SmartTranscript of House Healthcare - 2025-02-27 - 11:00 AM

[Chair Alyssa Black]: We are, pivoting to h two zero two. Specifically, there's two sections in two zero two that I thought would be helpful for us to get a walk through on, from lunch council as they pertain to, three forty b and reporting type things. So [Assistant Jen Carvey]: thanks, Jen. Sure. Good morning. Jen Carvey from the office of legislative council. Let me put this language up. So this is h two zero two. It's an act relating to increasing the transparency of prescription drug costs and spending. Sounds like we will skip sections one and two for now and just look at sections three and four. Yep. K. So section three would add a new provision in title eighteen on reporting on participation in the three forty b drug pricing program. It would require annually on or before July first that each hospital that participates in the federal three forty b drug pricing program submit to the Green Mountain Care Board a report detailing the hospital's participation in the program during previous calendar year, and the board would have to post that report on its website. Report would be to contain at least the following information. First, the aggregated acquisition cost for all prescription drugs that the hospital obtained through the three forty b program during the previous calendar year, the aggregated amount that the hospital received for all prescription drugs obtained under the three forty b program and dispensed to patients during the previous calendar year, the aggregated payment amount that the hospital made pharmacies with which the hospital contracted, so the contract part three forty b contract pharmacies from our discussion yesterday to dispense drugs to its patients under the three forty b program during the previous calendar year, the aggregated amount that the hospital made to any other outside vendor for managing, administering, or facilitating any aspect of its three forty b drug program during the previous calendar year, all other expenses related to administering the three forty b program, including staffing, operational, and administrative expenses during the previous calendar year, the names of all vendors, including split billing vendors, contract pharmacies, and pharmacy benefit managers with which the hospital contracted to provide services associated with its three forty b program participation during the previous calendar year. [Chair Alyssa Black]: Can I interrupt real quick? What's a split billing, Linda? I'll let somebody else tell you that. I don't Okay. Okay. It's not [Assistant Jen Carvey]: a it's not a term. I know it. The number of claims for all prescription drugs the hospital obtained through the three forty b B program during the previous calendar year, including the total number of claims and the number of claims reported separately by payer type, including Medicare, private insurance, and uninsured, a description of the ways in which the hospital uses savings from its participation in the three forty b program to benefit its community through programs and services funded in whole or in part by savings from the three forty b program, including services that support community access to care that the hospital could not continue without these savings, a description of the hospital's internal review and oversight of its participation in the three forty b program in compliance with her you heard about HRSA yesterday. It's the US Department of Health and Human Services, Health Resource and Services Administration, and they have three forty b program rules and guidance. And finally, such additional information as the board may request. So that would all be posted on the Green Mountain Care Board's website for each hospital that participates, I believe, all of our hospitals. Section four is another new section in the same chapter and subchapter title eighteen on annual prescription drug disclosures to consumers. There's a few different parts. First, annually within six months following the end of the plan year, a health insurer would have to provide to each individual covered under a plan offered or administered by the insurer a report of the total amount that the plan actually spent on prescription drugs for or on behalf of the covered individual during the previous plan year net of all rebates and discounts, so the actual drug spend. The health insurer shall send the prescription drug spending report to the covered individual at the same address to which the insurer sends the covered individual's explanation of benefits. Some privacy provisions in case there is a different address that somebody is receiving, explanation of benefits at than perhaps the one for the main policyholder. Also, annually on or before March first, each covered entity participating in the federal three forty b drug pricing program shall notify its patients if one or more of the prescription drugs prescribed for that patient by a health care professional affiliated with the covered entity was purchased through the three forty b program. And for a covered entity that is a hospital, the notice must include information about how to access the report on the Greenmount Care Boards website that was in the previous section, including the ways in which the hospital uses savings from its participation in the program to benefit its community. And that's it. The act would take effect on July first with the first hospital reports to the Green Mountain Care Board about their three forty b