House Health and Human Services Finance Division 9/26/19

>> GOOD AFTERNOON EVERYONE I WOULD LIKE TO CALL THE HEALTH AND HUMAN SERVICES FINANCE DIVISION TO ORDER. WELCOME EVERYONE I’M DELIGHTED TO SEE SUCH A FULL ROOM; APOLOGIZE FOR THE KEY TO WE REALIZE IT’S RATHER WARM IN HERE AND WE ARE TAKING STEPS TO GET THE HEAT TURNED DOWN I HOPE THAT HE IS A METAPHOR FOR SOMETHING. I’M GLAD TO SEE YOU ALL HERE WE ARE GOING TO GET GOING AND I WANT TO BEFORE WE START WITH THE ATTORNEY GENERAL ELLISON TO GIVE EVERYONE A LITTLE BIT OF A ROAD MAP HERE. THERE HAVE BEEN SOME COMMUNITY CONVERSATIONS AROUND THE STATE TO TALK ABOUT AND TO HEAR FROM IMPORTANTLY TO HEAR FROM PEOPLE WHO ARE AFFECTED BY THE HIGH SKYROCKETING COST OF INSULIN. WE ARE HERE TODAY WE’RE GOING TO HEAR FIRST AN UPDATE FROM ATTORNEY GENERAL ELLISON ON THE ADVISORY TASK FORCE ON LOWERING PRESCRIPTION DRUG PRICES AND WE’RE TAKING THE ATTORNEY GENERAL FIRST BECAUSE HE HAS TO BE SOMEWHERE ELSE WE ARE STARTING WITH HIM; THEN WE’RE GOING TO GO INTO AN UPDATE ON THE COMMUNITY CONVERSATIONS AND TALK SOME MORE ABOUT THE ALEX SMITH EMERGENCY INSULIN ACT AND AT REPRESENTATIVE HOWARD WILL GIVE AN UPDATE ON THAT. WE’LL HEAR FROM SOME ADVOCATES AND THEN WILL HAVE SOME DISCUSSION FOLLOWING THAT WE ARE GOING TO HEAR FROM SOME OF THE HEALTH PLANS ABOUT WHAT THEY HAVE BEEN DOING AROUND THIS SAME ISSUE AND HAVE AN OPPORTUNITY HERE TO HAVE SOME DISCUSSION WITH THEM AS WELL I HOPE. TO GET MOVING WE APPRECIATE EVERYONE BEING HERE; IT’S NICE TO SEE EVERYONE; I KNOW SOME OF US HAVE SEEN EACH OTHER AT DIFFERENT THINGS BUT IT’S GOOD TO BE BACK TOGETHER AND TO DEAL WITH THIS IMPORTANT ISSUE WELCOME ATTORNEY GENERAL ELLISON PLEASE GO AHEAD. >> MADAM CHAIR THANK YOU SO MUCH AND THANK ALL OF THE MEMBERS FOR BEING HERE TODAY. FROM THE CROWD IN THIS ROOM IT’S CLEAR YOUR TOPIC TODAY IS OF PRESSING AND URGENT PUBLIC CONCERN. I WILL ASSURE YOU THE EXPERIENCE OF OUR TASK FORCE ON THAT LOWERING DRUG PRICES AT REFLEXED THE URGENCY AND THE INTEREST OF THIS COMMITTEE HEARING. OUR GROUP IS NON- PARTISAN TO DEMOCRATS TO REPUBLICANS; TO HOUSE MEMBERS TO SENATORS; WE CANNOT AFFORD TO ALLOW THIS CRITICAL ISSUE TO LAPSE UNTIL SOME SORT OF POLITICAL FOOTBALL WHERE PEOPLE’S LIVES ARE ON THE. WE ARE URBAN WE ARE SUBURBAN AND WE ARE GREATER MINNESOTA; WE HAVE A GREAT DIVERSITY IN TERMS OF THE DEPTH BACKGROUND AND EXPERIENCE SOME MEMBERS ARE PEOPLE WHO USE THE MEDICATIONS LIKE THEY DEPEND UPON TO SAVE THEIR LIVES OTHERS ARE PEOPLE WORK IN THE INDUSTRY WE HAVE PEOPLE FROM GOVERNMENT AT THE PRIVATE SECTOR AND WE ALWAYS HAVE MY HANDFUL OF PEOPLE WHO USE THE TIME WE ALLOT FOR PUBLIC COMMENTS. WE ARE ABOUT HALFWAY THROUGH OUR WORK AND WE EXPECT TO HAVE OUR REPORT ISSUED IN JANUARY THE FINDINGS WE PLAN ON HAVING START WITH WORKED THE ATTORNEY GENERAL’S OFFICE IS GOING TO DO BUT WE DON’T BELIEVE IN HAVING TASK FORCE IS JUST TO FIGURE OUT AND A SUGGEST OTHER PEOPLE DO WE TAKE THE RESPONSIBILITY ON OUR OWN SHOULDERS WE WILL HAVE SOME LEGISLATIVE PROPOSALS AND HAVE SOME ADMINISTRATIVE PROPOSALS AND OTHER COMMUNITY PROPOSALS THAT MAY INVOLVE THAT MAY NOT INVOLVE GOVERNMENT AT ALL. WE LOOK AT THIS AS A MULTI PRONGED PROBLEM AND IT MADAM CHAIR INSULIN IS WITHOUT A DOUBT A RECURRING THEME OF OUR TASK FORCE BECAUSE OF THE TREMENDOUS URGENCY A NUMBER OF PEOPLE DO TO RATIONING DUE TO THE HIGH COSTS HAVE LOST THEIR LIVES SO THIS DOES OCCUPY MUCH OF OUR ATTENTION THUS FAR. AS THE PEOPLE’S LAWYER WHICH I CONSIDER MYSELF TO BE I HAVE HEARD FROM PEOPLE IN EVERY CORNER OF MINNESOTA THAT WE ARE HAVING TROUBLE AFFORDING OUR LIVES AND THE COST OF PRESCRIPTION DRUGS IS A MAJOR FACTOR IN THAT. WE’RE ALL UNITED IN ONE SIMPLE IDEA AND WE’RE ENTITLED TO LIVE THEIR LIVES AND DRUG PRICES ARE JUST TOO HIGH SO AGAINST THIS PROBLEM BY FORMING A TASK FORCE OF LOWERING THE COST OF PHARMACEUTICAL DRUGS WE HAVE CHARGED THE TASK FORCE WITH GATHERING IN THE BEST THINKING IN ORDER TO UNDERSTAND WHY THE PRICES OF PRESCRIPTION DRUGS ARE SO HIGH AND IN SOME CASES ARE UNCONSCIONABLY HIGH AND COME UP WITH MULTI PRONGED STRATEGY IS TO LOWER PRICES. THESE WILL INCLUDE LEGISLATIVE LEGAL REGULATORY AND COMMUNITY-BASED STRATEGIES ARE A TOTAL OF ABOUT THE MAKEUP OF OUR TASK FORCE I HOPE YOU WILL INDULGE ME TO MENTION THE NAMES OF SOME OF OUR PARTICIPANTS. OUR COCHAIRS ARE NOW CALLED SMITH-HOLT WHO LOST HER SON DID YOU TO RATIONING AND OF INSOLENT; ALSO ARE CO-CHAIR IS SENATOR JENSEN WHO IS A PHYSICIAN AND ALSO SERVING DISTRICT 47 WE HAVE A NURSE CONSULTANT AT; WHO IS ALSO THE PRESIDENT OF THE BLACK NURSES ASSOCIATION OF GENERAL PEDIATRICIAN AND HEALTH PARTNERS; A PATIENT ADVOCATE; WE HAVE EXECUTIVE DIRECTOR OF THE MINNESOTA NURSES ASSOCIATION; DR. STEVEN SCHONDELMEYER ; DIRECTOR AND PROF. AT THE UNIVERSITY OF MINNESOTA FOREMOST EXPERT ON DRUG PRESCRIPTION DRUG PRICES AND PHARMACEUTICALS; WE HAVE A PATIENT ADVOCATE WHO COMES TO OUR MEETINGS IN A WHEELCHAIR AND COMING UP WITH PROPER OUTCOMES IS DIRECTLY AND PERSONALLY IMPORTANT TO HIM. WE HAVE THE FOUNDER AND CEO OF HEALTH EAST; A PHARMACY MANAGER AT NORTH POINT MEDICAL CLINIC; A NURSE PRACTITIONER; DR. CODY WIBERG EXECUTIVE DIRECTOR OF THE MINNESOTA OF BOARD OF PHARMACY IT WAS HERE TODAY AND A SENATOR MATT LITTLE FROM SENATE DISTRICT 58 REPRESENTATIVE JOHN LESCH FROM HOUSE DISTRICT 66 B AND REPRESENTATIVE ROD HAMILTON FROM HOUSE DISTRICT 22 BE. WE HAVE HAD FOR A FULL TASK FORCE MEETINGS THUS FAR INCLUDING ONE YESTERDAY AND WE HAVE FOUR SCHEDULED MEETINGS REMAINING PUBLIC TESTIMONY HAS BEEN TAKEN AT EACH TASK FORCE MEETING OUR WORK WILL BE COMPLETED AND THE REPORT WILL BE ISSUED IN JANUARY. WE ALSO HAVE LISTENING SESSIONS IN ADDITION TO THE TASK FORCE MEETINGS ONE OF THEM WAS IN READING AND ANOTHER IN CHASKA OF; AND DOZENS OF MINNESOTANS HAVE ATTENDED THESE LISTENING SESSIONS AND PROVIDED CRITICAL INPUT. THE TASK FORCE ALSO IS BROKEN DOWN INTO SMALLER WORKING GROUPS AND THOSE WORKING GROUPS HAVE MET OUTSIDE THE FULL TASK FORCE MEETINGS THE AREA OF THE WORKING GROUPS AND THE FOCUS IN TOPICS HAVE BEEN LEGISLATIVE REGULATORY ACTION; AND THEIR TASK IS TO DETERMINE THE ROLE OF FEDERAL AND STATE LEGISLATIVE AND REGULATORY ACTIONS; THE SECOND GROUP IS CAUSES AND CONTRIBUTORS THEIR TASK IS TO IDENTIFY THE ROOT CAUSES AND CONTRIBUTING FACTORS TO THE INCREASE IN PHARMACEUTICAL DRUG PRICES; 3 IS PASSED CURRENT AND FUTURE STRATEGIES TO CONDUCT A COMPREHENSIVE ANALYSIS OF VARIOUS STRATEGIES THAT HAVE AND COULD BE UNDERTAKEN TO LOWER DRUG PRICES. THOSE ARE THE SUBGROUPS IN THE COURSE OF OUR WORK MADAM CHAIR WE HAD THE OPPORTUNITY TO LISTEN TO A LOT OF PEOPLE AND ALLOW ME TO SHARE VERY QUICKLY THAT IN CHASKA I YOUNG WOMAN TALKED ABOUT HER EIGHT YEAR-OLD SON WAS DIAGNOSED WITH TYPE 1 DIABETES AT 18 MONTHS SHE GOT INVOLVED WITH A LOCAL ORGANIZATION FOR JUVENILE DIABETES RESEARCH AND AS A PARENT ADVOCATE ATTENDED A LUNCHEON SPONSORED BY THE DRUG COMPANY AND FOUND OUT THERE WAS A LAWSUIT AGAINST THEM FOR USING PATIENCE TO MAKE GENERIC DRUGS UNAVAILABLE. SHE SHARED HER SON AS A TYPE 1 DIABETICS AND WHEN HE WAS DIAGNOSED IN 2009 OF BEIL COST $35 THE SAME FILE TODAY COSTS $233 ANDERSON GOES FOR ONE BOTTLE OF EVERY 10 DAYS SO THEY’RE PAYING $700 EACH MONTH SHE WAS DIAGNOSED WITH BREAST CANCER AND PAID 900-8 $800 PER TREATMENT IN THE DRUG COCKTAIL OF ONE DRUG COSTS $2;500 AND REQUIRES AND SHE HAS DIABETES. WE’RE LOOKING AT A NUMBER OF RECOMMENDATIONS WE DON’T HAVE THEM YET THAT’S WHAT WE’RE DOING IS DEVELOPING THE RECOMMENDATIONS. I THINK I CAN TELL YOU A NUMBER OF THINGS WE ARE CONSIDERING OUR FOCUSING ON RECOMMENDATIONS SUCH AS THESE; MINNESOTA AND SHOULD KNOW WHAT IT SPENDS ON PRESCRIPTION DRUG COSTS THE COMMITTEE HAS TALKED ABOUT TRANSPARENCY IN MAKING SURE THE STORY GETS OUT THAT PEOPLE KNOW WHAT THEY’RE BUYING AND I WOULD SAY THAT SOMETIMES IN THIS BODY AND OVER THE COUNTRY THE DEBATE FREE- MARKET APP VS GOVERNMENT INTERVENTION BUT I’VE NEVER MET ANY FREE- MARKET ADVOCATE WHO THINK IT’S OK TO HAVE OPAQUE MARKETS ONE FUNDAMENTAL BASIS OF ANY MARKET STRUCTURE WORKING PROPERLY IS INFORMATION AND THAT IS SOMETHING I THINK WE CAN AGREE ON. NO. 2; MINNESOTA SHOULD ACT AS A PRUDENT PURCHASER OF PRESCRIPTION DRUGS THAT IS THE RECOMMENDATION THAT’S BEEN MADE AND THE COMMITTEE HAS DISCUSSED MINNESOTA SHOULD FACILITATE AFFORDABLE CHANNELS FOR PRESCRIPTION DRUG PURCHASE THINK EXAMPLES INVOLVING INSULIN OF AN EPI PEN AND NALOXONE AND MINNESOTA SHOULD ENCOURAGE AND FACILITATE DRUG PRICE TRANSPARENCY MINNESOTA SHOULD PROHIBIT PERVERSE ECONOMIC BEHAVIOR’S RELATED TO PRESCRIPTION DRUGS SUCH AS IDENTIFYING MARKET LEADERS THAT LEAD TO PERVERSE ECONOMIC CONSEQUENCES THAT MAY LOT OF A COST MINNESOTA CONSUMERS I CAN ASSURE YOU THIS IS SOMETHING THE ATTORNEY GENERAL’S OFFICE IS LOOKING AT INDEPENDENT FROM OUR WORKING GROUP AND I MAY CONCLUDE I KNOW A LOT OF PEOPLE ARE WAITING TO TALK; MINNESOTA SHOULD IDENTIFY AND ADDRESS PRICE GOUGING RELATED TO PRESCRIPTION DRUGS MINNESOTA SHOULD ESTABLISH A PROCESS FOR ENSURING PORTABILITY AND ACCOUNTABILITY OF PRESCRIPTION DRUGS MINNESOTA SHOULD PROVIDE OVERSIGHT OF PBM STOCK MARKET BEHAVIOR IS MINNESOTA IT SHOULD ASSURE PATIENT ACCESS TO PHARMACIST SERVICES FOR EFFECTIVE MEDICATION USE AND MINNESOTA SHOULD SUPPORT RESEARCH ON PRESCRIPTION DRUGS. LET ME WRAP UP BY TELLING MY OFFICE IS NOT SIMPLY RELYING ON THE TASK FORCE AS MUCH AS WE ARE PROUD OF THIS AND WORKING WITH IT. IN ADDITION TO THE TASK FORCE MY OFFICE IS PURSUING LEGAL ACTION NOW ON PHARMACEUTICAL DRUG PRICES AS TO INSULIN SPECIFICALLY MINNESOTA IS CURRENTLY SUING THREE MAIN MANUFACTURERS INCLUDING ELI LILLY AND TWO OTHERS THEY ARE ALLEGING THE PRICE PUBLISHED WAS DECEPTIVE THE CASE REMAINS PENDING BUT JUST THIS MORNING WEEK FILED A RESPONSE TO THE MOTION TO DISMISS WHICH WE ARE VIGOROUSLY OPPOSING OF COURSE THAT IS WHAT OUR MISSION IS. MINNESOTA IS THE FIRST STATE IN THE COUNTRY TO ADVANCE THIS CASE AND KENTUCKY IS FOLLOWING AND NEW YORKERS INVESTIGATING THERE IS A LOT OF BENEFIT AND THE MULTISTATE LAWSUITS WE DO. FINALLY THIS IS MY LAST COMMENT MADAM CHAIR THE COMMITTEE MEMBERS THANK YOU FOR HAVING ME HERE TODAY; THE WORK OF THIS TASK FORCE LOOKS AT COSTS OF ALL PRESCRIPTION DRUGS ESPECIALLY THOSE IN THAT MINNESOTANS RELY ON TO STAY ALIVE INSULIN IS ONE OF THOSE DRUGS I LOOKED FOR A NOTE TO THE REPORT ISSUED IN JANUARY WILL HAVE RECOMMENDATIONS FOR INSULIN AND OTHER WAYS TO LOWER DRUG PRICES AND WITH THAT SAID MINNESOTA WITH DIABETES NEED HELP NOW THEY ARE DYING AND IT WOULD BE PRUDENT FOR TO FOCUS OUR ATTENTION AND HOW WE CAN DELIVER RELIEF NOW. WITH THAT BAT ME AGAIN OFFER MY THANKS FOR YOUR ATTENTION TO THIS CRITICAL ISSUE IT’S SOMETHING WE SHOULD ALL JOIN HANDS TOGETHER AND FIGURE OUT HOW TO SOLVE THIS I WILL SAY ONE PERSON WHO’S NOT ON OUR COMMITTEE WHO’S BEEN AT THE BEGINNING I WANT TO RECOGNIZE A REP BIERMAN WHO’S NEVER MISSED A MEETING HE IS NOT ACTUALLY ON THE TASK FORCE BUT THERE IS CERTAIN LIMITED TO THE MEMBERSHIP HE SHOWED UP ANYWAY. I WANTED TO SAY THANK-YOU TO THE REPRESENTATIVE . >> ATTORNEY-GENERAL ALLISON THANK YOU VERY MUCH FOR THAT PRESENTATION I WANT TO GIVE MY APPRECIATION AND ALL OF OUR APPRECIATION TO ALL THE MEMBERS OF THE TASK FORCE INCLUDING THE EX OFFICIO MEMBER REP BIERMAN FOR DOING THAT HARD WORK AND LOOKING FORWARD TO SEEING WHAT YOU COME UP WITH BECAUSE THIS IS A PROBLEM I THINK PRETTY MUCH EVERY STATE IS WRESTLING WITH THIS THIS IS NOT JUST IN MINNESOTA PROBLEM. HERE IN MINNESOTA WE HAVE A LOT OF CREATIVITY A LOT OF GOOD LINES AND A LOT OF ABILITY TO FORM PARTNERSHIPS AND FIND SOLUTIONS THANK YOU VERY MUCH FOR HELPING ME THAT EFFORT. >> BUT YOU MADAM CHAIR I WOULD ADD MADAM CHAIR THAT OUR COUNTRY AS IT REALLY TAKEN ANTITRUST LITIGATION SERIOUSLY IN THE LAST 40 YEARS IT’S A BIPARTISAN FAILURE IN MY OPINION; THERE WAS A TIME IN THIS COUNTRY WHERE WE WOULD USE THE SHERMAN ACT THE CLAYTON ACT TO BUST TRUST TO MAKE SURE WE HAVE COMPETITIVE MARKETS AND INNOVATION MY OFFICE IS RETURNING TO TAKE ANTITRUST ENFORCEMENT SERIOUSLY WHICH I BELIEVE WILL LEAD TO MORE DIVERSITY IN PRODUCTS AT LOWER PRICES. WITH THAT THAT THERE’S NOTHING ELSE BUT I’M HERE TO TAKE QUESTIONS. >> THANK YOU VERY MUCH WE APPRECIATE. WE’RE GOING TO MOVE ON TO THE UPDATE ON THE COMMITTEE CONVERSATIONS AND TALK ABOUT WHAT IS GOING NOT WITH THE ALEC SMITH EMERGENCY INSULIN ACT AND REPRESENTATIVE HOWARD. >> THANK YOU MADAM CHAIR AND MEMBERS OF THE COMMITTEE. I’M HAPPY TO BE HERE TODAY TO TALK ABOUT THE ALEC SMITH EMERGENCY INSULIN ACT AND UPDATE FOLKS ON THIS BILL THAT’S BEEN MORE THAN A YEAR IN THE MAKING AND AS PART OF THAT I WANT TO TALK A LITTLE ABOUT WHERE WE HAVE BEEN AND HOW WE GOT HERE TO THIS POINT AND EXPRESSED OPTIMISM. WHILE WE HAVE AN OPPORTUNITY TO MOVE FORWARD AND GET THIS DONE AND THIS SHOULDN’T BE A LEFT OR RIGHT ISSUE IT’S A LIFE OR DEATH ISSUE AND IT IS OF UTMOST IMPORTANCE WERE QUICKLY TO PASS THE ALEX SMITH OF EMERGENCY INSULIN ACT TO MAKE SURE NEVER