are there any questions or discussions any public comment. >> is there any. is there any public comment hearing none we're ready to go to a vote all opposed by the same sign all opposed by the same sign so it is approved >> fantastic. >> item. >> item 5 action item approval 2016 delta dental renewable for all plans. >> okay. i'm ready to go item 5 you have in your packet a nicely scripted document it outlines the 6 plans offered by the health services for dental plans you have 4 hmo plans the

hmos and two ppo plans the carries are delta dental and u h c delta dental race a self-insured ppo plan ann and retiree plan on a basis for retirees we've had many meetings on the retirement plan to make it as fair and rich as we can we went to the vendors that participated in those plans offers and discussed what we want to be able to present i have steel good news to offer in terms of my history with the board and what the rates have begun and where we are going to be going to 2016 i think this is great i wanted to say that we don't generally do this the representative for delta dental

has been a staunld individual and appropriate to say his name. >> raymond lee would you stand up raymond a strong advocate for the reduction that we will discuss briefing in the retiree rates for retirees in that program which i think is phenomenal he deserves that recognize okay so as we go through this whole thing i'll keep it brief we look at first on page the union rates let's go on page 4 yeah. that's correct page 4 are two d m h over dental our rate passes through 2016 so no change to rates okay that's good nothing t is going up there you look at the experience for the p p we know

on page 6 the ppo plan has been good we've added in the impact of the plain stabilization investment not to on and on what does this do to the rate page 11 we requesting you accept a 2.9 percent reduction in the self-ppo rates for 2016 those rates now on the retirement plan on page 8 the drum roll the rates were $90.87 fully insured rates those rates have been reduced 6 percent for two years not just one year but two years and that's really good $42.96

i'm very happy and the delta rate hmo guaranteed through 2018 and we go on to page 11 and we look at those and we look at the devil is in the details hemirates for retirees they're now goad through 2018 and then it outlines what we've talked about the rate for specific dental for activities and retirees by the way, u but we have a list of 6 recommendations on page 18 before i list the recommendations are there any questions about the dental program. >> is there any way to get those plans to again sickening

we have some next year that leads to a whole discussion of revenue or renewable and so for the any action of getting those plans to kind of singing up if they're up to exterior next year or expire 2017 we can give certain nose and indicate we're going out to the marketplace has that been explored directing your attention of our legislation. >> if we made it systematic that would be easier to discuss and lastly a detergent why one is this way and that way those rates are good for 3 years and those 3 years and theirs didn't go up and mine did i'll take that to heart and make that a

pirate in future reading sfaechlt. >> all right. when you say you're going to take it to heart it is going to be acted on. >> absolutely okay. so there is only one we can't do that we have to rate it every year for our risk. >> the self-funded ppo with that i have a list of 6 recommendations. >> please don't read them we have in in front of us. >> i move to approve that. >> i move we approve the recommendations for the dental plans. >> all right. there's been a motion to accept the approval as listed on this with the 6 domino

plan and been improperly seconded any discussion by the members of the board any comments from the public? is there any comment from the public? yes, please save me, please come forward a good vendor that is quite all right. your name and raymond lee delta dental thank you very much for accepting is recommendation but i wanted to make sure that all plans are very important to us and especially the retiree plan and with the partnership of - >> speak up. >> it has made that a very important renewable for us, and early renewable i was very happy we were able to get to the relatives we have today

pardon me i want to make sure that in the retiree plan even though we have a reduction at the moment that the d mp moment the diagnose nofkz that was effective in january 1st of 2016-2017 with this rate reduction that benefit didn't go away that benefit stays and it's very important we want to make sure that all members does not put aside any of their prevent work simply because of the plan design this is built in there to get their clarence and examines. >> just to reiterate the modification we've made beginning in january of this year is included in the representation and is staying there; is that correct. >> that's correct. >> for the retirees the maximums remain and so that

we're clear on what of the d mp match covers the two annual clarence and the two examines. >> two annual cleaners and two examines thank you thank you, very much. mr. lee and for your partnership. >> members of the public claire. >> thank you sciu retiree. >> and our r.c. c has asked i want to thank you and thank neil and mr. lee for all the work that was done on those for those rates that's a big issue we're happy wish it could be more and increase our benefits but we understand t and are very grateful. >> thank you very much any other public comment in these hearing none we're ready to vote all opposed by the same sign. >> i. >> all opposed by the same sign

no so ordered we're ready for item number 6. >> item 6 discussion item presentation of pharmacy trends. >> as as we look at this particular item we've been talking about points of education for members of the board for those things that are happening across the spectrum providing the health benefits for the employees this presentation i'll classify a discussion item at this meeting but something we need to focus on because i think you've heard if in item number 3 the issue of speciality drug costs and how to manage them is a profound issue across the whole spectrum of health care today, i thank naomi for taking the time to bring us up to speed.

