nonprofit we have a 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

that's out paigdz our efforts as mentioned in the presentation before me those costs of drugs are set by manufacturers upon drugs launched to the market once drugs o are on the market those prices set the prices for payers and manufacturers increase the price annually. >> prices increases for and speciality drugs on the market are seen at 11 to 13 percent annually compared to the cost of living index of 1230 percent speciality drugs as mentioned are increasing at 20 to thirty percent announcing and more than 50 percent of the drugs are speciality drugs many of the drugs require long term and it is okay to place

lower drugs. >> could you speak directly into the microphone. >> towards you. >> one example of the newer drug used to treat high cholesterol is a drug inhibit our their expended to cost $150 billion a year and to be the highest drugs in history estimated $270 billion in drugs expected to spend on drug in 2015 the cost per patient is 10 and $15,000 and it is not a one-time drug a drug you'll take for the rest of your life so in addition to the increases in drug prices there's increases in drug use that are driving

drug costs use of high cost drugs expected to drugs previously used to treat new conditions no low cost drug alternative and patient and subscriber are driving the drug use and eventually drawing costs there in drug costs is a problem as. >> make it affordable the true costs of drugs prices is for controlling the drug price increases and the policymakers should demand the long term pricing has on those drugs that those drugs have on health care go affordability those include holding hearings on drug pricing supporting trablts will legislation such ab

463 that i dude it forces the manufacturers to jif those prices thank you was that the end of your first of all, thank you blue shield we invited a number of insurance health plans and blue shield was the only carries that agreed to come we appreciate it is not necessarily the easiest meeting to come to so i example in terms of speciality drugs someone informed we they take into account blue shield pricing drugs and informed me with all of the drugs to cure fbi roads

and multiple sclerosis are on the speciality list for blue shield so i am appreciative of the hiv drugs are on the speciality tier for blue shield can you speak to that i don't know if you have the list and i mentioned we basis most of our drug tiering on costs it could be for regardless of what the condition is that is being treated. >> so if you're a blue shield member let's say a middle-class person and you have cystic fibrosis and ms not optional

drugs what would a person be expected to do so you're being told to pay a thousand dollars a month under the affordable health care act i guess the cap is 60350 a year with you that's still a lot what's should a person do showing should they people means they can't take their will medication because it is not a genetic alternative and can't pay 5 hundred or one thousand dollars a month what is that person to do. >> we have some exceptions you're right for those classes the drugs on tier had the highest tier we need to address this affordability crisis as an

industry i don't have an immediate answer for that person but we need help to make the cost of drugs a public expose to the public and . >> people buy insurance to be covered to have access they pay presumes or the employer pays the premiums for the access is blue shield position that that have someone no pay 5 hundred a or one thousand dollars a month for the necessary drugs that come applies with the affordable health care act if it effectively means a person with a disease is screened out coverage that's like a preexisting inclusion it seems to me to say blue shield's position having the extreme

level of co-pay consistent point affordable health care act. >> there are maximum as you mentioned the maximum out-of-pocket as mandated by the affordable health care blue shield's mission to insure all californians have access to the affordable price that's not something we can necessarily change over night something we're in for the long hall and the long term affordability we need to expose manufacturers and hold them accountable. >> but drug prices have also been high there's ice popping prices but not like their - they've been expensive especially the new drugs i don't

know in the reclassification is a new thing but sledder the health plans have a new tool to try to pass along costs and even with the 63 hundred and $50 cap for a lot of people that means not taking the drug and so i want to say i understand the industries point about the pharmaceutical and the cost of drugs not only on one sector to solve but we're seeing the insurance industry doing it's a problem in and of itself and there's a solid argument in my view is violates the affordable health care act if you have a disease that i listed no way to

get them through please line up on the screen side of the room. >> i am with the blue shield of california would it be okay if i answered. >> absolutely. >> the copayment and stent of coverage is described in the affordable health care act in you'll our products and internal decision completely follows the law but covered california as prescribed and what the law prescribes. >> okay. i would expect it blue shield will stack that position but there are differing points of view i'm not expecting blue shield to say we're violating the evicting but it is not only about blue shield there are a lot of insurance companies it's an industrywide issue one last next thing any hiv drugs

