these are the two circumstances that drive conversation around retiring or up tiering. some specific generic medications. you can see on page 8 what that can look like so trying to move away from this classic approach of calling drugs generic, preferred, nonpreferred and to more of a 1 through 4 approach. you can see how tier one is generic but can bring in lower cost branded medications or higher cost generics on page 7 moving to other tiers. >> from is a third scenario not as common as what you outlined.

there has been reported of generic companies buying the rights to produce a drug generically when they calculate how much money they can make selling that drug find it is more property annua profitable t company pays them off. to stock holders it is good because they make more money acquiring the rights to the generic and not making the drug and getting more income from another pharmaceutical company to keep it off the market. i don't know if that is covered. i don't think it is. there is certainly cases of this discussion in the press. >> i would imagine that is also driving retailing generic as

well. the final page of the discussion. i want to highlight that on the surface when you have a higher priced generic medication you may not think it impacts overall members but there is a fixed dollar prescription drug co-payment associated with the prescription drug coverage like on the hsf plans. if there is continued use of the higher priced generic cost so that feeds to the under writing when we produce the rates and when the plans produce calculations for insured plans rates. we have seeing employers with tg

strategies to focus on particular diagnostic categories where there are alternatives available. communication of the changes where thewhere they occur you wo have targeted communications to those impacted and our provider community the use of tools to help promote cost traffics paraphernalia see at the point of prescribing initiatives doctor mills spoke of. >> no further word about medicare getting involved in hsf, is that correct? >> not that i am aware. with this would there be more

transparency? >> there would be less? >> pharmacy benefit managers might get a bigger rebate we don't know about? >> the rebates apply to the branded medications, not necessarily to generic. this is really an attempt to increase utilization again within the full framework of wanting to deliver effective medication treatment to patients, but recognize that slight differences in formulation could result in a medication that is as clinically effective to the member but at a much lower cost. >> my concern it is that it works for the members to their advantage. >> again, you know, the complexity of this. both of you have really highlighted nicely.

it is awful for everybody. when i was in service practice one health plan gave me a list of five health plans they covered with the same corporate name. the different formulas for cold and allergy medications. not only was i supposed to know who their provider was. i left that to my girling person. when i -- to my billing person. i was to figure out which plan they had to figure out what was cost-effective for the member. quite frankly in any practice situation, i didn't have the time to do that for something that was just for a cold or whatever it was for.

this e prescribing thing can help if it covering all of the plans with the same blue shield or aetna or kaiser. the provider getting it on the screen. don't use this, use this. the next step is for the member. i will give you an anecdote. my father was dying of cancer and my mother was being discharged from the hospital for a prescription for an antacid not covered by the formula. there wa was one on the formall. i said talk to the doctor. i was her son the internist telling her there was an equivalent drug. that is what the doctor provided. my mother was a college professor. that is what the doctor prescribed, that is what i am going to play for. the complexity at every level is

not just the members. it is the pharmacy who is trying to do the right thing and there are pharmacists doing the right thing and the providers. we can't minimize the impact on anyone. >> i noticed that you ascribed no affirmative behavior to the pbm in this process. i thank you for that. >> any public comment on this item? come forward. >> my name is erica. i am a current employee. i am covered under blue shield. i have run into several issues

in my ability to access insurance. i have spoken with the director yant. i am going to speak on the drug prescription coverage. >> speak into the microphone. >> i will share personal and private information that is a bit uncomfortable. i know i am not the only member that is experiencing this. i have prescribed a litany of drugs that aren't covered under a co-payment. if i go to a specialty pharmacy the cost is 50% of the negotiated rate. i have copies of this if you need it. that was the price that i was quoted. then i was given the price if i pay 100% out of pocket. 100% out of pocket is 40% less

or 40% less than if i used my insurance which is supposed to be 50%. the 50% of the covered rate. my personal question. can i get reimbursed the 50% that is the coverage rate? the real question for you is how many other drugs fall into this category? how many other members are paying 100% out of pocket because the insurance coverage they pay for, that the city pays for would cost them more. i recognize there is no vote today but i wanted to highlight the great responsibility that you have t to t to to ensure t