>> thank you ford i'm dr. with a and hewitt i want to talk about the issues you've heard of the speciality drugs and i really will focus, if you will on 7 different components of the pharmacy trend nevertheless to say speciality drugs is a significant one but profound drugs that through a legislation change in 2012 that's beginning to you show up in all of the trend reports and it is just a timing loop that all of the trend reports for the various pharmaceutical manufacturing companies are being realized in this time period i've drawn likelyly from the trend reports i'm not a pharmacist their macro maybe a case i mispronounce some of the

pharmacy costs occur into in medical side and in the pharmacy side in the medical side those are drugs that are provided in the hospital or maybe provided in if an outpatient setting but to the pharmacy benefits this is not what ear talking about significantly about today because those trends will show up in our medical claims experience what wear looking at it what you're going to see as a pharmacy experience going forward. >> one of the things in 2012 speciality drugs represent 25 percent of the pharmacy accept and it is growing at a sustainable rate matt haney that is going to continue to grow at 20 percent clip-on the near

future according to the united health care this could represent by 2012 up to 9.9 percent of the national trend that's significant historically a hospital or hospital in patient costs have been a large portion as we're talking about the aco they're not here that's the outpatient side you want to see growing and growing at a small clip because it didn't cost as much, if you will, as hospitalization but to have a speciality drug to grow above and beyond is acquit alarming and so i'll talk about the speciality drugs and talk about the bio similar drugs and talk about a couple of particular

drugs cholesterol lowering agents you know about diabetes medication any public comment? and talk about component medication and was it has done additional jen ice cream on from the prospective it what is keep the costs down in the future the ability of jen ice cream to accomplish that has been somewhat i'll use the word compromise but altered the environment is changed and lastly what you should do about that so let's start what is a speciality drug a speciality drug is a drug that requires complex manufacturing and special handing and administration the root of the administration on how you take it can variable

or injectionable or oral only by a health care provider it is very how cost and the cost and the total cost is expensive we'll talk about one drug in particular in a minute clinic management it required and there is very small numbers hiv that required that so that if you have someone that is getting medication there are few people in the united states have this the negotiation lease we may talk about it for cholesterol there are 71 million people in the united states that have cholesterol slaeltsd chest that's not a small number right now 3 hundred speciality drugs about 10 to 15 years ago there probably were barely a handful

and over 6 thousand as many as a thousand in the that i'm like oncology but stands you know all the disease front and while we're talking about a commercial population here you have retirees oncology drugs speciality drugs for on cotton it significantly impacts our retirees in the future and on the one side a group you don't have as much the hepatitis c drug i bring it up as their costs go up it trickles to the commercial side and as you can see there are 5 drugs we talked about it the oncology drugs or the anti place metrics and the anti recites and multiple sclerosis and hilltop c are the primary drivers right

now what did many mean for you >> doctors on this particular draft i think i'd like to know presidential two bullet points speciality drugs represents 4.5 percent of all prescriptions filled and 26 paid for are population what is that in dollars rather than percent do you have an estimate. >> i don't have it with me i'm sorry. >> this is blue cross blue shield data not kaiser. >> this is only blue shield. >> i think that is helpful it is a percentage of what i think sometimes, people understand we're talking about several million dollars here i guess guess that but it will be helpful for both those topics particularly where we can localize it to our population

and if it is for one plan we obviously need it foroblast both plans and kaiser reports that stuff in the same way but at least we'd be able to identify a portion. >> we'll bring that information back we can get it from both parties and we don't have to discuss this further. >> i want to bring out one key points the hepatitis c category is 27.7 percent of your speciality drugs in 2014 it didn't exist in 2013 so that's an - it wasn't approved until december of 2013 that's one drug can mean for costs you spent $3 million for hepatitis c drugs

in 2013 and i've spent that already 2015 thank you blue shield it is sitting down driving our costs i want to spend a little bit of time urging hepatitis c as a case study, if you will, there are medications solve - that are out on the market with the paycheck coming only board in 2015 the names you don't have to rem remember but remember the cost the cost per 12 for that drug and most of the drugs are not administered in isolation they require additional support 84 thousand for one drug and 9 it