IN MINNESOTA INTO SOME AND LOSE THEIR LIVES BECAUSE THEY CAN’T AFFORD INSULIN THEY NEED TO SURVIVE. HOW WE GOT HERE I WILL MENTION THIS BILL HAS BEEN MORE THAN A YEAR IN THE MAKING AND IT’S A BILL THAT BEGAN BEING FORMED AT THE KITCHEN TABLE WITH NICOLE SMITH-HOLT AND JAMES COULTER AND LISTENING TO THE STORY OF THEIR SON ALEC WHO PASSED AWAY IN WRESTLING WITH THIS QUESTION HOW’D WE STOP THIS; AND MAKE SURE THIS NEVER HAPPENS AGAIN? IT HITS EVERYONE IN THERE … THIS IS WRONG AND SHOULD NEVER TAKE PLACE IN MINNESOTA WE GOT TO WORK WE WORK WITH MINNESOTA’S WITH DIABETES; STAKEHOLDERS; TO TRY TO BUILD A PROGRAM THAT WOULD CREATE A SAFETY NET FOR MINNESOTANS ” SO IF SOMEONE WAS IN THAT IMPOSSIBLE CHOICE OF MEETING THEIR INSULIN WHICH THEY NEED TO SURVIVE AND NOT HAVING THE MONEY TO AFFORD IT THERE WOULD BE A SAFETY NET TO MAKE SURE YOU COULD AVOID THAT AND. WE WORKED TO DEVELOP A STRONG BILL THAT WE PASSED IN THE MINNESOTA HOUSE AND AS WE ALL KNOW THAT BILL WAS BLOCKED BY THE SENATE AT THE END OF THE LEGISLATIVE SESSION AND WE WEREN’T ABLE TO MOVE FORWARD BUT WE KEPT WORKING AND WE HEARD FROM MINNESOTANS ACROSS THE STATE WHO WERE FRANKLY OUTRAGED THAT THIS LEGISLATURE WASN’T ABLE TO GET ACROSS THE FINISH LINE AND THAT PUBLIC PRESSURE FROM MINNESOTANS ESPECIALLY THOSE WITH DIABETES I AT OFFER MY UTMOST GRATITUDE BECAUSE THERE’S NO QUESTION WE WOULD NOT BE IN A POSITION IF NOT FOR THOSE MINNESOTANS CONTINUALLY THE SHARING THEIR BRIEF STORY AND PUSH US TOWARDS ACTION. THERE WAS A BIPARTISAN WORKING GROUP THAT FORMED SENATOR LITTLE INVITED A GROUP AND BICAMERAL LEGISLATORS TO KEEP WORKING ON THE ISSUE AND MEMBERS OF THE HOUSE REPRESENTATIVE MAN AND REPRESENTATIVE MORRISON AND HAMILTON PARTICIPATED IN THAT GROUP I WANT TO THANK THE SENATE AUTHOR SENATOR WIKLUND AND SENATOR JENSEN END AT ABELER OFFERING CONTRIBUTIONS TO THAT GROUP AS WELL. DID A GOOD WORK WE DISCUSSED THE ISSUE AND HAVE PUT SOME OR BIPARTISAN RECOMMENDATIONS AND MADE A STRONG BILL EVEN STRONGER. I WILL TALK ABOUT THAT IN THE BIT WE ALSO STRENGTHEN THE BILL ITS FOR MINNESOTANS ACROSS THE STATE WE’VE HAD MULTIPLE LISTENING SESSIONS ACROSS THE STATE I’VE HEARD FROM MINNESOTANS IMPACTED BY DIABETES AND WE HEARD EMOTIONAL STRONG COURAGEOUS TESTIMONY FROM ALL CORNERS OF THE STATE. FREQUENT STORIES FROM THE ATTENDEES ABOUT RATIONING INSULIN AND TRYING TO DETERMINE THE LEAST AMOUNT THEY COULD TAKE TO PREVENT THEM POINT TO THE HOSPITAL. WE HEARD CONCERNS ABOUT SUPPLIES THE CHALLENGES OF WORKING WITH PROVIDERS TO IN SURE THE MEDICATION IS COVERED ; WE HEARD FROM HEALTH-CARE WORKERS WHO WOULD SEE AN INCREASE IN MINNESOTANS COMING TO THE EMERGENCY ROOM BECAUSE THE PROBLEMS ASSOCIATED WITH AFFORDING THEIR INSULIN WE HEARD OF CONCERNS OF YEARS FROM PARENTS WITH CHILDREN WHAT’S GOING HAPPEN WHEN AGE OF THEIR INSURANCE? AND MANY OF THE DAY- TO-DAY CHALLENGES I WILL SAY I WAS LEFT WITH FROM THOSE HEARINGS FROM MINNESOTANS THAT THIS IS A STATEWIDE PROBLEM THAT AFFECTS US IN EVERY CORNER OF THE STATE EVERY COMMUNITY YOUNG AND OLD AND THE SCOPE OF THE CHALLENGE IS EVENTS AND THIS BILL EMERGENCY INSULIN BILL WOULD TACKLE THE JOB NUMBER ONE TO MAKE SURE NO ONE IS LOSING THEIR LIFE THIS IS AN ISSUE WE NEED TO WRESTLE WITH GOING FORWARD. THE OTHER TAKE AWAY I WAS LEFT WITH MORE THAN ANYTHING WAS THIS THE FEELING OF FEAR AT SOME FAMILIES AND MINNESOTANS FACED. THEY MAY HAVE A HANDLE COVERAGE NOW TO COVER THEIR INSULIN BUT WHAT IF THEY DON’T? WHAT IF MY DAUGHTER WAS 18 AS YOU HEARD AT IN RICHFIELD WHAT HAPPENED WHEN SHE AGES OF OUR INSURANCE WHAT HAPPENS IF I LOSE A JOB AND MY COVERAGE GOES AWAY? THAT STRIKES AT THE HEART OF WHY THIS BILL IS SO NECESSARY WE ABSOLUTELY NEED A SAFETY NET SO MINNESOTANS HAVE THAT SECURITY AND GUARANTEED WITH THE DRUG THAT IS LIFE NECESSARY THERE’S A SYSTEM IN PLACE TO MAKE SURE THEY’LL HAVE ACCESS TO IT ON AN EMERGENCY BASIS. THAT I WANT TO WALK THROUGH THE BILL; IN PARTICULAR FOCUS ON AREAS THAT HAVE BEEN IMPROVED UPON SINCE WE WERE BEFORE THIS COMMITTEE TALKING ABOUT THE ALEC SMITH’S BILL DURING SESSION. IT’S VERY SIMILAR BUT I WOULD SAY IT’S STRENGTHENED IN A NUMBER OF WAYS IT’S STRUCTURED VERY SIMILAR TO PROVIDE A SAFETY NET FOR MINNESOTANS MOST IN DANGER OF BEING IN AN EMERGENCY AND NOT BEING ABLE TO AFFORD THEIR INSULIN. WE’RE PUTTING A STRUCTURE IN PLACE THAT’S PAID FOR BY THE INSULIN MANUFACTURERS THAT PROFITED WHILE PRICES WENT UP AND DUMPED. THE CHANGES I WANT TO MENTION FIRST OF ALL WE HAVE REDUCED THE BARRIERS FOR PATIENTS TO ACCESS INSULIN. I WANT TO THINK MEMBERS OF THE BIPARTISAN WORKING GROUP IN PARTICULAR SENATOR JENSEN AND ABELER WORKING ON THIS ISSUE WE’VE DEVELOPED IN OUR PROGRAM IF THE MINNESOTANS IN NEED OF INSULIN TAKEN ON A TEST TO THEIR NEED AT A PHARMACY AND GET AN EMERGENCY SUPPLY A 30 DAY SUPPLY OF INSULIN THAT DAY IN THE PHARMACY WE THINK THAT’S INCREDIBLY IMPORTANT AS WE’VE HEARD FROM MINNESOTANS THIS IS A DANGEROUS NOT HAVING A SUPPLY IS A DANGEROUS ISSUE THAT CAN ESCALATE QUICKLY WE CAN AFFORD HAVE MULTIPLE WEEKS LEAD TIME BEFORE PEOPLE HAVE ACCESS THAT WOULDN’T BE AN EMERGENCY ACCESS PROGRAM WE REDUCE THE BARRIERS. WE’VE ALSO INCREASE THE ELIGIBILITY FROM CONVERSATIONS WE HEARD FROM MINNESOTANS AND AGAIN THERE WAS A SUGGESTION FROM SENATOR JENSEN WE’VE INCREASED ELIGIBILITY UP TO 400 PERCENT OF THE FEDERAL POVERTY GUIDELINES TO 600 PERCENT AND INDIVIDUAL COULD BE EARNING UP TO $70;000 PER YEAR. WE HAVE ALSO INCLUDED LANGUAGE THAT STRIVES TO CONNECT MINNESOTANS IN A BETTER LONG TERM RESOURCES TO MANAGE THE COST OF INSULIN BECAUSE WE KNOW THE JOB NUMBER ONE IS TO ADDRESS THE EMERGENCY THAT MINNESOTANS MAY FIND THEMSELVES AND WE ALSO WANNA MAKE SURE WE ARE CONNECTING RESOURCES THAT ARE AVAILABLE ON WHETHER IT BE INSURANCE COVERAGE OR OTHER PROGRAMS THAT HELP SERVE THEM WELL. LASTLY WE KNOW ACCOUNTABILITY IS IMPORTANT ADDED TO REPORT BACK TO THE LEGISLATURE TO BETTER UNDERSTAND HOW THE PROGRAM IS BEING UTILIZED IN A PERFECT WORLD THIS BILL WOULDN’T BE NECESSARY I HOPE AFTER WE PASS THIS BILL THAT CAN GO WAY BECAUSE WE SOLVE THIS PROBLEM AND WE WANT TO REPORT BACK TO THE LEGISLATURE HOW WE CAN UTILIZE AND IMPROVE UPON IT AS A MENTIONED THE BILL IS A PAYMENT STRUCTURE THAT ASKS INSULIN MANUFACTURERS TO PAY A FEE TO COVER THE COST OF THE PROGRAM AND WE THINK THAT’S VERY IMPORTANT. A BOTTLE OF INSULIN THAT COSTS ABOUT $30 IN THE 1990’S NOW COSTS OVER $300 WE KNOW THE INSULIN MANUFACTURERS CONTROL THE ENTIRE MARKET AND A BREAK IN THE PROFITS OF BILLIONS AND BILLIONS OF DOLLARS WE BELIEVE A MODEST FEE IT WOULD BE A SLIVER OF THE PROFITS OF THOSE COMPANIES TO ENSURE ” THEY’RE HAVING A STAKE IN SOLVING THE PROBLEM IS MORE THAN FAIR. I DID WANT TO COMMENT BRIEFLY ON THE SENATE PROPOSAL THAT WAS OFFERED LAST WEEK AND PROVIDES IT GIVES ME OPTIMISM AS WE MOVE FORWARD THE SENATE AND AS A WORTHY CONCEPT IN PARTICULAR THEIR PLAN IS CONCERNED ABOUT TRYING TO DEVELOP LONG-TERM SOLUTIONS FOR FOLKS ON INSULIN BUT TO BE CLEAR IT ISN’T AN EMERGENCY PROGRAM; THAT’S JOB NUMBER ONE. THEIR GOAL IS CONNECTING FOLKS TO LONG- TERM HEALTH CARE OPTIONS IS WERE THE I’M OPTIMISTIC WE CAN ADDRESS THE EMERGENCY CRISIS IN OUR BILL AND IN ADDITION TO WORK TOGETHER TO TACKLE THE LONG-TERM CHALLENGES. LASTLY I WANT TO EXPRESS OPTIMISM WITH THE SENATE AGREES DOES NOT AGREE THAT IN SOME MANUFACTURERS THE PROGRAM IS ASKING AND SOME MANUFACTURERS TO PAY A BIG STUMBLING BLOCK AT THE END OF THE LEGISLATIVE SESSION WE’VE REACHED CONSENSUS ON THAT ITEM I BELIEVE HELPS US TAKE AN IMPORTANT STEP TO GET THIS DONE. LASTLY BEFORE WE HEAR FROM THE TESTIFIERS MY OTHER COMMENT IS WE SHOULD STILL FEEL THAT SAME PRESSURE WE FELT ON THE LAST DAY OF THE LEGISLATIVE SESSION TO GET THIS DONE BECAUSE IT’S NOT THE RADICAL IT’S A LIFE-AND-DEATH ISSUE. SINCE OUR SESSION ADJOURNED AT WE’VE LOST ANOTHER MINNESOTA WHO RATIONED INSULIN AND WE’D ASK OURSELVES ARE WE COMFORTABLE WITH ANY MORE MINNESOTANS HAVING A THAT DECISION THE ANSWER SHOULD BE A RESOUNDING NO WE NEED TO WORK TOGETHER SO NO ONE EVER AGAIN LOSES THE LIKE BECAUSE THEY CAN’T AFFORD INSULIN THEY NEED TO SURVIVE BANK YOU MADAM CHAIR. >> THANK YOU REPRESENTATIVE HOWARD I APPRECIATE THAT I APPRECIATE YOUR ASSISTANCE IN ORGANIZING THOSE COMMUNITY CONVERSATIONS AND A LOT OF US WERE AT THOSE. I HAVE TO TELL YOU I WISH EVERYONE THERE WERE SO HEARTBREAKING; THE STORIES WE HEARD AND I THINK YOU’RE SO RIGHT ITS THE EMERGENCY ASPECT OF THIS IS HOME PORT IN THE IDEA FOR PEOPLE THERE IS A SAFETY NET EVEN FOR PEOPLE WHO MAY NEVER NEED GET THAT IT’S A THERE. ONE OF THE THINGS I HEARD IN SOME OF THESE MEETINGS IS EVEN THE ANXIETY ON PEOPLE WHO USE INSULIN FOR TYPE ONE AND HOW THEY’RE AFFECT THEIR BLOOD SUGAR AND THE PAIN AND AGONY OF THE INSECURITY WE HEARD WAS JUST THIS IS GOING ON AS YOU SAID EVERYWHERE IN OUR STATE THE OTHER THING THAT BROUGHT HOME TO ME WITH THIS COULD BEAT ANY OF US BECAUSE MANY OF THE PEOPLE WE HEARD FROM SOME OF THEM BECAME DIABETICS IN CHILDHOOD OTHERS LATER IN LIFE I THINK WE HEARD FROM ONE WOMAN WHO MUST OF BEEN PERHAPS IN HER FIFTIES WHEN SHE SUDDENLY BECAME TYPE ONE. THAT WAS KIND OF WITHOUT WARNING IF I REMEMBER IF ANYONE THINKS THEY’RE IMMUNE TO THIS THINK AGAIN NEITHER WE OR OUR FAMILIES ARE IMMUNE THIS IS SOMETHING THAT CAN AFFECT ANYONE OF US AT ANY TIME AS A STATE IT BEHOOVES US TO HAVE OF AT THE VERY LEAST A SAFETY NET AS YOU SAY NO ONE SHOULD DIE FROM LACK OF INSULIN. IT SHOULD BE AND NEVER EVEN LIKE TO TALK ABOUT HOSPITALS SHOULD NEVER CUT OFF THE WRONG LEG NO ONE SHOULD NEVER DIE FROM LACK OF ACCESS TO INSULIN. THANK YOU VERY MUCH I WILL CALL UP NOT IN A CALL AND SMITH-HOLT AT SOME DATE SCHERER- BOYD IF YOU WOULD WANT TO BOTH COME UP TOGETHER. WELCOME TO THE COMMITTEE IF YOU WOULD PLEASE INTRODUCE YOURSELVES AND GO AHEAD AND TELL US WHAT YOU’D LIKE US TO KNOW. >> THANK YOU MADAM CHAIR AND COMMITTEE MEMBERS I’M NICOLE SMITH-HOLT AND I’M THE MOTHER ALEC SMITH. DID YOU HEARD THE STORY OF HOW IN 2017 ALEC DIED FROM RATIONING IS INSULIN BECAUSE IT COULD NOT AFFORD TO PAY THE $1;300 BILL AT THE PHARMACY. BECAUSE YOU HEARD ABOUT HIS DEATH ALREADY I WILL RETELL THE STORY WE’RE HERE TODAY TO TALK ABOUT THE IMPLEMENTATION OF THE ALEX SMITH EMERGENCY INSULIN BILL I BELIEVE THIS BILL SHOULD BE CREATED AND PASSED IMMEDIATELY IT’S THE TRUE NEED FOR THOSE IN MINNESOTA WHO ARE TYPE 1 DIABETICS. MINNESOTA NEED THIS THIS BILL IT’S A SAFETY NET FOR ALL OF THOSE WHO REQUIRE INSULIN TO STAY ALIVE. WE SHOULD ALSO MAKE SURE THE INSULIN MANUFACTURERS HAVE THE RESPONSIBILITY OF PROVIDING FUNDING FOR THIS BILL. ELI LILLY AND THE OTHER MANUFACTURERS RAISE THE PRICE OF INSULIN OVER TWO UNDER PERCENT MAKING THIS PRODUCT THAT NEARLY HALF A MILLION MINNESOTANS RELY ON UNAFFORDABLE. WE ALL REALIZE MOST PEOPLE ARE ONE PAYCHECK AWAY FROM HOMELESSNESS ONE CRISIS AWAY FROM BANKRUPTCY IF THEY ARE TYPE WANT A CHANGE IN JOBS THAT THIS TURNING AGE 26 OR A DIVORCE OR EVEN AN UNEXPECTED CAR REPAIR COULD MEAN LIFE OR DEATH. FAR TOO MANY AND TOO OFTEN PEOPLE WORE PLAIN FED UP THEY’RE EXHAUSTED THEIR TIRED OF THE FINANCIAL BURDEN OF THIS DIAGNOSIS. PEOPLE ARE ACTIVE LATE GIVING UP ON THAT LET THEIR PLANNING THEIR OWN FUNERALS IT BREAKS MY HEART TO HEAR THIS BECAUSE DIABETES HAS COME SO FAR OVER THE YEARS. THE OUTLOOK IS SO MUCH BETTER THAN IT WAS 50 YEARS AGO ON FORTUNATELY THE FINANCIAL ASPECTS OF THIS DISEASE IS TAKING PEOPLE BACK 100 YEARS TO WIN THIS DISEASE WAS A DEATH SENTENCE. I SPENT AN AVERAGE OF 10 HOURS A WEEK AND INSULIN SUPPLIES IN DONATIONS AND GIVING THEM TO PEOPLE IN NEED WHEN IS IT ACCEPTABLE TO RELY ON THE GENEROSITY OF OTHERS TO STAY ALIVE? I PERSONALLY COULD NOT IMAGINE DEPENDING UPON A BROKEN SYSTEM OR THE KINDNESS OF OTHERS FOR THE GIFT OF LIFE. THE RATES OF DIABETES DIABETIC KETO ACIDOSIS AND HOSPITALIZATIONS FOR ADULTS HAS DOUBLED WHAT THEY ARE IN CANADA CAN YOU GUESS WHY CALL? COST IS ONE REASON CANADA IT PAYS ONE 10TH FOR THE SAME PRODUCT THAT WE USE HERE THE OTHER REASON WOULD MOST LIKELY BE BECAUSE IN CANADA INSULIN IS SOLD OVER THE COUNTER WITHOUT A PRESCRIPTION SO THIS IMPROVES ACCESSIBILITY. MANY PEOPLE WHO USE INSULIN CARE STRUGGLE WITH THEIR INSURANCE COMPANIES TO EVEN GET ACCESS TO IN SOMEONE. IN YOUR KNOWLEDGE DOESN’T BRING DOWN NOT PRESIDENTS WHEN BUT FOR NOW FOR THE IMMEDIATE CRISIS PEOPLE FIND THEMSELVES IN WE NEED TO PASS THIS EMERGENCY BILL WE NEED TO HOLD MANUFACTURERS ACCOUNTABLE AND SAVE LIVES. THIS BILL WOULD HAVE SAVED MY SON ALEC AND SAVED JESSE IF WE CAN SAVE JUST ONE MORE LIFE FROM ALL THIS HARD WORK AND DEDICATION; ON THIS AMAZING TEAM I THINK WE WOULD BE SUCCESSFUL THANK YOU. >> THANK YOU VERY MUCH WELCOME. >> MY NAME IS CINDY SCHERER- BOYD MY SON PASSED AWAY 90 DAYS AGO DUE TO INSULIN RATIONING. THAT ALEC SMITH EMERGENCY INSULIN ACT WAS NOT PASSED ON MAY 20TH OF THIS YEAR AT THAT TIME THOSE WHO DEFENDED MADE INACCURATE STATEMENTS ABOUT TYPE 1 DIABETES INSULIN USE AND AVAILABILITY. IT SEEMED THEY DID NOT