for our public dollars. theresy tremendou -- there is as impact this will have. i called another one from san francisco. these are from boss t boston. that is the cost. thank you for your time. >> have you talked to our director? >> i do appreciate everybody coming here to speak out today. it is a challenge. erica has been a fabulous advocate for herself. we have worked alongside of her to uncover some of these difficult situations that our members experience from time to time. i appreciate having the opportunity to work directly with her and the carrier to see

where we can intervene in this case or in cases in general. it speaks to and i know that many folks here including our board hear from members on a regular basis. it is so beneficial that we hear directly from them so we can dig deep into the story. that is the most informative we can do. i think it allows us to provide the most support to our membership. i appreciate it and we will continue to work through this situation. >> thank you for coming. >> i think the one thing we know there is always money in drugs. whatever side of the fence you are on there is a lot of money in drugs. one of the things that occurred to me while listening to this

presentation is the level of advertising that is going on. when you are trying to get patients to consider generic, they have been watching ads for name brands for a period of time, number of years, many months. i know actually i had colleagues who said they would still be working if it wasn't for hue hua that helped them on the job and i have watched transition with the colleagues. then what i notice is the drugs are advertised for other kinds of conditions which is always curious to me. this is a drug that has multi-uses and the diagnosis seem very opposite. i think what we are not looking at, if you are trying to get people to switch to generic

there is a psychological issue. this name brand is the best there is. when you are offering me generic it is sub standard. it is a third rate. i know out to buy my benadryl from cost could. i can get a big bottle to last a year from costco versions a regular pharmacy. i think we have to take a look at the bigger picture. as long as the drug manufacturers understand they can use advertising to influence people, when it comes to what we are looking at is saves money. also the fact we are looking at an exact replica of the original but lower costs because we have passed that threshold where they are not trying to recover all the money on experimentation or

whatever it is and advertising. it is the same thing. in our blindses as consumers we -- in our minds as consumers we don't see it as the same. you are offering generic. i don't know how to change that. you can see it in magazines and on tvs and the internet, everywhere you look you see ads for new drugs and the influence it has on consumers. thank you. >> any other public comment. i want to say a former speaker. it seems like the last couple years i have heard a lot of complaints about expensive drugs people have to take. life saving drugs they have a tough time affording. it seems like there is something more we should be able to do about that as a health plan.

i don't know. the whole pharmacy thing is scary. that is just a comment. we are done with the regular rates and benefits section. we are now moving to the regular board meeting matters. that is item 14, please. >> item 14. reports and updates from contracted health plan representatives. >> good afternoon. i am from kaiser. i would like to introduce a change in account management. for those familiar with a trisha. she has been the account manager or a couple years and has done a wonderful job and has been promoted to management. we are happy for her. as she transitions out we have a new account manager to take her place. that is debbie.

sheep has many years of experience -- she has many years of experience working on public sector accounts. i am confident she will fill the big shoes patricia has been wearing. >> any other reports here? public comment? seeing none. item 15. >> item 15. opportunity for the public to comment on matters within the board's jurisdiction. >> last chance for public comment. seeing none. item number 16. >> opportunity opportunity to place items within the board's jurisdiction on future agendas. >> you are in negotiations still? okay.

nutrition counseling from blue shield. they are the only plan that doesn't have that as far as i can tell. i mean if they are not going to do it then we should find somebody else that will. that should be part of the plan. there shouldn't be any question. last reports said go to your primary care doctor. that was like an insult to me. that has to be part of the negotiations. i appreciate that. thank you. anyone else have comments on this item? seeing none. if there is no objection this meeting is adjourned..