participation due on or before July first of twenty twenty six. [Chair Alyssa Black]: Leslie? I have a question. Sorry. I shut up. I'm just wondering how p sixty six and two zero two kinda intersect. And I'm not that familiar with Phil's, so if it's obvious, I'm sorry. But [Assistant Jen Carvey]: I think they're both relating to three forty b drug pricing. Two sixty six is looking at practices, manufacturers, and ensure and payers practices with respect to to participants in the three forty b program. This would be having the participants doing some reporting on their participation. [Chair Alyssa Black]: Well, there's no reason to have them together or do you want me to think that's a committee prerogative to talk about? [Assistant Jen Carvey]: Right. I'm saying it's up to the committee. Okay. [Chair Alyssa Black]: I just wanna make sure I'm I'm understanding Right. [Assistant Jen Carvey]: We're we're looking at the looking at the two bills that specifically address three forty b and Put it in. And the committee can decide whether there are any parts of either or both [Chair Alyssa Black]: and what can we build? Thank you. On page six, line twelve, that whole piece, there's no requirement that the covered entity that participates in the 340B has to tell a patient how much they acquired the drug for. Is that I mean, it just has to say you you were prescribed a drug, and it was purchased through three forty b program. [Assistant Jen Carvey]: Yes. One or more of the drugs purchased prescribed for you was purchased through the three forty b program. And if it's a hospital, they would say, and here's how to learn more about our participation in three forty b by on the Green Mountain Care Board's website. [Member Woodman Page]: Is there any specific reason why this is it it appears, I mean, I could be wrong, to to be dealing just with the hospital? [Assistant Jen Carvey]: Section three is just on the hospital, and you may want to ask the proposers of the bill the rationale there. I think some of it was the the, effort involved in reporting and whether you wanted FQHCs and others to be, going through that effort. Right? But the lead sponsors. [Chair Alyssa Black]: Did you yeah. No. No. Actually, I'm thinking about the rest of the bill. Will we have a chance to do a read through of the whole bill? We will? K. I know this is just related. Yeah. I just wanted to think about design the table in case it fit into the other. Yep. This is actually just for my knowledge. But is there something in the statute with regard because it's required that payers send explanation of benefits. Is there something that exempts prescription drugs from having to send an explanation of benefits? Why are they not doing that now, I guess, is my [Assistant Jen Carvey]: I don't believe it's a statutory requirement. They send explanation of benefits that may be a different may just be a practice or a a DFR requirement. I don't think the statute itself speaks to explanation of benefits. [Chair Alyssa Black]: I thought that I guess I thought that insurers had to okay. Maybe I'm I [Assistant Jen Carvey]: think that I think there are there are a requirement exists somewhere. It is not, to my knowledge, a statutory requirement. [Chair Alyssa Black]: Okay. Thank you. Alright. Oh, Woody. Yeah. [Witness Catherine O'Neil]: It just seems I it's probably a reason behind this, but it seems like it's a lot of administrative requirements for hospitals to do this work. Wondering, you know, how much time and effort a hospital will have to to take to do this, particularly when we're trying to reduce administrative costs for our, our health care, and it just seems like we're adding more more requirements on them. And I and perhaps there's a necessity behind it, but that's just what I'm seeing with this. [Chair Alyssa Black]: So you're speaking specifically about section four? [Witness Catherine O'Neil]: Well, I'm I'm speaking about section three as well. And and here again with the Green Mountain Care Board, how much time and effort are they going to have to be required to to work on this? Just my thoughts. [Chair Alyssa Black]: K. I think next up, we have Catherine O'Neil from Green Math Care Board. So let's talk to her about that. [Witness Noah Montemarano]: Good morning. Are you able to [Chair Alyssa Black]: hear and see me alright? Yep. [Witness Noah Montemarano]: Great. Good morning. Thank you for the opportunity to talk with you this morning, specifically on section three of the bill. I am Catherine O'Neil, director of prescription drug pricing at the Green Mountain Care Board. And on screen, here with me today is Noah Montemarano. He's a policy analyst at Green Mountain Care Board. We're working together on, understanding prescription drug pricing, specifically to, act one thirty four, which is passed last year. And so we're here this morning with a few general comments specifically to section three, and then we'll summarize that here. And then we have some recommendations on a few of the subsections in this section. As a follow-up later today, we'll provide these in written comments back to the committee. So hospitals do report some aggregate three forty b data already to the Green Mountain Care Board as part of their annual submissions. This bill would expand on that reporting. Yeah. We do think it would be helpful to specify the the purpose for this additional reporting, whether it's to better understand how hospitals use the three forty b revenues to fund hospital other hospital operations