space. i want them to have the longer space so more students can get on the bus and there's other problem. i know that because of the bus is so crowded many of the students that walk to school instead of taking the bus so i want you to pay more attention to the po tecialt safety and more students can get to school safely and thank you. >> thank you so much. are there any other members of the public that would like to speak so this item? seeing none. public comment is now closed. [gavel] . i just want to thank all of the students that came to speak today. it's important to have your actual voices heard at these hearings so thank you for making the time to be here, so commissioners, supervisors any comments or questions? okay. again i know commissioner mendoza recognized that the staff from sfusd that mere to

speak on the item and i want to thank you for being today to answer any questions if we had any so thank you for your time as well. i think that this is a really, really important discussion and this is the right committee to be having a discussion that talks about better agency coordination between sfusd and one of our city agencies. i think that i learned a lot in today's hearing based on the data presented today and i really love to continue to see coordination to work to improve especially upon some of the comments we heard today and what i think i largely heard partially of course was the time to get to school but seems like a larger issue is the frequency of the buses to ensure that students it get on when buses are crowded and they're skipping stops and of course its connection to next muni which i love but can be very frustrated by when i see it go to zero and

no bus and have to wait for the 15 minutes for the next bus but i am glad we had this first hearing. i hope we can continue the discussion today so seeing no further comments i would like to make a motion to continue this to the call of the chair. we have a motion. we can do that without opposition. madam clerk are there any other announcements? >> there are none supervisor. >> can i -- >> i'm sorry. commissioner wynns. >> thank you. i want to remind the committee i have asked several times that we have a hearing on the after school bra initiative. >> i am sorry i didn't get that. >> i would have liked it before but i know we had scheduling conflicts with our own staff and i think they might have that for the next couple of months so i would like to ask that someone work with the staff to figure out a time for that.

if we had that hearing prior to this month we would have been publicly discussing expanded after school opportunities for people in the school assignment process but if we do it later it would be before school starts when people are thinking about school. i don't know when is the best time but i think it's important since we did so much work and expansion of after school opportunities to be publicly discussed so people understand what we're doing before school starts next year. >> great. our office will work on that if you can let us know the appropriate staff person we will do that. just so the committee is aware there are at least four items pending for april and may. we have one on homeless families within the school district which i know was a great discussion in december recently with a major grant from some of the private sector folks. we have a continuation of an item on the work that our planning department is doing with sfusd on the growing

population and whether we need to plan also to build schools or grow schools with our population growing which is very exciting, and we do also have on the docket a hearing item on the health curriculum and sexual relationships in consent curriculum as well, so i know supervisor cohen also has a hearing on the docket we're we're trying to schedule and that is what is coming up over the next coming months. madam clerk are there any announcements? >> no, there are none supervisor. >> seeing none meeting is adjourned. [gavel] thank you everyone. i

good afternoon, everyone. welcome to the san francisco budget & finance committee for wednesday march 25, 2015, my name is mark farrell i'll be chairing this committee i'm joined by commissioner chan and supervisor scott wiener i believe we'll be joined that i supervisor mar and supervisor norman yee i want to thank the clerk clerk linda wong and

members of the sfgovtv mark and scott >> madam clerk, any announcements? completed speaker cards and documents to be included should be submitted to the clerk. items acted upon today will appear on the march 31st board of supervisors agenda unless otherwise stated okay. thank you madam clerk call item one. >> item one hearing to review the health insurance trend of reclassifying certain life saving drugs including aids drugs thereby increasing the cost of access for those drugs for patients. >> thank you madam clerk this item was sponsored by supervisor wiener. >> thank you very much mr. chairman and scheduling this colleagues today will be discussing did growing health

care assess issue we must address locally and federally and state naming the implosion of life saving drugs including - medication and treatment for hepatitis c and cancer and others onions do you to insurance companies reclarifying a drawing as a quote/unquote specialist drugs instead of a a patient paying a typical co-pay of 1b or 25 or 50 conflict of interests a month the patient in addition must pay a significant percentage of the drug when means a co-pay insurance of $6,000 or more the explosion important drug costs our hiv and

cancer and rheumatoid arthritis denies the folks the insurance benefits and remain on those medications that is clear here for many most people that havetions and need access to life saving drugs that requiring them to pay six or eight hundred or $6,000 a month is the same as saying they can't have the drug a denial of assess for hiv patient for example for many people that means going off our medications that results in serious ionize and death reducing the access to hiv medication in addition to harming the hiv positive people leads to increased infections

because people on medication are less likely to pass on their ill in essence they'll be less healthy and get for sick and today and increased risk of ineffecting other people san francisco strategy to reduce and end hiv infection is in par an hiv people have immediate and consistent access to medication reclassification as so-called specialist drugs directly undermines our city health strategy around hiv and is to the acceptable last month we heard with the kaiser permanente members that are fatiguing 6 hundred monthly co-pay i reached