>> shop and dine the 49 promotes loophole businesses and changes residents to do thirds shopping

and diane within the 49 square miles of san francisco by supporting local services we help san francisco remain unique and successful where will you shop and dine shop and dine the 49. >> my name is neil the general manager for the book shop here on west portal avenue if san francisco this is a neighborhood bookstore and it is a wonderful neighborhood but it is an interesting community because the residents the neighborhood muni loves the neighborhood it is community and we as a book sincerely we see the same people here the shop all the time and you know to a certain degree this is part of their this is created the neighborhood a place where people come and subcontract it is in recent years we see a drop

off of a lot of bookstores both national chains and neighborhoods by the neighborhood stores where coming you don't want to - one of the great things of san francisco it is neighborhood neighborhood have dentist corrosive are coffeehouses but 2, 3, 4 coffeehouses in month neighborhoods that are on their own- that watching. >> ever wonder about programs the city is working on to make san francisco the best place to live and work we bring shine won our city department and the people making them happy what

happened next sf oh, san francisco known for it's looks at and history and beauty this place arts has it all but it's city government is pretty unique in fact, san francisco city departments are filled with truly initiative programming that turns this way our goal is to create programs that are easily digestable and easy to follow so that our resident can participate in healing the planet with the new take dial initiative they're getting close to zero waste we 2020 and today san francisco is diverting land filled and while those numbers

are imperfect not enough. >> we're sending over 4 hundred thousand tons of waste to the landfill and over the 4 hundred tons 10 thousands are textile and unwanted listen ones doesn't have to be find in the trash. >> i could has are the ones creating the partnerships with the rail kwloth stores putting an in store collection box near the checks stand so customers can bring their used clothes to the store and deposit off. >> textile will be accessible in buildings thought the city and we have goodwill a grant for them to design a textile box

especially for families. >> goodwill the well-known store has been making great strides. >> we grateful to give the items to goodwill it comes from us selling those items in our stores with you that process helps to divert things it from local landfills if the san francisco area. >> and the textile box will take it one step further helping 1230 get to zero waste. >> it brings the donation opportunity to the donor making that as convenient as possible it is one of the solutions to make sure we're capturing all the value in the textiles. >> with the help of good will and other businesses san francisco will eliminate 39 millions tons of landfill next

year and 70 is confident our acts can and will make a great difference. >> we believe that government matters and cities matter what we side in san francisco, california serve as a model phenomenal in our the rest of the country by the world. >> whether you do not to goodwill those unwanted text told us or are sufficient value and the greater community will benefit. >> thanks to sf environment san francisco has over one hundred drop off locations visit recycle damn and thanks for watching join us >> i personally love the mega jobs.

i think they're a lot of fun. i like being part of a build that is bigger than myself and outlast me and make a mark on a landscape or industry. ♪ we do a lot of the big sexy jobs, the stacked towers, transit center, a lot of the note worthy projects. i'm second generation construction. my dad was in it and for me it just felt right. i was about 16 when i first started drafting home plans for people and working my way through college. in college i became a project engineer on the job, replacing others who were there previously and took over for them. the transit center project is about a million square feet.

the entire floor is for commuter buses to come in and drop off, there will be five and a half acre city park accessible to everyone. it has an amputheater and water marsh that will filter it through to use it for landscaping. bay area council is big here in the area, and they have a gender equity group. i love going to the workshops. it's where i met jessica. >> we hit it off, we were both in the same field and the only two women in the same. >> through that friendship did we discover that our projects are interrelated. >> the projects provide the power from san jose to san francisco and end in the trans

bay terminal where amanda was in charge of construction. >> without her project basically i have a fancy bus stop. she has headed up the women's network and i do, too. we have exchanged a lot of ideas on how to get groups to work together. it's been a good partnership for us. >> women can play leadership role in this field. >> i tell him that the schedule is behind, his work is crappy. he starts dropping f-bombs and i say if you're going to talk to me like that, the meeting is over. so these are the challenges that we face over and over again. the reality, okay, but it is getting better i think. >> it has been great to bond

with other women in the field. we lack diversity and so we have to support each other and change the culture a bit so more women see it as a great field that they can succeed in. >> what drew me in, i could use more of my mind than my body to get the work done. >> it's important for women to network with each other, especially in construction. the percentage of women and men in construction is so different. it's hard to feel a part of something and you feel alone. >> it's fun to play a leadership role in an important project, this is important for the transportation of the entire peninsula. >> to have that person -- of women coming into construction, returning to construction from family leave and creating the network of women that can rely on each other. >> women are the main source of income in your household. show of hands.

