SENATE COMMITTEE ON HUMAN SERVICES

 

 

February 22, 2005                                                                                                   Hearing Room D

3:00 P.M.                                                                                                                     Tapes  22 - 23

Corrected 10/03/2005

MEMBERS PRESENT:         Sen. Bill Morrisette, Chair

Sen. Jeff Kruse, Vice-Chair

Sen. Laurie Monnes Anderson

Sen. Charles Starr

 

MEMBER EXCUSED:          Sen. Rick Metsger

 

STAFF PRESENT:                 Rick Berkobien, Committee Administrator

Katie Lowry, Committee Assistant

 

MEASURES/ISSUES HEARD:

Evidence-based Process on Prescription Drugs: Drug Reviews, Improving Drug Use Safety, and Application of Information – Informational Meeting

Oregon’s Mental Health Medication Initiatives: Partnership for Psychiatric Medication Access – Informational Meeting

The Medicaid 340B Program: Overview, Other State’s Experience and Potential for Use in Oregon – Informational Meeting

 

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 22, A

005

Chair Morrisette

Calls committee to order at 3:06 p.m.  Opens informational meeting on Evidence-based Process on Prescription Drugs.

EVIDENCE-BASED PROCESS ON PRESCRIPTION DRUGS - INFORMATIONAL MEETING

010

Dr. Mark Helfand

MD, Oregon Health and Sciences University (OHSU) Evidence-based Practice Center.  Introduces himself.

012

Chair Morrisette

Notes that the members are in a sub-committee.

013

Helfand

Gives background information and explains evidence-based process on prescription drugs.

034

Chair Morrisette

Recognizes the committee is now a full committee.

035

Helfand

PowerPoint presentation: Explains systematic reviews.

060

Helfand

PowerPoint presentation: Explains outcomes.

070

Helfand

PowerPoint presentation: Discusses evidence.

075

Helfand

PowerPoint presentation: Discusses systematic literature reviews.

090

Helfand

PowerPoint presentation: Discusses drug-class reviews.

110

Helfand

PowerPoint presentation: Discusses strengths of evidence-based process.

130

Sen. Kruse

Asks how you get a correct demographic sample if it is reviewed by the public.

135

Helfand

States that some experts also review it. States that the public review process has been mostly productive. Describes demographics of public reviewers.

150

Sen. Kruse

Comments that he was misunderstanding the term “public review.” Verifies that the reviewers have to have some type of knowledge or background to be able to review.

155

Helfand

Confirms that they do have to have some knowledge or experience.  Comments that the reports tend to be technical and hard for a layperson to read. Discusses that it is important for those being studied to have input.

170

Sen. Kruse

Discusses understanding of Helfand’s comments.

180

Chair Morrisette

Comments on difference between peer review and public review.

181

Helfand

Comments that when the reports are open for public comment, that many people who comment are peers.

183

Chair Morrisette

Inquires regarding Helfand’s knowledge of a study.

185

Helfand

Discusses the approval process of the Federal Drug Administration (FDA) and studies that come out of it.  Discusses an example involving Vioxx prescription drug and heart attacks.

230

Helfand

Discusses the benefit of having physicians on panels to do research because of the lack of time for physicians to read all information.

240

Chair Morrisette

Inquires if there is evidence that show the effectiveness of medical marijuana.

255

Helfand

Answers that he has not been asked to perform a study on that.

258

Chair Morrisette

Comments that he would like to have a study done.

260

Helfand

Comments that before they spend money on research they look to see if someone else has done it.

267

Chair Morrisette

Comments that there is a fund to assist in research. Discusses the need to perform the research.

285

Helfand

Remarks that there is an investigator that is investigating different issues of pain.

295

Dr. Kathy Weaver

MD, Oregon Office of Health Policy and Research. Submits example pages from website (EXHIBIT A). Explains what the Health Resources Commission does.

330

Weaver

Explains process for drug review.

365

Weaver

Shares how many evidence based reports have been done by the Health Resources Commission and how often reports are updated.

385

Weaver

Explains sub committees and who is a part of it.

400

Weaver

Refers to EXHIBIT A, page 2, which covers the types of drugs that have been reviewed and reports that were completed.

TAPE 23, A

005

Chair Morrisette

Inquires if insurance companies in Oregon use the list.

007

Weaver

Answers that they have been doing a survey to discover this. Explains that it is more complicated for insurance companies because of rebates.  Discusses knowledge of companies who use the list.

015

Chair Morrisette

Inquires regarding the commission’s website and recommended drugs.

020

Weaver

Discusses competition to be on the preferred drug list and the creation of supplemental rebates.

025

Chair Morrisette

Discusses the need of information.

030

Weaver

Remarks that the knowledge of cost effectiveness and bulk purchasing provides leverage and competition.

