SENATE COMMITTEE ON HEALTH POLICY

 

 

February 20, 2003†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Hearing Room B

1:00 PM††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Tapes 22 - 23

 

MEMBERS PRESENT:†††††††† Sen. Bill Morrisette, Chair

Sen. Bill Fisher, Vice-Chair

Sen. John Minnis

Sen. Frank Shields

Sen. Charles Starr

Sen. Vicki Walker

 

STAFF PRESENT:†††††††††††††††† Marjorie Taylor, Administrator

Saranelle Allen, Committee Assistant

 

MEASURE/ISSUES HEARD:†††††††††† Informational Meeting

††††††††††††††††††††††††††††††††††††††††††††† Review of OMAP/OHP Administration

 

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

 

TAPE/#

Speaker

Comments

Tape 22, A

008

Chair Morrisette

Opens an informational meeting at 1:05 p.m.

INFORMATIONAL MEETING

Review of OMAP/OHP Administration

012

Lynn Read

Acting Administrator, Office of Medical Assistance Program.Introduces Jim Edge, who will begin with an overview of the pharmacy program.

028

Jim Edge

Acting Assistant Administrator of OMAP.Gives an overview of the pharmacy program and details of its operation.States there are two programs, one Managed Care and the other a Fee for Service, which covers the mental health program.

053

Edge

Gives additional details on what drugs are included, and any regulations that must be met.

 

Edge

Gives details on a Pharmacy Benefits Manager (PBM).States that we are contracted with First Health.Explains further on specifics of a PBM and how they operate.

 

Read

Advises there is currently no audit on PBM, but it has been suggested one be done.

 

Chair Morrisette

Asks if he could get written materials on todayís presentation.

 

Read

States she will supply information.

 

Sen. Minnis

Asks if DHR helps groups get into the program.

155

Edge

States that yes, they do assist people to get into a mail order program.States that notification is usually done by mail-outs and replies to phone inquiries.

 

Read

States that over the past couple of months further education has been done for field staff to include specifics on co-pays and on mail order programs.

 

Chair Morrisette

Raises questions on difference in 30-day and 90-day rules for mail order and local pharmacy capabilities.

280

Sen. Fisher

Some discussion back and forth with Read on drugs that might be filled that werenít on the covered service.

 

Sen. Fisher

Asks if any study had been made comparing cost savings on a 90-day mail-in prescription vs. service from a local pharmacy.

 

Edge

States none done as yet as more data is required.Gives details on the intent of the 90-day refill program.

Tape 23, A

041

Sen. Minnis

Asks how payments are made to the pharmacies currently in the plan.

 

Read

States all payment is done by automation through the PBM.States that we process 1.7 million claims a month, and this doesnít imply that checks are written on each claim.

104

Sen. Minnis

Asks why the state doesnít do a line transfer to the vendors.

 

Read

Advises that checks are written, but we do not do electronic transfer of payments in the Medicaid system.States that electronically they can only do remittance advices.Advises we do not have computer capabilities at the present time, but are moving forward with the procurement of a new Medicaid management information system.

127

Chair Morrisette

Suggests that a cost analysis would be appropriate.

 

Sen. Minnis

Questions why we arenít currently using our banking service to do electronic payment as a cost savings to the plan.

 

Read

Advises that the Systems staff has reviewed the current system for compatibility with banking hardware and software to implement this program, with the determination that the current computer system is in need of updates before this could happen.

130

Read

Agrees to provide more information in answer these questions.

 

Read

Advises that a positive to our pharmacy processing program is that the payments to the providers go out within a week.

144

Sen. Fisher

Asks what the control is over the PBMís.

 

Edge

States that they have a controlling document/system in their contract.

 

Read

Relates that monitoring is done within OMAP as well, to insure compliance with the contract.

199

Sen. Fisher

Questions cost savings on using a PBM instead of a state level group.

 

Sen. Minnis

Asks about administrative costs if we compare state to PBM.

270

Read

Explains the variety of duties and costs of OMAP staffing.

350

Sen. Minnis

Discusses the possibility of upgrading claim processing electronically in lieu of manual or time inefficient processes.

369

Chair Morrisette

Continues discussions back and forth with Sen. Minnis and Read on PBM costs and department costs.

Tape 22, B

020

Edge

Continues overview on OMAP payment process, and co-payments.

080

Chair Morrisette

Asks for some documentation on lists.

 

Read

Advises she will get a list of different categories of people and what plans/benefits are applicable.

130

Sen. Minnis

Notes that during the interim session, staff had provided most of this information to committee members.

 

Read

Offers to work with staff to obtain any additional information.

 

Edge

Continues review on payment/rebate procedures.

280

Edge

Gives specifics on constraints in the preferred drug plan.

 

Read

Suggests it would be good to add Continuing Medical Education (CME) to our Oregon Health Plan for physicians on the plan.

Tape 23, B

010

Sen. Minnis

Asks if other states are having difficulty in working with the Federal government on todayís rebate programs, and is there a centralized entity working on our behalf.

 

Read

Advises that some states are trying to work together in negotiating for supplemental rebates.

065

Sen. Minnis

Asks if there is a current liaison within Oregon who would be communicating the desires of the state to the Federal government.

088

Read

Suggests further discussions with Governorís office.

 

Edge

Explains a summary of needs: ability to operate more like the private sector and less like a government; need more flexibility in the preferred prescription program to save money; have more classes of drugs be evaluated with less exclusions; enhanced ability to use the prior authorization system, and finally, to build on supplemental rebates, over and above what the Federal government negotiates for us.

162

Read

Reviews state rules and restraints.

228

Read

Reviews budget reductions.

 

Sen. Morrisette

States that meetings are happening this week, and he would like to be kept apprised of what is on the priority list for OMAP.

355

Read

Gives a wrap up.

389

Chair Morrisette

Adjourns meeting at 2:54 p.m.