Oversight of pharmacy benefit managers floor debate  5/9/19

Oversight of pharmacy benefit managers floor debate 5/9/19


NEXT BILL ON THE CALENDAR FOR THE DAY IS SENATE FILE 270. THE CLERK WILL REPORT THE BILL>>CHIEF CLERK: SENATE FILE NUMBER 278 NUMBER THREE ON THE CALENDAR FOR THE DAY AND ACT RELATING TO HEALTHCARE.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE AUTHOR OF THE BILL THE MEMBER FROM DAKOTA REPRESENTATIVE MANN TO EXPLAIN THE BILL>>REPRESENTATIVE MANN: C SPEAKER MEMBERS; SENATE FILE 278 DEALS WITH THE LICENSURE AND TRANSPARENCY OF THE PHARMACY BENEFIT MANAGERS OR PBM’S. A PHARMACY BENEFIT MANAGER FUNCTIONS AS A MIDDLEMAN BETWEEN THE DRUG MANUFACTURER AND HEALTH CARRIER OR PHARMACY. INITIALLY; THEY WERE HIRED TO MAKE DEALS WITH THE MANUFACTURE BY [INAUDIBLE] FOR PRESCRIPTION MEDICATION. AND PASSED THE PRICE DOWN TO THE PATIENT. UNFORTUNATELY; IN MANY CASES THAT IS NOT THE CASE ANYMORE. SO WHAT IS HAPPENING NOW IS THAT THE PBM GO TO THE MANUFACTURE AND TAKE THEM I WILL PUT YOUR DRUG ON THE FORMULA WHICH IS A LIST OF MITIGATIONS AND KEEP YOUR COMPETITOR’S OFFICE LIST BUT I WILL NEED AN INCENTIVE TO DO THAT. SO THEY WILL GET WHAT THEY WE CALL A KICKBACK AND I COULD B E A [INAUDIBLE] PERCENTAGE OF THE DRUG IT PLACED ON THE FORMULARY. BECAU SE OF THIS; IN ORDER FOR THE MANUFACTURES TO KEEP THEIR PROFIT MARGIN HAVE TO INCREASE THE PRICE OF THE DRUG. AND BECAUSE OF THESE INCENTIVES; PBM’S CAN ALSO CHOOSEMORE EXPENSIVE DRUGS TO PUT ON THE FORM THAT CHOOSING BRAND-NAME DRUGS VERSUS THE GENERIC DRUGS. WHICH; OF COURSE; INCREASE THE PRICE OF THE DRUG FOR THE PATIENT. THESE PRACTICES HAV E ONLY BEEN INTENSIFYING OVER THE LAST SEVERAL YEARS AS WE NOW HAVE A SYSTEM THAT IS BEEN MONOPOLIZED BY ONLY THREE PBM’S. WHO OWN NOW OVER 75% OF THE BUSINESS. THESE TWO PRACTICES HAVE TWO SIGNIFICANT OUTCOMES BUT ONE IS COST LIKE I TOUCHED UPON ALREADY IN THE SECOND RESULT WHICH IS MOST IMPORTANT TO ME; THE MEDICAL OUTCOMES. – WHEN THE FORMULARY IS CHANGED; TO START THE PATIENT HAS TO START A NEW DRUG. THIS MEANS THAT MEDICAL DECISIONS ARE BEING MADE NOT BECAUSE THEY ARE MEDICALLY NECESSARY; NOT BECAUSE THE DOCTOR WANTS HIM TO CHANGE; NOT BECAUSE THE PATIENT WANTS THEM TO CHANGE BUT THEIR MAIN MADE FOR MONETARY REASONS. WHE N A MEDICATION CHANGES; PATIENTS NOW HAVE TO COME BACK TO THE OFFICE FOR REPEAT BLOOD WORK TO MAKE SURE THEY’RE NOT HAVING ANY SIDE EFFECTS; TO MAKE SURE THE MEDICATION IS WORKING . THEY HAVE TO MISS WORK AND POTENTIAL ANY CHILD CARE. OF COURSE THIS INCREASE THE COST OF HEALTHCARE AS A WHOLE. THE PBM’S ARE ESSENTIALLY MAKING SOME VERY BIG MEDICAL DECISIONS THAT DIRECTLY IMPACT PATIENT CARE IN THE STATE OF MINNESOTA AND THEY ARE DOING THIS WITHOUT ANY OVERSIGHT. SO ONE OF THE MANY THINGS THAT THIS BILL WILL DO IS TO LICENSE PBM SAID NURSES; DOCTORS MANUFACTURES HOSPITALS EVERYONE IS LICENSED TO PRACTICE IN THE STATE EXCEPT FOR THE PBM. THIS BILL WOULD REQUIRE A TRANSPARENCY IN THE DEALINGS OF THE PBM . WHAT REBATES DID YOU GET? HOW MUCH WOULD YOU CHARGE FOR THE DRUG? WOULD YOU PAY THE PHARMACY FOR THE DRUG AND WHERE IS THE MONEY GOING? THIS BILL WILL PROHIBIT PBM FROM SHORTCHANGING PHARMACIES WHICH ARE REALLY PUTTING OUR FAMILY ON PHARMACIES IN THE STATE. THEY WILL PROHIBIT PBM SOME CHARGE A PATIENT A HIGHER COST AT THE POINT-OF-SALE TO ALLOW PATIENTS TO SYNCHRONIZE THE MEDICATIONS WILL MAKE THEIR LIVES EASIER. IT WILL ALLOW THE PHARMACIST TO DISCUSS CHEAPER ALTERNATIVES WITH THE PATIENT. THIS IS A REALLY GREAT BIPARTISAN BILL. IT WILL BRING ACCOUNTABILITY AND TRANSPARENCY TO A VERY OBSCURE PLAYER IN OUR HEALTHCARE SYSTEM . IT WILL PUT PRESSURE ON PBM’S MO RE FAIR ACTRESSES AND BRING ON THE COST OF PRESCRIPTION DRUGS. I ASK FOR YOUR SUPPORT.