2019 Regular Session The Florida Senate COMMITTEE MEETING EXPANDED AGENDA HEALTH POLICY Senator Harrell, Chair Senator Berman, Vice Chair MEETING DATE: Monday, April 8, 2019 TIME: 12:30—3:30 p.m. PLACE: Pat Thomas Committee Room, 412 Knott Building MEMBERS: Senator Harrell, Chair; Senator Berman, Vice Chair; Senators Baxley, Bean, Book, Cruz, Diaz, Hooper, Mayfield, and Rouson BILL DESCRIPTION and TAB BILL NO. and INTRODUCER SENATE COMMITTEE ACTIONS COMMITTEE ACTION 1 Presentation on Prescription Medicines: Share the Savings Saumil Pandya, Deputy Vice Presented President Policy & Research, PhRMA 2 SB 1620 Health Care Licensing Requirements; Designating the Fav/CS Gainer "Exemption of License Requirements for the Yeas 9 Nays 0 (Compare CS/H 885) Treatment of Veterans Act"; exempting certain health care practitioners from specified licensing requirements when providing certain services to veterans in this state, etc. HP 04/08/2019 Fav/CS AHS AP 3 SB 258 Genetic Information Used for Insurance Purposes; Fav/CS Bean Prohibiting life insurers and long-term care insurers, Yeas 9 Nays 0 (Similar CS/H 879) except under certain circumstances, from canceling, limiting, or denying coverage, or establishing differentials in premium rates, based on genetic information; prohibiting such insurers from taking certain actions relating to genetic information for any insurance purpose, etc. BI 03/11/2019 Favorable HP 04/01/2019 Temporarily Postponed HP 04/08/2019 Fav/CS RC S-036 (10/2008) 04082019.1608 Page 1 of 3 COMMITTEE MEETING EXPANDED AGENDA Health Policy Monday, April 8, 2019, 12:30—3:30 p.m. BILL DESCRIPTION and TAB BILL NO. and INTRODUCER SENATE COMMITTEE ACTIONS COMMITTEE ACTION 4 SB 1192 Electronic Prescribing; Requiring all prescriptions to Fav/CS Bean be electronically generated and transmitted upon a Yeas 9 Nays 0 (Similar CS/H 831) certain practitioner’s license renewal or by a specified date; prohibiting electronic prescribing from interfering with a patient’s freedom to choose a pharmacy; repealing provisions relating to electronic prescribing for medicinal drugs, the unlawful sale, manufacture, alteration, delivery, uttering, or possession of counterfeit-resistant prescription blanks for controlled substances, and counterfeit-resistant prescription blanks for controlled substances listed in Schedule II, Schedule III, Schedule IV, or Schedule V, respectively, etc. HP 04/08/2019 Fav/CS AHS AP 5 CS/SB 1180 Consumer Protection from Nonmedical Changes to Fav/CS Banking and Insurance / Mayfield Prescription Drug Formularies; Prohibiting specified Yeas 8 Nays 1 (Similar CS/H 1363) changes to certain insurance policy prescription drug formularies, except under certain circumstances; requiring small employer carriers to limit specified changes to prescription drug formularies under certain health benefit plans; prohibiting certain health maintenance organizations from making specified changes to health maintenance contract prescription drug formularies, except under certain circumstances, etc. BI 03/18/2019 Fav/CS HP 04/08/2019 Fav/CS RC 6 SB 1774 Parental Consent for Abortion; Creating the "Parental Favorable Stargel Consent for Abortion Act"; prohibiting a physician Yeas 5 Nays 4 (Compare H 1335, Linked S 1778) from performing an abortion on a minor unless the physician has been presented with consent from the minor’s parent or guardian, as appropriate; providing an exception for a medical emergency; authorizing a minor to petition any circuit court in which the minor resides for a waiver of consent required to obtain an abortion, etc. HP 04/08/2019 Favorable JU RC S-036 (10/2008) 04082019.1608 Page 2 of 3 COMMITTEE MEETING EXPANDED AGENDA Health Policy Monday, April 8, 2019, 12:30—3:30 p.m. BILL DESCRIPTION and TAB BILL NO. and INTRODUCER SENATE COMMITTEE ACTIONS COMMITTEE ACTION 7 SB 1778 Public Records/Minor’s Petition to Waive Fav/CS Stargel Consent/Abortion; Providing a public records Yeas 8 Nays 1 (Compare H 1397, Linked S 1774) exemption for information that could identify a minor which is contained in a record held by the court relating to the minor’s petition to waive consent requirements to obtain an abortion; providing for future legislative review and repeal under the Open Government Sunset Review Act; providing a statement of public necessity, etc. HP 04/08/2019 Fav/CS GO RC TAB OFFICE and APPOINTMENT (HOME CITY) FOR TERM ENDING COMMITTEE ACTION Senate Confirmation Hearing: A public hearing will be held for consideration of the below- named executive appointment to the office indicated. Secretary of Health Care Administration 8 Mayhew, Mary C. (Tallahassee) Pleasure of Governor Recommend Confirm Yeas 7 Nays 2 BILL DESCRIPTION and TAB BILL NO. and INTRODUCER SENATE COMMITTEE ACTIONS COMMITTEE ACTION 9 SB 832 Adoptee Birth Certificates; Requiring the Department Fav/CS Rader of Health to issue a noncertified copy of an original Yeas 9 Nays 0 certificate of birth to certain adoptees if certain requirements are met; providing that an adoptee does not need his or her adoptive parents’ permission to receive