HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

April 09, 2003 Hearing Room 50

3:15 PM Tapes  90 - 91

 

MEMBERS PRESENT:            Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Kruse

 

MEMBERS EXCUSED:            Rep. Randy Miller

Rep. Susan Morgan, Vice-Chair

Rep. Jeff Merkley

Rep. Alan Bates

 

GUEST MEMBERS:               Rep. Carolyn Tomei

                                                Rep. Mitch Greenlick

                                                Rep. Gordon Anderson

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

ISSUES HEARD:                     Invited Testimony

                                                Informational Meeting

 

Pharmacy Perspective on the House Audit Committee’s Recommendations

Tom Holt, Oregon State Pharmacists Association

Mike Douglas, Mike's Medical Pharmacy

 

Pharmaceutical Industry's Perspective on House Audit Committee's

Medicaid Cost Containment Recommendations

Don Stecher, Novartis Pharmaceuticals

Anne Tweedt, Bristol-Myers Squibb Co.

Jim Gardner, Pharmaceutical Research and Manufactures of America

 

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 90, A

003

Chair Westlund

Calls the meeting to order and notes that the witnesses are not in the room and calls the meeting to recess until 4:00 pm to hear testimony from Tom Holt.  Meeting is in recess 3:15 pm

INFORMATIONAL MEETING

010

Chair Westlund

Calls meeting to order 4:00 pm and invites Tom Holt to begin his testimony and opens the informational meeting.

015

Tom Holt

Oregon State Pharmacist Association introduces himself and presents his testimony and begins presentation. (EXHIBIT A-C).

099

Rep. Tomei

Asks whey wouldn’t the pharmacist go to generic automatically for Prozac.

103

Holt

Describes the process for filling prescriptions.  Continues presentation.  Makes comments about the article he brought with him. (EXHIBIT D).

145

Rep. Greenlick

Makes comments that he was part of the study discussed in that article.

152

Holt

Continues presentation.

295

Rep. Greenlick

Asks how he sees the capitation rate working with pharmacy.

300

Holt

States that, that is not what he was talking about and makes his comments more clear and continues.

352

Rep. Greenlick

Comments about (EXHIBIT C).

TAPE 91, A

006

Holt

Responds about the questions on (EXHIBIT C).

021

Rep. Tomei

Asks why is it that fee for service gives a better rebate than Managed Care.

026

Holt

Responds that it becomes a numbers game of who has the biggest pot and who has the most leverage.

030

Rep. Tomei

Asks if the state had a Managed Care program they could get the same rebate.

032

Holt

If the state had everyone under single management, and one would assume a single drug list, the state could maximize their drug rebates and continues presentation and extends a comment that OMAP has been doing great work over there.

061

Chair Westlund

Thanks Tom for the thank you to OMAP.

062

Rep. Tomei

Needs clarification about what he was saying about Arizona.

068

Holt

Gives clarification about how he feels their process works.

072

Berkobien

Asks if their dispensing fee is on this chart as well.

075

Holt

Responds no, it is not.

078

Berkobien

Asks where this chart came from.

081

Holt

Responds that they just made it this morning as a result of a meeting with OMAP.

085

Rep. Greenlick

Want to elaborate more on Rep. Tomei’s question, he thinks that there is an assumption that you can create a virtual managed care piece for the drugs and elaborates.

105

Holt

Responds that CMS would be able to deliver an answer of whether or not they will let them take this approach and elaborates.

125

Rep. Greenlick

Lets say CMS says it is ok, asks it is then feasible.

128

Holt

Responds about its feasibility.

133

Mike Douglas

Mike’s Medical Pharmacy introduces himself as a small pharmacy owner in Newberg and fills prescriptions for Oregon Health Plan patients and begins his testimony.

252

Rep. Tomei

Asks if a physician has sat down and had a conversation with this man you are discussing.

258

Douglas

Responds why this man that he discussed is falling though the system.

290

Rep. Greenlick

Comments that he is painting a bleak picture but the ultimate point is the important one and he bets the physician has spent twenty five or thirty minutes in the last couple of years in a frustrated conversation not having the tools to do anything, but it is very hard in the health care system to have that constant feedback with the patients and as a pharmacist you may have the time to do that.

336

Douglas

Comment that some of these folks can only see the physicians only so many times per year and comments that they have a greater chance to make an impact on these people and elaborates.

