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 reductions with the network which helped individuals to reduce the costs this hearing is timely in that this last week i'm helping a client for 14 months his individual co-pay was $35 a month until recently changed under the speciality tier which brought him up to $500 a month pharmacy bill this was factoring in the fact

you have to pay for individual to the doctor as well as the lab during the pricing and gain access to medication through programs you such medication assistance program and a co-pay card and assess network we reduced those costs for the individual is looking at $20,250 a month this is well outside of his financial bracket he came to us seeking proving lax assess because of the speciality tearing of the medication we provided him a pass and are actively helping him to continue for his access to life saving services. >> i want to acknowledge

katherine dodge do you want to say something about this issue with our familiarity. >> thank you katherine dodi want to highlight because we spread your costs across one hundred and 27 lives our members are not effected by those costs i was briefed yesterday by blue shield we spent in the 2014 calendar year $3.1 million on help it's c but right behind that we spent $2.8 million our overall speciality spending is 2 point plus for our blue shield members the issue of pharmacies a one as hard as we try to keep

down our health costs we can't do anything about the pharmacies i appreciate you shining a lien light. >> thank you right now is the the city absorbing those increased costs for speciality drugs or the plans absorbing it. >> not city pays for it. >> and do you see at some point are we likely to see increased co-pay for city employees related to speciality drugs. >> i hope not. >> i hope not too but i don't want to put you on the spot we don't knows what the future holds. >> the issue come up with a plan design it keeps costs down of keeping costs down is by

charging co-pays and the federal government is got a cadillac tax in 2018 as the cost of pharmaceuticals go up we need to stay below the excise tax so we can increase co-pays if we needed to do that it wouldn't it would be co-pays on doctor visits or lab work but that's the only out let that the federal government allows on the costs pga them on those to the actual beneficiary so there's a train at the end of the tunnel. >> remind me when does our

contract come up with blue shield and kaiser. >> we're norwalk the renewables right now are blue shield and kaiser we're not anticipating a plan change for 2016. >> thank you. >> thank you for asking. >> yeah. >> okay with that, mr. chairman i think we're ready for public comment. >> ms. supervisor are there speakers. >> i don't 0 not. >> why in the public comment anyone that want to speak please come up and if there's more than 1 speaker line up on the far wall anyone wish to comment on item one. >> i think we have one. >> thank you for having this hearing i'm michael smith an out liar

about 10 years ago i severely broke my back with a taxicab that was a minor fall actually about t but it caused any veer to be crushed and spinal colonel aluminum to be pitched chronic pain and over the years i've got 10 other bones realized this was a problem two years ago i broke the strongest bone in my body the femur it had to be with a high-speed car crash but i wasn't in one it took a week of hospitalization and $150,000 for that week after that it was far more expense or competitive 14 weeks of construction i broke

the other femur the other strongest bone in the body another $150,000 for hospitalization and the costs were phenomenal i know there's an automatic disease after many months i spoke to kaiser about 8 or 9 months ago at the put me on the bone strengthening drug kaiser said this would be $50 a month when i went in january, i was surprised by found out that it was 6 hundred and 50 delores dollars for that month it is a bait-and-switch they told me specifically saving me money yet i had to pay this amount of money per month and

the problems continue. >> this is the photo i referenced earlier thank you for sending that to me. >> is there anyone from the public who wishes to speak okay seeing none, public comment is closed supervisor wiener. >> again, thank you mr. chairman for allowing me to hold this hearing thank you, everyone who presented i really want to thank blue shield for coming today, i know it's not easy to come to this kind of hearing and you were the only insurance companies that agreed to come to and i appreciate the candor that the condition exists whatever our views to address it but regardless how we address it that has to be addressed and you know when your that talking about very serious medical

continues conditions like hiv or hepatitis or cancer and so on and so forth when you start telling anyone whether or not necessary have insurance but particularly paying monthly promotes for insurance effectively you canned have this drug because when you tell someone they have to pay $600 a month that can be the difference between sickness and health or life and death it is not an acceptable situation trending in a bad direction trending worse and worse we can have victories had a carries clarified a drug as a non-speciality there's not a lot of we can do voeshl i want to thank the department of public health for the work with

the chinese health plans and ultimately at the state level it has to be addressed i'm glad assemblyman chow and ultimately the federal government needs to actually enforce the evicting and the department of public health and public services needs to provide the appropriate combined for this to happen so mr. chairman i ask we continue this to those to the call of the chair. >> we have a second item on this we'll take that without objection. >> thank you, supervisor wiener for those present so colleagues, we have two more items real quick controllers hearing on the six months status report we'll continue this to the budget & finance committee with the financial plan updated and adaptation to madam clerk call that real quick and go to

item 2. >> hearing other than the six months hearing and requesting the controller's office and mayor's office to report. >> so real quick we'll continue open up for public comment seeing none, public comment is closed. >> colleagues, can i have a motion to continue to the april 15th full meeting okay. a a motion by supervisor mar and supervisor tang we'll take that without objection. >> all right. madam clerk call item 2. >> item 2 for the city's economic strategies and requesting the office of economic workforce development to report. >> thank you madam clerk colleagues, i called for to hearing to have a dignities as we talk about the budget this report serves as one of the 12r07b8g9 reports to derivative our economic policies and thank you oewd