>>HOUSE SPEAKER HORTMAN: THERE ARE NO AMENDMENTS AT THE DESK. THE CLERK WILL GIVE THE BILL ITS THIRD READING.>>CHIEF CLERK: THIRD READING SENATE FILE NUMBER 278>>HOUSE SPEAKER HORTMAN: THE THIRD READING>>[GAVEL]>>HOUSE SPEAKER HORTMAN: DISCUSSION TO THE BILL? REPRESENTATIVE MUNSON..>>REPRESENTATIVE MUNSON: THANK YOU; MME. SPEAKER. I GUESS; I DO HAVE A QUESTION FOR THE BILL’S AUTHOR. WE ARE VOTING ON THE SENATE FILE AND NOT USING THE HOUSE LANGUAGE?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. SO IT’S CALLED THE SENATE FILE BUT I N THE LAST COMMITTEE STOP WE ADOPTED THE HOUSE LANGUAGE FOR OUR VERSION.>>REPRESENTATIVE MUNSON: OKAY; THANK YOU MME. SPEAKER. I GUESS I’M WORKING OFF A SECOND ENGROSSMENT OF THE HOUSE FILE 278; BUT I DO WANT TO CLARIFY THAT UNDER SECTION 4 THE THAT IT STILL HAS THE LANGUAGE THAT THE PHARMACY BENEFIT MANAGER IS A FIDUCIARY DUTY TO THE HEALTH CARRIER. I’M GETTING A NOD FROM THE BILL’S AUTHOR. I HAVE A CONCERN IN COMMITTEE WHEN I HEARD THIS LANGUAGE BECAUSE I KNOW IN THE PRIVATE SECTOR JOB I DEAL WITH CLIENTS HAVING A FIDUCIARY DUTY BUT THE FIDUCIARY DUTY IS ALWAYS TO THE CLIENT OR THE CUSTOMER AND NOT TO ANOTHER HEALTH CARRIER WHICH IS WHAT IT IS LISTED IN THIS BILL. SO I KNOW THERE IS LANGUAGE THAT CAN BE WORKED OUT IN CONFERENCE COMMITTEE; BUT I HAVE A HARD TIME WITH THE PHARMACY BENEFIT MANAGER; THE PBM; HAVING TO KEEP CONTROL ON THE FIDUCIARY THE BOTTOM LINE FOR ANOTHER PRIVATE ENTITY. AND WE REALLY SHOULD BE FOCUSING WHEN WE CREATE LEGISLATION; THAT’S GOING TO BRING BRING TRY SPENCER HE TO THE PHARMACEUTICAL INDUSTRY THAT’S GOOD WE DO THIS FOR THE BENEFIT OF THE PATIENT OR THE ENROLLEE. AND I DO SUPPORT MANY PROVISIONS OF THIS BILL. THERE’S LEGISLATION I CARRIED OUT LAST YEAR AND REMOVING THE GAG ORDER FOR PHARMACIES AND ALLOWING PATIENTS TO GO TO THE PHARMACY AND ACTUALLY SEE WHAT THINGS COST. THAT IS REALLY IMPORTANT. FOR LOWERING THE COST OF PHARMACEUTICALS IN THIS COUNTRY; IT’S A VERY IMPORTANT THAT PEOPLE UNDERSTAND WHAT THE COSTS ARE.. NOT JUST TO THEIR CO-PAY; BUT TO THE UNDERLYING HEALTH INSURANCE PLAN BECAUSE OUR HEALTH INSURANCE COSTS ARE JUST A COLLECTION OF WHAT THE HEALTHCARE COSTS ARE ROLLED INTO ONE. SO UNDERSTANDING THE DIFFERENCES BETWEEN GENERICS AND NAMEBRAND DRUGS; THE ACTUAL COST OF THE INSURANCE IS VERY IMPORTANT. SO REPRESENTATIVE MANN; THANK YOU FOR OFFERING THIS BILL AND THEIR SMALL PROVISIONS IN THIS BILL I DISAGREE WITH. I DO SUPPORT THE BILL AND ITS PURPOSE AND I HOPE WE CAN REALLY DRIVE SOME CHANGE.. I DO WANT TO SAY THAT I DON’T TYPICALLY VOTE FOR REGULATIONS INCLUDING THE LEVEL OF BUREAUCRACY AND AN INDUSTRY; BUT I CONSIDER MYSELF A CAPITALIST AND I SUPPORT THE INNOVATION THAT’S DRIVEN THROUGH FREE MARKET COMPANIES AND NOT JUST RUNNING THINGS BY THE GOVERNMENTS. BUT THE PHARMACY BENEFIT MANAGERS ARE DOING AND WHAT THEY’VE DONE TO THE PHARMACEUTICAL INDUSTRY; IS NOT CAPITALISM. THIS IS CRONY CAPITALISM. THIS IS BUYING LEGISLATION