>> people are very charmed with the idea of the reverse role, that there's a dad at home instead of a mom. you won't have gender equity in the office until it's at home. >> whatever you do, be the best you can be. don't say i can't do it, you can excel and do whatever you want. just put your mind into it. >> we take a lot of pride in what we do. the electric shop covers all of waste water, so out of this location here, we cover everything from oceanside to southeast plant and all the computations including treasure island and yerba buena. we have all the preventative

responsibility, maintaining maintenance and also keeping up with work orders from operations. i would say one of the things fortunately for me is the staff is incredibleably motivated. the staff here knows what to do, how to do the job safely, and it makes my job incredibly easy. >> they know the job, and they know the challenges, and i think it's all about personal pride. they want to do a good job. from our maintenance group to our i.n.c., dedication to the people. when they're going home, and they're crossing the bay bridge, and they get a call that there's a problem with a pump station on treasure island, they return to work. they turnaround in westbound traffic and get back to work and get this pump back in line, and i can't tell you how much

that means to me as a boss and the city and county of san francisco. >> as a group, if they didn't do what they do, the streets would be flooded with waste and gray water, and it could become a health hazard. we take a lot of pride in what we do, and we do the jobs right, and you walk away fulfilled that you've done the city a

[♪] ♪ homelessness in san francisco is considered the number 1 issue by most people who live here, and it doesn't just affect neighbors without a home, it affects all of us. is real way to combat that is to work together. it will take city departments and nonprofit providers and volunteers and companies and community members all coming together. [♪] >> the product homeless connect community day of service began about 15 years ago, and we have had 73 of them. what we do is we host and expo-style event, and we were the very force organization to do this but it worked so well that 250 other cities across the globe host their own. there's over 120 service providers at the event today, and they range anywhere from hygiene kits provided by the basics, 5% -- to prescription glasses and reading glasses,

hearing tests, pet sitting, showers, medical services, flu shots, dental care, groceries, so many phenomenal service providers, and what makes it so unique is we ask that they provide that service today here it is an actual, tangible service people can leave with it. >> i am with the hearing and speech center of northern california, and we provide a variety of services including audiology, counselling, outreach, education, today we actually just do screening to see if someone has hearing loss. to follow updates when they come into the speech center and we do a full diagnostic hearing test, and we start the process of taking an impression of their year, deciding on which hearing aid will work best for them. if they have a smart phone, we make sure we get a smart phone that can connect to it, so they can stream phone calls, or use it for any other services that they need. >> san francisco has phenomenal social services to support people at risk of becoming homeless, are already experience and homelessness, but it is

confusing, and there is a lot of waste. bringing everyone into the same space not only saves an average of 20 hours a week in navigating the system and waiting in line for different areas, it helps them talk, so if you need to sign up for medi-cal, what you need identification, you don't have to go to sacramento or wait in line at a d.m.v., you go across the hall to the d.m.v. to get your i.d. ♪ today we will probably see around 30 people, and averaging about 20 of this people coming to cs for follow-up service. >> for a participant to qualify for services, all they need to do is come to the event. we have a lot of people who are at risk of homelessness but not yet experiencing it, that today's event can ensure they stay house. many people coming to the event are here to receive one specific need such as signing up for medi-cal or learning about d.m.v. services, and then of course, most of the people who are tender people experiencing homelessness today. >> i am the representative for