GRASP THE EMERGENCY 30 DAYS LATER ON JUNE 28TH I FOUND IT MIGHT 21 YEAR-OLD SON A PERSON LIVING WITH TYPE 1 DIABETES ; AND DAD FROM DIABETIC KETO ACIDOSIS. ON APRIL 4TH HE WAS HOSPITALIZED WITH DIABETIC KETO ACIDOSIS IN THE HOSPITAL HE ADMITTED BECAUSE OF SOME FINANCIAL DIFFICULTIES HAVE BEEN RATIONING IS INSULIN. HE HAD INSURANCE HE WORKED FULL TIME BUT WITH THE PROHIBITIVE COST OF INSULIN HE COULD NOT AFFORD WOULD BE NEEDED TO LEFT. I ASKED MYSELF HOW JUST MONTHS LATER DID WE FIND IT JESSE IN HIS HOME HAVING DIED FROM DIABETIC KETO ACIDOSIS HOW COULD THIS BE? WE HAD JUST SEEN IN TWO DAYS BEFORE ANY SEEMED SO HEALTHY. I WILL TELL YOU HOW; DIABETIC KETO ACIDOSIS CAN DEVELOP IN LESS THAN 24 HOURS THE DETECTIVES WHO CAME TO HIS HOUSE DETERMINED HE DID NOT HAVE THE INSULIN HE NEEDED TO KEEP HIM ALIVE. JESSE DIED THE DAY BEFORE HE WAS PAID HE WAS TRYING TO RATION HIS INSOLENT TO MAKE IT TO THE NEXT PAYDAY. EVERY DAY IT IDEAL TO PAY A FINDING MY SON DEAD DEAD BECAUSE HE DID NOT HAVE THE INSULIN GENE NEEDED TO KEEP HIM ALIVE IT ANGERS ME TO KNOW PHARMACEUTICAL COMPANIES ARE CHARGING AT HISTORICALLY HIGH PRICES FOR INSULIN WITH NO EXPLANATION AND CHILDREN ARE DYING ARE PLAYING RUSSIAN ROULETTE WITH THEIR LIVES BECAUSE OF THE COST. WE NEED ALEC SMITH OF EMERGENCY INSULIN ACT PASSED SO WE MAY SAVE OTHER LIVES WHO ARE FACING THE SAME ISSUE THAT JESSE FACED WE NEED THE BILL PASSED SO PEOPLE CAN GET PRESCRIPTIONS FILLED ON AN EMERGENCY BASIS AND IN THE DRUG MAKERS TO PAY FOR AT. STUDIES INDICATE A ONE IN FOR DIABETICS HAVE RESORTED TO RATION THEIR INSOLENT AND DUE TO LACK OF ACCESS TO AFFORDABLE INSULIN ARE WE REALLY GOING TO RISK LOSING ANOTHER DIABETIC BECAUSE WE CAN MAKE A DECISION AND GET THIS BILL PASSED? THE EMERGENCY ACCESS IN THIS BILL IS CLEAR THE EMERGENCY IS PASSING THIS BILL NOW TIME IS PRECIOUS AND I WISH I HAD MORE TIME WITH JESSE. DON’T TAKE TIME AWAY FROM ANOTHER MOTHER FATHER BROTHER OR SISTER OF ANOTHER PERSON WHO’S INSULIN DEPENDENT PLEASE PASS THE ALEC SMITH EMERGENCY INSULIN ACT. >> THANK-YOU VERY MUCH THANK YOU FOR BEING HERE TODAY AND I KNOW JUST WHAT THE AUDIENCE KNOW WE CAN’T RESPOND AND I APPLAUD HERE AT THE HEARINGS WE APPRECIATE YOU BEING HERE AND YOUR ACTIVISM BECAUSE WE DO KNOW THIS IS AFFECTING SO MANY PEOPLE THAT ONE IN FOUR FIGURE IS REALLY PRETTY SHOCKING ONE FOR DIABETICS ARE ACTUALLY RATIONING THEIR INSULIN. >> IT’S PROBABLY MORE THAT WAS JUST THE NUMBER THAT REPORTED THE RATIONING THERE’S A LOT OF SHAME BEHIND IT THE BASIC SUPPLY . >> MISS SMITH-HOLT I’M WONDERING IF YOU’RE ABLE TO TALK A LITTLE ABOUT THE DIFFERENCE BETWEEN THE ALEC SMITH EMERGENCY INSULIN ACT AND THE BILL THAT WAS INTRODUCED IN THE SENATE I ASSUME YOU; TRACK YOU COULD TO MAKE IT CLEAR TO PEOPLE WE’RE NOT SAYING THAT’S THE BILL THAT’S A DIFFERENT VERSION. >> FROM MY STANDPOINT THE TWO BILLS WOULD GO HAND-IN-HAND WITH EACH OTHER. THE ALEC BILL WE’VE TOUCHED ON THAT IS FOR EMERGENCY SITUATIONS WHILE THE SENATOR PRATT BILL IS MORE OF AN URGENT THAT’S HOW THEY DESCRIBED IT AT THE SENATE HEARING I COMPLETELY AGREE WITH THAT. IT IS MORE OF A ONCE WE GET OUT OF THIS EMERGENCY SITUATION THIS IS THE SECONDARY BILL THAT WOULD HELP. I BELIEVE THEY WOULD GO HAND IN HAND. >> THANK YOU. AT THIS POINT WE COULD PROBABLY TAKE SOME QUESTIONS FROM MEMBERS OR ENTERTAIN DISCUSSION WITH MEMBERS ARE INTERESTED IN THAT. REP. CANTRELL DID YOU WANT TO MAKE A STATEMENT? >> NOT AT THIS TIME MADAM CHAIR. I PROBABLY WILL BE. >> REPRESENTATIVE MUNSON. >> THANK YOU MADAM CHAIR REPRESENTATIVE HOWARD WE’VE HAD A LOT OF DISCUSSIONS ON THIS EAVES SIT NEXT TO THEM FOR ANSWERS ABOUT FROM THE CHANGES YOU’RE PROPOSING TO MAKE IN THE BILL. IT’S ABOUT EXPANDING THE COVERAGE FOR PEOPLE TO GO DOWN TO SIX UNDER PERCENT OF THE POVERTY LEVEL FOR FAMILY OF FOUR TO OVER $150;000 A YEAR. DID YOU HAVE A NEW SYSTEM ON THIS BILL? >> MADAM CHAIR AND REPRESENTATIVE MONTH AND WE’RE WORKING ON ONE WILL HAVE ONE SOON. THERE HAS BEEN NOT ONLY DID IT CHANGE BUT CHANGES IN THE INSURANCE MARKET WE HAVE A FEW INSURERS WHO FRANKLY STEPPED OUT NOW THAT THE STATE HAS BEEN REDUCING COPAYS AND THAT MAY HAVE IMPACT ON THE FISCAL NOTE AS WELL. JUST AN ASIDE THEIR WE’VE SEEN SOME OF THE INSURER’S STEPUP. WE HAVEN’T SEEN MANY OF THE MANUFACTURERS’ STEPPED-UP THAT’S STILL A CRITICAL PIECE FROM MY CONVERSATIONS I WOULD ESTIMATE THE FISCAL NOTE MAY NOT LOOK ALTOGETHER DIFFERENT FROM THE BILL WE HAD BEFORE US DURING SESSION. >> MADAM CHAIR THANK YOU. REPRESENTATIVE HOWARD K. YEUTTER ANSWER I CAN IMAGINE ” MOVING THE LEVEL OF ABILITY UP TO $150;000 WOULD ENCOMPASS AN ENORMOUS AMOUNT OF MINNESOTANS AND THE BILL TALKS ABOUT YOU CHANGE THE LANGUAGE IN THE VERSION TO INCLUDE PEOPLE WHO HAVE INSURANCE BUT RATHER TO DOUBLE UP THE BOAT IS OVER $12;000 WHICH IS THE LARGE PERCENTAGE OF THE PRIVATE MARKET THEY HAVE INSURANCE AND BIGGEST HAVE DEDUCTIBLES WE HAVE TO MEET. ONE THING ONE ASK YOU HOW THIS FEE IS CALCULATED FOR THE INSURANCE COMPANIES FOR THE INSULIN MANUFACTURERS? WE DISCUSSED BEFORE I THINK THIS IS GOING TO BE A FEE THAT’S PUT BACK ON THE CONSUMERS OF INSULIN FROM THE PEOPLE WHO DEALT ARE IN THE PROGRAM WILL HAVE TO PAY A HIGHER COST OF A FUND WITH A FEE IS CALCULATED IN THE BILL IS LET’S SAY YOU HAVE THREE DRUGS IT BEEN OFFERED AS AN EXAMPLE THREE DIFFERENT MANUFACTURERS ONE MANUFACTURER SELLS AT $100 PER UNIT ONE SELLS AT $300.10 AT $900 TO EACH CELL THE SAME 3000 UNITS A YEAR SO THE TOTAL COST OF THE PROGRAM IS $30 MILLION PLUS $5 BILLION THAT THE STATE GOING TO CHARGE $5 MILLION FOR THE ADMINISTRATOR PROGRAM OF THE TOTAL COST OF $30 MILLION THE WAY THE BILL IS DESIGNED EACH MANUFACTURER PAYS A PRO RATED PERCENTAGE OF THE FEE FOR THE PROGRAM THE MANUFACTURER WOULD BE CHARGED $10 MILLION AT THE MANUFACTURER’S SELLING AT ONE NIGHT THE COST AS CORN TO PAY THE SAME SOMEONE’S CHARGING NINE TIMES THE COST YOU’RE CREATING A PERVERSE INCENTIVE FOR THE INSULIN MANUFACTURERS TO INCREASE THE RATE SO THEY ARE THE MOST EXPENSIVE INSULIN IN MINNESOTA. THEY CAN’T INCREASE THE FEE TO OTHER STATE BECAUSE THAT WOULD BREAK THE I CONSTITUTION COMMERCE CLAUSE THE HAVE TO DIRECT THE FEES BACK TO PATIENTS WITHIN THE STATE OF MINNESOTA. I CAME TO THE CAPITAL TO LOWER HEALTH-CARE COSTS AND PROGRAMS LIKE THIS WHICH ARE WELL INTENDED WOULD DIRECTLY INCREASE THE COST OF INSULIN FOR PEOPLE NOT ON THIS PROGRAM AND THE CALCULATIONS FOR THE FEED DOES THAT AT ONE OF MY BIGGEST CONCERNS ABOUT THE BILL. >> REPRESENTATIVE HOWARD. >> MADAM CHAIR; I WOULD DISAGREE WITH SOME OF THE PREMISE AND SOME OF THE NUMBERS YOU PUT OUT THERE. IT ESSENTIALLY WE’RE ASKING THESE THREE LARGE INTO THE MANUFACTURERS TO PAY FOR THEIR PROPORTION THEIR SHARE OF THE MARKET IN MINNESOTA I’VE PROVIDED AN EXAMPLE FOR FOLKS ELI LILLY LAST YEAR DID $25 BILLION OF BUSINESS THEY ALSO PAY THE FEDERAL TAX EFFECTIVE TAX RATE OF $0 WE’RE ASKING IN THIS BILL POTENTIALLY PAY A FEW MILLION DOLLARS A YEAR SO GET OUT YOUR CALCULUS AND DO THAT THIS IS A SLIVER OF A SLIVER OF THE PROFITS I SERIOUSLY DOUBT IT FOR AFFECT THE RATES OF DRUGS AND THE SECOND POINT IS THEY’RE ALREADY DOING IT EVERY SINGLE DAY EVERY SINGLE YEAR THE PHARMACY COMPANIES ARE JACKING UP THE PRICE FOR MINNESOTANS. THE NOTION WERE GOING TO DO THE IS BIDDING FOR THE PHARMACEUTICAL COMPANIES I REJECT ON ITS FACE AND THEY NEED TO BE HELD ACCOUNTABLE I JUST WANT TO UNDERSCORE AGAIN THIS SENATE PLAN ALSO ASK MANUFACTURERS TO PAY THAT’S ACTUALLY AN AREA WHERE WE FOUND A WAY TO REACH CONSENSUS AND I BELIEVE HELP US MOVE FORWARD. >> THANK YOU REPRESENTATIVE HOWARD I ALSO WANTED TO COMMENT ONE OF THE THINGS I LEARNED WAS REALLY BROUGHT TO MY ATTENTION WHEN I WENT TO THE COMMUNITY CONVERSATIONS THERE ARE MANY FAMILIES WITH MORE THAN ONE PERSON WHO NEEDS THIS INSULIN. I DON’T NOT HOW EXACTLY WE CAN ACCOUNT FOR THAT IN THE BILL BUT HAVING HIRE FRESH HOLD A GUESS IT SOUNDS LIKE IT’S PRETTY HIGH ELIGIBILITY THRESHOLD BUT IF YOU HAVE TWO OR THREE PEOPLE USING INSULIN AND YOUR FAMILY AT A LOT OF MONEY AND APPARENTLY SOMETHING WE HAVEN’T YET TACKLED IS THE COST OF SUPPLIES WHICH IS ALSO A HUGE. IT MAY SOUND LIKE A PERSON IS MAKING A FAIR AMOUNT OF MONEY IF YOU HAVE THIS ONGOING EXPENSE MY GOSH IT COULD STILL BE AN EMERGENCY. I JUST WANTED TO PUT THAT OUT THERE WE HAVE REPRESENTATIVE GRUENHAGEN AND AND REPRESENTATIVE HALVERSON. >> THANK YOU MADAM CHAIR THANKS FOR YOUR WORK ON THIS REPRESENTATIVE HOWARD YOU HAVE MY SINCERE SYMPATHY FOR THE LOSS IN YOUR FAMILY; I HAVE MEMBERS OF MY OWN FAMILY NOT IMMEDIATE BUT RELATIVES WHO HAVE DIABETES AND TWO OF THEM HAVE PASSED AWAY NOT DUE TO THIS SITUATION BUT I UNDERSTAND THE COMPLICATIONS IF YOU DON’T TAKE CARE OF YOURSELF AND HAVE A LOT OF NUMEROUS CUSTOMERS WITH DIABETES. THIS IS AN AREA OF GREAT INTEREST FOR ME. I HAVE TWO QUESTIONS FIRST IS IN RELATION TO THE BILL THAT WE PASSED A I WOULD LIKE TO ASK THE BOARD OF PHARMACY IF THERE’S A REPRESENTATIVE HERE I THINK THERE IS; WE PASSED A BILL LAST SESSION THAT REQUIRES THE BOARD PHARMACY TO CREATE A DATABASE OF INSULIN RESOURCES THIS WILL HELP ALL DIABETICS FIND AVAILABLE RESOURCES THAT CAN HELP THEM AFFORD THEIR MADISON THAT WAS ONE PROVISION. I’M WONDERING WHERE IS THAT NOW AND TO WHAT DEGREE IS THAT BEING IMPLEMENTED OR WHAT IS THE PROJECTED DATE OF IMPLEMENTATION? >> THANK YOU REPRESENTATIVE GRUENHAGEN AZZI DR. CODY WIBERG GETTING READY TO COME UP I THINK HE’S THE BEST PERSON TO RESPOND TO THAT. WELLCOME. >> MADAM CHAIR MEMBERS I’M DR. CODY WIBERG EXECUTIVE DIRECTOR OF THE MINNESOTA BOARD OF PHARMACY. MAYBE I SHOULD MENTION I’M ALSO A TYPE 2 DIABETICS MYSELF. JUST FOR DISCLOSURE REPRESENTATIVE . PRESENTED GRUENHAGEN; I HAVE BEEN WORKING ON THIS PROGRAM I’VE NOT HAVE A LOT OF RESOURCES READY TO GO IN TERMS OF A DURING THE WEBSITE I HAVE THE REPRESENTATIVES OF ELI LILLY IN MY OFFICE TO EXPLAIN GIVE ME INFORMATION ABOUT. THEIR ABOUT MET WITH SENATOR BENTSEN ON MONDAY AND YES THE SAME QUESTION WE INTEND HAVE THIS UP AND RUNNING BY OCTOBER 31ST IN A NORMAL YEAR WE PROBABLY ARE HE WOULD OF HAD IT UP AND RUNNING AS MEMBERS KNOW THERE WAS ALSO THE OPIATE PROVISIONS AND THOSE WERE EFFECTIVE JULY 1ST THAT’S WHERE MY FOCUS HAD TO BE. WE SHOULD HAVE A WEBSITE UP AND RUNNING ON OCTOBER 31ST YOU DID ASK ABOUT THIS I WOULD ALSO MENTION ANOTHER THING THAT WE’RE DEVELOPING WHICH IS A PRESCRIPTION DRUG REPOSITORY PROGRAM. THAT REQUIRED US TO PUBLISH A REQUEST FOR PROPOSALS IN THE STATE REGISTRY WE DID THAT ON SEPTEMBER 6TH AND POTENTIAL INTERESTED PARTIES HAVE UNTIL THE THIRD WEEK OF OCTOBER TO RESPOND TO THAT I CAN’T REALLY TALK WITH ANYONE WHO MAY SUBMIT A PROPOSAL DIRECTLY COVERED THERE ARE SEVERAL HEALTH SYSTEMS AND REGIONAL PHARMACY CHAINS THAT ARE INTERESTED IN THAT PROGRAM. >> REP GRUENHAGEN. >> THANKS FOR THAT INFORMATION JUST TO FOLLOW UP DO BELIEVE THE OTHER PROVISION THAT WAS INCLUDED BY THE WAY THIS WAS THE AREA I WAS BORN TO COMPLIMENT YOU ON DURING THE SESSION; CHAIR LIEBLING; I’M COMPLIMENTING YOU ; AND THE OTHER ONE THAT WAS PASSED THIS SESSION REQUIRED HEALTH PLANS THAT THEY COULD NOT MAKE A PROFIT ON INSULIN BY A LIVING COST SHARING TO THE PRICE OF THE DRUG ANY REBATES OR OTHER COST SAVINGS MUST BE PASSED ALONG TO CONSUMERS. THOSE OF THE TWO PROVISIONS WE PASSED LAST SESSION IN YOUR OPINION DO YOU THINK THESE TWO PROVISIONS WILL HELP PEOPLE IN THE CRISIS A VACCINE INSULIN AND OTHER ANCILLARY THINGS THEY NEED IN A COST-EFFECTIVE WAY AND THE NEXT FEW MONTHS FOR THE IMMEDIATELY OR HOW SOON? >> REP GRUENHAGEN MAYBE THAT’S A QUESTION BETTER READ REST BY ONE OF OUR TWO TESTIFIERS OR REPRESENTATIVE HOWARD. ARE YOU DIRECTING IT TO DR. WIBERG? >> I THOUGHT HE MAY BE IN A POSITION TO RESPOND. HE WAS GOING TO CREATE THE ACCESS AND REDUCE THE COST TO NOTHING OR VERY LIMITED IN TERMS OF THE PEOPLE WHO ARE SUFFERING FROM THIS CRISIS. >> DR. WIBERG IF YOU COULD RESPOND. >> MADAM CHAIR I COULD RESPOND REPRESENTATIVE GRUENHAGEN I BELIEVE MOST OF THE REPRESENTATIVE HOWARD WAS THE FIRST LEGISLATOR TO APPROACH ME ABOUT THIS ON THE ACCESS ISSUE I SUGGESTED BASED ON A PROGRAM WENT INTO EFFECT THE SAME MONTH I STARTED UP ARMS PROGRAM AT DHS IN 1999 IT WAS CALLED THE PRESCRIPTION DRUG PROGRAM IT WAS MEANT FOR PEOPLE ON MEDICARE BECAUSE MEDICARE PART DE DIDN’T EXIST THEN. THAT PROGRAM PEOPLE ON MEDICARE PAID THE FIRST $35 A MONTH THE STATE PICKED UP THE REST OF THE COST AND I SUGGESTED THERE BE SOME SORT OF A PROGRAM OR ELIGIBILITY WAS DETERMINED AND PEOPLE WERE MANAGED THROUGH A PROGRAM LIKE THAT BUT IN THIS CASE IN A MUCH REDUCED MANNER JUST FOR EMERGENCY SUPPLIES OF INSULIN. THEN THE QUESTION CAME UP WHAT HAPPENS WHEN THEY EXHAUSTED THEIR EMERGENCY SUPPLY? ONE OF THE THINGS I SUGGESTED WE DEVELOPED ONE TOOL TO GIVE PEOPLE INFORMATION ABOUT WHERE ELSE THEY MAY GO BUT I THINK IN ADDITION TO THAT THERE WAS AN EXPECTATION THAT DHS WOULD DETERMINE ELIGIBILITY THEY WOULD ATTRACT THESE PEOPLE TO SEE IF THESE PEOPLE WERE ELIGIBLE FOR MEDICAID AND MINNESOTA