or services, or to better understand the impact of the three forty b program on the insurance plans, maybe to better understand the cumulative impact of the three forty b program on patient cost sharing or or maybe there's another goal that the committee has or that this bill is looking to accomplish. We do think that the wording in this section doesn't appear to violate federal three forty b rules or confidentiality. We do wanna say though that if the Green Mountain Care Board were to be, collecting and posting, these data to the website, we'd like to suggest adding, something along the lines of subject to the Public Records Act just to ensure that release of any required permissions are aligned there. We recommend, including a requirement that hospitals attest or certify that the information provided is true and accurate. And it it wasn't clear to us in this bill whether the submission of the information, which would be due annually on or before July first, is intended to be done along with or as part of the annual hospital budget and required documentation submission to the Green Mountain Care Board, which is part of the hospital budget review process. We get that this could certainly serve to streamline submission, but important to understand that Green Mountain Care Board doesn't regulate on specific line items in a hospital budget. So if in the future, state law were to require that we do more with the three forty b data than just to collect it for transparency purposes, say, if the legislature wanted to, use the data as basis for regulation, we'd have to do that outside of the hospital budget process. And then the final general comment on this section is related to staffing. This if the required reporting submitted by the hospitals annually is just to post it to the Green Mountain Care Board website for added transparency. That wouldn't require much in the way of staff effort. But if we were to need to do additional analysis of the data collected pursuant to this bill, we it that would increase the required level of effort. We'd have to discuss that in addition separately. We have a few comments specific to some of the subsections. I think we need section two, four, seven, and eight. So shall I jump right into that? [Chair Alyssa Black]: We did section two. We did not do any walk through of Sorry. Section [Witness Noah Montemarano]: two. Section three. But but the yeah. But the subsections, the [Chair Alyssa Black]: Oh, do you have the page? [Witness Noah Montemarano]: Do you have the page number [Chair Alyssa Black]: and the line? [Witness Noah Montemarano]: Oh, I'm not looking at the bill that way. Sorry. [Chair Alyssa Black]: Alright. What section is she? What what section are you looking at? [Witness Noah Montemarano]: Section three Section three, the reporting on participation in the three forty b pricing program. And then, number two, the aggregated payment amount that the hospital receives for all prescription drugs obtained under the three forty b program? [Chair Alyssa Black]: Yep. Four line twelve. [Witness Noah Montemarano]: Thank you. Our, our comment there is, related to the collecting the total payment amount that the hospital receives. We'd recommend including patient cost sharing in the total amount so that we can more fully see the value of the three forty b program. And distinguishing between the total amount reimbursed by insurance companies versus the total amount reimbursed by patient cost sharing. That's just additional, you know, a a a deeper layer of of reporting and understanding on that. On line four, I'm not sure what number that or what line that is, but that subsection four related to the negotiated payments to vendors. We just thought that it's possible that a hospital might argue that their negotiated payments constitute trade secret and would warrant confidentiality. Just a comment here. We thought if we agreed with their assessment, we wouldn't be able to post this data publicly. We'd only be able to publish it in in more of an aggregate, like a combined total expenses, which which would combine three and four and five. On subsection seven related to reporting the number of claims that the hospital obtained through the three forty b program. We suggest including also reporting three forty b claims as a percentage of all claims. This is gonna help us to better see the scope of the three forty b program. And then on subsection eight, which is related to providing a description of the ways in which hospitals use the three forty b revenues, we just wanna say that while it it can it can be referred to as savings, and we do hear that. We heard it yesterday in the testimony that you received yesterday, here and there. It's not actually savings, so we just wanna point that out. It's revenue or profits because it's generated from the resale. It's it's dollars generated from the resale of drugs purchased at, at a discount from the manufacturers. So for clarity, we'd recommend considering using terminology other than savings. We'd also recommend adding a listing of the community programs, the total cost of each program in that year, and the percentage of the programs supported by three forty b revenue. And, finally, suggest requiring hospitals to provide detailed and quantitative data to support any claims that services that support community access to care would not be able to continue without three forty b revenue. And we say this because without without evidence, it would just be storytelling, and it wouldn't