THAT ALLOWS THEM TO OPERATE AND CONTROL PRICING THIS INDUSTRY TO DRIVE THE COST OF PHARMACEUTICALS UP AND TO PROFIT FROM THAT. SO THIS IS A RESULT. WHEN YOU TAKE ADVANTAGE OF LEGISLATION TO MASK PRICING FROM THE CONSUMERS; THIS IS THE REPERCUSSION. WE GET REGULATIONS ON YOUR INDUSTRY. AND THIS IS A NECESSARY REGULATION. A NECESSARY LEVEL BUREAUCRACY TO BRING PRICE TRANSPARENCY TO THE PUBLIC AND I HOPE THAT WE CAN DO MORE TO ALLOW CONSUMERS TO SEE THESE INDIVIDUALS KICKBACKS AND THAT WE WORK IT OUT IN COMMITTEE SO IT’S NOT JUST AT A GENERAL PBM LEVEL FOR THEIR COST BUT WE CAN ACTUALLY DRIVE DOWN TO SEE TO GIVE THE INFORMATION TO THE INSURANCE CARRIER SO THEY CAN SEE HOW THEIR CUSTOMERS;; THEIR PATIENTS; BEING DRIVEN TO BUY NAMEBRAND PHARMACEUTICALS OVER GENERICS. SO THANK YOU MME. SPEAKER MEMBERS COULD I URGE YOU TO VOTE YES ON THIS BILL>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM STEARNS REPRESENTATIVE O’DRISCOLL>>REPRESENTATIVE O’DRISCOLL: THANK YOU; MME. SPEAKER. MEMBERS; AYE; TO ALSO BELIEVE THERE ARE NUMBER OF PROVISIONS IN THIS BILL THAT OFFER REFORMS ARE NEEDED IN THE PHARMACEUTICAL INDUSTRY AND THE WAY THAT WE PROVIDE SERVICES TO MINNESOTANS AS RELATES TO HEALTHCARE. MY NUMBER ONE HANGUP ON THIS BILL AND WHY I’M GOING TO BE VOTING NO TODAY; IS THE PROVISIONS THE DEAL WITH FIDUCIARY RESPONSIBILITY. VERY QUICKLY; CONTRACT LAW IS AT ONE LEVEL IT I INTO A CONTRACT WITH SOMEONE COULD I EXPECT IT GOING TO BE ACTING IN GOOD FAITH. BUT THERE ALSO TO BE BEHAVING WITHIN THE CONFINES OF THE LAW. IN A FIDUCIARY RELATIONSHIP ALL THOSE THINGS ARE REQUIRED. PLUS; PLUS; PLUS; AND THE PLUS; PLUS; PLUS ON THIS IS THAT YOU HAVE TO HAVE YET TO ADVOCATE WHOLLY AND EXCLUSIVELY ON BEHALF OF ONE INDIVIDUAL. SO THE CONCERN THAT I HAVE AN EFFORT FROM MEMBERS IN THIS CHAMBER; I’VE HEARD FROM MEMBERS IN THE CHAMBER ON BOTH SIDES OF THE AISLE; THEY HAVE QUESTIONS ABOUT INSURANCE I SHOULD SAY HEALTH CARE INSURANCE DENYING CLAIMS DENYING MEDICAL AXIS LIMITED NUMBER OF TRIPS ONE CAN NEVER CERTAIN KINDS OF SERVICES AND THE LIKE. AND WE POUND THE DEATH WE POUND THE TABLE AND SAY THIS JUST ISN’T RIGHT. THE STRESSES AND RIGHTS. WITH THIS BILL DOES IS THIS BILL WAS A FIDUCIARY OBLIGATION FOR THE PHARMACIES TO PHARMACEUTICALS I SHOULD SAY; TO ENTER A FIDUCIARY RELATIONSHIP WITH HEALTHCARE INSURANCE PROVIDERS. MY QUESTION IS DO WE MOVE THE PROBLEM FROM ONE AREA TO ANOTHER . IF THOSE WHO BELIEVE THAT THE INSURANCE COMPANIES ARE GETTING BETWEEN THE PATIENT AND THEIR DOCTOR. DOES THIS HELP OR DOES THIS HURT THAT RELATIONSHIP? I AM BEEN UP THE REQUIREMENTS FOR THE PHARMACEUTICALS WITH THE HEALTH INSURANCE PROVIDER. IF YOU BELIEVE THAT THERE’S ALREADY TOO MUCH THAT THE INSURANCE COMPANIES ARE DOING; TO LIMIT ACCESS TO HEALTHCARE; TO LIMIT ACCESS TO PATIENT NEEDS; HOW DOES THIS FIX THAT PROBLEM? IT DOESN’T. AGAIN; I DO BELIEVE THAT ARE VERY IMPORTANT PROVISIONS THAT ARE FOUND IN THIS BILL IN AN AREA THAT NEED SOME SHOWING UP IN SOME REGULATION. BUT NOT WITH A FIDUCIARY. THAT’S PROBLEMATIC. I BELIEVE THAT THIS BILL BECOMES LAW THE WAY IT’S WRITTEN RIGHT NOW; THEY’LL BE SOME PEOPLE WILL BE HAPPY WITH THE PROVISIONS THAT ARE IN THEIR BUT WILL BE RIGHT BACK HERE IN THIS CHAMBER FOR ONE; TWO MAYBE THREE YEARS FROM NOW POUNDING THE TABLE ONCE AGAIN FOR THOSE WH O SAY HEALTH CARE INSURERS ARE GETTING THE WAY