the volunteer central. we are the group that checks and all the volunteers that comment participate each day. on a typical day of service, we have anywhere between 40500 volunteers that we, back in, they get t-shirts, nametags, maps, and all the information they need to have a successful event. our participant escorts are a core part of our group, and they are the ones who help participants flow from the different service areas and help them find the different services that they needs. >> one of the ways we work closely with the department of homelessness and supportive housing is by working with homeless outreach teams. they come here, and these are the people that help you get into navigation centers, help you get into short-term shelter, and talk about housing-1st policies. we also work very closely with the department of public health to provide a lot of our services. >> we have all types of things that volunteers deal do on a day of service. we have folks that help give out lunches in the café, we have folks who help with the check

in, getting people when they arrive, making sure that they find the services that they need to, we have folks who help in the check out process, to make sure they get their food bag, bag of groceries, together hygiene kit, and whatever they need to. volunteers, i think of them as the secret sauce that just makes the whole process works smoothly. >> participants are encouraged and welcomed to come with their pets. we do have a pet daycare, so if they want to have their pets stay in the daycare area while they navigate the event, they are welcome to do that, will we also understand some people are more comfortable having their pets with them. they can bring them into the event as well. we also typically offer veterinary services, and it can be a real detriment to coming into an event like this. we also have a bag check. you don't have to worry about your belongings getting lost, especially when that is all that you have with you. >> we get connected with people who knew they had hearing loss, but they didn't know they could

get services to help them with their hearing loss picks and we are getting connected with each other to make sure they are getting supported. >> our next event will be in march, we don't yet have a date set. we typically sap set it six weeks out. the way to volunteer is to follow our newsletter, follow us on social media, or just visit our website. we always announce it right away, and you can register very easily online. >> a lot of people see folks experience a homelessness in the city, and they don't know how they can help, and defence like this gives a whole bunch of people a lot of good opportunities to give back and be supported. be supported. [♪]

- working for the city and county of san francisco will immerse you in a vibrant and dynamic city that's on the forefront of economic growth, the arts, and social change. our city has always been on the edge of progress and innovation. after all, we're at the meeting of land and sea. - our city is famous for its iconic scenery, historic designs, and world- class style. it's the birthplace of blue jeans, and where "the rock" holds court over the largest natural harbor on the west coast.

- the city's information technology professionals work on revolutionary projects, like providing free wifi to residents and visitors, developing new programs to keep sfo humming, and ensuring patient safety at san francisco general. our it professionals make government accessible through award-winning mobile apps, and support vital infrastructure projects like the hetch hetchy regional water system. - our employees enjoy competitive salaries, as well as generous benefits programs. but most importantly, working for the city and county of san francisco gives employees an opportunity to contribute their ideas, energy, and commitment to shape the city's future. - thank you for considering a career with the city and county of san francisco. >> a way of life in san

francisco. when the next major quake hits, the city hopes a new law requiring seismic upgrades to five story buildings will help keep more residents safe and sound. tell me a little about the soft story program. what is it? >> it's a program the mayor signed into law about a year and a half ago and the whole idea behind it was to help homeowners strengthen buildings so that they would not collapse. >> did you the soft story program apply to all buildings or building that were built in a certain time frame? >> it only applies to buildings built in the time frame of 1978 and earlier. it's aimed at wood framed buildings that are three or more stories and five or more units. but the openings at the garage level and the street level

aren't supported in many buildings. and without the support during a major earthquake, they are expected to pancake and flatten ~. many of the buildings in this program are under rent control so it's to everybody's advantage to do the work and make sure they protect their investment and their tenant. >> notices have gone out to more than 6,000 owners of potentially at-risk properties but fewer than one-third have responded and thousands might miss an important deadline in september to tell the city what they plan to do. let's talk worst case scenario. what happens in a collapse? >> buildings have the tendency of rolling over. the first soft story walls lean over and the building collapse. in an earthquake the building is a total loss. >> can you describe what kind of strengthening is involved in the retrofit? >> one of the basic concepts, you want to think of this building kind of like rubber

band and the upper three floor are very rigid box and the garage is a very flexible element. in an earthquake the garage will have a tendency to rollover. you have to rubber band analogy that the first floor is a very tough but flexible rubber band such that you never drive force he to the upper floors. where all your damage goes into controlled element like plywood or steel frame. >> so, here we are actually inside of a soft story building. can we talk a little about what kinds of repairs property owners might expect? >> it's a very simple process. we deliberately tried to keep it that way. so, what's involved is plywood, which when you install it and make a wall as we have done here already, then you cover it with this gypsum material. this adds some flexibility so that during the earthquake you'll get movement but not collapse.