out to kaiser as a number of advocates in the community and met with them within a week kaiser readers itself moves people off the specialist list and grirsz people for the money the issue is not over it is far boarder than kaiser and hiv medication allocate insures have moved drugs into the specialist list this goes beyond hiv tennis irresistance this issue became public i've been contacted we people that have diseases that experienced massive co-pay increases due to the drug reclassification and other drugs at issue as well is it so noted just about cover collet we focus

on cover california the 5 health ininsures that today, we got a hiv poppe positive person and health net is not classifications ever clarified the ulcers plan it is specified you'll have to pay $800 a month to have this life saving medication this owner is complicated aid one type of insurance or one category it is broad and trend we need to stop in pits tracks trend possesses serious issue when president obama signed the 5ek9 e affordable health care act did whole point to make sure that all americans had access to

good health care the description was against people any move by insurance companies to deny the access to treatment for example by having high co-pays is no different than coverage for a popcorns medical condition is violates the laws and is illegal needs to stop colleagues weigh hear from our department of public health which is involved in 2, 3, 4 issue in terms of our own contract and the broader issue and we'll discuss our departments approach and we'll hear into two organizations to inform the san francisco aids foundation and we'll hear from blue shield which is the only covered california insurance

provider that agreed to speak publicly so mr. berkebile mr. chairman if no other remarks i ask we move to the department of public health. >> exchange supervisors colleen with the department of public health if i could get even though overhead please. so it's good timing we reached did 5 year anniversary of the affordable health care act and ass himself to the affordable health care act many americans have access to health insurance this means they have better access to health care services and the medications they need the majority of americans 70 percent of them take at least one prescription drug more than 50 percent take two and

advancements in medications treat life threatening conditions walk cancer and help it's and more the cost are often high as an example of the 12 cancer medications approved in 2012 the annual cost from 70 to $100,000 a year common drugs for ruchl toyed arthur reiterates costs more $68,000 a year more of the safety drugs relatively - pardon me. >> experts expect extending e spending on healthy medications will grow and 2019 they'll equal half off all drugs last year half of the drugs approved by

itself fda what's the definition it is generally agreed on they need special handling products like bio logics from living cell phones and cultural in the labor laboratory and they require temperature storage or have fda mandatory programs that restrict their distribution and generally medications that have maybe indigestables perhaps their administered in a driver's side office but the third category is high cost drugs not necessarily requiring special handling or complex modification but seen as those that cost more than $600 a

month so supervisor wiener referred to the tiering the medication pricing on health insurance this was a chart from health care california and it shows you the 4 tiers that health plans put medications into the higher the tier the higher the cost char the tier one are the high cost and the low brands this as a co-pay maybe 5 or 10 or $15 tier two are peripherally drugs that maybe a little bit brand names or number one jeb genetic they could have a higher co-pay tier

3 is the non-preferred drugs drugs in this category have a higher co-pay but still a co-pay of a 6 prices per medication filled so the fourth tier the specialist drugs we're talking about here the ones on that co-insurance 234089 the fixed amount but a percentage of cost of the drug to the plan so what is the concern with specialist tiering supervisor wiener laid it out. >> before you get to that the name is an odd name specialist it seems like maybe a special drug you're getting you know help you something like plastic surgery or something frivolous and fancy but you know some of

the drugs we're hearing for example, hiv drugs they're not i don't give them a specialist their drugs the direct said you needed need to be on this is those and i believe the deprived from the specialist pharmacies those first two categories i talked about the special handling or the complex administration the drugs that require special handling they went through speciality pharmacies with the shipping to control the temperatures or did some the patient education oneself education that's where it was derived the third category that is used the high cost medication i think more of

the issues are being seen oral medication that don't require special handling or special knowledge by the patient. >> so basically an insurance companies will say this drug is extensive so you're going to have to pay 40 percent of the drug costs. >> that's right it's not just health plans but the means to an end has the same definition. >> it is like baffling i suspect i'm preaching to the choir to say shocking that insurance companies you think you buy insurance so our covered and then all of a sudden i mean literally someone be sent me a photo with a cash register and

he showed up to get his monthly drug and he showed me a photo it's beyond me why insurance companies financial incentives it strikes me it is illegal. >> i have a little bit of additional information that gets to that point here. >> okay. >> so you laid out the speciality tiering as you stated supervisor wiener they may violate the affordable health care act provisions for protecting people that have preexisting conditions and maybe discriminatory and for patient it puts a substantial financial

strain on people and the costs cannot can be unexpected may be a person needs a drug for a disease and it's on a stoplight tier the health plan changed the policy and the cost increased dramatically as you've stated cost effects whether a person can afford their diner or medication they'll probably buy the food they need and this gets to your other point buyouts action of plan for plan the initiation of treatment with initiation of treatment for diseases coming sooner and in the stance of chronic deceased the plans are seeing an increased cost not only for the drug but for the time the

patient are on the drug what happens it leads to adverse selection among health plan those that covers medications for favorable will have more people on the plans that gets to the sustainability of plans over time as supervisor wiener mentioned that is a invading issue this is a recent study where affordable housing letter health looked at the study california was included with the federal health change population so public california and california those states represent 60 percent of the total population enrolled in health care and it is relative to the as supervisor wiener said it's to the limited to the