
to
meet
with
folks
on
some
transparency
related
issues.
The
one
problem
we
have
with
you
know
potentially
like
there's,
been
some
attempts
in
some
places
to
release
trade
secret
information,
and
that
would
be
a
problem
when
we're
trying
to
to
bid
on
a
new
contract
to
actually
drive
down
costs.
B
If,
if
all
the
competitors
in
the
marketplace
know
everything
that
we're
doing
they'll
just
say,
hey
we're
gonna
give
you
that
deal
over
there
and
we'll
lose
our
ability
to
negotiate
a
better
deal
on
behalf
of
either
the
plan
sponsor
and
those
beneficiaries.
And
so
there
are
elements
of
transparency
that
we
can
certainly
work
on
and
we're
happy
to
have
those
discussions.
But
there's
there's
certain
places
that
if
we
go
that
far,
we
will
in
fact
raise
drug
costs.
H
H
I
think
our
biggest
issue
with
section
five
is
that
it
seems
to
be
promoted
not
by
someone
on
behalf
of
a
patient
but
on
behalf
of
a
company
that
was
purchased
by
you
know
a
top
10
fortune,
500
company,
that
that
is
looking
to
monetize
on
this
data,
and
we
don't.
We
have
yet
to
see
a
problem
in
there
that
needs
to
be
addressed
by
by
legislation.
I
think,
but
to
the
extent
that
we
want
to
drive
transparency
to
the
patients,
we
fully.
F
H
H
As
michael
alluded
to
earlier,
so
the
vast
majority
of
pbns,
especially
the
biggest
pbms
that
serve
the
most
lives
utilize
tools
currently
and
pay
for
tools
he
mentioned
surescript,
which
is
a
tool
out
there
in
the
marketplace
that
most
of
the
pbms
use.
There
are
other
tools
out
there,
but
essentially
the
goal
of
that
is
to
put
all
of
that
information
for
the
patient
cost
information.
H
Formulary
information
in
the
patient's
hand,
on
their
you
know,
smartphone,
so
to
speak,
so
that
when
they're
sitting
in
the
physician's
office
and
the
physician
says
you
know
we're
gonna
prescribe
you
humira
that
the
patient
can
look
up
humira
and
see
where
it
is
on
the
formulary
see
how
much
it's
gonna
cost
them
out
of
pocket
and
then
give
them
the
opportunity
to
say
the
physician.
Is
there
something
else
or
is
there
something
that
we
can
do
to
help
me
with
the
cost
there?
Thank.
L
Yeah,
thank
you,
mr
chair,
but
my
idea
of
price
transparency
would
be.
You
know
when
when,
as
I
work
for
a
third
party
administrator-
and
I
send
a
plan
designed
out
to
a
potential
client,
you
know
I
have
the
cost
of
you
know
what
their
stop-loss
is
going
to
cost
them
their
stop-loss
insurance.
I
have
the
cost
of
our
admin
of
their
claims.
L
L
L
You
know
most
of
the
rebates
most
tpas
when
they
get
the
money
they
send
most
of
it
back
to
the
client,
so
that
that
is
cutting
into
the
cost
of
health
care
for
most
tpa,
some
tpas
pocket
all
or
some
of
that,
but
that
that
helps.
That
would
be
the
trice
price
transparency
I
would
think
of
and
and
when
you
suggest
you
know,
read
the
planned
document.
L
B
You
know
I
did
not
meant
to
mean
to
be
misleading,
for
example,
this
year
I
did
actually
read
through
my
document
and
picked
a
higher
plan
to
get
a
lower
monthly
premium,
and
one
month
in
my
daughter
broke
her
arm.
So
I
was
immediately
bid
on
the
back
side
by
having
to
pay
a
pretty
healthy,
a
pretty
hefty
cost
to
have
a
repair
done
to
her
arm,
and
so
I
wouldn't
have
said
it
if
I
didn't,
if
I
didn't
do
it
myself.
Thank
you.
L
H
F
F
G
We
can
say
something
in
closing,
mr
chairman.
Certainly
okay
for
the
year
2021
81
bills
have
been
proposed
in
29
states
related
to
pharmacy
benefit
managers
practices.
There
has
been
much
concern
in
tennessee
regarding
pbms,
but
little
action.
Mr
chairman
and
members.
Now
is
the
time
to
take
action.
I
renew
my
motion.
F
F
M
M
F
M
Thank
you,
chairman
kubar
members.
This
bill
would
allow
for
auto
enrollment
for
long
and
short-term
disability
plans
for
businesses
across
the
state,
employees
can
still
unenroll
within
30
days
and
again,
I
think
at
six.
Yes,
it's
60
days.
This
bill
also
creates
an
f
e
tax
credit
for
those
employers
who
do
participate
in
these
plans.
As
the
members
know,
this
year,
kovit
has
impacted
lots
of
citizens
across
the
state.