the blue shield describes and specialities. >> we don't have a speciality by the way hiv across all four tiers. >> and tier 4 so the difference between that and the speciality. >> well, we define our tiers based on cost and tier 4 is the highest co-pay and two strict gold and tipping la that are on the tier. >> i only know of one. >> who. >> tipping lesson. >> i thought there maybe two more. >> okay. >> thank you. >> okay. i'll now ask donald are you guys together or

separate? separate okay >> thank you, very much. and holding this pour hearing one pointed of clarification we did an analysis felt covered california plans the blue shield plan only was one drug on speciality level and let's see if i can get to the right slides before we started i want to thank you my technical assistant before we start i want to clarify one thing to the affordable health care act we're going to have to look to the state of california to clarify those although the government has said they last sector as colleen said did say we may have discrimination of all drugs placed on the highest tiers but they kind of not mitigated it but they added to this in a way that wasn't

helpful in saying the plans could also use another factor to see why the drugs are tiered at the highest level not showing a factor that is discriminatory so what i was going to do into into depth at the state level to make changes i pointed out i started with this as a presentation because of the lack of understanding of the speciality drugs i put speciality drug in quotations this may be based on costs the important point i want to make awhile making progress in california if we enact all the things in our tool dheft

we'll not make a difference until the pharmaceutical companies come to the table they're not there yet and extremely high-priced drugs make it difficult for insurance companies to make them affordable and the reason for that the plans are negotiators would the companies about the cost of those drugs so they need to have a type of mechanism like a tiering mechanism in order to bring the companies to the table to lower their prices this is unfortunate because the consumer losses so when we had extreme expensive drugs there shs cost sharing because of the necessity to negotiate and that at least a lot of assess and discrimination against people the first effort i want to talk about the cover

california that is a groundbreaking effort and they brought together the advocates and the plans and the regulators and the project is part of the workshop we've done action by the board to include the transparent and access this is really important even though it is not the speciality tiering it was a huge roadblock no real way to compare it prior to this action when we tried to analyze that it took tour analysts hours to get through what was on the form and not a single time to find a person to clarify questions we had so for a year 2016 plans will have to have this increases the access going to have to have an opted issue and provide an estimate of the

range of costs for specific drugs, the formulas will include all the covered drugs to treat hiv/aids and rheumatoid arthritis and lupus what was happening before people couldn't look at the preliminaries and have to have the exception process written on the formula that is a process that's not covered by the plan and they're going to this is a big win have to have a dedicated pharmacy service line that advocates and consumers can call to answer their questions and in addition colorado lien said standardized the tier definition so we know what drugs are in what tier i want to point out not all plans use the tier blue shield as a

$1,200 threshold i'm not certain but it is definitely higher in california recommendations also is that if there are 3 or more treatment options for treatment at least one drug in that drug category has to be an tier 13 and this is specifically 5i78d and rheumatoid 5th reiterates and lupus for us it didn't go far enough only one drug is there people need different drugs to treat hiv and aids the board is asking to access the implementation of caps on the speciality tier the issue is that when insurance companies putting put caps on the speciality tier cost sharing that means a substantial increases for drugs so it is

important for california to keep the formulas reasonable so i want to see the actuary process before making a final decision to cap that recommendations should be available or should go to the board in may sb 1052 is about formula transparent it was past last year to january 1st, 2015 the plans have to this have their formula current and a they have to be updated by january 1st, 2015, our california department of public health depth of insurance two regulate later in california to standard biz device it it includes the cost sharing if people need a prior

authorization or step management in order to get their drugs there also will clarify the difference between prescription drug benefits and list the process and steps between the drugs that are not covered and if feasible they're asking and requiring information on the co-insurance but not clear that is feasible a working group has been started to implement those provisions on ab 339 by assemblyman gordon for outpatient drugs it means any - right now two sets of regulars for california one for the department of insurance and one for the department of managed care this make sure the regulations cover all plans in california and add additional

regulations any california plan that covered prescriptions drugs covers all drugs and plans demonstrate the plans won't discourage the plans and specifically once the cost is over $250 people band their drugs it also had to demonstrate that they don't discourage the benefits or reduce the benefits for health conditions they'll have to demonstrate either cover single regimen and formulas or demonstrate those formulas are less effective will the clerk please than the tab let regime times they have to prove that it will not improve