OF DOCTOR AND PATIENT RELATIONSHIPS. THEY ARE LIMITING THE AMOUNT OF THIS KIND OF MEDICAL PROCEDURES; FIRED HI FROM CYNICAL OPTIONS COULD I USED NOW I HAVE TO HAVE. ALL THE THINGS THAT REPRESENTATIVE MANN HAD TALKED ABOUT HAVING TO GO BACK TO SEE HOW THIS IS WORKING;; I ENCOURAGE SIMPLY MOVING IT FROM ONE GROUP OF PEOPLE TO ANOTHER. IT DOESN’T SOLVE A PART OF THE PROBLEM. MEMBERS; I WISH I COULD BE VOTING YES FOR THIS TODAY. AGAIN AS I SAID I THINK THIS AREA IS RIGHT FOR SOME REFORM. BUT I REALLY HAVE HEARTBURN OVER THE FIDUCIARY RESPONSIBILITY ONCE AGAIN; IT’S HIGHER THAN CONTRACT LAW. RIGHT NOW; WE HAVE A PROBLEM WITH CONTRACT LAW IS SOMEWHAT SAY WITH A HEALTHCARE INSURER RECEIVING A CONTRACT ENTERING INTO A CONTRACT;. WHY DO WE THINK IT’S GOING TO BE BETTER IF WE AMP UP THE RELATIONSHIP AND MAKE IT A FIDUCIARY RELATIONSHIP? PLEASE; MEMBERS; VOTE NO. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM SCOTT REPRESENTATIVE ALBRIGHT.>>REPRESENTATIVE ALBRIGHT: THANK YOU; MME. SPEAKER. MEMBERS; REPRESENTATIVE O’DRISCOLL AND I HAVE SOMEWHAT UNIQUE EXPERIENCE FROM FINANCIAL EXPERIENCE; PERSPECTIVE WITH REGARD TO THEIR FIDUCIARY RESPONSIBILITY .. REPRESENTATIVE O’DRISCOLL LAID OUT I THINK ONE OF THE ISSUES WITH A FIDUCIARY RESPONSIBILITY. LET ME SHARE WITH YOU ANOTHER ONE. RIGHT NOW; IN STATE STATUTE THERE IS NO DEFINITION FOR A FIDUCIARY AS WOULD PERTAIN TO THE SUBJECT MATTER. SO I THINK THAT IN LIGHT OF TRYING TO IMPOSE A FINANCIAL LEVEL OF FIDUCIARY RESPONSIBILITY ON THE MEDICAL COMMUNITY; AS REPRESENTATIVE O’DRISCOLL HAS STATED; YOU ARE TRYING TO PUT A ROUND PEG IN A SQUARE HOLE. NOW IF YOU GO TO THE FEDERAL LEVEL; I KNOW WE WON’T HAVE TO REALLY ARGUE ABOUT THIS; BUT IF YOU WANT TO THE FEDERAL; BECAUSE THE BILL ITSELF SAYS THE STATE OR FEDERAL DEFINITION. IF YOU GO TO THE FEDERAL LEVEL; AND THEN YOU ARE DOING WITH THE ORISSA ; AND OTHER SUBJECT MATTER THE PROBABLY ONLY A FEW IN THIS CHAMBER APPRECIATE REPRESENTATIVE O’DRISCOLL. YOU HAVE THREE DIFFERENT LEVELS OF FIDUCIARY RESPONSIBILITY . NONE OF WHICH PERTAIN TO THE SUBJECT MATTER. WHICH BRINGS ME TO MY NEXT POINT. IN THE BILL; IT TALKS ABOUT RULEMAKING. BUT IT ALSO TALKS ABOUT THE PROBATION OF PROVIDING LICENSES AFTER A SET TIME.. I BELIEVE IT’S JANUARY 1 OF 2020. THAT WOULD LITERALLY GIVE THE DEPARTMENT OF COMMERCE FIVE MONTHS T O PUT RULEMAKING IN PLACE BEFORE THEY COULD PROVIDE LICENSES TO REPRESENTATIVE MANN; AS YOU TAKE THIS INTO CONFERENCE COMMITTEE; I HOPE THAT YOU CONSIDER CORRECTING THOSE PROVISIONS SO THAT THEY ALIGN. IN MOST CASE; RULEMAKING IS GOING TO TAKE A LOT LONGER THAN FIVE MONTHS AND THERE IS GOING TO BE A GAP IF THAT IS NOT CORRECTED. I SHARE THE CONCERNS THAT REPRESENTATIVE O’DRISCOLL HAS ENUMERATED HERE. ON THE BALANCE THERE’S A COUPLE OF OTHER ISSUES I WOULD LIKE TO TALK ABOUT AS WELL. IN THE BILL; IT TALKS ABOUT THE PROHIBITION AGAINST MAIL ORDER PHARMACIES. WELL; I UNDERSTAND THE SELF-SERVING NATURE OF HAVING A MAIL ORDER PHARMACY ATTACHED TO THE PBM; W HAT WE ALSO NEED TO ASCRIBE TO IS THAT THE DEPARTMENT OF DEFENSE ALSO FOUND THROUGH THEIR MAIL ORDER PHARMACY THAT THERE WAS A 23 TIMES GREATER ACCURACY RATE IN THE DELIVERY OF THOSE PRESCRIPTIONS; PLUS IT ACTUALLY DRILLS DOWN THE COST OF THO SE PRESCRIPTIONS. PLEASE; CONSIDER THAT REPRESENTATIVE MANN. MAYBE ONE OF THE LARGER ISSUES THAT I THINK