032

Chair Morrisette

Comments that the program is in an infancy stage.

035

Weaver

Remarks that this is an exciting and busy program.

037

Chair Morrisette

Discusses the desire to understand how the program is progressing.

040

Weaver

Comments that they work together, but are a separate program.

043

Sen. Kruse

Inquires how additional classes are under review right now.

045

Weaver

Answers question.

050

Sen. Kruse

Inquires what would be done if they did not have sufficient data sets.

053

Weaver

Answers question.  Describes procedure.

065

Sen. Kruse

Inquires regarding their plan to move into psycho tropics.

068

Weaver

Answers question.  Remarks that this is an area that needs to be looked at carefully.

080

Sen. Kruse

Discusses and inquires how they would factor in items that are subjective.

090

Weaver

Responds and notes that drugs are often compared to placebo.

105

Sen. Kruse

Discusses effectiveness of drugs.

113

Weaver

Remarks that she would like to see studies where effectiveness and safety are both measured in.

120

Chair Morrisette

Clarifies Weaver’s statement.  Closes informational meeting on Evidence-based Process on Prescription Drugs and opens informational meeting on Oregon’s Mental Health Medication Initiatives. 

OREGON’S MENTAL HEALTH MEDICATION INITIATIVES – INFORMATIONAL MEETING

130

Dr. David Pollack

Psychiatrist.  Medical Director, Office of Mental Health and Addiction Services. Gives PowerPoint presentation and submits the slides of presentation (EXHIBIT B).

175

Pollack

Continues PowerPoint presentation (EXHIBIT B, page 2, slide 1).

220

Chair Morrisette

Asks for further clarification to understand the relation to Pollack’s comments and SB 180.

230

Pollack

Answers that SB 180 addressing the concern of patients “doctor shopping.”

240

Pollack

Continues PowerPoint presentation (EXHIBIT B, page 4, slide 3).

265

Sen. Kruse

Inquires what would be a concern.

268

Pollack

Responds. Refers to next slide (EXHIBIT B, page 5, slide 2).

310

Sen. Kruse

Comments on the Medicaid population using a large part of the drug budget and inquires if this will help with this.

315

Pollack

Discusses response. Continues PowerPoint presentation (EXHIBIT B, page 5, slide 3) and explains graphs.

400

Pollack

Continues PowerPoint presentation (EXHIBIT B, page 8, slide 3).

TAPE 22, B

010

Pollack

Continues PowerPoint presentation (EXHIBIT B, page 11, slide 3).

050

Chair Morrisette

Asks for clarification of who the prescribing provider is.

056

Pollack

Explains.

060

Chair Morrisette

Clarifies that Pollack is speaking of psychiatrists.

061

Pollack

Answers that he is talking about psychiatrists and psychiatric nurse practitioners for the most post.

062

Chair Morrisette

Refers to testimony in a previous hearing.

068

Pollack

Discusses concern of those who prescribe prescriptions having the right education.  Discusses the departments efforts to assist in this.

080

Chair Morrisette

Discusses idea for assisting with the problem.

090

Pollack

Responds and comments that these issues are very connected. Discuses current efforts to help resolve the problem.

100

Pollack

Concludes PowerPoint presentation and testimony.

110

Chair Morrisette

Comments on the time limits to hear more information today.

123

Sen. Kruse

Discusses electronic prescription writing and costs associated with it.

145

Pollack

Responds to Sen. Kruse’s comments.  Discusses shortage of funds.

160

Sen. Kruse

Discusses changes happening in the system. Remarks that this needs to be explored.

170

Pollack

Comments that there are a lot of resources available today and agrees that they should be taken advantage of.

175

Sen. Kruse

Responds to Pollack.

185

Chair Morrisette

Closes informational meeting on Oregon’s Mental Health Medication Initiatives and opens informational meeting on the Medicaid 340B Program.

THE MEDICAID 340B PROGRAM – INFORMATIONAL MEETING

195

Shawna Kittridge

Consultant, Mercer Government Human Services Consulting. Licensed Pharmacist.  Presents PowerPoint presentation. Submits presentation slides (EXHIBIT C).

267

Rick Berkobien

Committee Administrator. Inquires regarding the cost comparison.

280

Kittridge

Responds. 

290

Kittridge

Continues PowerPoint Presentation (EXHIBIT C, page 6).

310

Chair Morrisette

Asks for clarification.

312

Kittridge

Answers clarification.

320

Kittridge

Continues PowerPoint Presentation (EXHIBIT C, page 7).

366

Chair Morrisette

Clarifies the number of pharmacies in Oregon participating in the program.

370

Kittridge

Responds. Comments on the need to verify the number.

375

Sen. Kruse

Clarifies if the safety net clinics are federally qualified.