CARE I THINK THE BOARDS WEB SITE WAS MEANT TO BE ONE POOL AND I THINK A GOOD TOOL BUT IT’S NOT SUFFICIENT TO COVER ALL THE BASES. I CAN ONLY SPEAK TO THAT BECAUSE THE BOARD OF PHARMACY DOES NOT REGULATE INSURERS OR PBM’S AND I CAN’T SPEAK TO THAT PART OF THE BILL. >> REPRESENTATIVE HOWARD DID YOU WANT TO RESPOND? >> MADAM CHAIR AND REPRESENTATIVE GRUENHAGEN I WOULD NOT ADD MUCH MORE OUT OF AND THAT WAS A PIECE OF THE ALEC SMITH BILL BUT NOT PASS THE WEBSITE THAT PART OF THE BILL I THINK IT’S ONE TOOL THAT DR. WIBERG MENTIONED BECAUSE YOU WANT TO CONNECT FOLKS TO WHAT RESOURCES ARE OUT THERE BASED ON CONVERSATIONS WITH MINNESOTA’S WITH DIABETES AND UNDERSTANDING HOW QUICKLY A CRISIS IT’S CERTAINLY NOT SUFFICIENT TO ADDRESS THE ENTIRETY OF THE PROBLEM. >> TO EITHER OF THE OTHER TESTIFIERS WANT TO COMMENT? >> I THINK IT’S A START THE WEBSITE WITH THE RESOURCES IS AMAZING HOW LOT OF PEOPLE ARE UNAWARE AT A LOT OF THE PROGRAMS THAT THEY COULD POTENTIALLY QUALIFY FOR WITH MANUFACTURERS. UNFORTUNATELY THOSE PATIENTS IN THE PROGRAMS ARE DIFFICULT TO QUALIFY FOR MORE THAN HALF OF ALL PEOPLE WHO APPLY FOR THOSE ASSISTANCE PROGRAMS ARE DENIED IN ITS TYPICALLY BASED ON THEIR INCOME. IF THEY’RE TALKING ABOUT THE INSULIN AND A COST SHARING AND A MAXIMUM OR IS STILL LOOKING IN A GREAT FINANCIAL BURDEN THAT SOME PEOPLE COULD BE FACING UPWARD OF $100 A MONTH FOR MORE THEY WOULD BE RESPONSIBLE FOR FOR SOME PEOPLE THAT’S ON AN UNREASONABLE AND UNACCEPTABLE THEY COULD NOT AFFORD THAT. >> THANK YOU. DID THE OTHER TESTIFIER WANT TO COMMENT ON THIS? YOU DO NOT HAVE TO. THE NEXT QUESTION WE HAVE REPRESENTATIVE HALVERSON. >> THANK YOU MADAM CHAIR THANKS TO REPRESENTATIVE HOWARD FOR THE ADDITIONAL WORK THIS SUMMER ON THE BILL. I WAS IN THOSE MEETINGS AS WELL THERE WAS A LOT OF INTENSE AND FRANK CONVERSATIONS. ONE OF THE THINK I THINK WE GOT TO GET AT THE END OF THOSE CONVERSATIONS WAS THE ACKNOWLEDGMENT THIS IS AN EMERGENCY IN MINNESOTA A LOT OF FOLKS TO DEPENDS FACING A CRISIS THE ONE FIGURE OUT A WAY THAT IT’S NOT A CRISIS WE HAVE TO DO HEAVY LIFTING IS THERE A BETTER IS THERE A WAY TO GET AROUND THIS AND A LOT OF QUESTIONS; ASKED ABOUT WHAT COULD PEOPLE WITH DIABETES TO WHAT ADDITIONAL PROGRAMS? WHO IS HAVING TROUBLE ACCESSING INSULIN? WE DISCOVERED THROUGH OUR MEETINGS THE BIPARTISAN MEETINGS IN TRAVELING AROUND THE STATE IS THIS IS TRULY AN EMERGENCY IN MINNESOTA ANYONE WHO IS DOUBTING IT OR QUESTIONING IT ANYMORE IS FLAT WRONG. THE ROOT CAUSE WE HAVE ALSO I THINK MADE CRYSTAL CLEAR IT IS THE COST OF INSULIN THAT’S BEING DISTRIBUTED BY THE MANUFACTURER THAT’S DRIVING THIS CRISIS. THE SOLUTION TO MAKING SURE THAT MINNESOTANS STAY ALIVE MINNESOTANS LIVING WITH DIABETES TO ALLOW THIS TO MAKE SURE THAT ACCESS TO HENSEL AND MAKE SURE IF THERE RATIONING AND NOT WAITING FOR THE NEXT PAYCHECK GOD FORBID WE ARE REHEARD TO STORIES OF SOMEONE’S THINK I CAN MAKE IT TO MY NEXT PAYCHECK AND GET MY PRESCRIPTION FILLED AND PAY THOUSANDS OF DOLLARS OUT OF POCKET FOR THAT MASSON. PERHAPS THEY WOULD HAVE TO RATION IT AGAIN BECAUSE THE COST IS SO VERY HIGH THESE ARE PEOPLE WORKING FULL TIME IN MINNESOTA PEOPLE WITH GOOD JOBS IN MINNESOTA. THESE ARE PEOPLE WHO ARE WORKING HARD TO MANAGE A VERY HARD TO MANAGE DISEASE AND A QUESTION OF PHARMACEUTICAL COMPANIES RAISING THEIR PRICES IF THEY HAVE TO CONTRIBUTE TO A SOLUTION FOR A PROBLEM MAY COST IS TROUBLING. I WOULD BE SHOCKED IF THEY RAISE THEIR PRICES BECAUSE OF SOMETHING WE DID IN MINNESOTA THEY RAISE THEIR PRICES CONSISTENTLY SINCE 19961200 PERCENT IS IT ANYTHING ELSE YOU BY YOUR LIFE THAT IS GONE UP IN PRICE AT 1200 PERCENT? I CAN’T THINK OF ANYTHING THAT IS SOMETHING UNIQUE TO STAY ALIVE AND STAY HEALTHY. THAT IS WHAT THE PROBLEM WE’RE TALKING ABOUT HERE AND THIS IS WHY WE HAVE AN EMERGENCY AND ASKING PHARMACEUTICAL COMPANIES TO PARTICIPATE IN THE SOLUTION TO A CRISIS THEY COST IS VITALLY IMPORTANT. WE HEARD TESTIMONY BEFORE WE PASS THE ALEC SMITH EMERGENCY BILL IN THIS BODY LAST SESSION FROM PHARMACEUTICAL MANUFACTURERS WHO SAID WE JUST WANT EVERYONE ELSE TO COME TO THE TABLE TO. WELL IN MINNESOTA THE HOUSE OF REPRESENTATIVES PASSED A BILL THAT GOT SIGNED INTO LAW REGULATING PBM’S THE PBM IS ARE AT THE TABLE MINNESOTA’S MAJOR NONPROFIT INSURERS STEPPED UP AND SAID WE’RE GOING TO CAP OUT-OF-POCKET EXPENSES FOR PEOPLE WITH DIABETES BECAUSE WE DON’T WANT ANYONE TO DIE THE INSURERS ARE AT THE TABLE. PHYSICIANS ARE IN COMMUNICATION WITH THEIR PATIENTS PHYSICIANS ARE AT THE TABLE. ONE GROUP WAS NOT COME TO THE TABLE IS THE PHARMACEUTICAL COMPANIES TO SAY WE NEED TO FEAR THEIR VENGEANCE ON US FOR TAKING ACTION TO TRY TO SAVE THE LIVES OF MINNESOTANS IN THIS REALLY CRAZY. I’M SORRY I CAN’T COME UP WITH A BETTER WORD IT’S AN ELEGANT. WHEN WE TALK ABOUT COST MORE WE TRY TO SAVE FROM THE COST OF THIS CRISIS? THE PEOPLE WANTING TO% PHARMACEUTICAL MANUFACTURERS TO THE EXPENSE OF EVERYONE ELSE IN THE SYSTEM? DO YOU THINK THEY’RE NOT PUSHING PREMIUMS THE PREMIUMS WE COMPLAIN ABOUT ALL THE TIME THESE TO THE NUMBER ONE DRIVER IS WHY PREMIUMS ARE GOING UP EVERY YEAR LET’S BE HONEST WITH THE COST OF PRESCRIPTION DRUGS THAT THE DRIVER THE MAJOR DRIVER. NOT IF THEY’RE GOING TO CONTRIBUTE TO AN ADDITIONAL TAXPAYERS IF WE HAVE ONE OUT OF FOR PEOPLE WITH DIABETES WHO TAKE INSULIN RATIONING THEIR INSULIN THE STATE AND THAT’S A CONSERVATIVE ESTIMATE THAT I AGREE WE HOPED THAT WE ARE GOING TO SEE TREMENDOUS ADDITIONAL COSTS WITH REGARD TO DISABILITY IN THE STATE OF MINNESOTA. DIABETES IS A LEADING CAUSE OF BLINDNESS OF LOWER LIMB AMPUTATIONS; OF KIDNEY FAILURE AND HEART DISEASE IN THE STATE AND AROUND THE WORLD. THIS IS A COSTLY EMERGENCY IN MINNESOTA THE ECONOMICS OF PROTECTING PEOPLE FROM HIGHER HEALTH-CARE COSTS IS IMPORTANT SOLVING THIS CRISIS NEEDS TO BE IMPORTANT. WE NEED TO PROTECT MINNESOTANS WE NEED TO PROTECT THEM FROM THE HIGH COST OF HEALTH CARE WE NEED TO MAKE SURE THAT WE ARE PROMOTING OPTIMUM DIABETES MANAGEMENT IN MINNESOTA FOR NOT PUTTING PEOPLE AT RISK. MOST IMPORTANTLY WE NEED TO SAY THAT ONE DEATH IN MINNESOTA WAS UNACCEPTABLE AND WHEN THE DIABETES COMMITTEE MET WITH THE GOVERNOR AND THE GOVERNOR SAID WHAT OF THE STAKES IF WE DON’T IT IS PASSED BEFORE NEXT SESSION? THE DIABETES COMMUNITY SAID SOMEONE ELSE IS GOING TO DIE. YOU GUYS HAVE SEEN HAVING MOTHERS HAVING TO COME AND TRY TO SAVE OTHER KIDS’ LIVES TO SAVE OTHER MOTHERS FROM THIS AND IT’S HAPPENED AGAIN IT HAPPEN AGAIN BECAUSE WE DIDN’T GET TO THE TABLE AND WE DIDN’T ACT. THIS IS AN EMERGENCY TREATED LIKE EMERGENCY THE RIGHT PEOPLE ARE AT THE TABLE TELLING US WHAT NEEDS TO BE DONE OUR JOB IS TO REPRESENT THEM. THANK YOU FOR ALL OF YOUR HARD WORK AND ALL YOU DO TO TRY TO MAKE MINNESOTA BETTER. >> THANK YOU REPRESENTATIVE HALVERSON. REPRESENTATIVE CANTRELL IF YOU CAN FOLLOW THAT. …LAUGHTER…. >> I WILL TRY NOT TO FOLLOW THAT BUT TO ADD MY PERSONAL THOUGHTS AND FEELINGS. PAINT YOU SO MUCH FOR YOUR BEAUTIFUL WORDS REPRESENTATIVE HALVERSON AND MADAM CHAIR. REPRESENTATIVE HOWARD AND MADAM CHAIR WE HAD A COMMUNITY CONVERSATION IN MY DISTRICT IN BURNSVILLE AROUND INSOLENT AND ACCESSIBILITY AND PHARMACEUTICAL ACCESSIBILITY AS A WHOLE I THINK YOU REMEMBER A COMMITTEE MEMBER OF MIND SHE WORKS FOR THE UNITED STATES POSTAL SERVICE FOR 30 YEARS SHE WAS PROMISED AT THE OUTSET OF YOUR CAREER STABILITY IN RETIREMENT STABILITY OF FINANCIAL INSTABILITY IN TERMS OF ACCESS TO HEALTH CARE. SHE IS SOMEONE WHO LIVES WITH DIABETES AND BECAUSE THE COST OF INSULIN HAS RISEN SO EXORBITANT WAY SHE HAD TO COME OUT OF RETIREMENT AFTER BEING ALIVE LONG PUBLIC SERVANT TO WORK FOR DOOR-TO RUN A FOOD TO PEOPLE BECAUSE SHE NEEDED EXTRA MONEY AND OTTER TO AFFORD THIS LIFE-SAVING MEDICATION. I WANT IS ALL TO BE CLEAR ABOUT WHAT’S HAPPENING HERE AND IN THE PHARMACEUTICAL INDUSTRY AND WITH A LOT OF OTHER DRUGS AS WELL BUT NO HAVE TO PLAY BY THE RULES THE U.S. GOVERNMENT HAS SAID HE DON’T HAVE TO PLAY BY THE RULES EVERY OTHER SEGMENT OF OUR ECONOMY NEEDS TO PUT OTHER RULES YOU CAN’T PRICE GOUGE CITIZENS IF YOU DO SOMETHING AT LEAST TO SOME ONE STEP TO RUN TO BE PENALIZED THE PHARMACEUTICAL INDUSTRY THEY’VE BEEN GIVEN A BLANK CHECKS. THE GOVERNMENT AS FAR AS THE CONCERN SAYS GO AHEAD RAISE YOUR PRICES AS MUCH AS YOU WANT AND WHAT HAPPENS AT THE STATE GOVERNMENT OR SOMEONE TRIES TO REIN IN THE COST OF THE PHARMACEUTICALS MANY OF WHICH HAD BEEN DISCOVERED AND MANY OF WHICH THAT COUNTIES HAVE NO ROLE IN CREATING WHAT SO EVER? THEY SAY WE’RE GOING RAISE THE COST OF YOUR BROUGHT GUESS WHAT A PHARMACEUTICAL INDUSTRY BECAUSE OF UNFETTERED GREED THAT PEOPLE COULD BE BANKRUPTED BY THEY’RE STILL RAISING THE COST OF THE DRUGS AND IT’S HIGH TIME WE PENALIZE THEM FOR THEIR ON FAIR AS FAR AS I’M CONCERNED ON CAPITALISTIC AND ON AMERICAN PRIORITIZING THEIR OWN PROFITS AND PROFIT SHARING AND INCREASING THEIR SHAREHOLDER VALUE TO PLEASE WHOEVER HOLDS THE SHARES RATHER THAN PROTECTING THE PATIENTS WITHOUT WHOM THEY WOULD HAVE AN INDUSTRY TO BEGIN WITH. I WANT TO THANK YOU ALL OF YOU SO MUCH EVERY ADVOCATE IN THIS ROOM BEFORE THE FIGHT YOU BROUGHT TO THE LEGISLATURE A PHARMACEUTICAL LOBBYISTS WILL BE THE ONES TO BE TRYING TO STEER THE BOAT ON THIS BECAUSE OF THE THIS IS CENTERED AROUND PEOPLE AND WITH THAT YOU’RE ACTUALLY DRIVING THE CONVERSATION ABOUT WHAT SAVES PEOPLE’S LIVES I THINK YOU FOR EVERYTHING YOU’VE DONE SORRY WE DIDN’T GET THIS DONE LAST SESSION IT’S APPALLING; GOD IS MY WITNESS WILL GET THIS DONE NEXT SESSION. >> REPRESENTATIVE MUNSON. >> THANK YOU MADAM CHAIR AND REPRESENTATIVE HOWARD OF THE FEW MORE QUESTIONS ON THE EMERGENCY BILL I’VE TALKED ABOUT IT ON THE FLOOR AND AGAIN DURING THE DAY AFTER THE LAST DAY OF OUR SPECIAL SESSION WHEN A MINORITY OF US VOTED FOR THE BILL AND THAT BECAUSE WE WERE GOING TO PAY FOR OUT OF THE HEALTHCARE ACCESS FUND A FUND THAT WAS SET UP SPECIFICALLY AT THE GIVEBACK CENTS TO CARE FOR PEOPLE CAN’T AFFORD IT. I’M CONCERNED ABOUT INCREASING THE COST OF INSULIN IN MINNESOTA BY FORCING THE MANUFACTURERS IF SHORTSIGHTED THING THEY’RE NOT GOING THE INCREASED COSTS ON US ON CONSUMERS IN THE BILL WHEN I LOOK UNDER ELIGIBILITY FOR THE PROGRAM YOUR TESTIFIERS HAVE MENTIONED WE NEED INSULIN FOR TYPE 1 DIABETICS AND THIS BILL DOESN’T SAY THAT IT BASICALLY WOULD APPLY TO ANYONE ASSUMING HAVE A PRESCRIPTION THE DOCTORS WHO WRITE THE PRESCRIPTION DOES THIS AFFECT ALL DIABETICS IT’S MY UNDERSTANDING 90- 95 PERCENT OF DIABETICS ARE TYPE 2 DIABETICS THAT ARE NOT IN SO THE INDEPENDENT. DOES THIS COVER ALL DIABETICS ARE JUST TIGHTEN ONE? >> MADAM CHAIR AND REPRESENTATIVE MUNSON; HELPS A DOCTOR OR ONE OF MINNESOTA’S WITH DIABETES WOULD BE ANSWERED AFTER THIS MY UNDERSTANDING IS TIED TO DIABETICS ABSOLUTELY MAY NEED INSULIN. IT’S NOT THE SAME RELATIONSHIP AS TYPE 1 BUT IT WOULD BE ELIGIBLE FOR TYPE 2 DIABETICS AS WELL A. >> I DON’T KNOW IF YOU DIDN’T ACTUALLY USE INSULIN I DON’T KNOW WHY YOU WOULD USE THE PROGRAM. AND ONLY APPLIES TO PEOPLE NEED INSULIN. >> MADAM CHAIR THE REASON WHY WE’RE DOING IS IT’S NOT JUST TO BRING DOWN THE COST OF INSULIN NATIONWIDE THIS IS TO GIVE EMERGENCY ACCESS TO PEOPLE NEEDED AND I THINK THE TESTIFIERS HAVE TALKED ABOUT IT BEING LIFE-SAVING DRUGS AND FOR THE OVERWHELMING MAJORITY OF TYPE 2 DIABETICS IT IS NOT SOMETHING THEY NEED TO LIVE. IT IS SOMETHING TO HELP CONTROL DIABETES WE COULD HAVE A DEBATE ON THIS AND A DISCUSSION OF BUT OVER THE INTERIM DOCTORS AND PHARMACISTS HAVE DISCUSSED DIABETES IT CAME TO MY ATTENTION THAT HUMAN INSULIN DOES WORK AND IT COULD BE USED IN EMERGENCY. THERE WAS TESTIMONY HERE FROM AND ENDOCRINOLOGIST AND WHO CALLED ME AND WE HEARD ABOUT THIS DISCUSSED THAT THERE IS EMERGENCY INSULIN AVAILABLE IN THE PRIVATE MARKET SOMEONE CAN USE WITH DOCTOR’S INSTRUCTIONS FOR THE PROGRAM THAT CAN SAVE LIVES AND AND THEIR OPINION AND NO ONE SHOULD BE RATIONING INSULIN BECAUSE THE CAN’T AFFORD INSULIN FOR OF A FEW DAYS OR A SHORT TIME PEOPLE’S LIVES CHANGE I WENT FROM WORKING IN A GREAT SHOT DRAGGING ALL PIGS OUT OF A BARN AND THINGS CHANGED IT’S IMPORTANT TO HAVE A PLAN IN PLACE TO WHAT TO DO AN EMERGENCY SITUATION SO YOU DON’T HAVE TO RATION CARE NO ONE SHOULD BE RATIONING INSULIN IN HIS OPINION AND MANY OTHERS THE OTHER INSULIN THAT AVAILABLE IN THE MARKET WITHOUT A PRESCRIPTION OR OVER-THE-COUNTER AT 4000 RETAIL LOCATIONS AROUND THE COUNTRY ON WEEKENDS AS WELL AS A POSSIBILITY FOR LIFESAVING INSULIN AND I THINK IT’S IMPORTANT HAVE AN HONEST DISCUSSION ON YOUR TALKING ABOUT AN EMERGENCY PROGRAM WERE NOT TALKING ABOUT LOWERING THE COST OF INSULIN AND HAVE THIS BIG FIGHT WHICH MOST OF THE SOLUTIONS TO LOWER-COST OF REIMPORTING DRUGS IS ALLOWING NEW MANUFACTURERS TO COME IN THAT’S IMPORTANT BY IF THERE’S TO UNDER THOUSAND DIABETICS IN MINNESOTA AND A GOING TO INCLUDE EVERYONE IN THE POSSIBILITY IN THIS PROGRAM THE ONE IN FOUR OR RATIONING INSULIN IS 50;000 PEOPLE THAT MEANS THIS IS GOING TO BE $100 MILLION A YEAR PROGRAM AND AGAIN THE INSULIN MANUFACTURER