TAPE 90, B

001

Rep. Greenlick

Asks if the model he portrays a reality for the larger pharmacies.

011

Douglas

Makes his comments about what he believes is a reality for these larger pharmacies.

040

Rep. March

Asks if Ned is still operating in Newberg and what is the percent of people on eight or more drugs.

045

Douglas

Gives the percentages of those on eight drugs or more and responds yes, that Ned is still operating in Newberg.

050

Chair Westlund

Thanks them for their testimony and call the next witness to the dais.

060

Jim Gardner

Oregon Counsel for PhRMA introduces himself, presents testimony (EXHIBIT E) and begins presentation.

120

Rep. Greenlick

Asks if he thinks this is feasible for the larger pharmacies.

124

Gardner

Responds yes, it will take some considerable management but could be feasible.  Continues presentation.

130

Rep. Kruse

Asks if there is an advantage to being multi-state rather than just Oregon.

145

Gardner

Can’t answer that specifically but elaborates on that pool verses others.

151

Chair Westlund

Asks aren’t we Federally statutorily entitled to get the lowest transacted price to a public entity.

152

Gardner

Responds yes, if you are the purchaser.

155

Chair Westlund

Comment that it would be for the same quantity.

157

Gardner

Comments that that would be for Medicaid purchases, but you make other kinds of purchases.

158

Rep. Kruse

Comments that we are speaking about Medicaid in this instance.

159

Gardner

Doesn’t think on the Medicaid side that the group purchasing will yield you additional savings, but it could for other agencies.

160

Rep. Greenlick

Asks is it not true that it is the lowest price for the same quantity.

165

Gardner

Responds no.

168

Chair Westlund

Asks Don if he could write some of this down and get back to us and elaborates.

173

Rep. Kruse

Gives an example of one of the fears going into Minnesota that isn’t Medicaid is that we may actually be worse off on the Medicaid side by that pooling than we are just being as a state with the Medicaid purchase and elaborates.

182

Don Stecher

Introduces himself and elaborates on the issue of the prices that different states are receiving.

201

Chair Westlund

Comment that if he could flesh that out for us that would be great.

204

Rep. Greenlick

Makes questions about special pricing on the direct institutions.

210

Stecher

Responds that he will look into that.

220

Gardner

Continues presentation.

285

Chair Westlund

Comments about the direction that the committee is going, when this is all said and done and hopefully adopted the fee for service population at least 95 percent of them will go into Managed Care and they will present a card not similar to, exactly the same because they will be members of an enrolled managed care plan, that will be your key point, why managed care works and be responsible for the risk of that patient.

304

Gardner

Comments that is wonderful, because that has always been the direction of the Oregon Health Plan.  Continues presentation.

TAPE 91, B

008

Rep. Greenlick

Comments that the issue is that the best physicians clinical judgment is actually has some basis and there is a whole lot of evidence that the physicians best clinical judgment in situation where there is no scientific evidence is essentially a mental flipping of the coin or it’s equivalent or worse and elaborates.

022

Gardner

Comments that those were very interesting points and elaborates.

050

Rep. Greenlick

Comments that this is a central issue and would like to discuss this at a later date.

055

Chair Westlund

Would like this to wrap up soon as we are twenty five minutes past five and he is concerned about staff getting out of here.

060

Gardner

Continues presentation.

095

Rep. Greenlick

Comments that the basis assumption that drug A is no better than drug B.

102

Gardner

Responds to the basis assumption.

110

Rep. Greenlick

Comments what his approach would be.  The question is, when you have more than two drugs, the physicians are at a loss, when drug A doesn’t work try drug B.

120

Gardner

Responds to the comments about the different approaches.

137

Rep. Kruse

Comments that it clearly becomes an asset test.

142

Gardner

Comments that they wanted to put it on the table because it is an expenditure.

145

Rep. Kruse

I think this is a question to throw at Rep. Shetterly and have him get back to us on it.

154

Chair Westlund

Calls meeting to a close and adjourns 5:33 pm.

 

 

EXHIBIT SUMMARY

 

A – Informational, prepared testimony, Tom Holt, 1 p

B – Informational, prepared testimony, Tom Holt, 1 p

C – Informational, prepared testimony, Tom Holt, 1 p

D – Informational, prepared testimony, Tom Holt, 1 p

E – Informational, prepared testimony, James Gardner, 5 pp