376

Kittridge

Responds.

380

Sen. Kruse

Asks if rural health clinics are a part of it.

382

Kittridge

Responds.

385

Sen. Kruse

Inquires if there is a list of the clinics.

392

Kittridge

Answers that it is available on 340B website.

396

Sen. Kruse

Asks staff to obtain the list.

398

Kittridge

Continues PowerPoint presentation (EXHIBIT C, page 8).

TAPE 23, B

003

Kittridge

Continues PowerPoint presentation (EXHIBIT C, page 9).

013

Chair Morrisette

Inquires regarding the states that participate currently.

016

Kittridge

Responds.  Continues PowerPoint presentation with specific state examples (EXHIBIT C, page 10).

030

Sen. Kruse

Asks if there is equivalent savings to their current procedures.

033

Kittridge

Responds.  Answers that Texas found 340B savings to be greater.

035

Sen. Kruse

Clarifies Kittridge’s answers.

036

Kittridge

Responds.

038

Sen. Kruse

Discusses need to be careful in changing current procedure.

040

Chair Morrisette

Responds.

042

Kittridge

Continues PowerPoint presentation (EXHIBIT C, page 11).

050

Chair Morrisette

Inquires if a scenario by Kittridge would need a waiver.

053

Kittridge

Explains response.

059

Kittridge

Continues PowerPoint presentation (EXHIBIT C, page 12).

072

Sen. Kruse

Inquires if waivers are case by case.

078

Kittridge

Answers question.

081

Sen. Kruse

Inquires how specific waivers need to be.

090

Kittridge

Explains.

094

Kittridge

Continues PowerPoint presentation (EXHIBIT C, page 13).

125

Chair Morrisette

Inquires what would be entailed if Oregon mandated enrollment of healthcare providers.

136

Kittridge

Explains.

141

Chair Morrisette

Clarifies question.

152

Kittridge

Responds.

155

Sen. Kruse

Asks a question about Kittridge’s comments.

163

Kittridge

Asks for clarification of Kruse’s question.

164

Sen. Kruse

Re-states question.

173

Kittridge

Answers question.

175

Chair Morrisette

Inquires what qualifies a patient to become a client of the entity.

178

Kittridge

Answers question.

185

Berkobien

Inquires if programs in Oregon could potentially become 340B programs.

188

Kittridge

Responds.

190

Stephanie Davis

Mercer Government Human Services Consulting.  Addresses question. Discusses reasons why people would not be participating in 340B entities.

206

Sen. Kruse

Remarks that small providers might not participate because it is not worth the effort.

209

Kittridge

Comments on the administrative burden related to getting set up.  Continues PowerPoint presentation (EXHIBIT C, page 16).

258

Chair Morrisette

Asks who they are currently working with.

260

Davis

Answers they are working with the Oregon Health Policy Institute.

264

Chair Morrisette

Inquires if they have spent much time consulting in Oregon.

272

Davis

Explains. Refers to ongoing work with the benchmarking project.

283

Chair Morrisette

Inquires if they have addressed the bulk purchasing program of pharmaceuticals in Oregon.

285

Kittridge

Discusses efforts to obtain information on the state of Oregon.

298

Chair Morrisette

Asks if Kittridge is currently physically working in Oregon.

303

Davis

Remarks that one person came to Oregon today just for the meeting, but the others were already in the state.

308

Chair Morrisette

Inquires if they will be available later on to discuss things further.

310

Davis

Answers, yes.

311

Chair Morrisette

Comments on the need to obtain more information.

315

Sen. Kruse

Asks question about past experience.

317

Davis

Answers that there is a reconciliation that is ongoing.

326

Berkobien

Inquires if there are numbers available to show the potential savings.

332

Kittridge

Comments that these numbers are not currently available.

342

Chair Morrisette

Comments on appreciation of the testimony given.  Ask Kruse if he has been involved in 340B in the past.

357

Sen. Kruse

Answers that this is his first exposure to 340B.  Discusses experience.

373

Davis

Comments that many states are also learning about the basics of the Medicaid 340B program.

410

Chair Morrisette

Discusses testimony given at a previous hearing.

430

Sen. Kruse

Remarks that he is interested in the steps that New Mexico went through with hemophilia and the costs associated with it.

445

Chair Morrisette

Closes informational meeting on the Medicaid 340B Program.  Adjourns meeting at 4:59 p.m.

 

EXHIBIT SUMMARY

 

  1. Prescription Drugs, Evidence-based Process On, website pages, Kathy Weaver, 14 pp
  2. Oregon’s Mental Health Medication Initiatives, PowerPoint presentation, David Pollack, 12 pp
  3. Medicaid’s 340B Program, Overview , PowerPoint presentation, Shawna Kittridge, 19 pp