cures so that you do a 12 or 24 week courses and then your hepatitis c should be curd and that's what they're looking at they also the positive thing will be drugs in the pipeline which is ac h, 3102 that is tested that combinationan reduce overall it will keep the costs sustainable for hepatitis c. >> thank you. >> but the thing i want to point out to you is that while hilltops c the numbers are

growing or those being identified p are growing as people develop liver and cancer sincerely roses it takes 20 to 40 years for the impact of the advisor to, if you will, wear it's ahead but we're talking about now speciality drugs are really looking at the individuals structure and while it will be more efficient it didn't necessarily mean that it is more it will be less costing because each drug will have to be manufactured to that specification no mass manufacturing for speciality drugs as now. >> at least in the current state. >> in the current state. >> i would hope with all the things around innovation this

will be an opportunity going forward so - >> you know it is interesting you say that because as an opportunity one of the things that hadn't happened competition the original virntder or creatorer of one drug wasn't expected to be sold for $84,000 for one week angela i can't came in and bought it and created a price it has not been controlled so what they've said is what is it is being paid the shield to their creditor is working to set up standards for the hilltops c medications but their pretty much behind an eight ball when only one drug in the system available to them

another class of drugs that be salary /* similar bio similar means it's not exactly a like it is behaviors cause the same results but they are not going to necessarily have the same mechanism of action and as you can see accordingly to express scrips they're expecting about $250 billion can be saved by 2024 with the use of bio similar or so two examples at least one you're familiar with because the direct attorneys on television with an

is the 92 grin an anti meow plastic there's ban a bio similar approved for it it is expected to come online very shortly just to put it into prospective people with oncology received one $.2 billion for this last year another drug is rem cascade and that's k what is used for chromes deceased and rheumatoid arthritis a drug in the that i'm for that it is expected and it is hoped to be approved as early as june and other sales was 4 buyout $5 billion last year that is although in the initial 6 months to a year the price will be variable and not less comprehend as it stacks out in the

long-term there will be savings. >> the most enlightening point boy similars was another thing but this kind of replacing jen ice cream in the broad market bio similars is a genetic in the speciality market considering that's a useful comparison going forward for all us for the language. >> the ones i want to talk about are the ones that are common hepatitis c will take it's 12 or 24 weeks you're down any public comment? cholesterol is a lifetime depending on when it is identified earlier and earlier those days we're looking at drugs that will not may not be $84,000 for a 12 yearbook courses that will be in that

neighborhood for a year so right now there's the ph f-9 probable cause terrors cardio those are really focused on a third to 40 percent of the people that does not respond to traditional lowering agents those are the ongoing volume of people that maybe eligible for speciality drugs where you only had a handful maybe 2 hundred people in the united states this represents a grateful costs other area we've seen the

increase of experience in is diabetes it the only drug in the non-speciality growth share there was a release of who knew medications as the so many up they remove sugar is from the kidneys from our blood stream but no drugs in the that i'm those drugs are better but higher costs they either improve what you currently get or act on the insulin producing cells to produce them natural but not without a costs as well as a bio similar will be created for

insulin so the next areas, if you will are the changes and regulations historically exponents were priced by their hoist cost ingredient now they exponent our i think gents based on all the ingredients so the impact of components polling people that can't take medication in a normal form or topic topical ointment through the skin instead through the mouth right now that is just skyrocketing it didn't have the significant volume or costs but nevertheless it is a cost if i look forward united health care

the report was written in 2012 they explicit mentioned he see anyone on 2014 experience condone drugs are flushing and people are i am reintroducing to figure out a way to managing that new change in regulation genetic to 85 percent of medication is filed with a genetic and historically that has represented about a thirty percent off of brand names it is the jen ice cream but in 2014 that has decreased to 20 percent and the reason for that comes back to the simple word composition historically multiple firms creating a genetic when you agreed to 0

genetic substitution thank you may or may not gotten the same measuring company you had your last time you foiled our prescription now the people that those companies with mooring they're being bought by a larger company so you have many of the measuring companies now becoming more mainstream, if you will, as a result may be one to 3 options before you had as many as 678 that raises the costs secondly fall because of the new regulations drug shortages jen ice cream continues to balance the budget we need them to grow you have to remember they represent only thirty