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tv   [untitled]    March 27, 2015 7:00am-7:31am PDT

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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
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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
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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
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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
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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
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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
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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 oer remarks i ask we move to the department of public health. >> exchange supervisors colleen
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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
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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
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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
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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
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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
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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.
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>> 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
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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
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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
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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 health plan in the health insurance plan. >> this is important one conversation we were having in the community there are people that opt for the high digestible plans and find the dedublt are noted manageable we're ask them to go to a silver plan we're
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talking about spll silver plans having drugs that are effectively unaffordable for people that's a real problem. >> absolutely and i didn't mention when i was talking about the unexpected nature of the health costs brauj plans you pay a lower amount but the minute you need health care it is far more expensive 2, 3, 4 a baggage plan the cost sharing for speciality plans can be 40 percent of the cost for drugs so what that table shows the proportion of the plans for all the drugs in a specified class into the tier for hiv medications they looked at medications broken covering
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medications for example 29 percent of the plans for all probable cause terrors and 60 percent of plans put the cancer medications into a stoplight column it is nationwide issue a study was done in speciality medications in 11 health care plans this is a chart from that report that looktsdz the formulas so the dark blue colors show when messages for hiv may appear in tiers 1, 2, 3 and the other is for tier 4 there are 4 plans that have more than 70 percent of mayor medications for
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hiv in the highest cost tier it is important to point out here i think that the plans that tend to place those medications in the highest one were smaller carries and represent about 5 percent of the overall enrollment in california and also note those plans include one out listeners listener and the health care has been in contact with the health care to address the issue and have shown a willingness to make changes. >> what's the other 3. >> i don't know. i think that sharp and valley is one - >> (inaudible). >> solly think - southern
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california. >> here's a true cost example with using the hiv medication it is about $15,000 announcing and the amount that the patient pays to get this to a health plan on covered california varies on the level that the person purposes as mentioned the brauj plan seem more effective when you buy and have to pay every month but they could be more expensive you have to pay more when you access a health care service 40 percent of 42 percent of san franciscans incomes higher than that choose the bronze plan and platinum
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has the highest premiums but on a bronze plan a participants might take 40 percent of speciality medications but on a platinum plan 40 percent looking at the difference between platinum and browns plan the platinum a person access the medication and the plan on the preferred tier that cost is one hundred and 80 there's a year for that one medication if the speciality tier the cost is one thousand $500 a year compared to the browns plan if the medication were put on the preferred brand that's tier 35 thousand dollars plus a year and tier out-of-pocket maximum a plan can't charge a patient more
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than $6,350 a year that hits the $6,000 cap only on one medication there are efforts to address this issue since they've been identified in may 2014 a complaint in the federal health and human services in a statement in response to that allegation they said if an issue replaces most or all drugs that treat the plan it discriminates or discourages enrollment that is a clear practice and the federal budget proposal currently before congress allows the skeet of health and him
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services allows the high cost preparation drugs the affordable health care act eliminated the ability of the government to negotiate drug pricing there are also is statewide effort to address the tiering last year, it was sb passed that covered the california covered plan the sub stabilize that program that helps patient to look at the medications they need just recently earlier 24 year covered california encompassed additional requirements for implementation the addition to those all the time by sb 52 we wanted it earlier and created a standardized definition and for
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conditions treated with speciality medication hasn't at least one medication must be on tier 1, 2, 3 and physical evidence looking at the future for the ability to access the caps or spreading of maximums throughout the year a person who wouldn't spend 0 more than a certain amount in one year or shift the burden there are two bills pending before the state legislation ab 39 prevents the copies from a tier and assemblyman bill requires the companies to report medications that costs more $10,000 just to conclude it is clear it matters in san francisco but that helps to put a finer point on this is a chart
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showing element san franciscans living with hiv we don't have good numbers for multiply scleras and other disease but necessary need access to treatment that is why it is an important issue here in san francisco thank you very much priscilla so mr. chairman i'd like to ask as mentioned our assemblyman david chiu is sponsored legislation around this and aaron's office is here i want to ask him to come up and speak on the assembly man's behalf. >> thank you very much as the supervisor said i'm here i'm
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aaron on behalf of dude for the most part thank you, supervisor wiener for this important topic so through the affordable health care act millions of californians now have comprehensive plans and this is on affordability high-priced drugs and speciality drugs taken place to derail the coverage and the co-pay who have 6 price tags are struggling with the chronic and complex disease as mentioned far too many patients living with hiv and aids and cancer and as well as hepatitis c and having to my for their childcare food over and over in san francisco their housing spending on the speciality drugs
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is expected to quadruple to $400 billion if 0 noticing nothing is done to address those those are impacting the drug governor jerry brown state budget is looking at the hepatitis c 2r5e789s and that if be a tremendous breakthrough more than one thousand dollars per pill those are a burden on the health care system and unsustainable in the long term from the package of proposition d david chiu worked on this it is clear with the san franciscans stand at the state level we're working to aid this with two patrol officers proposals we have seen ab and
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assembly member chow talked about the high-priced drugs specifically to report data to the state of california for the policymakers with insights into the costs of drugs and will vooblth for ever treatment above $10 the pharmacy companies must disclosure the costs and martha advertising and materials and manufacturing and government substantive grant and the costs attributable to that drug with the mind of the drugs no genetic alternatives highlight the need for scrutiny how drugs are priced and the rationale behind charging the government and patient prices beyond the
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sustainability of our health care system ab 43 provides that scrutiny and shiendz the light on this and we must have the ability to help all folks thank you very much. >> next i'd like to call up alison from blue shield of california director or - director of pharmacy network. >> good afternoon. thank you for inviting us here i'll start off by saying unemployed is is a nonprofit health plan we serve cervical in addition to nonprofit we have a
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net cap to 2 percent of our revenue we have the largest foundation in california and one of the first plans to support of universal coverage. >> so blue shield tier drugs are based on the cost not the condition for which is used four tiers of the drugs to treat hiv are not on the highest tier we're one of the plans that on the grid that has a blue and orange bars to the left side of the chart we occasionally make exception to our guidelines when we cover a more expensive drug at the lower cost tier the drug tiering is only one of the plans for the health be affordability it's the increase of drugs