have much value, and it would be, you know, added burden for busy work. So that's it for our comments. Thank you again for the opportunity to provide input, and I'll give it back to you, Chair Black. [Chair Alyssa Black]: Great. Any questions for Catherine? Yeah. I'm going to send this in writing. Yeah. She's gonna send this in writing this this afternoon, trusting my notes. Yeah. I currently, right now, within the hospital budget review process Eleven twenty four AM. Thank you, Tucker. Right on, Tucker. You're watch. That's my plan. [Witness Charles Becker]: I don't wear it. [Chair Alyssa Black]: Apparently, he's telling me to get a move on. Yeah. So currently, in the in the current hospital budget review process, do hospitals report any type of data around their revenue from three forty b? [Witness Charlie Becker]: I can take this if you want. [Witness Noah Montemarano]: Aggregate? Oh, I'm sorry. No. I'm talking over you. I was going to say yes. They do. I would like to turn it over to Noah for more specifics. He worked on the hospital budget review process last year, so I think he knows a little bit more about that. [Chair Alyssa Black]: That's great. [Witness Charlie Becker]: Yeah. I apologize if there's a lag. Just let me know if I'm accidentally interrupting anybody. Yes. So for each hospital, we collect total revenue that that's all, so on their income, on their income sheet, there's one line designated for three forty B revenue. And so we have a just lump sum value for each hospital. Some hospitals and their narratives detail pharmaceutical expenses, and some of them get into three forty b expenses. Some of them don't. It's it's not standardized. But [Chair Alyssa Black]: they list do they list their in their liabilities, how much they spent on three forty b? I mean, so they're telling you how much revenue. Do they also tell you how much it's costing them? [Witness Charlie Becker]: No. No. Just the only standardized line is revenue. [Chair Alyssa Black]: Great. Any questions for Wadi, did you wanna ask your question around administrative burden to I think [Witness Catherine O'Neil]: she mentioned that if we they have to go into some sort of analysis of data, then they might require additional staff if I understood what she was saying. [Witness Noah Montemarano]: Yes. I will say that as part of Act one thirty four, which is looking at the options for regulating prescription drug costs and affordability in Vermont. The three forty b program is just one of the areas in which we are looking. We in in a in a more comprehensive manner, we will be providing a a final report with recommendations next year to the legislature, and that would include a an analysis of the most likely, you know, the the recommendations that we would have that would be most beneficial for regulating prescription drug costs that wouldn't result in, you know, a a burden. So the best bang for our buck kind of thing. So we would this is a part of that. I do think that right now as it stands, collecting the data would be added burden for hospitals, not so much added burden for the Green Mountain Care Board. Again, the way the bill is written, it's we're posting the reports that are provided by the hospitals. If we're asked to do analysis and and, you know, certainly, any kind of regulation related to that, then then, yes, then we would have to, you know, look at how how much of a how much staffing would be required for that. [Chair Alyssa Black]: Would would having this data help inform your work in the position that we created around prescription drug affordability? [Witness Noah Montemarano]: It certainly would. I know that other states collect this or similar data, which we are looking at to understand what, you know, what the impact of the three forty b program is and, you know, any any and all data is certainly gonna help us. [Chair Alyssa Black]: Okay. Now on to Jake. [Witness Charlie Becker]: Yeah. Not to interrupt. Apologies. I'm I'm trying to wait for the lag. To to go back one moment, I just wanna fully answer your previous question. I've pulled up an income sheet here. So, to confirm about the data that the hospital budget process collects, we have a line item for three forty b revenue. So that's revenue designated only as three forty b, and then we have an expense line for our all pharmaceuticals. So that includes three forty b, but it also includes inpatient drugs and and other things. So there's no way at the moment to compare apples to apples, income and expenses. [Chair Alyssa Black]: Great. Thank you. Thank you both. And, Charlie from oh, here at the kid's office. [Witness Charles Becker]: Hello? How's everyone doing? Good. For the record, I'm Charles Becker. Most people call me Charlie Becker. I'm a staff attorney with the office of the health care advocate. Been with health care advocates office for three years. It's an honor to, you know, be an advocate for affordability and access of health care for Vermonters. It's also a a a a joy for me to be able to, as a part of my work, spend time really digging into pharmaceutical pricing. I think I spoke to this committee last year about my personal experience as a person with chronic illness who relies on expensive medication to stay healthy. And, it's been a a a a very strong interest of mine to try to figure out why are pharmaceuticals so expensive. And, and now I get to do that for as part of my job. So one of the things you learn about when you're trying to figure out why drug prices are the way they