NEEDS TO BE ADDRESSED AS YOU WALK INTO CONFERENCE COMMITTEE IS THE ISSUE OF DATA COLLECTION. UNDER THE BILL; YOU WILL COLLECT INFORMATION ON EVERY SINGLE PRESCRIPTION ISSUED IN THE STATE OF MINNESOTA.I THINK THAT THE NUMBER IS ROUGHLY; 57 MILLION PRESCRIPTIONS. AND BY WHAT YOU HAVE IN YOUR BILL; REPRESENTATIVE MANN; THAT RISK IS AN INSURED IN TERMS THAT IS IN SHORT IN TERMS OF DATA COLLECTION. IT IS VOLUMINOUS TO NOW WHILE WE APPRECIATE FOR DISAGGREGATION; FOR DEDUCTING THE POTENTIAL PRIVACY; I ALSO BELIEVE THAT YOU HAVE WAY TOO MUCH IN TERMS OF INFORMATION FOR ANYONE TO DIGEST .. AND SO THE PERTINENCE OF ANY OF THOSE PIECES OF INFORMATION SHOULD BE CONSIDERED PARTICULARLY; IN LIGHT OF THE FACT THAT YOU ARE GOING TO COLLECT AND RETAIN THE PRIVATE PRESCRIPTIONS FOR MINNESOTANS AN D RIGHT NOW; THAT STANDS AT 57 MILLION DIFFERENT PIECES OF INFORMATION. NOT ONLY IS THAT CUMBERSOME; BUT I THINK AS OTHERS IN THE CHAMBER WOULD PROBABLY ELABORATE ON; YOU HAVE GOT AN IT PROBLEM OF A MAGNITUDE OF OTHER NATURE IN TERMS OF SECURITY; MANAGEMENT; ACCESSIBILITY; AND SECURITY. SO PLEASE; CONSIDER THAT. THE FIDUCIARY RESPONSIBILITY ITSELF HAS BEEN POINTED UP AND IT’S ALSO BEEN PROVIDED IN THREE OTHER STATES. NONE OF WHICH HAS USE IT EFFICIENTLY AND IN ONE STATE I BELIEVE WAS MAINE; THEY HAD IT ON THE BOOKS BUT IT WAS NEVER ENFORCED AND ACTUALLY THEY TOOK IT OFF THE BOOKS BECAUSE IT WAS NOT ENFORCEABLE. SO THE FIDUCIARY RESPONSIBILITY;; AS A KEY FEATURE OF WHAT YOU ARE TRYING TO DO; IS WELL INTENDED ;; BUT I THINK YOU CAN ACCOMPLISH THE METHODOLOGY OF PROVIDING MORE ENFORCEMENT AGAINST THE PBM’S WITHOUT THE FIDUCIARY NATURE OF WHAT YOU’RE PUTTING IN THERE . MEMBERS; WHEN WE LOOK AT BILLS WE HAVE TO LOOK AT THEM IN THE BALANCE. THE PROVISIONS THAT ARE WELL-MEANING; THE ONES THAT ARE PROBLEMATIC. AS WE DEBATE AND VOTE ON THIS BUT GOING OFFICE FLOOR; I THINK AS I WOULD SEE IT AND I REPRESENTATIVE O’DRISCOLL HAS ARTICULATED; THE BALANCE SHIFTS THIS ONE FOR ME INTO NOT VOTING FOR IT BECAUSE OF THESE PROVISIONS. THANK YOU; MME. SPEAKER.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM COTTONWOOD REPRESENTATIVE HAMILTON.>>REPRESENTATIVE HAMILTON: THANK YOU; MME. SPEAKER. REPRESENTATIVE BAKER’S GONNA HOLD ME UP IF I NEEDED. THAT’S WHAT HE SAID. A LITTLE HUMOR TO IT IF I WILL. FRIENDS; THIS BILL IS LONG OVERDUE. I’VE BEEN WORKING ON THIS FOR A NUMBER OF YEARS. YOU WERE SUPPOSED TO TO KEEP ME FROM NOT GETTING EMOTIONAL; TOO. THAT’S YOUR RESPONSIBILITY THERE; TOO. OUR SPIRAL SMALL ROLE PHARMACIES ARE BEING DESTROYED I SAY IT’S BY PHARMACY BENEFIT MANAGERS; BY PBM SO AGAIN; THIS LONG OVERDUE. I SHARE WITH YOU MY STORYAND HOW I’VE BEEN DIRECTLY IMPACTED. NEGATIVELY.. A PBM INTERFERED WITH A DELICATE SITUATION OF MY HEALTH AND THE INTERFERED WITH THE DOCTORS PRESCRIBING TO ME AND I’VE SHARED IT AND SAID I PLAY THEM COME IDLY THEM STRAIGHT OUT PUTTING ME IN THE WHEELCHAIR. IT’S WRONG. IT’S ABSOLUTELY WRONG WAS TAKEN PLACE IN THIS NEEDS TO BE ADDRESSED ANY TO BE ARRAIGNED IN . AGAIN; SHARE MY STORY ARE A NUMBER OF TIMES I’M NOT GOING TO BORE YOU WITH ALL THE DETAILS; BUT THIS IS ONE BIG STEP IN THE RIGHT DIRECTION. WE HAVE THE OPPORTUNITY TO DO THE RIGHT THING AN D TO REPRESENT THE PEOPLE THAT SENT US HERE TO MAKE TH ESE TOUGH DECISIONS; IF YOU WILL. REPRESENTATIVE MANN; THANK YOU. YOU BEEN ABLE TO GET THIS BILL FARTHER THAN I HAVE IN THE PAST. I THANK YOU FOR THAT. OBVIOUSLY; THIS IS A BIG ISSUE AND VERY IMPORTANT TO ME. THAT IS; I’M SSIMPLY GOING TO ASK FOR YOUR SUPPORT. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM DAKOTA REPRESENTATIVE GAROFALO. THE>>REPRESENTATIVE GAROFALO: WITH THE AUTHOR YIELD FOR A COUPLE OF QUESTIONS? THANK YOU; MME. SPEAKER. TO THE AUTHOR; THIS IS A SENATOR FILE. IN YOUR CONVERSATION WITH THE SENATE AUTHORS YOU IS YOUR EXPECTATION THEY WILL BE CONCURRING WITH A NEW LANGUAGE FOR THAT TO BE REQUESTING A CONFERENCE COMMITTEE?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. I’VE SPOKEN TO THE AUTHOR OF THE SENATE FILE AND WE WILL CONFERENCE THIS BILL.>>REPRESENTATIVE GAROFALO: THANK YOU; MME. SPEAKER. SO OBVIOUSLY THIS ANOTHER STEP IN THE PROCESS RATHER THAN AS LOOKING AT FINAL PASSAGE AND WITH THE AUTHOR YIELD FOR ANOTHE R QUESTION? THANK YOU; MME. SPEAKER. TO THE AUTHOR; IN THE EVENT THAT GOVERNMENT WOULD STEP IN IS THE RESPONSIBILITY OF EXISTING PBM’S ARE ENGAGED IN; WITH THESE REGULATIONS MAKE CHANGES APPLY TO GOVERNMENTS?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. ARE YOU I’M NOT QUITE SURE YOU ARE ASKING ARE YOU LIKE ASKING GOVERNMENT RUN PROGRAMS LIKE MEDICAID OR>>REPRESENTATIVE GAROFALO: MME. SPEAKER IF THE AUTHOR WOULD CONTINUE TO YIELD? THEM TO THE AUTHOR; THERE’S BEEN EXTENSIVE CONVERSATION ABOUT THE GOVERNMENT MANAGING THEIR OWN FORMULARY LIST IN PROVIDING SOME THE TRADITIONAL ROLES THE PBM’S HAVE ENGAGED IN. SO IN A CASE WITH A CHANGES IN THE BILL BY TWO GOVERNMENT SHOULD GOVERNMENT TO DEVELOP THEIR OWN EXCLUSIVITY LIST?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. IF PBM’S ARE INVOLVED THEY WOULD REQUIRE THE SAME DATA FROM PBM’S.>>REPRESENTATIVE GAROFALO: MME. SPEAKER OF THE AUTHOR WOULD YIELD? BETTER TO THE AUTHOR; UNDERSTAND IT APPLIES TO PBM TO WHAT I’M SAYING IS THAT THE GOVERNMENT STEPS IN REGARD AS A PEOPLE’S POSITIONS ON PBM’S; THE GOVERNMENT WAS TO STEP IN AND ASSUME THE ROLE THAT CURRENTLY THE PRIVATE SECTOR PBM’S ARE ENGAGING IN; THESE WITH THIS BILL PRIOR TO THAT ENTITY?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. TH IS BILL DEALS SOLELY WITH PHARMACY BENEFIT MANAGERS.>>REPRESENTATIVE GAROFALO: MME. SPEAKER AND MEMBERS I THINK WHAT THAT MEANS IS THE ANSWER IS; NO. IF YOU SEE GREATER MOVEMENT TOWARDS THE IDEA OF GOVERN MENT MODEL; WE SEE THAT WE ARE CREATING YET ANOTHER INCENTIVE TO MOVE TOWARDS A SINGLE-PAYER HEALTH C ARE MODEL. FOR THAT AND OTHER REASONS MEMBERS I WOULD ASK FOR A NO VOTE ON THIS BILL.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM SCOTT REPRESENTATIVE VOGEL.>>REPRESENTATIVE VOGEL: THANK YOU; MME. SPEAKER. THANK YOU; AUTHOR FOR THE BILL. I DO BELIEVE AS HAS BEEN SPOKEN TO; THAT A LOT OF THESE THINGS ARE NECESSARY BUT I DO RISE AND I KNOW YOU ARE GETTING SICK OF HEARING THE WORD; FIDUCIARY; BUT DOING IN THE BUSINESS IS IDEAL IN; THAT HAS A BIG CONNOTATION AND ALTHOUGH IT SEEMS LIKE JUST ONE WORD AND NOT A REASON TO VOTE AGAINST THIS BILL; MY CONCERN IS THAT WE ARE TAKING THE FIDUCIARY RESPONSIBILITY TO HEALTH CARRIERS. IF THE AUTHOR WOULD YIELD FOR A QUESTION MME. SPEAKER?>>TESTIFIER: THANK YOU. THE QUESTION I HAVE IN A .3 IT’S A FIDUCIARY RESPONSIBILITY TO HEALTHCARE CARRIER I’M CURIOUS WHY YOU WOULD PUT THE FIDUCIARY RESPONSIBILITY TO THE CARRIER NOT TO THE PATIENT?