If
they
had
been
enrolled
in
short-term
or
long-term
disability
programs,
it
would
have
been
better
for
them
and
their
families.
M
J
K
M
Please
yep!
Yes,
I
appreciate
you
asking
me
that
question
the
fne
tax
credit
would
be
for
the
businesses,
because
they're
automatically
enrolled
into
those.
This
would
give
a
credit
for
those
that
are
impo
that
would
be
employed
there.
I
think
the
the
challenge
for
their
corporate
tax
for
f
e
tax,
it's
an
incentive
for
businesses
to
to
participate
in
these
programs
for
them
to
do
it,
and
that's
the
reason
why
it's
in
the
bill.
It
is
probably,
if
found
favor
in
this
committee.
F
Any
more
questions,
chip
members
well,
thank
you
for
bringing
this
really
for
working
families.
Disability
in
disability
income
is
very
crucial,
as
things
happen
in
life.
Seeing
no
further
questions
without
objection.
We
are
voting
on
house
bill
979
as
amended
all
those
in
favor.
Please
say:
aye
opposed
the
bill.
Moves
on
to
finance.
Thank
you.
F
C
This
type
of
insurance
plan,
which
would
be
if
a
patient,
went
to
a
doctor
and
wanted
to
pay
cash
and
get
that
cash
discount
and
then
be
reimbursed
by
their
insurance
company.
So
there
seemed
to
be
some
confusion
in
the
insurance
market,
whether
or
not
that
type
of
plan
was
allowed.
This
is
simply
clarifying
it.
F
F
F
F
F
F
J
F
J
F
J
Madam
excuse
me,
as
we've
worked
through
this,
we
adopted
a
different
amendment
had
the
same
context
to
it,
but
had
some
preamble
clauses
and
whereas
and
what
four
clauses
in
it
and
I
had
a
50
50
chance
at
picking
the
right
amendment
last
week
in
subcommittee
and
I
picked
wrong.
So
this
amendment
that
we
have
is
the
is
the
same
intent
the
same
language
as
we
passed
in
subcommittee
last
week.
It
just
removes
the
warehouses
claus,
whereas
clauses
and
is
the
same
as
the
senate.
K
J
J
J
Have
a
fiscal
note
on
it
at
all
chairman
hawk
in
the
onset
there
was
thought
that
the
department
of
commerce
and
insurance
would
need
another
employee
to
to
retrieve
this
data.
We
were
reminded
and
reminded
department
of
commerce
and
insurance
that,
as
I
mentioned
in
this
five-year
process,
we've
been
working
on
this.
J
F
F
A
House,
bill
619
would
require
insurance
companies
to
apply
the
value
of
drug
coupons
to
their
enrollees
deductibles.
Many
patients
across
the
state,
especially
those
with
chronic
complex
conditions,
rely
on
copay
assistance
programs
to
afford
their
medications.
These
programs
offer
vital
financial
assistance
to
help
cover
out-of-pocket
prescriptions,
as
co-pays
have
increased
steadily
over
the
years.
These
programs
have
become
more
important
for
tennesseans
house
bill.
619
makes
sure
that
the
value
of
these
co-pay
assistant
programs
counts
toward
patients
annual
deductibles.
A
F
H
H
That
law
goes
on
to
to
dictate.
Actually,
in
some
cases,
the
pharmacist
shall
dispense
a
lower
cost
generic
or
a
lower
cost
brand.
If
it's
available
in
the
pharmacy
and
is
as
a
bioequivalent
from
our
perspective,
I
think
we
certainly
understand
when
there
is
a
high-cost
brand
name
drug
on
the
formulary,
and
it
is
the
only
drug
that
the
patient
can
take
that
that
a
drug
coupon
should
be
should
be
used
to
help
that
patient
offset
their
costs.
H
I
think
our
our
issue
with
the
language
is
is
in
a
scenario
where
that
drug
coupon
is
used
to
get
a
brand
name
drug,
where
there's
either
an
equivalent
brand
or
a
bioequivalent
generic
on
on
the
formulary
and
and
we'd
be
happy
to
work
with
the
sponsor
on
amending
the
language.
To
address
that
concern,
I
would,
I
would
add
that,
10
years
after
that
law
was
passed,
the
speaker
sexton
carried
a
bill
that
had
to
do
with
biologics
and
biosimilars.
H
It
amends
that
same
section
of
the
code
and
deals
with
sort
of
these
high-priced
biologic
drugs
and
now
that
are
going
off
patent,
and
you
have
some
competition
now
through
biosimilars
coming
on
the
market.
You
know
we
think
addressing
that
in
this
bill
would
would
be
good
for
patients
and
the
state
as
well,
but
to
the
extent
that
there's
just
a
single
source
drug
on
on
the
formulary
and
the
patient
it
has
to
have
that
drug.
E
H
And
I
would
add
that
kentucky
passed
a
law
that
addressed
that
issue
with
respect
to
generics.