are is you encountered the three forty b program. And so you've heard testimony over the, you know, past day and a half, already about the three forty b program. In its simplest form, you know, covered entities, buy drugs at a low price, and then sell them at a high price. The result being, a margin. Some might call it a spread, but it's a little pot of money for each three forty b transaction multiplied by however many thousands of drug transactions covered entity may fill per year, and that little pot of money becomes a big pot of money, which is intended to stretch scarce federal resources as far as possible to reach as many patients and to provide as many services as possible as we've heard multiple times over the past couple of days. And that's a good thing. Right? We wanna be able to stretch those scarce resources. But what happens when you have a big pot of money is that a lot of people take an interest in it. And that's what you've been hearing about over the past day and a half. Lots of voices expressing positions about three forty b revenue. None of which is to say that three forty b is good or bad. I think you did hear multiple witnesses saying yesterday that if they were to design an ideal healthcare system, three forty b wouldn't be a part of it, and I'll add my voice to that chorus. But three forty b exists in this imperfect system that we have. So I'm here to talk about h two zero two, but to quickly touch on two sixty six. Whatever this committee decides to do with two sixty six, and I do think you've heard some really good testimony over both days presenting both sides of the story. And and I will say, and it might be controversial here, that the pharma lobbyist, the point of view that they presented was not unreasonable. They have a reasonable point of view. But the financial condition of our Vermont providers, on balance, is probably more important. And until there's a federal fix to the program, the contract pharmacy protections at least in h two sixty six makes sense to the HCA. I know there was testimony, I think, this morning from MVP about some of the, payer language in two sixty six that might make merit further investigation, but but contract pharmacy language makes sense to the HCA. At the same time, you've heard testimony about how big the three forty b program has gotten. Just knowing how big that program has gotten is the number one reason why I think we need legislation like the transparency language that's in section three of h two zero two that that you just, had to walk through from ledge council and, that the GMC beaches spoke about. Simply, you know, when you have a large sum of money at stake, and in Vermont, I believe three forty b revenue comes in and certainly the tens of millions of dollars a year across all of the covered entities, probably over fifty million dollars a year. When you have that large of a sum of money and multiple actors who are not providers of health care like PBMs, third party administrators, vertically integrated chain pharmacies, which arguably they're providing health care. But when you have for profit interests seeking to get a share of that three forty b money, you know, it's probably a good idea to have as much insight into that program as you can possibly get. Mhmm. And right now, we don't have any transparency at all into the program. Only two states have passed language similar to what's in section three of of h two zero two, Minnesota and Maine. And, as you heard yesterday from the farm pharma lobbyists, Minnesota has already issued their first report based on the data that they obtained, from a language that is very similar to what's in h two zero two. Of the Maine and Minnesota models, h two zero two is closest to Minnesota. And Minnesota has their first report up. It it is very interesting and eye opening, and you can simply Google Minnesota three forty d transparency report, and you might see the kinds of information that we would get here in Vermont if we pass something similar. What reporting would be most helpful? I mean, there's nine or ten sub paragraphs in this section. You know, certainly thankful to the GMCV for bringing their thoughts for improving that language to the table. I think what they've suggested are great improvements. We'd make the reporting stronger. And I'm, you know, I'm certain that with further testimony and discussion amongst this committee, you'll find the right spot, the right reporting that would be helpful to the State of Vermont. But just, you know, two zero two secondtion three where we're at is a good place to start, and the HCA hopes that there is some movement towards three forty b transparency here in Vermont. I think it would go hand in hand with giving the Fqhcs and and hospitals and other covered entities, giving them unlimited contract pharmacies, but also getting us a little something back, some some data, some information about how this program is operating here in the State. I'm gonna pivot quickly to, section four of the bill. I mean, that that was my testimony on section three. It I maybe should stop and see if there are any questions. [Chair Alyssa Black]: Any questions for Charlie? Are we gonna get it right? [Witness Charles Becker]: I could provide this in writing. Yes. [Chair Alyssa Black]: Please. Okay. [Witness Charles Becker]: That would [Chair Alyssa Black]: be very helpful. I mean, I keep notes. Okay. Okay. Do you have any information or experience, or have you had any discussion with hospitals or insurers from