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. WELL AT THIS POINT THE PBM WORKS AS A SUBSIDIARY OR SUBCONTRACT TO HEALTHCARE YOU ARE NOT THE PATIENT DIRECTLY.>>REPRESENTATIVE VOGEL: THANK YOU; MME. SPEAKER. MY CONCERN THERE IS THAT BY DOING THIS I THINK WE ARE CREATING AN INHERENT CONFLICT BECAUSE WE ARE TELLING THE PBM THAT THEY HAVE A FIDUCIARY RESPONSIBILITY TO A HEALTHCARE CARRIER . THEREFORE; IF THEY ARE LOOKING AT HOW THEY ARE GOING TO EITHER OFFER THE DRUG OR DEAL WITH CO-PAYS OR DEAL WITH OTHER PRODUCTS; THAT FIRST AND FOREMOST THEY FIDUCIARY RESPONSIBILITY IS TO THE HEALTHCARE CARRIER; NOT TO THE PATIENT. THAT’S WHY I LIKE THE IDEA OF THIS BILL BECAUSE IT’S GETTINGTO THE PATIENT AND GIVING THEM THE INFORMATION AS WELL AS PUTTING IN STATUTE MORE PROTECTIONS FOR THEM. IF THE AUTHOR WOULD IT YIELD AGAIN MME. SPEAKER? THANK YOU; MME. SPEAKER. SO I SAID THAT I BELIEVE THAT IT IS GOING TO CREATE AN INHERENT CONFLICT BECAUSE WE ARE TELLING THE BENEFITS MANAGER TO HAVE A FIDUCIARY RESPONSIBILITY TO HEALTH CARRIER . DO YOU SEE ANY POTENTIAL FOR THAT TO BE A CONFLICT WITH THE PATIENT SINCE THE FIDUCIARY RESPONSIBILITY IS TO THE CARRIER WHO IS ACTUALLY MAKING A PROFIT OFF THE INSURANCE PRODUCT THAT THE PATIENT IS PAYING FOR?>>REPRESENTATIVE MANN: SO THIS PART OF THE ISSUE. IT’S THE CHAIN THAT GOES ALL THE WAY FROM THE MANUFACTURE ;; THE INSURANCE; THE OTHER WAY DOWN TO THE PATIENT. AND WE NEED TO START SOMEWHERE STOPPING THE CHAIN FROM PROFIT PROFIT PROFIT PATIENTS. SO RIGHT NOW; WHAT WE ARE SAYING IS ASKING THE PBM FOR A FIDUCIARY RESPONSIBILITY TO HEALTHCARE AND THE HOUSE GARY SHOULD ACT IN THE BEST INTEREST OF THE PATIENT AND WERE TAKING ONE STEP IN THE CHAIN TO MAKE THINGS BETTER. WHEN WE TALK ABOUT TAKING STEPS TO MAKE THINGS BETTER WE OFTEN HEAR THIS NARRATIVE OF WELL; IF YOU ARE GOING TO FIX THE ENTIRE PROBLEM RIGHT NOW AND NOT BEHIND IT. SO I JUST DON’T THINK THAT HOLDS MUCH WATER.>>REPRESENTATIVE VOGEL: THANK YOU; MME. SPEAKER. AN D THANK YOU REPRESENTATIVE>>HOUSE SPEAKER HORTMAN: MEMBERS PLEASE BE QUIET DURINGDEBATE SO MEMBERS CAN HEAR ONE ANOTHER. REPRESENTATIVE VOGEL>>REPRESENTATIVE VOGEL: THANK YOU; MME. SPEAKER. I STILL CONTEND THAT WHEN WE ARE MAKING THE FIDUCIARY RESPONSIBILITY TO HEALTHCARE CARRIER AND NOT TO THE PARENT THE PATIENT AND I DON’T DISAGREE THAT THE CARRIER HAS A RESPONSIBILITY TO THE PATIENT. I’M NOT SO SURE IT’S A FIDUCIARY RESPONSIBILITY MAY BE ENCODED I’M NOT FAMILIAR WITH ALL THE STATUTES; BUT IN THIS CASE; WHAT WE ARE SAYING HERE IS THAT IF THE PBM HAS TO MAKE A DECISION ; THEY HAVE A FIDUCIARY RESPONSIBILITY TO HEALTHCARE CARRIER EXCLUSIVE OF THE PATIENT BECAUSE THERE’S NOTHING IN HERE THAT IS SAYING DEAL WITH THE PATIENT. SAME DEAL WITH THE CARRIER. SO MME. SPEAKER; MEMBERS; IS MUCH AS I WOULD LIKE TO VOTE FOR THIS BECAUSE I REALLY BELIEVE THE GOOD IDEA AND IT’S TIME HAS COME; I REALLY THINK WE HAVE TO BE CAREFUL WHEN WE USE WORDS LIKE FIDUCIARY RESPONSIBILITY; BECAUSE AND ESPECIALLY IN THIS CASE WHERE WE COULD BE IMPACTING NEGATIVELY THE PEOPLE THAT IT’S MEANT TO HELP. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM OLMSTED REPRESENTATIVE QUAM.