as supervisor wiener medicationed the seniors are the people that biltd the community and this lgbt right moouvment. they fought hard to get us to the this point. san francisco has been a leader for decades in civil rights matters and this ordinance is the next chapter of that legacy. thank you. >> thank you very much. mr. redman. colleagues with that i think we are reedy to go to paublic comment. i want to acknowledge we have several members of the lgbt task force today. i believe some will be speaking and also want to acknowledge and thank you tom noleen with the department of aging service and helps to move these items forward. >> supervisor christensen would like >> i just want to-in hearing from supervisor wiener about the ordiance i was taken back. my sister was a emergency care-nurse at ucsf in 1980 when aids cases came in. the thing that touched her most, not only for the patient is the exclusion of their partners. i remember her being effected by that that they were excluded from heblth care decision squz participation in the greechbing process. it never occurred that 35 years la

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 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 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 dr

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 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 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