WHO HOURS THE COST IS PENALIZED UNDER YOUR LANGUAGE WE SHOULD BE WEREN’T TO LOWER- COST OF ISLAM NOT LIKE TO DISCUSS ALL DIABETICS WOULD BE IN THE PROGRAM OR JUST TYPE ONE PEOPLE ARE ABSOLUTELY DEPENDENT ON INSULIN AND IT WOULD BE EMERGENCY INSULIN NOT SOMETHING TO HELP TREAT THEIR DISEASE. >> I’M GOING TO GO TO REPRESENTATIVE HALVERSON FOR OUR PHYSICIAN HERE AT THE TABLE REPRESENT OF MORRISON MAY WANT TO COMMENT AS WELL. REP HALVERSON SHALL WE LET HER COMMENT THE COMMENTS MADE ABOUT TYPE 2 DIABETES HAVE ONE OF THOSE CLOSE TO ME AND KNOW THAT’S NOT RIGHT. >> REPRESENT OF MORRISON IF YOU COULD GIVE US THE SCIENTIFIC RESPONSE HERE. >> THANK YOU MADAM CHAIR I THINK IT’S IMPORTANT WE NOT PRACTICE MEDICINE HERE THE LEGISLATURE ESPECIALLY WHEN WE DON’T HAVE THE FACTS BEHIND US. TYPE 1 DIABETES AND TYPE 2 DIABETES HAVE TO DO WITH WHEN YOU’RE DIAGNOSED AND THE MECHANISM OF ACTION FOR YOUR DIABETES THERE ARE PEOPLE WHO HAVE TYPE 2 DIABETES WHO REQUIRE INSULIN TO LIVE SO THIS BILL IS DESIGNED FOR PEOPLE WHO HAVE DIABETES WHO NEED INSULIN IN AN EMERGENCY SITUATION. IT’S REALLY NOT RELEVANT OR MATTER OF CONVENIENCE THAT THIS IS DESIGNED TO HELP PEOPLE IN AN EMERGENCY WHERE THEY REQUIRE INSULIN. >> THANK YOU AND REPRESENTATIVE HALVERSON. >> THANK YOU MADAM CHAIR WE’RE SO FORTUNATE TO HELP PHYSICIANS AT THE TABLE WITH US TO GIVE AS GOOD MEDICAL FACTS. I’M INCREDIBLY CONCERNED ABOUT WHAT I HAVE HEARD A FROM REPRESENTATIVE MUNSON AND INCREDIBLY CONCERNED ABOUT LETTER THAT WAS INCLUDED FROM A PHYSICIAN IN ARIZONA AND NOT A MINNESOTAN AND I BELIEVE IS CONNECTED WITH SOME OTHER POLITICAL ORGANIZATIONS LIKE THE HERITAGE FOUNDATION. WE NEED TO BE AWARE OF WHO’S GIVING US MEDICAL ADVICE AND REPRESENTATIVE MORRISON COULD BE MORE RIGHT TO ASK TO COME FROM POSITIONS HERE IN MINNESOTA AND UNDERSTAND IT WHAT IT’S LIKE TO LIVE WITH DIABETES HAVE TO COME WITH PEOPLE FROM DIABETES I HAVE TYPE 1 DIABETES; AND WE LIVE WITH UNDERSTANDINGS OF ARE IN THIS ALL THE TIME AND VOID WE GIVE ADVICE. WE GET QUESTIONS WE GET THIS TRUST ME I KNOW THIS. I KNOW WHAT IMPACTS MY BLOOD GLUCOSE EVERY SINGLE DAY AND IT’S REALLY COMPLICATED TO MANAGE AND IT’S REALLY ABOUT EACH INDIVIDUAL IT’S NOT ABOUT THESE BLANKET PROCLAMATIONS THAT: CHECK OUT WAL-MART INSULIN BECAUSE IT’S A SOLUTION THAT IS NOT A SOLUTION. PEOPLE HAVE DIED TRYING TO THAT SOLUTION TO STAY ALIVE THIS IS ALSO HAPPEN IN THE LAST YEAR. TO RECOMMEND THAT AS A POSSIBLE SOLUTION FOR MINNESOTANS IS VERY UNINFORMED AT PAST TO DOUBLE DOWN AT AND SAY THAT PEOPLE WHO NEED INSOLENT IF THERE SOME REASON YOU CAN’T AFFORD $30;000 WORTH OF INSULIN IN YOUR LIFE THE INSULIN THAT KEEP YOUR BLOOD SUGAR REGULAR THAT KEEPS THEIR DIABETES OPTIMALLY MANAGED SO VOTE YOU KNOW THAT YOU HAVE A FUTURE WE COULD GO FOR A WALKOUT IN THE PARK WITH A GRANDCHILD AND REPRESENTATIVE USE A WHEELCHAIR BECAUSE YOU LOST A LIMB; TO KNOW YOU CAN READ A BOOK AT YOUR CHILD AND NOT HAVE TO HAVE THEM READ IT TO YOU BECAUSE YOU LOST YOUR EYESIGHT. TO NOT DIE OF HEART ATTACK BECAUSE YOU’RE BLOOD GLUCOSE WAS NOT OPTIMALLY MANAGED IT THESE OF THE CHOICES YOU’RE ASKING MINNESOTANS TO MAKE BY SANG GO TO WAL-MART AND BY INSULIN FOR $25. THAT IS A TERRIBLE CHOICE WE DEFINE THE PROBLEM MEMBERS THE PROBLEM IS INSULIN IS TOO EXPENSIVE A MODERN INSULIN WE HAVE DESCRIBED THAT DOCTORS PRESCRIBE THE BEST COURSE OF CARE AND I WILL TELL YOU DIABETES IS GONE THROUGH RIGOROUS REFORMS WITH REGARD TO OPTIMAL CARE AND BEST PRACTICES ONE OF THE FIRST ISSUES THAT WAS TACKLED TENOR 20 YEARS AGO IN TERMS OF HOW WE MAKE SURE WE’RE GETTING THE BEST RESULTS FOR PEOPLE WITH DIABETES? BECAUSE IT IS SO COSTLY ITS COSTLY IN LIVES AND COSTLY IN DOLLARS DEBT NOT HAVE DIABETES OPTIMALLY MANAGED SO THE CLINICAL GUIDELINES AROUND DIABETES CARE HERE’S HOPING YOU CAN AFFORD IT AND IF YOU CAN’T GO GET WAL- MART INSOLENT GO GET OUTDATED INSULIN. THE OPTIMAL APPROACH IS TO MAKE SURE WE’RE SEEING DOCTORS REGULARLY WE TAKE OUR MEDICATION ON A REGULAR BASIS THAT WE GET A REGULAR EXERCISE AND WE GET OUR FEET CHECKED WITH THEIR BLOOD PRESSURE CHECKED SEVERAL TIMES A YEAR. WE TAKE INSULIN THAT IS MODERN AND THAT WORKS AT WAL-MART INSULIN YES ; IT’S BETTER THAN DYING BUT IS NO GUARANTEE YOU WON’T DIE IF YOU TAKE AT. THERE’S DEFINITELY NO GUARANTEE YOU’RE GOING TO GET OPTIMAL BLOOD GLUCOSE CONTROL THERE’S A GUARANTEE YOU WANT YOUR BLOOD SUGAR IS GOING TO BE HIGHER AND LOWER ALL DAY LONG WE NEED INSULIN THAT GOING TO MAKE SURE THAT HER BLOOD SUGAR DOES NOT SPIKE AND FALL ALL DAY LONG. EVEN KNOW WHEN WERE DOING EVERYTHING RIGHT IT’S STILL GOING TO HAPPEN YOU GET THE FLU WHAT HAPPENS TO YOUR BLOOD SUGAR? FOR SOME OF US IF WE EXERCISE LIKE WERE SUPPOSED TO WE GET A CRASH SOME PEOPLE GO I WONDER BODIES WERE ALL DIFFERENTLY WONDERFULLY MADE WERE ALL VERY UNIQUE. DON’T PRETEND TO UNDERSTAND WHAT WE LIVE WITH EVERY SINGLE DAY AND THEN LEGISLATE BASED ON THAT. ” WE LEGISLATE REPRESENTATION LISTEN TO PEOPLE WHO LIVE WITH THE DISEASE EVERY DAY LISTEN TO THE PEOPLE WHO SAID THIS WOULD HAVE KEPT MY KID ALIVE LISTEN TO PEOPLE WHO SAY I DON’T WANT TO LIVE A LIFE THAT STARTS WITH DISABILITY. THOSE ARE THE RIGHT QUESTIONS TO BE ASKING THOSE PEOPLE AND I GUESS I’M ONE OF THOSE PEOPLE. FORGIVE MY FRUSTRATION; AND I GIVE A LOT OF PEOPLE A LOT OF ROOM FOR NOT UNDERSTANDING THE DISEASE IS COMPLICATED WE HAVE QUESTIONS ALL THE TIME WE HAVE QUESTIONS OF EACH OTHER I AGREE THERE IS THE COMMITTEE HERE AND THAT WE NEED EACH OTHER. >> THANK YOU REPRESENTATIVE ALDERSON MEMBERS WE HAVE ON THE LIST I REPRESENTATIVE IN ORDER AND HAYLEY LIPSCHULTZ AND GRUENHAGEN WILL TRY TO GET THROUGH THOSE AND TRY TO MOVE ON TO OUR SECOND PHASE OUR NEXT PHASE OF OUR HEARING. >> THANK YOU MADAM CHAIR. THANK YOU REPRESENTATIVE HOWARD AND THE TESTIFIERS NICOLE AND CINDY. THE STORIES YOU HAVE SHARED WITH US RESONATES WITH MANY MINNESOTANS AND AT THE BEGINNING OF THIS MONTH SOMEONE SUFFERED A STROKE BECAUSE SHE COULD NOT AFFORD INSULIN. A WELL FUNCTIONING MINNESOTA AND IS NOW A CRISIS WHICH WE SHOULD OF TAKING CARE OF THIS ISSUE IF WE PASS THE ALEC SMITH MANAGER. THE COST OF INSULIN HAS RISEN STEADILY THAT IS COSTING THE LIVES OF MANY MINNESOTANS PARTICULARLY OF THOSE WHO HAVE INSURANCE AND THOSE WHO ARE UNINSURED THERE MANY PEOPLE WE DON’T KNOW ABOUT WHO ARE SUFFERING TODAY BECAUSE WE DON’T HELP THOSE INDIVIDUALS WHO ASKED US TO COME HERE AND ADDRESS THE CRISIS THAT EXISTS IN OUR COMMUNITY. THE SUPPLY CHAIN OF INSULIN FROM THE MANUFACTURERS TO THE PBM’S TO THE INSURANCE TO THE PHARMACY IS THEY ALL HAVE A RESPONSIBILITY. A ONLY WHAT WHAT’S BEST FOR THE SHAREHOLDERS AND NOT FOR THE PEOPLE WHO NEED INSULIN AND MEDICATION WE CAN NO LONGER SIT BACK WE HAVE A BROKEN SYSTEM PEOPLE TAKING ADVANTAGE AND WE NEED TO HELP THEM NOW IT’S A FACT NO ONE SHOULD DIE BECAUSE THEY CANNOT AFFORD INSULIN KNOW MINNESOTA SHOULD DIE EVER BECAUSE THEY CANNOT AFFORD ANY LIFESAVING MEDICATION. WE HAVE A DUTY TO MINNESOTANS WE NEED TO ACT NOW WE NEED TO ADDRESS THIS ISSUE A CAT WAIT FOR TOMORROW OUR ACTIONS WHAT WE DO TODAY WILL SPEAK LOUDER TO MINNESOTANS THAT WE CARE ABOUT THEM THAT AND THEIR LOVED ONES WHO’VE LOST WE CAN PROVIDE HELP THIS IS NOT SOCIALIST MEDICATION PEOPLE TALK ABOUT ITS CARING FOR MINNESOTANS WHO NEED HELP NOW. I THINK WICCAN ACT QUICKLY AND ADDRESS THIS ISSUE. >> THANK YOU REPRESENTATIVE MORE. >> THANK YOU MADAM CHAIR THANK YOU REPRESENTATIVE FOR WORK AND TO THE MOTHER’S MOTHER WHO IS LOVED THAT JOB THERE’S NO WORDS TO EXPRESS TO YOUR FAMILY. REPRESENTATIVE HOWARD I’VE A COUPLE OF TECHNICAL QUESTIONS WHAT IS REGARDING ELIGIBILITY. SINCE WE DO HAVE INSURANCE COMPANIES IN MINNESOTA WHO HAVE COME TO THE TABLE AND STEPPED UP WITH $25 COST IN COPAYS HOW DOES THAT IMPACT YOUR PROPOSAL AND APPLY FOR FOLKS WHO ARE UNINSURED AT MY FIRST QUESTION IN MY SECOND QUESTION IS REGARDING IMPLEMENTATION WE HAVE FOCUSED ON THE EMERGENCY NATURE OF THIS CRISIS AND WHEN I READ YOUR BILL PATIENT WOULD GO INTO A PHARMACY AND A LOT PAPERWORK DHS WOULD TAKE 31 DAYS TO DECIDE ON ELIGIBILITY. I’M CONCERNED HOW DOES THAT MEET ANY EMERGENCY NEED AND COMPARE AND CONTRAST WITH THE SENATE BILL BECAUSE I THINK WE’VE COME TOGETHER ON THIS IDEA ON THE IMPORTANCE OF INSULIN TO PEOPLE RIGHT AWAY AND IT IS AN EMERGENCY? IF YOU COULD TALK TO THOSE TWO ISSUES I WOULD APPRECIATE IT. >> THANK YOU MADAM CHAIR AND REPRESENTATIVE CAILE BOZIC RICHARD TO THE FIRST QUESTION ON ELIGIBILITY; THE BILL IS STRUCTURED AGAIN TO TARGET THE FOLKS MOST WE THINK ARE IN NEED OF THE SITUATION FOLKS WERE UNINSURED AND POTENTIALLY FOLKS ON THESE HIGH DEDUCTIBLE INSURANCE PLANS WITHOUT A POCKET COSTS UPWARDS OF $5;000. BECAUSE OF THE ACTION OF CAPITAL OUT OF POCKET COSTS THERE’S A SET OF MINNESOTA PROBABLY WOULD NOT BE ELIGIBLE FOR THIS PROGRAM BECAUSE THEY’RE ON AN INSURANCE PROGRAM WITH THE IT $25 INSULIN CO-PAY FOR IS $0 CO-PAY I BELIEVE AT THREE OUT OF FOUR LARGE INSURERS HAVE MADE THAT MOVE. SO THERE’S A SEGMENT FOR FOUR MONTHS AGO PROBABLY WOULD HAVE ACCESS THIS PROGRAM THAT NOW WOULD WE STILL KNOW THIS A LARGE GROUP THAT AS EMPLOYER BASED INSURANCE AND IT MAY NOT MR. HAVE THAT SAME COPAYS IT FOR SOME MAY BE IN A HIGH DEDUCTIBLE PLAN THOSE FOLKS WOULD STILL BE ABLE TO ACCESS THE PROGRAM AND FOLKS WERE UNINSURED AND THERE’S A HUGE NEED IN THIS PROGRAM AS WELL. GENERAL WHAT IS THAT THE UNIVERSE OF FOLKS WERE TALKING ABOUT? THAT’S SOMETHING WE’RE WORKING TO ASSESS AND A SMOOTH OUT WITH A FISCAL NOTE PROCESS THAT’S AN IMPORTANT ELEMENT OF THIS TOUR THE FOLKS MOST IN NEED SO THAT’S A GOOD QUESTION. YOUR SECOND QUESTION ABOUT HOW SOON TO GET MEDICATION IN THE HANDS OF THOSE IN NEED; ; ALL THROUGH THE PROCESS THIS WAS THE MILLION-DOLLAR QUESTION BECAUSE WE KNOW THERE’S A EMERGENCY NEED HOW CAN WE DO THIS TO MAKE THIS EFFICIENT AS POSSIBLE FOR THE PATIENT? THE BILL TODAY HAS AN IMPROVED STREAMLINED PROCESS THE MINNESOTANS WOULD BRING IN A BASIC FORM ATTESTING TO THEIR ELIGIBILITY TO THE PHARMACIST AND THEY WOULD BE PRESUMED ELIGIBLE AT THE PHARMACY LEVEL AND RECEIVED A 30 DAY SUPPLY OF INSULIN THAT DAY FROM THE PHARMACY. THE FORM WOULD THEN BE SENT UNDER THE CURRENT BILL TO DHS OR SOME MECHANISM TO HAVE THE ELIGIBILITY MORE RIGOROUSLY CHECKED THAT THE QUALIFIED THERE WOULD BE APPROVED FOR ANOTHER 60 DAY SUPPLY OF INSULIN. THAT’S THE FACE TO AND ALSO WANTED DIRECT FOLKS TO LONGER TERM OPTION THIS SPEAKS TO HELP PEOPLE WORK TOGETHER TO FIND A PATH FOR DIMENSION THE SENATE PROPOSAL AS I UNDERSTAND IT’S NOT REALLY AN EMERGENCY PROGRAM . THE PATIENT WOULD HAVE TO APPLY THROUGH PROGRAM ON MNSURE WEBSITE AS I UNDERSTAND THE SENATE PROPOSAL THAT WOULD HAVE TO GO TO A DOCTOR AND GET AN APPOINTMENT WITH THEIR DOCTOR WITH THIS SHEET OF PAPER THEY’RE ELIGIBLE THE DOCTOR WOULD SEND THAT TO A DRUG MANUFACTURER THE DRUG MANUFACTURERS SENDS THE SUPPLY BACK TO THE DOCTOR AND THAT’S HOW THE MEDICATION WOULD BE SUPPLIED TO PATIENTS. I LET’S FACE IT SEEMS LIKE ANOTHER MULTI WEEK PROCESS AND WE’VE ALSO HEARD THERE MAY BE ISSUES WITH DOCTORS THEMSELVES BEING THE RESPONSIBLE PARTY TO PROVIDE THE MEDICATION. WE THINK THE PHARMACY MAKES MORE SENSE FOR THAT THE LONG STORY SHORT IS THE CONCEPT ADDRESSED IN THE EMERGENCY WILL ALSO FIND A WAY TO DIRECT PEOPLE TO LONG-TERM OPTIONS THAT MAKE SENSE THAT’S WHY THINK PRODUCTIVE CONVERSATION TO BE HELD BETWEEN HOUSE AND SENATE. >> MADAM CHAIR I HAVE A FOLLOW- UP. I WANT TO ENCOURAGE CONTINUED WORK ON BOTH THESE PROPOSALS I THINK YOU SAID YOU ARE ENCOURAGED BY THE CONVERSATIONS AND THE FACT I THINK THE CITIZENS OF MINNESOTA SHOULD KNOW THE SENATE AND HOUSE ARE WORKING DILIGENTLY ON A SOLUTION. THEIR STEPS IN THE PROCESS IN BOTH PROPOSALS I THINK WE NEED TO LOOK AT WHAT WILL TAKE TO IMPLEMENT THEM IN YOUR BILL YOU’RE LOOKING AT JULY OF 2020 THAT’S ALMOST A YEAR FROM NOW. IF THERE’S A PATHWAY WHICH COULD HAVE A SOLUTION WHICH CAN AND MORE QUICKLY THAT’S MORE EFFICIENT FOR THE PEOPLE THAT WOULD BE GREAT . I ALSO HAVE A QUESTION ON THE HIGH DEDUCTIBLE BECAUSE MY UNDERSTANDING IS ARE THEY CARVED OUT OF YOUR PROPOSAL OR WOULD THEY BE SERVED BY THEIR INSURANCE COMPANY WE’RE PROVIDING THE $25 INSULIN REGARDLESS OF THE HIGH DEDUCTIBLE? >> MADAM CHAIR END REPRESENTATIVE CAILE I’M NOT SURE I UNDERSTAND YOUR QUESTION. THIS IS MEANT TO APPLY TO SOMEONE STRICTLY ON A PLAN THAT HAS THE HIGH THRESHOLD BUT IF YOU’RE ON A PLAN THAT CAPPED INSOLENT AT THE $25 CO-PAY YOU WOULD NOT BE ELIGIBLE FOR THIS PROGRAM. >> MEMBERS; OTHER MEMBERS ARE ADDING THEIR NAMES TO THE LAST AND I THINK WE HAVE TO CUT THIS SHORT AT SOME POINT. I HAVE ON THE LIST WHEN I SAID WE’RE GOING TO STOP I HAD REPRESENTATIVE SCHULTZ AND GRUENHAGEN AND IF YOU WANT TO SEE YOUR TIME AND REPRESENTATIVE MUNSON. >> MADAM CHAIR I’VE BEEN CALLED OUT BY NAME BY ANOTHER MEMBER. >> WE CAN’T GO BACK FOREVER I THINK EVERYONE’S POSITION HAS BEEN STATED WELL REPRESENTATIVE FRANSON ALSO AS A QUESTION REPRESENTATIVE GRUENHAGEN I KNOW WHAT YOU WANTED ASKED. IF IT’S REAL