HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

February 28, 2003   Hearing Room D

9:00 A.M. Tapes 37 – 39

 

MEMBERS PRESENT:            Rep. Jeff Kruse, Chair

Rep. Billy Dalto, Vice-Chair

Rep. Carolyn Tomei, Vice-Chair

Rep. Gordon Anderson

Rep. Jeff Barker

Rep. Laurie Monnes Anderson

 

MEMBER EXCUSED:             Rep. Ben Westlund

 

STAFF PRESENT:                  Sandy Thiele-Cirka, Administrator

Mara McGraw, Assistant

 

ISSUES HEARD:                     WORK SESSION

                                                Introduction of Committee Bills

                                                INFORMATIONAL MEETING

                                                Overview of Prescription Drug Programs

·         National Organization of Drug Store Chains

Lis Merten, Regional Director of State Government Affairs

Tom Holt, Oregon Pharmacists Association

·         Prescription Patient Assistance Programs-Generic Perspective

Ron Hartman, Geneva Pharmaceuticals

Judith Milford, Teva Pharmaceuticals U.S.A., Vice-President Government Affairs

·         Prescription Patient Assistance Programs-Brand Perspective

Jim Gardner, Pharmaceutical Research and Manufacturers of America (PhRMA)

Paul Nielson, Pharmacia, Chairman of Oregon PhRMA Task Force

·         Senior Discount Prescription Programs

Ann Tweedt, Bristol-Myers Squibb Company, State Government Affairs

Russ Spencer, Pfizer, Inc.

           

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 37, A

004

Chair Kruse

Calls meeting to order at 9:21 A.M. and opens work session on LC Draft 2365. Submits LC Draft 2365 (EXHIBIT A).

BILL INTRODUCTION – WORK SESSION

017

Rep. Tomei

MOTION:  Moves LC 2365 BE INTRODUCED as a committee bill.

 

 

VOTE:  4-0-3

EXCUSED:  3 - Anderson, Dalto, Westlund

 

Chair Kruse

Hearing no objection, declares the motion CARRIED.

021

Chair Kruse

Closes work session on LC 2365 and opens work session on LC 2963.  Submits LC Draft 2963 (EXHIBIT B).

BILL INTRODUCTION – WORK SESSION

022

Rep. Tomei

MOTION:  Moves LC 2963 BE INTRODUCED as a committee                 bill.

 

 

VOTE:  4-0-3

EXCUSED:  3 - Anderson, Dalto, Westlund

 

Chair Kruse

Hearing no objection, declares the motion CARRIED.

027

Chair Kruse

Closes work session on LC 2963 and opens informational meeting on prescription drug programs.

INFORMATIONAL MEETING

034

Lis Merten

National Association of Chain Drug Stores (NACDS), Northwest Regional Director. Submits informational packet (EXHIBIT C).  Offers background, process, policies and participant list of NACDS.  Requests committee look at system as continuum when considering a solution. Notes research and cost savings agreement opportunity for Oregon Medical Assistance Programs (OMAP).

102

Chair Kruse

Inquires on turn around time on research.

106

Merten

Explains two week period for data from University of Texas.  Addresses success of preferred drug list. Presents information on preferred drug list, supplemental rebate program, and prior authorization programs in Florida, Michigan and Vermont. Details savings.

154

Rep. Monnes Anderson

Requests specifics on savings.

158

Merten

Reports savings are to the department.  Notes partnership with community pharmacies.  Addresses issues of patients with multiple prescriptions.  Summarizes cost savings mechanisms from packet (EXHIBIT C).  Explains option to explore cost savings mechanisms rather than reduce reimbursement rates to pharmacists.  Encourages committee to get at root of problem of prescription drug costs.  Addresses issues with current cost savings solutions.  Discusses elimination of senior assistance programs. 

317

Rep. Monnes Anderson

Inquires on clinics dispensing prescriptions as cost savings mechanism. 

333

Merten

Defers to Tom Holt to address question.

338

Tom Holt

Executive Director, Oregon State Pharmacists Association. Explains remote dispensing programs and related issues regarding patient safety. 

375

Rep. Monnes Anderson

Notes impact of case management as tool for success.

390

Holt

Explains panel used to oversee remote dispensing programs.

408

Chair Kruse

Inquires on Florida’s four brand cap program.

415

Holt

Discusses data regarding four brand cap program. 

439

Chair Kruse

Requests data on four brand cap program.

444

Merten

Notes Washington State’s program and available data.