Minnesota about their experience? [Witness Catherine O'Neil]: I have not. And that would [Witness Charles Becker]: have been a good bit of research to do, but I have not. And, certainly, I could and it's good homework to follow-up. Yes. That's you. Yeah. Yeah. [Chair Alyssa Black]: Can I Yeah? I just found this Minnesota Yeah. We're Connecticut. Yeah. So If we get that on our website, I think that would be Yeah. If you just send you a link. Yeah. That's great. Alright. You wanna Okay. Good. Section [Witness Charles Becker]: Section section four. Yeah. As you heard, ledge council describe section four would require two types of slow disclosure to Vermont consumers. I'll start with the second of those disclosures which I I guess would be in paragraph b of section four. This paragraph would require three forty b covered entities to once per year notify patients if drugs that were prescribed by the covered entity were purchased through the three forty b program. Why is this something a person would want? I I I see I I see the the question coming already. I would say this is about transparency. To go back to h two sixty six for a second, the other bill, there's language in that bill in the bill summary that says the purpose of h two sixty six is to protect three forty b covered entities and three forty b contract pharmacies and their patients' languages in there, Then goes on in at least three other locations in that bill to, refer to protecting a patient's choice to receive drugs from the three forty b covered entity or a three forty b contract pharmacy, which to me seems like a weird thing to to be protecting, to say that we're protecting patient choice when patients have no idea that their healthcare is involved in this program. Section four would address that lack of transparency to the consumer. Would some consumers be confused? I think we heard testimony this morning that that there's a concern that that consumers would be confused. Maybe some would be. Would hospitals need to open up a separate helpline to answer questions? I think that's doubtful. Would consumers would some consumers find meaningful information in that disclosure or be inspired to learn more about what's going on with their health care? I would say I I hope so. I think when consumers are more informed about what's going on with their health care, the system works better. The other disclosure required in section four, that's at paragraph a, would require health plans to annually provide an accounting to individual beneficiaries of actual drug spending. As representative Cortes testified when she introduced the bill last week, for medical claims, you get that EOB that tells you accurately what the health care provider charged, what the discounts were, and what your health health plan actually paid out on your behalf. That's not strictly the case with pharmaceutical claims. It may be that you get an EOB, or if you log into your portal, you'll see some sort of processing of your pharmacy claim. But the best you're going to get when you look at your pharmacy claim in that in that member portal is an indication that there was some discount off of the full price of that drug that your health plan negotiated on your behalf. But we all know with prescription drugs, especially brand name drugs, that those upfront discounts are only a part of the story and that there are rebates and other discounts that health plans receive after the fact that significantly reduced their overall drug spending. So significant are those savings from, post claim adjudication, rebates, and discounts that health plans vigorously defend them. Last year, this committee briefly entertained the idea of the sale rebate pass through to consumers. That was a part of the PBM bill. It was briefly a part of it. The health plans vehemently opposed that language because any concession of rebates to consumers would, in their opinion, lead to increased premiums. And opinion is probably not the right word. By giving up some of their rebate to consumers, there would inevitably be some push upward pressure on premiums. I I can't say how much that would be. And and and in this environment we're in, okay, we all get it. Any upward pressure on premiums is something we really can't have. But if you can't pass through the rebates and discounts to the person whose illness has generated that rebate and discount, at least tell them that you got it. And and and and tell that consumer how much you actually spent on their care. You know, there's something that people any person with a chronic illness might relate to. It's you do log in to that member portal, and you see how much they're saying has been spent on your care, two hundred and fifty thousand dollars, five hundred thousand dollars, and you think to yourself, well, first of all, can that really be is it really that high? And second of all, you think to yourself, man, that's a lot of money. Right? It would be great to know that that total really wasn't that high and to really have an accurate accounting of how much a health plan is spending on your on your on your health care and your pharmaceutical care, in particular. And that is my that's my testimony on section four. Are there any questions on that? [Chair Alyssa Black]: No questions? [Witness Charles Becker]: I can see where the confusion is. You can see where the confusion I don't care. Right? If I get a stick, ask ask money. I don't know. I pay for insurance. I pick up my drugs. I I think that's just gonna lead to more