SHORT YOU HAD ONE OPPORTUNITY THIS WILL BE YOUR SECOND. >> THANK YOU MADAM CHAIR I’LL TRY TO BE BRIEF AS WELL. I DON’T THINK WE SHOULD ALL SAY THAT WE FAILED BECAUSE THE HOUSE DFL PASSED THIS BILL EARLIER THIS YEAR AND WE TRIED DESPERATELY TO GET THE SENATE REPUBLICANS TO SUPPORT THIS BILL AND PASS AT AND WE FAILED TO GET THEM TO SUPPORT IT AND PASS IT WILL COST. WE COULD BE CAREFUL WHEN WE USE THE WORD WEEK; MANY PEOPLE IT IN THIS ROOM SUPPORT THIS BILL AND TRY TO GET IT PASSED. SECONDLY I THINK THIS CONVERSATION IS A GREAT CONVERSATION AND WHAT I HEAR FROM REPUBLICANS CONSISTENTLY IS THERE FIND THEY ARE OK WITH HAVING HEALTH CARE BE RATIONED BY IN COME OR BY ABILITY TO PAY AND MANY OF US HERE ARE NOT FINE WITH THAT WE THINK HEALTH CARE IS A RIGHT AND WE SHOULDN’T GIVE ONE TYPE OF MEDICINE TO PEOPLE POOR POORER OLDER TYPE MEDICINE THAT DOESN’T MEET THE CLINICAL GUIDELINES AND PEOPLE CAN PAY TO GET THE BEST MEDICINE. THIS IS THE MESSAGE I HEAR AS WELL NOT JUST ON INSULIN BUT THIS RATIONING BY IN COME HAVE TO STOP. HERE IN MINNESOTA AT THAT WAS AN INCENTIVE FOR PEOPLE TO LIVE IN MINNESOTA TO MAKE SURE EVER AND HAS THE BEST POSSIBLE HEALTH CARE AND IT SHOULDN’T BE BASED ON ABILITY TO PAY WE NEED TO RECTIFY THAT NOW AND THAT’S A BIGGER CONVERSATION. PEOPLE JUST BECAUSE THEY CAN’T PAY THEY SHOULDN’T GET LEACH’S OR BLOODLETTING THEY SHOULD GET THE LATEST MADISON THE TECHNOLOGY BASED ON CLINICAL GUIDELINES FROM A TRAINED PHYSICIAN WHEN I HEAR SOME INDIVIDUALS AT THE TABLE TALK ABOUT OTHER TYPE OF INSULIN THAT’S NOT THE BEST PRACTICE; THAT’S NOT A SOLUTION AND WE NEED TO THINK ABOUT HOW WE CAN REFORM HEALTH CARE IN MINNESOTA UP SO WE’RE NOT RATIONING BY INCOME OR ABILITY TO PAY AND EVERYONE HAS ACCESS TO THE BEST POSSIBLE MADISON TO IMPROVE THEIR LIVES AND EXTEND THEIR LIVES TO SAVE THEIR LIVES AND THAT’S WHAT’S IMPORTANT THAT’S THE CONVERSATION WE DON’T REALLY TALK ABOUT THE ISSUE OF WHETHER OR NOT IT’S OK TO RATION BY INCOME AND THAT’S WHERE WE NEED TO START WHEN WE TALK ABOUT HEALTH CARE REFORM IN THE FUTURE IS WHAT A HEALTH CARE LOOKS LIKE HOW WE PAY FOR SO WE DON’T RATION BY ABILITY TO PAY. >> THANK YOU. REPRESENTATIVE FRANSON WILL LET HER ASK YOUR QUESTION AND THEN IF YOU OF A BRIEF STATEMENT AND WILL BE DONE WITH THIS. THEN I WILL WRAP THIS UP AT THE END. SHE HAS NOT SPOKEN YET REPRESENTATIVE FRANSON. >> THANK YOU I HAVE BEEN QUITE IT IS A VERY DEEP TOPIC AND I SHARE THE FEELINGS WITH THE MOMS THERE AND REPRESENTATIVE HOWARD I AGREE WITH YOU AS WE SHOULD NEVER EVER DO THE BIDDING AND PHARMACEUTICAL COMPANIES THANK YOU FOR THAT STATEMENT WHICH SHOULD NEVER DO THAT. REPRESENTATIVE MORRIS AND YOU’RE ABSOLUTELY RIGHT WE SHOULD NOT PRACTICE MEDICINE HERE IN THE LEGISLATURE OR ABSOLUTELY CORRECT. WE SHOULD NEVER MANDATE A PRODUCT ON PEOPLE THAT SHOULD BE BETWEEN THE DOCTOR AND THE INDIVIDUAL IN THE CLINIC ROOM. THIS ISN’T JUST TO GET POLITICAL HAVE TO GET A LITTLE BIT OF TRUTH ON RECORD WE’RE HEARING NOTHING WAS DONE LAST YEAR REPUBLICANS DIDN’T OFFER SOLUTIONS THE DEMOCRATS TOOK CARE OF THAT. DURING THE END OF SESSION REPRESENTATIVE HAMILTON DID OFFER AN AMENDMENT TO USE HEALTH CARE ACCESS FUNDS THAT FUN IS NOT GOING AWAY THE LEGISLATURE VOTED TO CONTINUE THAT I THINK IT WAS VOTED DOWN TO 1.8% PROVIDER TAX NOW WE TOOK THAT VOTE REPRESENTATIVE HOWARD I’M SURE YOU REMEMBER YOU VOTED AGAINST THEM AND WE THOUGHT THIS BEING AN EMERGENCY LET’S TAKE CARE OF IT NOW AS USE THE HEALTH-CARE EXCESS FUNDS I THINK THAT’S STILL ON THE TABLE PERHAPS TO CONTINUE HAVING THAT DISCUSSION. HOUSE REPUBLICANS DID VOTE FOR THAT IT WAS VOTED AGAINST BY THE DEMOCRATS BECAUSE IT WAS MADE CERTAIN WE WANT A PHARMACEUTICAL COMPANIES LIABLE THEY NEEDED TO BE AT THE TABLE WE NEEDED TO PUNISH THEM I JUST WANT TO GET SOMETHING DONE FOR THE PEOPLE NOT TO GET POLITICAL BUT I NEEDED TO GET OUR SIDE ON THE TABLE AS WELL. THE QUESTION ABOUT FARMS PARTICIPATION I’M SURE WE’RE ALL GOING HAVE PHARMACIES ASKING HOW THIS IS GOING TO WORK WITH YOU WALK US THROUGH IT TO BE MANDATED TO PARTICIPATE IN HOW DO YOU SEE THE PHARMACIES PARTICIPATING IN THE BILL DOESN’T EXPLAIN THE REIMBURSEMENT FOR THE PHARMACIES AS WELL IF YOU COULD HELP WITH THAT THANK YOU. >> THANK YOU MADAM CHAIR END REPRESENTATIVE FRANSON JUST TO THE FIRST STATEMENT I WANT TO REITERATE ONE PIECE ON THE FUNDING THAT’S DIFFERENT FROM AND OF LEGISLATIVE SESSION WE NOW HAVE A CONSENSUS WITH THE HOUSE AND SENATE THE INSULIN MANUFACTURERS SHOULD BE THE ONES PAYING FOR THIS PROGRAM. THAT WAS CONTENTIOUS WITH THE AMENDMENT IN THE LEGISLATIVE SESSION I’M HOPING I WILL BE CONTENTIOUS GOING FORWARD NOW WE HAVE AGREEMENT WITH THE HOUSE AND SENATE ABOUT WHO SHOULD BE PAYING. TO YOUR QUESTION ON THE PHARMACY’S IT’S A GOOD QUESTION WE WORKED WITH THE BORDER PHARMACY AND CONSULTATION THE PROMISES ON THIS PROGRAM WON A PICTURE OF A PROGRAM THAT WORKS WELL ON THEIR AND AND REIMBURSEMENT IS IMPORTANT . THAT’S WHY WE STRUCTURED THE PROGRAM WHEN A PATIENT WILL GO INTO THE PHARMACIST TO GET THEIR SUPPLY OF INSULIN THE PHARMACIST WILL BE REIMBURSED DIRECTLY AND THAT WILL HAPPEN THROUGH THE COORDINATION OF THE PHARMACY BENEFIT MANAGER AND ESSENTIALLY WILL BE HANDLING THE INDUSTRY TO FUNCTION OF THIS PROGRAM. BUT WE BELIEVE IT WILL WORK WELL FOR PHARMACISTS AND UTILIZE THE EXISTING NETWORK SO MINNESOTANS CAN GO TO THE PHARMACY THEY’RE FAMILIAR WITH AND GET THEIR INSULIN. >> I QUICK FOLLOW-UP REPRESENTATIVE FRANSON. >> THANK YOU FOR INDULGING ME MADAM CHAIR AND REPRESENTATIVE HOWARD LET’S WAIT WITH THE REIMBURSEMENT WOULD BE THE TRUE COST OF THE EDS PLAN OR WE LOOKING AT A NEGOTIATED PRICE? I HEARD YOU BENCH IN THE PBM IS THERE’S A LOT OF A DISTRESSED WITH THE PBM IS CURRENTLY. >> MADAM CHAIR AND REPRESENTATIVE FRANSON THAT’S A GOOD QUESTION WE’VE INCLUDED THE LEGISLATION AND A BILL THAT WOULD PREVENT REBATES SO IT WOULD BE THE TRUE COST. >> REP GRUENHAGEN. >> MADAM CHAIR I WOULD JUST MAKE A STATEMENT TO GIVE YOU FOOD FOR THOUGHT. WHEN I LOOK OF THE BUILT WE’RE ASKING DHS TO MANAGE THIS PROGRAM AND THE LOOK OF THE RECORD OF DHS ITS LAST THAN A GREAT TO SAY THE LEAST. CURRENTLY WE HAVE TOP EXECUTIVES LEAVING THE DHS. REP >> PRISON OF GRUENHAGEN I GAVE YOU INDULGES TO DO THIS IF YOU’RE GOING TO USE THIS TO MAKE A BIG STATEMENT ABOUT ANOTHER TOPIC I WILL CUT YOU SHORT IF YOU HAVE A QUESTION. PLEASE GET TO THAT I WON’T ALLOW YOU TO A DEAD AND THAT OTHER THINGS. >> I AM SAYING TO REPRESENTATIVE HOWARD LOOK AT THE DHS TRACK RECORD A PRIVATE SECTOR HAS THINGS IN FORCE IF WE WORK WITH THEM WE MAY BE ABLE TO STREAMLINE SOME OF THAT AND WHEN WE GET DHS INVOLVED A LOT OF TIME THINGS DON’T GO VERY WELL. I’VE CUSTOMERS WHO REPRESENTATIVE PROBLEMS PAYING THEIR CO-PAY OR FOR IN THEIR DRUGS ONE OF THINGS I USE IS SENIOR LINKAGE THEY’VE BEEN VERY GOOD ABOUT KNOWING ABOUT PROGRAMS THAT A BEEN AVAILABLE WITH PHARMACEUTICAL COMPANIES OR OTHER ONES AVAILABLE AND HELPING PATIENTS WITH THEIR COSTS. EXPLORE THOSE AVENUES VERSUS GETTING DHS CONTROL OVER THIS I THINK THE ACCESS TO INSULIN WILL BE MUCH QUICKER THAT WAY AND WE ALL WANT A DIABETIC PATIENTS TO GET THE ACCESS THEY NEED NOT OF US DISAGREE WITH THAT. I DON’T KNOW IF DHS IS THE BEST WAY TO GO BASED ON THEIR TRACK RECORD THINK YOU MADAM CHAIR. >> MADAM CHAIR AND REPRESENTATIVE GRUENHAGEN WHAT I HEARD YOU SAY IS LET’S LOOK TO THE PRIVATE SECTOR LET’S LISTEN TO THE CURRENT SYSTEM IN THE CURRENT SYSTEM MINNESOTANS ARE DYING. WE NEED TO CREATE A PROGRAM SLOOT MINNESOTANS GET THE INSULIN THEY NEED AND TO THE QUESTION ON DHS I WANT TO BE CLEARED THESE ARE VERY LIMITED ROLE WITH DHS TO PLAY IN THE ADMINISTRATION OF THIS PROGRAM AND THAT’S BY DESIGN WE DIDN’T WANT TO CREATE A NEW INFRASTRUCTURE WE WANT TO USE THE EXISTING NETWORKS IN PLACE SELL WE KNEW AT DHS WOULD BE CONTACTING WITH FARMERS TO BENEFIT MANAGERS TO ADMINISTER IT PRETTY BASIC BENEFIT FOR MINNESOTANS WITH IT OR THE PHARMACIST TO GET THEIR DRUGS. EXPERIENCES IN EVERYTHING WE’VE HEARD FROM MINNESOTANS WITH DIABETES TELLS US WE NEED THIS BILL WE CANNOT RELY ON THE SAME OLD SAME OLD WE NEED TO PASS THE ALEC SMITH EMERGENCY INSULIN ACT THANK YOU. >> YOU REPRESENT OF OUR I WANT TO NOTE THE SENIOR LINKAGE LINE IS RUN BY DHS. …LAUGHTER…. ITEM THINK WE’RE GIVING DHS I WANT TO CLOSE UP WITH PART. >> MADAM CHAIR MAN RESPOND? >> NO REPRESENTATIVE MONTH IN HAVE SPOKEN TWICE I THINK YOU CAN TAKE THIS OFFLINE. >> AND AS WE RECOGNIZE PHYSICIAN TESTIFIED. . . >> REPRESENTATIVE MUNSON WE HAVE IN OUR PACKETS THANK YOU. IT IS SO NOTED. I WANTED TO FINISH THIS BY NOTING AS I’M UNDERSTAND THE DISCUSSION BETWEEN THE SPEAKER OF THE HOUSE AND THE MAJORITY LEADER IN THE SENATE ABOUT ESTABLISHING HIGH WE MOVE FORWARD FROM HERE AT THINK THAT’S ON EVERYONE’S MIND. WE RECOGNIZE THAT THERE MAY BE FURTHER TWEAKS THAT WE NEED TO THE BILL AND A LOT OF YOUR INTERESTED AND COMMENTS ON THE DRAFT ARE APPRECIATED THIS IS THE WAY WE GET LEGISLATION THAT WORKS WELL WHEN PEOPLE COME TOGETHER AND LOOK AT IT AND SAY WHAT ABOUT THIS AND WHAT ABOUT THAT; AND WE MAKE THIS WORK BETTER? I AM HOPEFUL WHAT WE’RE GOING TO SEE IS THE HOUSE AND SENATE APPOINTING EVEN THOUGH WERE IN THE INTERIM AND WHEN THE OFFICIAL CONFERENCE COMMITTEE BUT APPOINTING PEOPLE TO CONFERENCE COMMITTEE LIKED GROUP THAT WOULD HAVE ACTUAL AUTHORITY TO COME TO AGREEMENT WE HAD AT LEGISLATORS WORKING ON THAT OFFLINE ON A WORK GROUP WHICH WAS VERY MUCH APPRECIATED AND REPRESENTATIVE HOWARD HAS MENTIONED SOME OF THE CHANGES AND DIDN’T PUT THAT WAS VALUABLE TO. AT THIS POINT I THINK WE NEED TO COME TO AGREEMENT ON LEGISLATION SO THE GOVERNOR CAN GO AHEAD AND CALL A SPECIAL SESSION AND WE CAN ENACT THIS. HOPEFULLY THE NEXT STEP FOR THE HOUSE AND SENATE TO APPOINT PEOPLE AND THAT’S WHERE THE GOVERNOR SHOULD APPOINT PEOPLE AS WELL TO HAVE A DISCUSSION IN WHICH WE CAN COME TO AN ACTUAL AGREEMENT ON A BILL THAT WOULD BE AGREEABLE TO MOST OF EACH BODY AND WE COULD MOVE FORWARD THAT KIND OF I DON’T KNOW WHAT THE TIME LINE HAS FOR THAT I DON’T KNOW IF ANY OF US HAVE THE TIME LINE WE’RE HOPING THAT CAN HAPPEN RATHER QUICKLY BECAUSE WE RECOGNIZE THIS IS REALLY AN URGENT URGENT SITUATION. FOR MANY MINNESOTANS WE WANT MOVE FORWARD AND MOVE FORWARD NOT BACKWARDS INTO THIS AS QUICKLY AS WE POSSIBLY CAN THANK YOU TO THE TESTIFIERS AND THE ADVOCATES OF THE ROOM; THIS WE KNOW IS A LOT OF WORK ON YOUR PART AND WE REALLY APPRECIATE YOUR INPUT. NOTE THERE SHOULD NOTHING ABOUT THIS WITHOUT YOU TO SUPPORT YOUR VOICE IS REPRESENTATIVE THE TABLE AND BRING THIS FORWARD IN MY LIMITED EXPERIENCE LISTENING TO MINNESOTANS IN THOSE CONVERSATIONS YOU’RE DOING A GREAT JOB BRINGING FORWARD THOSE VOICES. I HAVE GREAT APPRECIATION FOR THAT PAYING Q. WE’RE GOING TO MOVE TO THE NEXT PHASE OF OUR HEARING AND BRING UP HERE MORE ABOUT WHAT’S BEEN GOING ON WITH SOME OF HEALTH PLANS ON ME INSULIN COPAYS SO WE CAN GET AN UPDATE ON THAT. HOPEFULLY WILL HAVE A LITTLE BIT OF TIME FOR SOME QUESTIONS AND DISCUSSION AROUND THAT AS WELL FIRST WE WILL INVITE J. MCCLAREN UP TO THE TABLE AND I’VE ASKED WE HAVE MEDICA AND HEALTH PARTNERS AND BLUE CROSS AND BLUE SHIELD AND ASK THEM TO GIVE US A VERY BRIEF EXPLANATION OF WHAT THEY HAVE DONE AROUND THIS ISSUE SO WE CAN GET SOME CONTEXT AND ZERO COMPARE AND CONTRAST MR. MCLAREN WELCOME. >> Q MADAM CHAIR AND MEMBERS I’M THE VICE PRESIDENT OF PUBLIC POLICY AND GOVERNMENT RELATIONS AT MEDICA @ THANK YOU FOR THE INVITATION TO TESTIFY FOR THE COMMITTEE MADAM CHAIR AND MEMBERS OF. OBVIOUSLY INSULIN IS THE ANSWER IS ISSUE FOR PATIENTS WITH DIABETES IS A BIG ISSUE NATIONALLY AND HERE IN MINNESOTA WITH MORE THAN 30 MILLION AMERICANS WHO ARE LIVING WITH DIABETES AND MORE THAN FOUR AND A THOUSAND MINNESOTA’S LIVING WITH DIABETES. DUE TO THE ATTENTION THIS ISSUE HAS DRAWN IN THE MEDIA AND HERE THE LEGISLATURE; OUR EXECUTIVE TEAM CAME TOGETHER IN JULY OF THIS YEAR AND HAD A DISCUSSION OF WHAT CAN WE AS AN ORGANIZATION DO TO HELP TO MAKE SURE ALL OF THESE THINGS WE’RE SEEING IN THE NEWSPAPER AND THE TRAGIC EVENTS THAT OCCURRED HERE WITH RATIONING HOW CAN WE PREVENT THAT FROM HAPPENING AGAIN? OUR LEADERSHIP TEAMS CAME TOGETHER AND MADE A DECISION TO MAKE AN INVESTMENT IN OUR MEMBERS HERE IN MINNESOTA TO MAKE SURE CO- PAYMENTS FOR ALL ARE FULLY INSURED MEMBERS IN MINNESOTA THAT’S EVERYONE IN THE INDIVIDUAL MARKET AND THROUGH GROUP COVERAGE THAT WE ARE FULLY INSURING ARE GOING TO PAY MORE NO MORE THAN $25 COPAYMENT FOR A 30 DAY SUPPLY OF INSULIN. THIS IS SOMETHING WE DID THAT APPLIES TO ALL OF THE INSULIN ON OUR FORMULARY IS NOT EXCLUSIVE TO ANY SPECIFIC PRODUCT. IT IS SOMETHING WE DID NOT INCREASE OUR RATES FOR IT FOR NEXT YEAR AND AGAIN IT’S SOMETHING WE DID IN ORDER TO MAKE SURE THE TRAGIC EVENTS WE’VE HEARD ABOUT IT WOULD NEVER HAPPEN AGAIN IN OUR STATE. WE BELIEVE THIS INVESTMENT WILL MAKE A MEANINGFUL DIFFERENCE BY DECREASING THE FINANCIAL BURDEN ON MEMBERS WITH DIABETES I WANT TO GIVE A SPECIAL THANK-YOU TO THE DEPARTMENT OF COMMERCE; REACHED