TAPE 38, A

011

Holt

Notes cost savings to health care system via therapeutic prescription drug use such as averted surgeries.  Addresses cuts in pharmacy reimbursement rates.  Notes data provided to 2003 session Oregon Health Plan (OHP) workgroup.  Explains impact of reimbursement cut on pharmacists. 

062

Rep. Tomei

Inquires why pharmacies sell prescriptions at a loss.

063

Holt

Relates dedication to serve community. Explains margins that balance profit losses.

075

Rep. Tomei

Restates question and cost clarification.

077

Holt

Explains rates of sale are determined by Medicaid. Explains rate ceiling and maximum allowable costs determined by OMAP and Medicaid for the various classes of drugs.

090

Rep. Tomei

Inquires on purchasing.

093

Holt

Explains purchasing as it relates to price determination and acquisition costs. Details buying groups and discusses Inspector General reports on prescription rates.   

148

Rep. Tomei

Questions losses on drug cost and dispensing fees.

151

Holt

Explains pharmacies operate on narrow margins.  Notes current analysis on Oregon pharmacies.  Notes current savings to General Fund. 

195

Rep. Anderson

Inquires on point of sale (POS) items used to offset losses.

201

Holt

Explains importance of POS and “front end” items in pharmacy survival.

212

Rep. Monnes Anderson

Explores co-pays as method to curb costs. 

220

Holt

Explains position on voluntary co-pay policies. Reports benefits of mandatory co-pay policies. Suggests means test and recommends co-pay not apply to generic drugs. 

265

Ron Hartman

Manager, Government Affairs, Geneva Pharmaceuticals. Submits Medicaid data sheet (EXHIBIT D). Offers background on Geneva.  Speaks to therapeutic and cost savings benefits of generic prescription drugs. Offers suggestions to increase use of generic drugs. Discusses data on cost savings, generic rebates and profitability for generic manufacturers

360

Rep. Monnes Anderson

Inquires on the generic drug research process.

363

Hartman

Explains research and development is focused on duplicating the brand drug.   

367

Rep. Barker

Inquires in Indian Health and military purchase of generic drugs.

372

Hartman

Reports volume of product sold to military and Indian Health agencies.

376

Rep. Tomei

Comments on Medicaid data sheet (EXHIBIT D) correction.

377

Judith Milford

Vice President, Government Affairs, Teva Pharmaceuticals, U.S.A.  Offers background on Teva U.S.A. Notes correction to Medicaid data should read average price of generic drug after rebate is less than $18 (EXHIBIT D). 

TAPE 37, B

020

Milford

Highlights suggested pharmacy cost savings programs such as promotion of generic drugs through prior authorization in combination with preferred drug lists. Explains impact of rebate programs. Estimates costs savings through use of generic drugs.

075

Rep. Monnes Anderson

Explores income generated via research. Requests information on shareholders and profits.

082

Holt

Explains low cost and high volume results in profits.

098

Vice-Chair Tomei

Inquires on 1% cost savings figure (EXHIBIT D). 

100

Milford

Reports figure is annual and based on 2001 data.

102

Vice-Chair Tomei

Requests information on profit margins.

109

Holt

Agrees to provide information at later date.

119

Jim Gardner

Oregon Counsel for Pharmaceutical Research and Manufacturers of America (PhRMA). Submits written program materials and data on other states (EXHIBIT E). Addresses collaborative efforts between invested parties. Notes senior discount programs and suggests changes to ease application process. 

198

Paul Nielson

Manager, Regional State Government Affairs, Pharmacia Corporation and Chairman, PhRMA Task Force. Submits patient assistance program directory (EXHIBIT F). Offers estimated figure for industry on assistance programs and describes the patient access process.

276

Vice-Chair Tomei

Inquires on categories of promotional drugs.

277

Nielson

Explains qualifying drugs. Continues description of process for patient access to assistance programs. Addresses waiting period to access prescriptions.              

321

Vice-Chair Tomei

Inquires on patient access via community clinics.

328

Gardner

Clarifies safety net clinics are prime users of programs.

335

Vice-Chair Tomei

Inquires if process applies to separate drugs.

336

Nielson

Explains manufacturer process.

348

Rep. Monnes Anderson

Inquires on whether patient would know which drug manufacturer to contact.

352

Nielson

Explains promotion of assistance programs. Explains physicians and care givers can inform on manufacturer.  Points out variety of criteria for assistance program qualification. 

460

Nielson

Continues presentation on patient assistance programs. Reports provider staffing and exposes related to assistance programs. Notes advocacy coalition work to enroll patients in assistance programs. Reports on research regarding patient assistance access.   