confusion, more phone calls, and more probably misinformed information. So that part, I I can see. And the other thing is to make it so complicated that all these people gonna have extra staff, their profit's not gonna be there. So in the in the long run, it what they're spending it if they're spending it on what they say they are, that's gonna change. So All fair points. [Witness Charles Becker]: I mean, I I don't wanna confuse people, and I know the system is very confusing. I, you know yes. I I don't I certainly it's not the HCA's position to wanna cause consumers to be confused. And Mike might shut me down, but, you know, I mean, the HCA is also a a a resource for confused consumers. You know? So yeah. [Chair Alyssa Black]: Alright. Question. But I also wanna respond to that. I I would say that it's not this that would confuse people. It the system itself is confusing, and we're trying to help educate people. And it would take effort. I would argue that legislators would probably be one of the first people peep first group of folks that people would reach out to, probably not not the hospitals. But to the burden of sending, we heard I think it was MVP that said it would be burdensome to send, again, another like, a snail mail piece. Like, in the estimate the EOB kinds of information. And so further discussion, we can have what might be what electronic means be acceptable. And I don't know where to go. I'd be curious about Minnesota and being or Minnesota with your experience mostly with that. [Witness Charles Becker]: We should definitely dig in more to Minnesota and and and Maine. And and I and I absolutely agree. And maybe there's language that we could come come across that, you know, people receive their communications electronically these days. No one wants a piece of paper in the mail. So Excuse me. Oh, no. Come on out of [Witness Charles Becker]: my place. [Witness Charles Becker]: I'm sorry. [Chair Alyssa Black]: I'm sorry. Alright. Either or. Representative? Yeah. I have a lot of constituents who don't [Witness Charles Becker]: have Oh, many. Okay. Okay. [Chair Alyssa Black]: Or any mail [Witness Charles Becker]: or I think the the language would have to be however the member chooses to receive their communications, whether by mail or electronically, would be how this disclosure would be, Which is how we provide us. [Chair Alyssa Black]: Businesses do it anyway. You can get to opt in to electronic or spam mail. I don't know if you know the answer to this, but Medicare currently sends quarterly explanation of benefits to all members, don't they? Mhmm. [Witness Catherine O'Neil]: Actually not. [Chair Alyssa Black]: In the mail? On my Yes. Okay. Oh, yes. Mhmm. Okay. So this would be a yearly, basically, be a yearly letter that would say you've received drugs that were purchased through a period party b. [Witness Charles Becker]: That was the intention, a yearly notification. Yeah. [Chair Alyssa Black]: Yeah. Yeah. I have a question. I'm just wondering if the genesis of this bill, the writing of this speech to bills are based on the Minnesota bill or May bill or what is the article? Let's ask the sponsor of the bill. There's a personal genesis, which I think has already been mentioned, by, our witness, combined with, a personal, for both of us, interest in helping increase transparency around pharmacy the drug market and how much identifying how much money is moving around where we don't see it. And so we have no way of being able to ensure that our precious health care dollars are being utilized in the in the most appropriate way. So I think transparency is really critical. [Witness Charles Becker]: And if I could add on to that, is that is that okay? Yeah. So, the the transparency language specifically in section three is closest to Minnesota's transparency language, except that Minnesota required reporting from all covered entities where section three is limited to just hospitals. And and I think the intention of that was to, most of the three forty b revenue, by volume is going to the hospitals. FQHCs are smaller. They you know, it's it's important to them, the money, but they're just getting a smaller amount of it. The most of it's going to the hospitals. And so I mean, just as a as a start, I think the thought was that [Witness Catherine O'Neil]: you would require reporting from hospitals. [Chair Alyssa Black]: So let's let's see. Let's see. Let's see. Let's see. The the executive summary from the Minnesota report, and it's really good. It it's accessible. So it really helps explain that just what you said. You know, we have possibly have a better money. We have much either getting tiny money. You know, everything is sort of summarized very nicely, you know, just for whatever. Mari? Yeah. Just I I really liked your comments in the beginning about I don't think any of us are saying we want the we we want the we're trying to make the three forty b program go away. We're not. I I I realize and have been protected of the three forty b program for hospitals because I know what it's such an important program. So it is the system that we have, and I'm I'm not with this bill in any means trying to undermine the inside the b program for hospitals and other health care providers. Thank you. Thanks, Charlie. [Witness Catherine O'Neil]: So much. Yeah. Thank you. [Chair Alyssa Black]: Great. So we're back here at one o'clock. Yeah. Are we gonna try and work this out? I'm just wondering.

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