OUT A VATICAN AND OTHERS REACHED OUT BEFORE OUR ANNOUNCEMENT TO TALK TO THIS CHANGE WOULD LIKE TO MAKE TO OUR PRODUCTS FOR NEXT YEAR AND WORK THROUGH WITH THEM A TIME LINE AND A PROCESS FOR US TO DO THAT WHILE WE WERE IN THE MIDDLE OF THEM REVIEWING OUR PRODUCTS FOR NEXT YEAR IT’S A VERY BUSY TIME FOR THEM AND THEY WORKED AND WERE ACCEPTABLE TO ACCOMMODATE THE CHANGES FOR NEXT YEAR AND AND THERE WAS SOME EXTRA WORK ON THEIR PART SO A SPECIAL THANK- YOU TO. THE DEPARTMENT OF TO IN OUR ANNOUNCEMENT ON AUGUST THAT WE’VE HAD OPPOSITE RECEIVED A LOT OF POSITIVE FEEDBACK AND LOCAL MEDIA AND FROM GOVERNMENT OFFICIALS AND OTHERS THE MOST REWARDING FEEDBACK WE’VE GOT OUR FROM OUR MEMBERS AND FROM OUR FAMILY MEMBERS AND FROM PEOPLE IN OUR COMMUNITY WHO HAVE COME UP WAS A DIFFERENT EVENTS AND THANK US FOR THE DECISION OUR ORGANIZATION HAS MADE. WE WERE VERY DELIBERATE AND DOING THIS AND WANT TO DO TO MAKE SURE PEOPLE WON’T FIND THEMSELVES IN THE SITUATION WHERE THERE RATIONING THEIR INSULIN AND WE’RE VERY HUMBLED BY THE IMPACT IS GOING TO HAVE ON MEMBERS. I WILL CONCLUDE BY SAYING WE OBVIOUSLY KNOW THIS DOESN’T FIX THE UNDERLYING ISSUE WHICH IS THE COST OF INSULIN. THIS IS SOMETHING THAT THAT HELPS WITH HOW MUCH PEOPLE ARE GOING TO PAY FOR INSULIN OUT A POCKET BUT IT DOESN’T ADDRESS THE UNDERLYING COST WHICH I DON’T NEED EDUCATE THE COMMITTEE AND WE LOOK FORWARD TO WORKING WITH THE COMMITTEE AND OTHERS IN THE LEGISLATURE ON THAT ISSUE AND OTHER ISSUES THAT AREN’T FIXED BY OUR DECISION WHICH IS THE UNINSURED POPULATION AND ALSO FOLKS WHO DON’T QUALIFY FOR THIS PROGRAM WILL HAVE THEIR INSURANCE AVAILABLE THROUGH THE SELF FUNDED EMPLOYER. LOOK FOR TO WORKING WITH THE COMMITTEE AND THE LEGISLATURE ON THOSE ISSUES THIS CONCLUDES MY TESTIMONY AND I’D BE HAPPY ANSWER A QUESTIONS MADAM CHAIR. >> THANK YOU MR. MCLAREN I THINK WE WILL ADHERE FROM ALL THE DIFFERENT COMPANIES TESTIFYING AND IF YOU WOULD STAY AROUND FOR QUESTIONS I HAVE REPRESENT OF LOEFFLER ON THE LIST. REP ARE YOU ALL RIGHT HOLDING YOUR QUESTION? >> MADAM CHAIR I WOULD BE GLAD TO WAIT I’D LIKE TO HEAR FROM ALL FOUR ON A TECHNICAL ISSUE. >> THE PERCENTAGE OF PEOPLE THE INSURER WOULD MATCH WOULD BE AFFECTED BY THIS MY UNDERSTANDING THE MAJORITY OF PEOPLE WITH EMPLOYER BASED COVERAGE WOULD NOT BE AFFECTED BY THIS I THINK THE PUBLIC NEEDS TO UNDERSTAND. >> THAT MAKES SENSE IF EACH OF YOU COULD MENTION THAT MAYBE WHEN YOU COME OUT THAT WOULD BE HELPFUL. THE PERCENTAGE OF YOUR PEOPLE YOU COVER WOULD BE AFFECTED BY THIS AS MR. MCLAREN MENTIONED THE PEOPLE WHO ARE SELF INSURED IT DOESN’T AFFECT EVERYONE IN THE MARKET. IF YOU HAVE THAT AS A PERCENTAGE DO YOU? >> WE CAN SUPPLY THAT TO THE COMMITTEE MADAM CHAIR. OBVIOUSLY REPRESENTATIVE LOEFFLER AS YOU KNOW A LARGE PERCENTAGE OF PEOPLE IN MINNESOTA GET THEIR COVERAGE THROUGH SUPPLEMENTAL AN EMPLOYER AND THE REASON WE CAN’T GUARANTEE THIS POINT OFFERED THROUGH THEM IS BECAUSE THEY’RE THE PLAN SPONSOR THEIR THE ONES AT RISK THEIR THE ONES TO MAKE THE DECISION ON HEALTH INSURANCE UP THE OFFER EMPLOYES SO WE CAN’T GUARANTEE THAT. >> OKAY THANK YOU VERY MUCH. AND THAT WE HAVE MISS COX FROM HEALTH PARTNERS IS NEXT WELCOME TO THE COMMITTEE. >> GOOD AFTERNOON A. BARBARA COX TESTIFYING ON BEHALF OF HEALTH PARTNERS WE ARE AS MOST OF YOU KNOW AND INTEGRATED CARE SYSTEM WITH HEALTH PLANS CLINICS HOSPITALS AND PHARMACIES. OF A UNIQUELY BROAD VIEW OF THE IMPACT OF DRUG PRICES ON OUR MEMBERS. HEALTH PARTNERS HAS DONE A LOT OF WORK IN THIS AREA WE HAVE INTERNATIONAL DIABETES CENTER A BAPTIST HOSPITAL WE TESTIFIED LAST NIGHT IN THE ATTORNEY-GENERAL TASK FORCE I UNDERSTOOD THE QUESTION FOR TODAY WAS COVERAGE AND THAT’S WHAT I HAVE FOR THIS TESTIMONY CURTLY HEALTH PARTNERS OFFERS PLANT AND ALL OF OUR COMMERCIAL MARKET SEGMENTS THAT INDIVIDUALS FULLY INSURED SMALL GROUP AND LARGE GROUP AND FULLY INSURED. THERE’S HIGH CO-PAY OF $25.50 DOLLARS APPLE LOWEST LEVEL TO PURCHASE INSULIN. I WANT TO NOTE THIS COVERAGE HAS EXISTED BEFORE THE RECENT ATTENTION ON INSULIN THIS ISN’T A NEW PROGRAM FOR US THIS IS SOMETHING WE HAD. GOING FORWARD IN 2020 WE’RE WORKING NOW ON A SYSTEMATIC APPROACH TO BACK IN 2020 ALL OF OUR FULLY INSURED MEMBERS WILL OF ACCESS TO INSULIN FOR $25 OR LESS PER MONTH OR. WHAT WE WORK LIKE A SAID TO IMPLEMENT THIS CHANGE WE URGE YOU TO CONTINUE YOUR POLICY WORK TO LOWER THE COST OF INSULIN WHICH IS THE UNDERLYING ISSUE THANK YOU. >> THANK YOU VERY MUCH PLEASE STAY AROUND FOR QUESTIONS. UCARE WE HAVE A GHITA WORST YOUR. >> THANK YOU MADAM CHAIR AND COMMITTEE MEMBERS. I’M PETER WERE STIRRED. >> I LIVE IN MASSACHUSETTS FOR A WHILE. …LAUGHTER… >> UCARE CURRENTLY SERVE 437;000 MEMBERS IN MINNESOTA BUT OF THAT MEMBERS 81;000 ARE ON AND ENSURE TODAY AND THAT’S OUR ONLY THE INDIVIDUAL AND FAMILY COVERAGE IN ANSWERING THE QUESTION ALL OF OUR MEMBERS WILL BE ABLE TO BENEFIT FROM THE $25 CO-PAY BUT WE DON’T HAVE ANY OTHER LINES OF BUSINESS THAT ARE DEFECTIVE BECAUSE OF WE CURRENTLY COVER. WITH THE DEPARTMENT OF COMMERCE ISSUE IN RATES WE CAN TALK ABOUT THOSE TODAY WHAT WE SAW HAPPENING AFTER WE HAD FILED TO THE RATES IN THE SPRING WAS THAT THERE WAS A NOTICE FROM THE IRA’S THAT GAVE US THE ABILITY TO DO SOMETHING DIFFERENT KIND COMPATIBLE PLANS WE WOULD BE OFFERING THAT PLAN AND WHAT WE REVEL TO DO WAS TO WORK WITH ALL OF OUR STAKEHOLDERS AND ALLOW THE $25 MAXIMUM OUT-OF-POCKET ON INSULIN FOR ALL OF THE COVERED FORMULARIES WOULD BE ABLE TO BE PUT INTO PLACE FOR THE 2020 CONTRACT YEAR. WE ALSO THANK THE DEPARTMENT OF COMMERCE FOR THE QUICK WORK ON THIS ON THIS IMPORTANT TOPIC. THEIR PIECES WE CAN IT NOT A TEAR UP THEIR COMMENTS DURING THE DISCUSSION THAT INDIVIDUALS WHO HAVE COVERAGE ARE JUST GETTING BY WE SEE PEOPLE COMING INTO OUR STATE PUBLIC PROGRAMS INTO OUR MEDICARE PRODUCTS THAT HAVE BEEN RATIONING OR GOING WITHOUT AND MEDICAL CARE THEIR RECEIVING HAS BEEN COMPROMISED WHEN THEY COME ON. ALL OF THE ISSUES ABOUT THIS WERE INCREDIBLY IMPORTANT FOR OUR ORGANIZATION IT DID NOT CHANGE OUR PREMIUM RATE WE’RE ABLE TO WORK THROUGH HOW WE COULD PUT THIS IN PLACE BECAUSE WE KNEW WHAT WAS AN IMPORTANT TOPIC TO INCLUDE FOR OUR MEMBERSHIP. WE SUPPORT WHAT YOU’RE TRYING TO DO ON EMERGENCY CARE AND THE FACT THAT WE SET SEE THAT ” CARE DELIVERY FOR INDIVIDUALS WITH DIABETES IS IMPORTANT FOR INSULIN COVERAGE AND THE CARE THAT’S PROVIDED BY THE PHYSICIAN TO MEET BECAUSE AFTER LOOKING AT THIS IN A HOLISTIC APPROACH. THANK YOU FOR ASKING US TO TESTIFY TODAY. >> THANK YOU VERY MUCH WITH. HAVE BLUE CROSS AND BLUE SHIELD MR. NELSON. >> GOOD AFTERNOON BANK EVER HAVING ME HERE TODAY. I’M DIRECTOR OF LEGISLATIVE AFFAIRS FOR BLUE CROSS BLUE SHIELD OF MINNESOTA. AS A NONPROFIT PASTOR OR A POSITION BLUE CROSS IS A LARGE HEALTH PLANS OF THE COVERING 2.9 MILLION MEMBERS I APPLAUD THE COMMITTEE EFFORTS TO TAKE A DEEPER LOOK AT THE UNDERLYING COST OF CARE SPECIFICALLY PRESCRIPTION DRUGS AND IN THIS CASE INSULIN. AS PART OF OUR BROADER EFFORT A TO REIN IN HEALTH-CARE COSTS THAT POSE A FINANCIAL BURDEN ON FAMILIES THROUGHOUT THE STATE TO CROSS AND BLUE SHIELD OF MINNESOTA OFFERS INSULIN COVERAGE TO THOUSANDS OF MEMBERS WITH AT $0 COST SURE AND TO ANSWER REPRESENT OF LAWFORD IN THE MARKET FOR CARBON IT’S ABOUT TWO UTTERED 50;000 MEMBERS AT THIS POINT IN TIME OBVIOUSLY THAT CAN CHANGE AFTER JANUARY 1ST AS MEMBERS FLUCTUATE BETWEEN PLANTS. IN 2020 BLUE CROSS BLUE SHIELD WITH YOUR ONE AND TIER 2 AND SOME OPTIONS AS A COVERED OPTION WITH NO MEMBER COST SHARE PLANTS WITH BLUE CROSS WHO REFERRED TO AS THE INSURED MARKET THE PLAN IS OFFERED AS INDIVIDUALS AND FAMILIES ON MNSURE AND OFF MNSURE SMALL EMPLOYERS AT LARGE EMPLOYERS IN SOME BENEFIT CHANGES IN THAT COMMERCIAL FULLY INSURED MARKET MANY LARGE EMPLOYERS AND NATIONAL CORPORATIONS SET THEIR OWN HEALTH BENEFITS THIS IS UNDER THE ERISA LAW WHICH BLUE CROSS ADMINISTERS WITH ACCESS TO THE BLUE CROSS PROVIDER NETWORK THIS IS REFERRED TO AS A SELF INSURED MARKET YOU BOARD HEARD ABOUT BLUE CROSS HAS THE ABILITY TO ADMINISTER A SIMILAR INSULIN BENEFIT TO THOSE MEMBERS IF. ASK FOR US TO IF . INDIVIDUALS AND OF LAWYERS WILL HAVE THIS BENEFIT CHANGE BY JANUARY 1; 2020. OUR FIRST RESPONSIBILITY IS TO DO WHAT WE CAN’T TO IMPROVE THE HEALTH AND FINANCIAL STABILITY OF OUR MEMBERS WE FELT THE RESPONSIBILITY TO ADDRESS THE SKYROCKETING PRICE OF INSULIN WITH THE OPTIONS WE HAVE AVAILABLE OUR ACTION WILL PROVIDE SOME MEASURE OF FINANCIAL RELIEF TO MANY MEMBERS WHO LIVE WITH DIABETES. HOWEVER THE PROBLEM IS MUCH LARGER THAN INSULIN MORE MUST BE DONE TO HOLD THE PHARMACEUTICAL COMPANIES ACCOUNTABLE FOR THE ASTRONOMICAL AND ARBITRARY PRICES THE SET FOR MEDICATIONS OVER ILLNESSES AND CHRONIC ISSUES WITH NO OVERSIGHT OR ACCOUNTABILITY THESE COMPANIES WILL CONTINUE TO CHARGE WHATEVER THEY WANT AS A STATE WE NEED TO WORK TOGETHER AND ADDRESS THE ROOT CAUSES OF WHAT’S MAKING AFFORDABLE TREATMENT OUT OF THE REACH OF TOO MANY PEOPLE THANK YOU. >> THANK YOU VERY MUCH. I HAVE A LIST HERE AND REPRESENTATIVE LOEFFLER YOU ARE A MASTER QUESTION TO YOU HAVE MORE? >> THANK YOU MADAM CHAIR I WANTED TO POINT OUT TO THE PEOPLE WHO ARE WATCHING US BECAUSE INSURANCE IS REALLY COMPLICATED IS WE ALL KNOW; THE INSURERS DID A NICE JOB OF EXPLAINING WHAT THEY STEP UP TO DO AND I REALLY APPRECIATE THEM STEPPING UP AND OFFERING MORE AFFORDABLE OPTIONS. AS I STATED THE MAJORITY OF OUR EMPLOYERS DOING IT AND A SELF INSURED WHEN IT PEOPLE NEED TO UNDERSTAND IF YOU’RE GETTING YOUR COVERAGE THROUGH EMPLOYER AND ARE INSULIN DEPENDENT IT WOULD BE WORTHWHILE FOR YOU TO GO TO YOUR H.R. DEPARTMENT OR THE PRESIDENT OF YOUR COMPANY AND SAY MY LIFE DEPENDS ON THE S AND I UNDERSTAND AT YOUR THE INSURER WE BED WITH IS OFFERING AN AFFORDABLE OPTION FOR INSULIN COVERAGE AND I HOPE YOU WILL STEP UP AND TAKE THAT WHEN YOU DECIDE ON OUR BENEFIT PACKAGE FOR NEXT YEAR BECAUSE IT WON’T BE AUTOMATIC AND I THINK THE MORE WE CAN GET PEOPLE COVERED BY AFFORDABLE COVERAGE THE MORE WE’RE GOING TO AFFECT OUR ABILITY TO PREVENT A RATIONING AND DEATH AND DISABILITY AND I THINK THAT’S IMPORTANT. I LOOK FORWARD TO ADDRESSING AND WORKING ON SOME OF THE OTHER DRUGS THAT PEOPLE WITH CHRONIC ILLNESSES HAVE FOR PREVENTABLE DISABILITY AND DEATH THAT THINK IT’S IMPORTANT IF WE CAN GET THE SELF-EMPLOYED INSURANCE EMPLOYERS TO STEP UP WHETHER STAY WITH BROAD COVERAGE THAT WILL MARRY WELL WITH THE REPRESENTATIVE HOWARD BILL. >> THANK YOU REPRESENTATIVE SCHULTZ. >> THANK YOU MADAM QUESTION I HAVE A QUESTION OF THE INSURANCE PROVIDERS TO JUST BACK TO BED LIKE TO KNOW WHAT STRATEGY THEY HAVE TO NEGOTIATE DRUG PRICES THE SITES THROUGH THE PBM’S. I KNOW THEY NEGOTIATE WITH OTHER PROVIDERS AT HOSPITALS AND CLINICS FOR REIMBURSEMENT I’M INTERESTED TO LEARN TO EDUCATE THE PUBLIC HOW THEY NEGOTIATE LOWER DRUG PRICES AND SECONDLY WHY STOP AT INSOLENT IF YOU’RE REALLY CONCERNED ABOUT THE COST OF INSULIN WHY STOP THERE IN CREATING SPECIAL PROGRAMS. >> THANK YOU ALL FOR COMING TO THE TABLE I WAS GOING TO SUGGEST IF YOU COULD DEFER TO EACH OTHER I THINK WE NEED ANOTHER CHAIR THERE. IF YOU ALL HEARD THE QUESTION MR. MCLAREN IT LOOKS AS IF YOU’RE READY TO RESPOND. >> MADAM CHAIR J. MCCLAREN WITH BACK ON. MADAM CHAIR AND REPRESENTATIVE SCHULTZ; AT OUR BUSINESS OPERATES WE DEAL WITH EVERYONE IN THE COMMITTEE CONTRACT WITH THE PBM TO MANAGE PHARMACY BENEFITS FOR ALL MEMBERS THE VALUE OF USING A PBM IS THAT OUGHT BASICALLY CONSOLIDATE PURCHASING POWER FOR ANY PHARMACEUTICAL MANUFACTURER WHO WANTS TO PARTICIPATE IN THE AMERICAN MARKET NEEDS TO GO THROUGH A PBM HERE FRANKLY AND HAVE TO GO TO THE PBM’S THAT GIVES THEM SOME PURCHASING POWER TO BE ABLE TO TRY TO REDUCE THE COST COMPARED TO WHAT OTHERS MAY BE ABLE TO DO ON THEIR OWN. I THINK FOR US IT’S A GOOD POINT OF WATER SOME OF THE OTHER STRATEGIES I THINK FOR US AND THE LIVES WE WOULD BRING TO THE TABLE WITH A PHARMACEUTICAL MANUFACTURER THERE NOT AS LARGE AS THE NUMBER OF LIVES THE PBM SPRING TO THE TABLE WITH THE PHARMACEUTICAL MANUFACTURERS LOOKING AT IT AND DIFFERENT STRATEGIES TO ADDRESS THE PLANS I THINK THERE ARE SOME ECONOMIC REALITIES THAT MAKE IT EXTRAORDINARILY DIFFICULT TO THE GET WERE GETTING TO THE PBM’S. >> THERE WERE TWO QUESTIONS AND MADE WE SHOULD LET THE METS OF THE ONE AND THEN; DEAL WITH THE SECOND ONE. >> BARBARA COX FROM HEALTH PARTNERS THINK OF A QUESTION HEALTH PARTNERS IS UNIQUE WE DO NEGOTIATE DIRECTLY WITH THE DRUG COMPANIES. THE ONLY THING WE USE A PBM FOR HIS CLAIMS PROCESSING THIS IS SIMILAR TO WHAT THE STATE DOES THE STATE DEPARTMENT OF HUMAN SERVICES IS YOU A PBM FOR CLAIMS PROCESSING BY THE STANDING NEGOTIATE AND WE NEGOTIATE DIRECTLY WITH THOSE COMPANIES. WE WOULD LOVE TO HAVE OUR PHARMACIES COME AND PRESENT ON OUR WORK SHE DOES A GREAT JOB. >> ” WE’RE NEGOTIATING A AS MR. MCLAREN DESCRIBED IT BACK THAT I WANTED ANSWER THE OTHER QUESTION WITH WHAT IT INSOLENT IT WAS THE WAY WE’RE DEALING WITH THINGS RIGHT NOW WE HAVE TO BE COGNITIVE OF THE UPWARD PRESSURE ON