when the standard of care involves all treatment most of the drugs can't be included that on the tiring to say broader than the california recommendations this is a help for hiv drugs and help it's drugs formula layers so the individual market has to prove their the same or comparable to the groups shuns market and finally no cost sharing on one drug what about more than one 24th of the over all out-of-pocket cap required so for this year this is $270,000 actually for 2015 and that would be on if you have a family premium this will apply to our portion which is a good thing the family de2kub89s double so it's important it this applies

to only self-coverage and this ab 463 was talked about i'll skip over that and physical evidence very broadly we're supportive of the work this is going on at california state level wear concerned right now we have significant issues we have as colleen mentioned 4 out liar plans for all the hiv drugs continue to be tiered at the highest level the chinese community health plan and the drugs at this level have co-insurance that leads to people not being able to for the record their drugs 90 most in not all plans have the hepatitis drugs at the highest levels i'm sure you're aware of most people that hiv and hepatitis c take

multiple drugs so adu inheritance to the regular the can be completely out of reach and again most studies so cost sharing at $250 a month is where the cost sharing is impacted hiv and hepatitis c dispropgs effect people of color and transgender and youngest gay men and people that inject drugs those unaffordable high cost drugs lead to humble disparticipants hiv and hepatitis are infection they when we are having the hepatitis c they put our prove

lax out of reach for many, many people not only a treat to individual health but population and community health thank you very much. >> thank you so next, i want to call up james and matt from the san francisco aids foundation and. >> good afternoon supervisors. thank you first i want to thank you for bringing up this important discussion and opportunity i'm james the vice president of public affairs at san francisco aids foundation and i want to start by saying i stand before everyone with tremendous help the reason; right why the progress is one hundred percent when you think about it today community cross the united states for the very

first time are designing and implementing plans to eliminate the transition of aided even a few years ago would have been unthinkable this is progress we can't take for granted now more than ever we have to identify threats to this as we work to make san francisco the first hiv transition we're here today to address one of the threats san francisco aids foundation is concerned does the description between the lack of transparency in the health plans and the clients that be trying to get life saving medications considering the following some covered california plans place in their hiv and help it's drugs between 10 and thirty

percent of the cost of the drugs employer plans have similar descriptiony practices we become aware of a formula change at the one of the largest tech companies in the bay area and that move place oil hiv drugs both a speciality tier increasing caution significantly for hiv employees as well as the hiv negative employees that were taken a drug high out-of-pocket drug costs lead to issues as described earlier several studies have demonstrated that cost sharing results in the consumers for going their medication leading to poor outcomes for individual and the community both hiv and hepatitis c it is acceptable not only for individual height but we work to decrease the load and

decrease transition we building that speciality tiering shouldn't be based price costs plans should development a better exemplification reasonable medical management additionally, we building the rollout of the affordable health care act provides an interpretation opportunity for the insurance companies to better serve consumers by increasing accident transcript around the plan formulas as described for the information is often hard to find and interpret you can't interpret is it is often inaccurate those plans can change by addressing and subtracting drugs and it is impossible for consumers to make informed choices around plans

that ultimately determine if they can afford the drug we're making progress and we certainly understand the need for formula changes and want to see new drugs added on but we must build on the efforts by the establishing industrywide standards to make sure that the reliable information is that place at the start of the enrollment and changes are communicated in realtime for all those who are impacted and those impacted can change the plan without up to the present time we looking forward to working with the city to discuss our concerns and develop an action plan that when a new hiv infection in san francisco isly

thank you. >> i'm matthew the navigate our in the past 4 months we've had a pilot program we've enrolled one hundred and 68 into prep that's been demonstrated mel eligible for the proving lax 60 percent of the individual are insured and 17 are running into issues with speciality care main issue we're seeing with us within my role i've helped individual sign up through public california and the open enrollment period but with that we're seeing individuals choosing plans based on the low premium available because of the high costs in san francisco it is the most available as the

previous speakers mentioned awhile having the lowest monthly pro tem as the highest co-churns or insurance or point of care services i did my best to usual into the silver plan and venting to reduce the debelieving did you believe i'll be talk about how this increases the models monthly premium there are impacts within the service people making more than 5 hundred percent that comes out to $58,000 announcing and across the nation it considerable but in san francisco it puts individuals workplace that price range and the individuals were not able to assess price