I
think
we
supported
that
in
kentucky,
and
we
do
hear
the
only
thing
that
I
would
add
to
that
is
this
issue
of
biosimilar
is
just
because
this
legislature
has
been
out
front
sort
of
wanting
a
pharmacist
to
utilize
those.
F
M
Thank
you
I
just
to
your
point
about
if
there's
a
biosimilar
or
a
generic-
and
this
goes
to
the
question
that
we've
had
on
other
issues
in
here
about
medical
necessity,
just
want
your
take
on
this.
If
a
patient
has
been
on
stable
on
a
medicine
and
the
next
year
comes
up,
and
then
they
have
a
coupon
on
the
medicine
that
they're
on,
would
you
not
think
that
they
should
that
should
be
applicable
to
their
to
this
bill?.
H
Mr
moore,
thank
you,
mr
chairman,
and
dr
terry.
Yes,
assuming
that
you
know
the
generic
equivalent
in
the
in
the
physicians,
you
know
discretion.
It
does
not
work
well
right
and
there
are
laws
on
the
books
currently
in
in.
In
that
section,
I
reference
right
where
you
as
a
physician,
can
write,
dispenses
written
right
or,
and
that
directs
the
pharmacist
not
to
substitute
for
the
for
the
biosimilar
or
the
generic,
because,
for
whatever
reason
the
brand
is
is
necessary
and
the
generic
won't
work.
I
guess
my
point
would
be.
K
H
H
That's
correct,
representative,
so
coupons
in
the
drug
space
act
like
they
do
in
the
rest
of
the
world
right.
It's
it's!
It's
a
coupon
from
the
manufacturer
to
to
encourage
someone
to
get
a
drug.
Now,
when
you
talk
about
these
high-priced
biologics,
it
behooves
manufacturers
to
help
a
patient
afford
their
cost
sharing
in
order
to
sell
the
drug
which
are
gonna,
which
you
know
they
can
make,
that
cost
up
from
the
plan
when
they
purchase
the
drug
even
giving
that
discount
to
the
patient
on
the
front
end.
H
F
A
I
would
just
like
to
say
that
my
team,
my
intent,
is
very
elementary
on
this
piece
of
legislation
that
coupon
has
value.
The
value
of
that
coupon
should
go
toward
the
patient's
deductible.
These
patients
sometimes
have
catastrophic
deductibles.
That's
the
only
way
they
can.
They
can
have
insurance.
These
coupons
have
value.
You
spoke
of
2005
and-
and
you
were,
you
know,
the
lower
your
to
lower
cost
to
the
citizens
that
hasn't
happened.
A
A
This
helps
lower
those
deductibles,
so
those
patients
get
the
medication
that
they
need,
and
it
also
smacks
a
little
bit
to
step
therapy
to
me
when
you
talk
about
the
formulary
and
let's
try
this
first
or
that
first
we're
getting
between
the
doctor
and
the
patient.
So
that
is
my
closing
statement.
I
ask
you
to
support
the
patients,
it's
good
for
our
patients
in
the
state
of
tennessee.
They
should
receive
the
value
of
that
coupon.
Thank
you.
Thank
you.
L
Yeah
I
appreciate
mr
chairman
and
sponsor
I
I
support
your
bill,
but
this
just
kind
of
proves
the
point
that
you
know
the
drug
companies
are
overpricing
their
drugs,
so
they're
able
to
give
a
coupon
to
you
know,
take
a
look
away,
a
little
of
their
profits,
but
unfortunately,
what
we're
doing
with
this
piece
of
legislation
instead
of
going
after
the
drug
companies,
we're
making
someone
else
pay
for
the
drug
drug
companies,
greed,
and
so
you
know
it's
good
for
the
consumer,
but
someone
else
is
paying
the
price
for
someone
else's
greed.
Thank
you.
K
Thank
you
chairman.
I
feel
like
I've
taken
a
disproportionate
time
on
this
microphone
today.
So
thank
you,
committee
for
putting
up
with
me.
I
was
mike.
I
maybe
I
think
I
co-sponsored
this
bill.
I
think
I
put
my
name
on
this
bill
sitting
and
listening
to
this
as
tied
together
as
the
pharmacy
benefit
managers.
Are
the
manufacturers
are
the
insurance
company,
the
health
and
this
this
isn't
poking
at
anyone.
This
we've
created
this
over
the
decades.
All
right,
let's
recognize
that
my
concern
is:
will
the
coupons
dry
up
if
we
impact?
K
A
Understanding
that
drug
companies
are
the
ones
a
lot
of
times
that
supply
these
coupons.
So
I
don't
see
that
the
coupons
would
dry
up
because
they're
always
going
to
have
a
new
product
on
the
market,
a
better
solution,
and
that
goes
back
to
the
discussion
between
the
doctor
and
the
patient
as
to
what
that
doctor
thinks
is
best
for
that
patient.
So
I
don't
think,
there's
an
issue
with
drug
coupons
and
that
benefit
going
drying
up.