PREMIUMS WHILE WE WOULD LIKE TO LOOK AT EVERYTHING WE CAN’T LET THE MANUFACTURERS OFF THE HOOK FOR THE PRICE WE CONTINUE TO TRY TO NEGOTIATE A PRICE BUT WE CAN’T ALWAYS DO THAT AND WE CAN’T DO IT OURSELVES WE HAVE TO RELY ON WORK WITH THE FEDERAL GOVERNMENT AND WERE MUCH APPRECIATE THE WORK OF PRICE TRANSPARENCY OR TRYING A VARIETY OF OPTIONS IS NOT ONE SINGLE METHOD. >> I’M THE DEBT WORCESTER FROM YOU CARE IT WOULD BE VERY DIFFICULT FOR US TO NEGOTIATE WITH OUR COMPETITORS WHO ARE STRUGGLING IN SOME WAYS AS WITH BLUE CROSS AND BLUE SHIELD AND MEDICA WE DID SERIOUSLY LOOK AT OTHER DRUGS AND PLANS WE WANTED TO BE AWARE OF THE LEVELS AND NOW THE FEDERAL GOVERNMENT PUTS TOGETHER THE WAY WE CAN OFFER BENEFITS AND WE MODIFIED THE INSULIN COVERAGE WE STARTED TO HIT AT THE TOP OF THE MARKET LEVELS ALREADY WERE GOING TO HAVE TO GO BACK AND FIGURE OUT HOW TO DO THIS IN A WAY THAT WILL BE ALLOWED IN LINE WITH THE FEDERAL GOVERNMENT TO DO ANY KIND OF MODIFICATIONS FURTHER IN DRUG COVERAGE. WE VERY MUCH ACKNOWLEDGED THIS IS JUST THE BEGINNING THE LONG JOURNEY IN CONTROLLING DRUG COSTS. >> REPRESENTATIVE SCHULTZ. >> THANK YOU IT SOUNDS LIKE WE HAVE RIGHT NOW IT IS NOT QUITE WORKING IN BEING ABLE TO NEGOTIATE LOWER DRUG PRICES SOUNDS LIKE A GOVERNMENT MAY NEED TO STEP IN CORRECTING THIS PROBLEM AND I GUESS WHAT OTHER COUNTRIES ARE DOING IN REGULATING DRUG PRICES MAY BE THAT OPTION IS SOMETHING WE NEED TO SERIOUSLY LOOK AT IN MAKING SURE WE CAN REGULATE THOSE OF THEIR NOT PRICE GOUGING AND NOT MAKING A PROFIT OFF SICK PEOPLE BANKING FOR THAT INPUT. >> I JUST WANT TO ANSWER THE SECOND QUESTION FROM REPRESENTATIVE SCHULTZ OUR. COVERAGE FOR INSOLENT WITH THE $5.20 $5 IS THE SAME WITH ALL OR OUTPATIENT PHARMACIES SAY FOR THE SPECIALTY PHARMACY. >> DID EVERYONE ANSWER THE QUESTION I’M NOT SURE WE GOT THE RESPONSES? MR. MCCLURE AND DID YOU ANSWER AS WELL? >> AGAIN J. MCCLAREN WITH MEDICA THE ANSWER. A SIMILAR TO WHAT MR. WEBSTER SAID PARTICULARLY IN THE INDIVIDUAL MARKET YOU CAN’T GET A $25 CO-PAY TO EVER THINK IF YOU WANT TO OFFER A BRONZE PLAN THOSE ARE REALITIES OF DIFFERENT THINGS AND ALSO I WOULD AGREE WITH WHAT MISS NELSON SAID FROM BLUE CROSS THIS IS SOMETHING WE HAVE THE ABILITY IMPACT NOW FOR 2020 AND TOOK ADVANTAGE OF THAT AND ARE FRANKLY PLEASED IF WE DID SOMETHING ON THIS TOPIC. >> OKAY THANK YOU REPRESENTATIVE GRUENHAGEN. >> ANCHORED JUST A QUICK QUESTION JUNE OF LEGISLATION THAT’S BEEN PASSED BY OTHER STATES AND OR AT THE FEDERAL LEVEL THAT MIGHT HELP WITH A COST OF DRUGS GOING OUT EXPONENTIALLY WITHOUT HURTING RESEARCH AND DEVELOPMENT ON DRUGS? ARE YOU AWARE OF ANY STATE TO HAVE DONE SOMETHING THAT’S ACTUALLY WORKED WELL? >> WHOEVER WOULD LIKE TO ANSWER THAT. >> MADAM CHAIR AND MEMBERS J. MCCLAREN FROM MEDICA TO ANSWER YOUR COMPLETE? REP GRUENHAGEN I WOULD DEFER TO THE PHARMACEUTICAL MANUFACTURERS YOUR FULL QUESTION WAS JUST ABOUT WHAT COULD BE DONE ABOUT PRICE BUT WHAT CAN YOU DO ABOUT PRICE WITHOUT IMPACTING OUR ANDY AND OTHER THINGS? THINK IT WOULD BE BETTER SUITED TO ANSWER THE QUESTION. >> DOES ANYONE ELSE WANT TO WEIGH IN ON THAT? >> LYNN NELSON FROM BLUE CROSS THERE’S A SIMILAR BILL THAT WAS IN OREGON AND CALIFORNIA FOR DRUG PRICE TRANSPARENCY. >> MADAM CHAIR; REPRESENT OF GRUENHAGEN IT’S IN THE EARLY STAGES NOW. I WOULD HAVE TO LOOK INTO THAT. >> THANK YOU VERY MUCH. WELL I APPRECIATE YOUR ROLE HERE AND I GUESS I THE QUESTION FOR YOU I’M NOT SEEING ANYONE ELSE ON THE LIST NOW. WE HAVEN’T TALKED AS MUCH ABOUT THE COST OF INSULIN SUPPLIES I DON’T KNOW AT THAT TO THE SAME BUCKET AS THE INSULIN ITSELF UNDER THE COVERAGE THAT YOU OFFER. OBVIOUSLY IF A DIABETIC CAN TEST THEIR BLOOD CHARTER IT’S NOT MEANINGFUL IF YOU HAVE INSOLENT HOW IS THIS HANDLED? IS THERE ALSO A CO-PAY CAP ON THAT BOARD IS THERE ANY THING IF YOU CAME PREPARED WITH ADDED PERMISSION; IF YOU CAN GIVE BETTER SHOT. >> MADAM CHAIR AND MEMBERS J. MCCLAREN WITH MEDICA OF IT $25 CAP AND EVEN FOR FULLY INSURED PRODUCTS APPLIES TO INSULIN IT DOES NOT APPLY TO THE OTHER SUPPLIES. AGAIN IT A DIFFERENT TYPE OF EXPENSE WERE IT’S NOT ON GOING BUT THE NORMAL POSTURING WOULD APPLY TO THOSE SUPPLIES. >> MADAM CHAIR: NELSON WITH BLUE CROSS THERE’S ZERO COST SHARING ONLY APPLYING TO INSULIN THAT BLUE CROSS I WANTED TO MENTION ALSO THE ZERO COST SHARING COULD NOT MEET THEIR DEDUCTIBLE IT WOULD NOT APPLY TO THEIR IT DEDUCTIBLE BECAUSE IT WAS ZEROED OUT. >> WE CAN APPLY ITS ZERO. …LAUGHTER…. >> BARBARA COX FROM HEALTH PARTNERS THINK OF A CLARIFICATION THE SAME COVERAGE APPLIES TO OR DEDUCTIBLES THE 25 OR $5 ” PAY APPLIES FOR THE DEDUCTIBLE IS MET I’M SORRY I DON’T KNOW THE ANSWER TO YOUR QUESTION ABOUT OTHER SUPPLIES . >> OK THANK MISS WORCESTER. >> AND CHAIR AND MEMBERS ON A CLARIFICATION ABOUT THE CO- PAY NOT APPLYING TO THE DEDUCTIBLE BUT IT GOES TOWARDS THE MAXIMUM OUT OF POCKET. THAT CAN POCKET . I DID EXPECT YOU MIGHT AND ASK SOMETHING ABOUT THE SUPPLIES OF YOU; OTHER IS VERY EXPENSIVE THE TEST STRIPS CAN COST UP TO 50 KNOWS MONTH THAT’S A LARGE BUT WHEN THE IRS PUT IN THE EXPLANATION FOR THE COMPATIBLE PLANTS THEY DID NOT INCLUDE THE SUPPLIES AND REGULATION SO THAT SOMETHING WE NEED TO STILL WORK ON. >> THANK YOU FOR THAT. THE ONE THING THAT OCCURRED TO ME WE STARTED TO HEAR ABOUT OF YOU REDUCING OR OUT OF POCKET COSTS FOR INSULIN WAS THERE’S ALWAYS AN ISSUE ABOUT THIS ELECTION WHEN PEOPLE ARE CHOOSING PLANS AND IF INDEED YOU WOULD WANT TO ADDRESS I KNOW MAYBE WE DO SOME RISK ADJUSTMENTS ON AND HOW MUCH WE REALLY DO NOW; IF YOU’RE ADVERTISING HERSELF AS A PLANT OR DIABETICS CAN GET THE LOWEST COST POSSIBLE YOUR ATTRACTING MORE DIABETICS AND DIABETICS HAVE HIGH COSTS THERE PEOPLE WITH PRE-EXISTING CONDITIONS. I WONDERED IF IT WITH WHAT YOU’RE DOING IS COUNTER TO THAT EXPECTATION YOU’RE MAKING IT EASIER FOR DIABETICS TO GET WHAT THEY NEED WITHIN YOUR PLAN. I WONDER IF THERE WAS ANY THINKING ABOUT THAT IF YOU WOULD CARE TO RESPOND MAYBE YOU DON’T WANT TO RESPOND WHEN YOU’RE COMPANIES MADE THOSE DECISIONS. >> MADAM CHAIR AND MEMBERS; YES; SOME OF THOSE THINGS DID COME UP IN CONVERSATIONS FROM A POLICY PERSPECTIVE TO ADDRESS WHAT YOU TALKED ABOUT THERE’S A FEDERAL RISK ADJUSTMENT PROGRAM FOR THE INDIVIDUAL AND SMALL GROUP MARKETS IN MINNESOTA THAT DOES HELP TO TRY TO MITIGATE THE EFFECT OF ADVERSE SELECTION FOR A NUMBER OF DIFFERENT CONDITION DIABETES BEING ONE OF THEM. JUST FOR THE MEMBER’S KNOWLEDGE IT IS NOT FULLY MAKE UP FOR A COST OF A DIABETIC ON THAT PLAN SO THAT’S WHAT I WILL SAY ABOUT THAT MADAM CHAIR. >> MISS NELSON. >> AND CHAIR AND LOOKING AT THIS TO WE DID TAKE A LOT OF FACTORS INTO CONSIDERATION WHEN IT PERSONAL USES DIABETES AND SULLEN AND OUR CURRENT MEMBERSHIP PUT THAT FORWARD WHETHER WE WOULD BE ADVERSE TESTING OR NOT WE HAVE ALLOWED IT FAULT OF THOSE IN OUR MARKET NOT WE THOUGHT IT WOULD BE A PART ADDRESS THE MEMBERS WE HAVE NOW INSTEAD OF AND MEMBERS WE HAVE IN THE FUTURE. ? >> OF COURSE WE CAN’T KILL TO MENTION THE SIZE DIABETICS GETTING PROPER CARE THEIR COSTS ARE LOW WE’VE HEARD SOME STORIES IF PEOPLE DON’T GET THEIR INSULIN THEY END UP IN THE EMERGENCY ROOM THEY END UP IN THE IC U THAT’S VERY EXPENSIVE. I ASSUME WHEN YOU’RE AN INSURER IT’S YOUR BEST INTEREST TO KEEP YOUR MEMBERS AS HEALTHY AS YOU CAN BY PROVIDING THAT KIND OF THE CENTRAL CARE AND THAT’S A GOOD COST CONTROL MEASURE. I SEE SOME HEADS NODDING. >> MADAM CHAIR AND MEMBERS I WAS GOING TO SAY WHEN WE LOOKED AT THE RISK ADJUSTMENT WITH OUR MEMBERS OF WHEAT IDENTIFIED A SHARE OF PEOPLE WERE GETTING ACCESS TO THEIR IN SEVEN IN A TIMELY MANNER AND COORDINATING WITH THEIR PHYSICIANS OFFICE WAS ACTUALLY SOMETHING THAT WAS GOING TO IMPROVE OUTCOMES AND POTENTIALLY REDUCE COSTS AND NOT INCREASE COSTS. >> MADAM CHAIR THANK YOU THAT; WAS SOMETHING I WAS THINKING OF HIS WEALTH THEY WERE GIVING THEIR RESPONSES. IN OUR DELIBERATIONS IN SIDE MEDICA WE TALKED ABOUT LOOKING NEXT YEAR AS WE ROLL THIS OUT ADHERENCE TO INSULIN AND HOW THAT IMPACTS THE UTILIZATION BY DIABETICS HAVE A LIKE SO WE CAN TRACK AND SEE WHAT THAT EXPERIENCE LOOKS LIKE NEXT YEAR AND BEYOND AND WE’D BE HAPPY WHEN WE HAVE HAD A DEBT TO COME IN AND PRESENT THAT TO THE COMMITTEE. >> THAT’S GREAT MISS COX. I THREW UP A GREAT SOFTBALL QUESTION DIDN’T DIE? >> WE DIDN’T HAVE ANY REASON FOR QUESTIONS ON THIS WE DID HAVE THIS $25 CO PAY OPTION PREVIOUSLY ON BEHALF OF THE 2000 DOCTORS WHO WORK IN OUR SYSTEM I THINK OUR INTEGRATED SYSTEM TAKES MEDICAL PART OF THE CARE REALLY SERIOUSLY AND JUST BECAUSE I WAS AT THE TEST LAST NIGHT WHERE HER MEDICATION THERAPY MANAGEMENT PRESENTATION DIABETES WAS ONE OF THE MEASURES THEY SHOWED AND HOW IT LOWERED COSTS AND HEALTH PARTNERS COVERS MTM SAID THAT’S ANOTHER WAY WE THINK THIS WORKS. >> LET’S SEE; WE HAVE REPRESENTATIVE BIERMAN. >> THANK YOU MADAM CHAIR UP WANTED TO GO BACK A LITTLE BIT YOUR VOLUNTEERING TO GIVE US SOME MORE INFORMATION ON THE COMPONENTS FOR DIABETICS. I RECENTLY WAS DOOR KNOCKING AT A HOUSE WHERE IT AS A SPOKE TO THE MEMBERS IT TURNED OUT THERE WERE FOUR DIABETIC AND HOUSEHOLD AND THEY TOLD ME AT LENGTH OF THE FACT THERE COMPONENTS THE TUBES THAT HAD TO REPLACE AND THE TEST STRIPS AND THE PUMPS WHICH ARE RECURRING COSTS OVER TIME FOR ALL OF THEM THAT THE COLONEL TO BE SOURCED FROM ONE PLACE I’M WONDERING ABOUT THE COMPETITION IN THE MARKET ALL THOSE PRODUCTS AND IF YOU’RE WILLING TO GIVE US MORE INFORMATION ON THOSE OTHER ASPECTS IF YOU COULD INCLUDE THAT I WOULD APPRECIATE IT. >> YOU’RE NOT LOOKING FOR AN ANSWER RIGHT NOW? THANK YOU. I’M NOT SAYING ANY OTHER QUESTIONS. IF GROUP WOULD MAKE ONE FINAL COMMENT ON THIS TOPIC A THINK ALL OF US ARE HAPPY TO SEE THIS HAPPENING I THINK I REMEMBER SEEING SOME PERSON IT WAS HERE OR IN COMMITTEE OR SOMEWHERE AT ST. WHEN THEY HEARD SOME OF THE COMPANIES OR GOING TO TAP OUT POCKETS THEY JUST CRIED IT MADE SUCH A DIFFERENCE IN THEIR LIFE. REPRESENT OF HALVERSON IT WAS YOU WHO SAID THAT? IT WAS VERY STRIKING TO ME AND IT WAS NOT VERY MEANINGFUL TO MINNESOTANS. I JUST WANTED TO RESPOND REPRESENTATIVE SCHULTZ WAS MENTIONING HOW WE COULD ADDRESS THE PROBLEM I THINK THERE’S ACTUALLY AT LEAST A SOLUTION AND VERY MUCH WORTH TRYING THAT IS HERE IN FRONT OF US IN MINNESOTA AND THAT WAS THE GOVERNOR’S PROPOSED AT PHARMACEUTICAL BUYING WILL. WE COULD USE THE POWER OF YOU TALK ANSWERED THE REPRESENTATIVE SCHULTZ QUESTION SOME OF YOU BY SANG YON HAVE ENOUGH BUYING POWER TO DRIVE DOWN PRICES AS A STATE AS A STATE IT’S HARD FOR ME TO BELIEVE THAT WE DON’T AND I WOULD LIKE TO SEE IS AGGREGATE OUR BUYING POWER I DON’T THINK I THINK THE COMPANIES WOULD IT MUCH HARDER TIME STOPPING US FROM DOING THAT THAN TRYING TO REGULATE PRICES DIRECTLY AND WE HAVE SOME OTHER SOLUTIONS OUT THERE REPRESENTATIVE MORRISON TRANSPARENCY BILL WHICH WE WILL HEAR MORE ABOUT THAT AND OTHER SOLUTIONS AS WELL. I CONTINUE TO BELIEVE USING OUR BUYING POWER AS A STATE TO GET BETTER PRICES IS SOMETHING WE REALLY CAN DO AND STARTING IN THE PUBLIC PROGRAM AREA AND ULTIMATELY FOR EVERYONE IN THE STATE 5.5 MILLION OF US THAT’S A LOT OF PEOPLE AND IT’S THE BIG MARKET AND WE COULD BE SAYING YOU WANT TO SELL TO US OR POINT IT NEGOTIATE PRICES WITH YOU AND BENEFIT FROM THAT WHETHER OR HEALTH PLANS OR GOVERNMENT PROGRAMS HOWEVER WE WOULD DO THAT. JUST WANTED TO PUT THAT BACK OUT THERE REPRESENTATIVE HALVERSON . >> TO MADAM CHAIR I WASN’T WINNING A AS IT WAS ME TO CRY ALL YOU PROBABLY COULD ASSUME IT WAS ME. IN ACKNOWLEDGMENT EVERYONE WAS ON THIS COMMITTEE WE HAVE TO FACE THE HARD REALITIES ALL OF THE COMMITTEES DON’T HAVE THE KIND OF STORIES THAT WE HAVE TO LISTEN TO. THINK YOU’RE ONE WHO SHOWS UP AND IS PART OF THESE CONVERSATIONS AND SERVES ON THIS COMMITTEE I THINK EVERYONE TO SIGN UP FOR HHS SIGNS UP BECAUSE THEY HAVE A PASSION FOR THE PEOPLE OF MINNESOTA AND HELPING THE PEOPLE OF MINNESOTA. BUT WHAT ACTUALLY HAD RAISED MY HAND FOR WAS TO NOTICE THAT WE HAD CONVERSATIONS OVER THE YEARS ABOUT HOW MINNESOTA IS SERVED BY HEALTH PLANS IN THE STATE AND THE POTENTIAL FOR SERVING BEING SERVED BY HEALTH PLANS OUTSIDE OF THE STATE AND THE PLANS THAT ARE SITTING AT THIS TABLE ARE BASED IN MINNESOTA AND ARE ALL NONPROFIT AND WE HAVE A LOT OF CONVERSATIONS ABOUT WHAT GOOD WITH REGARD TO DELIVERING HEALTH CARE IN MINNESOTA FOR-PROFIT HEALTH PLANS AND I THINK IT NOTABLE THESE ARE MINNESOTA BASED COMPANIES RESPONDING TO THE NEEDS OF MINNESOTANS AND THEIR NONPROFIT HEALTH PLANS THAT STEPPED-UP I WANTED TO MAKE NOTE OF THAT. >> THANK YOU MEMBERS BEFORE WE ADJOURN THE WANT TO NOTE WE’RE GOING TO BE AS PART OF A MINI SESSION WE’RE GOING TO BE HAVING MORE DISCUSSION IN ROCHESTER ABOUT THE PRICE OF PHARMACEUTICALS. IF ANYONE HAS SIGNED UP FOR THAT ONE IT WOULD BE GREAT TO SEE YOU THERE FOR THAT THAT ON OCTOBER 2ND. THE HEARING WILL BE AT 2:00 P.M. AND WITH THAT THANK YOU VERY MUCH FOR COMING TODAY MEMBERS TO HEAR THIS IMPORTANT TOPIC WE ARE ADJOURNED.

1 comment

Leave a Reply

(*) Required, Your email will not be published