TAPE 38, B

038

Nielson

Summarizes Northwest data on patient’s access to assistance programs. 

044

Gardner

Submits handout which documents Northwest patient access to assistance programs (EXHIBIT G).

053

Rep. Monnes Anderson

Questions implementation of assistance programs relating to case management programs. 

065

Gardner

Explains charitable contributions from PhRMA to implement program.  Notes software solutions to implement program. State industry preference to work collaboratively with private, nonprofit sector.

085

Rep. Monnes Anderson

Notes comments from constituents at a district forum. 

094

Gardner

Relates importance of broad based community effort.

101

Vice-Chair Tomei

Inquires on assistance program’s use of generic drugs.

103

Nielson

Reports on generic drug access.

109

Vice-Chair Tomei

Reports concern of providing brand drugs versus generic drugs.

112

Gardner

States nature of generic business as commodity business. Explains position on generic drugs. Reiterates program is not a substitute for long range solution. 

134

Nielson

Explains Oregon mandatory generic use policy. 

143

Vice-Chair Tomei

Restates question of PhRMA providing generic drugs.

144

Nielson

Reports that Pharmacia does not provide generic drugs.

160

Ann Tweedt

Bristol-Meyers Squibb Company. Submits informational packet on Together Rx (EXHIBIT H). Lists manufacturers participating in program. Discusses senior assistance program eligibility and benefits.  Discusses 150 drugs qualifying for coverage. 

229

Rep. Monnes Anderson

Inquires on process of brand drug becoming generic drug.

230

Tweedt

Describes patent process and timeline.

240

Rep. Monnes Anderson

Expresses benefits of shortening time period.

242

Tweedt

Explains relationship between patent and marketing.

250

Chair Kruse

Relates federal regulations regarding patents and marketing. 

263

Russ Spencer

Pfizer, Inc. Submits pamphlet (EXHIBIT I). Explains assistance program and discusses Pfizer’s Share Card and Connection to Care program (EXHIBIT J).  Addresses gap between need, access to programs and the one-stop access efforts.      

359

Vice-Chair Tomei

Inquires on complications created by multiple prescriptions. Questions unified process.

370

Spencer

Discusses clearinghouse concepts to simplify access. Notes policy on referring patients to correct manufacturer. 

395

Rep. Monnes Anderson

Inquires on generic timeline.

403

Spencer

Notes Pfizer, Inc. is not involved in generic drug manufacturing.  Offers PhRMA as a host for a Brand-Generic Drug Informational presentation to bring members up to speed on industry. Relates impact of generic drugs on brand manufacturers.   

424

Vice-Chair Tomei

Questions cost of brand drugs related to marketing.

435

Spencer

Offers example of marketing budget and research and development budget for Pfizer, Inc. 

TAPE 39, A

018

Vice-Chair Tomei

Inquires on percent of research and development budget is provided by federal government

019

Spencer

Responds the figure is low. Relates high cost of research and development.

030

Rep. Monnes Anderson

Inquires on research grant applications.

039

Chair Kruse

Requests saving that information for upcoming presentation at later meeting date.

045

Tweedt

Informs that specifics can be offered during an informational presentation as suggested earlier. 

049

Rep. Barker

Comments on research and development. 

057

Gardner

Submits Executive Summary (EXHIBIT K). Submits Michigan information on practitioner managed versus physician driven prescription program (EXHIBIT L). Submits Michigan website information on price differentials on retail prices of drugs (EXHIBIT M).

131

Rep. Tomei

Inquires on budget for advertising patient assistance programs. 

132

Gardner

Reports not having exact figure and will provide the information. Informs on expansion of new web resources. 

135

Chair Kruse

Notes complexity of issue. Adjourns meeting at 11:16 A.M.

 

EXHIBIT SUMMARY

 

A – LC Draft 2365, staff, 5 pp.

B – LC Draft 2963, staff, 9 pp.

C – Informational, written testimony, Lis Merten, 33 pp.

D – Informational, written testimony,  Ron Hartman, 1 p.

E – Informational, written testimony, Jim Gardner, 10 pp.

F – Informational, guide, Paul Nielson, 26 pp.

G – Informational, prepared testimony, Jim Gardner, 1 p.

H – Informational, prepared testimony, Ann Tweedt, 15 pp.

I – Informational, brochure, Russ Spencer, 8 pp.

J – Informational, prepared testimony, Russ Spencer, 2 pp.

K – Informational, prepared testimony, Jim Gardner, 1 p.

L – Informational, written testimony, Jim Gardner, 3 pp.

M – Informational, written testimony, Jim Gardner, 5 pp.