such certificate of birth, etc. HP 04/08/2019 Fav/CS JU RC 10 SB 410 Long-acting Reversible Contraception Pilot Program; Favorable Berman Requiring the Department of Health to establish a Yeas 8 Nays 1 (Identical H 579) long-acting reversible contraception pilot program in Duval, Hillsborough, and Palm Beach Counties; requiring the department to contract with family planning providers to implement the pilot program; requiring the department to submit a report to the Governor and the Legislature by a specified date, etc. HP 04/08/2019 Favorable AHS AP Other Related Meeting Documents S-036 (10/2008) 04082019.1608 Page 3 of 3 Saumil Pandya BIO: Saumil Pandya is a Deputy Vice President in the Policy & Research Department of PhRMA, and is focused primarily on policy and research related to prescription drug spending and utilization, the pharmaceutical supply chain, and trends in U.S. health care expenditures. Saumil has been at PhRMA for over three years. He came to PhRMA most recently from Evergreen Health Cooperative, where he was the Vice President for Medical Economics. Saumil has over 20 years of health care finance experience including Medical Economics and Finance roles at insurers CIGNA HealthCare and Coventry Health Care of Delaware, along with Pricing and Contracting Strategy experience at AstraZeneca Pharmaceuticals. He has extensive experience in managed care, financial analysis/modeling, and pharmaceutical pricing and contracting strategies. Saumil holds a Bachelor of Science Degree in Biology from Towson University, and a Masters Degree in Health Finance and Management from The Johns Hopkins School of Hygiene & Public Health. FOLLOW THE DOLLAR: UNDERSTANDING HOW THE PHARMACEUTICAL DISTRIBUTION AND PAYMENT SYSTEM SHAPES THE PRICES OF MEDICINES A medicine’s path from the biopharmaceutical company to the patient is complex and involves many entities across the biopharmaceutical supply chain. Examining how money flows through this system – which includes wholesalers, pharmacy benefit managers (PBMs), pharmacies and insurers – and how that impacts what patients pay at the pharmacy can help consumers and policymakers find answers to their questions about affordability and access to medicines. The prices wholesalers, pharmacies, PBMs, insurers and patients pay for a medicine all vary and are shaped by negotiations in the supply chain. In recent years, negotiated rebates have increased significantly. For example, in 2015, more than one-third of a brand medicine’s list price was rebated back to health plans or the government or kept by other stakeholders.i Continued growth in rebates, discounts and other reductions in price provided by biopharmaceutical companies—which now exceed $150 billion per year—have kept payers’ prices for brand medicines climbing at modest rates, despite more rapid growth in publicly reported list prices.ii,iii In fact, after accounting for all discounts and rebates, prices for brand medicines grew just 1.9 percent in 2017—slower than the rate of inflation.iv But even though discounts and rebates are growing each year, insurers are dramatically increasing the share patients are required to pay out of pocket. At the pharmacy, commercially insured patients with a deductible have seen their out-of-pocket costs for brand medicines increase 50 percent since 2014. One reason these costs are increasing is because discounts and rebates provided by brand manufacturers do not flow directly to the patients taking the medicine. Large deductibles and coinsurance can create affordability challenges for patients, as these types of cost- sharing are typically based on a medicine’s full, undiscounted price. In 2017, 55 percent of patients’ out-of-pocket spending on brand medicines was for prescriptions filled in the deductible or with coinsurance rather than with a fixed copay—a 20 percent increase since 2013.v The hypothetical patient profile below illustrates how patients often do not benefit from negotiated discounts and rebates and how they may end up paying more than their insurer for their medicine. This needs to change. Patients should benefit more from negotiated rates in the form of lower out-of-pocket costs at the pharmacy, like they do for other types of health care services. Sharing rebates with patients at the pharmacy could save certain commercially insured patients with high deductibles and coinsurance $145 to more than $800 annually.vi PATIENT PROFILE: SCOTT Scott takes insulin for his type 2 diabetes and has a health plan with a high deductible. Prior to meeting his deductible each year, he pays $408.00—more than the full undiscounted cost of his medicine—even though his health plan receives a rebate from the biopharmaceutical company that reduces the list price by 65 percent. Scott is paying the amount that is contracted between the health plan and the PBM, which in this case is higher than the list price of the medicine. Although the health plan does not pay for Scott’s insulin while he is in his deductible, it still receives the negotiated rebate and earns $239 per prescription.