and that gets strengthened even more when we go over to the steel frame to support the upper floor. >> so, potentially the wood and the steel -- it sounds like a fairly straightforward process takes your odds of collapse from one in 4 to one in 30? >> that's exactly right. that's why we're hoping that people will move quickly and make this happen. >> great. let's take a look. so, let's talk steel frames. tell me what we have going on here. >> well, we have a steel frame here. there are two of these and they go up to the lower floor and there is a beam that go across, basically a box that is much stiffer and stronger. ~ goes so that during the earthquake the upper floor will not collapse down on this story.

it can be done in about two weeks' time. voila, you're done. easy. >> for more information on how to get your building earthquake ready, >> my name is alan schumer. i am a fourth generation san franciscan. in december, this building will be 103 years of age. it is an incredibly rich, rich history. [♪] >> my core responsibility as city hall historian is to keep the history of this building

alive. i am also the tour program manager, and i chair the city advisory commission. i have two ways of looking at my life. i want it to be -- i wanted to be a fashion designer for the movies, and the other one, a political figure because i had some force from family members, so it was a constant battle between both. i ended up, for many years, doing the fashion, not for the movies, but for for san franciscan his and then in turn, big changes, and now i am here. the work that i do at city hall makes my life a broader, a

richer, more fulfilling than if i was doing something in the garment industry. i had the opportunity to develop relationships with my docents. it is almost like an extended family. i have formed incredible relationships with them, and also some of the people that come to take a tour. she was a dressmaker of the first order. i would go visit her, and it was a special treat. i was a tiny little girl. i would go with my wool coat on and my special little dress because at that period in time, girls did not wear pants. the garment industry had the -- at the time that i was in it and i was a retailer, as well as the designer, was not particularly

favourable to women. you will see the predominant designers, owners of huge complexes are huge stores were all male. women were sort of relegated to a lesser position, so that, you reached a point where it was a difficult to survive and survive financially. there was a woman by the name of diana. she was editor of the bazaar, and evoke, and went on and she was a miraculous individual, but she had something that was a very unique. she classified it as a third i. will lewis brown junior, who was mayor of san francisco, and was the champion of reopening this building on january 5th of 1999. i believe he has not a third eye

, but some kind of antenna attached to his head because he had the ability to go through this building almost on a daily basis during the restoration and corrects everything so that it would appear as it was when it opened in december of 1915. >> the board of supervisors approved that, i signed it into law. jeffrey heller, the city and county of san francisco oh, and and your band of architects a great thing, just a great thing. >> to impart to the history of this building is remarkable. to see a person who comes in with a gloomy look on their face , and all of a sudden you start talking about this building, the gloomy look disappears and a smile registers

across their face. with children, and i do mainly all of the children's tours, that is a totally different feeling because you are imparting knowledge that they have no idea where it came from, how it was developed, and you can start talking about how things were before we had computer screens, cell phones, lake in 1915, the mayor of san francisco used to answer the telephone and he would say, good morning, this is the mayor. >> at times, my clothes make me feel powerful. powerful in a different sense. i am not the biggest person in the world, so therefore, i have

to have something that would draw your eye to me. usually i do that through color, or just the simplicity of the look, or sometimes the complication of the look. i have had people say, do those shoes really match that outfit? retirement to me is a very strange words. i don't really ever want to retire because i would like to be able to impart the knowledge that i have, the knowledge that i have learned and the ongoing honor of working in the people's palace. you want a long-term career, and you truly want to give something to do whatever you do, so long

as you know that you are giving to someone or something you're then yourself. follow your passion and learn how to enrich the feelings along the way. >> welcome to a refill week. welcome to