>>REPRESENTATIVE QUAM: THANK YOU; MME. SPEAKER. MEMBERS IT’S PRETT Y OBVIOUS THAT WE ALL FEEL THERE’S A NEED FOR REFORM ON THIS PART OF HEALTHCARE. THE BIG RISK WHEN WE ARE ALL FOR IS THAT WE RUSH AND WE DON’T TRY TO AVOID STUMBLING STONES AND DELAYS. I THINK THERE ARE SOME ISSUES IN LANGUAGE THAT COULD CAUSE IMPLEMENTATION PROBLEMS. IT’S BEEN TOUCH ON IN RULEMAKING CAN IT’S BEEN TOUCHED ON THE PART OF THE LANGUAGE SIMILAR LANGUAGE IS BEING USED IN OTHER STATES. I FEEL THATTHERE IS A LITIGATION RISK TO PART OR THIS WHOLE BILL WITH THE CURRENT LANGUAGE. I ALSO FEEL THAT THERE IS RISK IN THE IMPLEMENTATION AND QUICK IMPLEMENTATION IS NOT ALWAYS THE BEST AND MOST EFFECTIVE. AND WE NEED TO IMPLEMENT SO IT WILL WORK. SO IT WON’T IN THE LONG RUN CAUSE MORE PROBLEMS THAN WE ARE SOLVING WERE DELAY THE FACT THAT WE ACTUALLY GET A GOOD SOLUTION IN. I AM HEARING A LOT OF CONCERN IN THAT; WE LOOK AND TRY AND FIX PORTIONS OF THIS AND THAT WE ARE FOR THE IDEA BUT WE DON’T WANT TO GO; WE PASSED SOMETHING IN THE NEXT YEAR OR THE YEAR AFTER; WE ARE REVISITING BECAUSE WE DID NOT TAKE CARE OF SOME OF THESE ISSUES. AND I HOPE WE LOOK AT THE ISSUESTHAT ARE IN HERE COULD I REALLY HOPE THE DEBATE BETWEEN THE CONFERENCE COMMITTEE CAN SOLVE THIS BUT I DON’T THINK THE LANGUAGE IN THE CURRENT BILL IS THERE YET. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM ANOKA REPRESENTATIVE SCOTT . THE>>REPRESENTATIVE SCOTT:>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM POCO REPRESENTATIVE ANDERSON>>REPRESENTATIVE ANDERSON: THANK YOU; MME. SPEAKER. MEMBERS; THERE’S A LOT OF SUPPORT FOR THIS BILL BUT WITH THE AUTHOR OF THE BILL YIELD FOR A QUESTION? THANK YOU FOR BRINGING THE BILL FORWARD. WE ALL AGREE IS BADLY NEEDED TO MY CONCERN IS THAT WE ARE IN A SECOND TO THE LAST WEEK OF SESSION AND YOU ARE TELLING US IT’S GOING TO GO TO A CONFERENCE COMMITTEE . CAN YOU GIVE US SOME LEVEL OF ASSURANCE THAT THIS BILL IS GOING TO IN FACT COME BACK AND NOT GET LOST THESE LAST HECTIC DAYS OF SESSION? BECAUSE AGAIN A LOT OF SUPPORT FOR IT AND WANT TO SEE IT COM E BACK AND HAVE A FINAL PASSAGE. SO WHAT LEVEL OF ASSURANCE CAN YOU GIVE USTHAT IS GOING TO COME BACK OUT OF CONFERENCE?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. SO I’VE BEEN WORKING ON THIS BILL SINCE PRETTY MUCH AT THE MOMENT I GOT HERE. WHEN THE MAIN REASONS I RAN FOR OFFICE. AND SO IF I HAVE ANYTHING TO SAY ABOUT IT; THIS BILL WILL COME BACK AND IT WILL BE PASSED OFF THE FLOOR.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM GOODHUE REPRESENTATIVE HALEY.>>REPRESENTATIVE HALEY: THANK YOU; MME. SPEAKER. JUST A FEW QUICK COMMENTS BUT I JUST WANT TO BE ON RECORD THAT I SUPPORT THESE REFORMS AND TAKE YOU TO REPRESENTATIVE HAMILTON FOR YEARS OF WORK ADVOCATING FOR PATIENTS RIGHTS. AND TO REPRESENTATIVE MANN; JUST AS A MEMBER OF THE COMMITTEE; AND SERVING WITH YOU ON HHS COME I KNOW HOW PASSIONATE YOU ARE ABOUT YOUR PATIENCE ABOUT PATIENT RIGHTS AS WELL. SO I DO BELIEVE WE HAVE A LOT OF COMPROMISE IN THIS AGREEMENT ON MOST OF THE COMPONENTS OF THIS BILL AND ALL THE THINGS THAT WILL DO TO HELP WITH PATIENT RIGHTS. AND MANY OF THE PROVISIONS IN FACT WERE PASSE D LAST SESSION AND WERE CAUGHT UP IN A VETO. SO I JUST WANT TO REMIND YOU THAT YOU HAVE A LOT OF SUPPORT HERE REPRESENTATIVE MANN AND THE COMMENTS THAT WERE MADE ABOUT THE FIDUCIARY LANGUAGE IS REALLY THE TROUBLESOME PIECE. SO I WOULD ENCOURAGE A SINCERE WORK ON THE PEAS SO THAT YOU CAN BRING IT BACK OUT OF CONFERENCE AND WE CAN HAVE GREEN ON THE BOARD. TO HELP ALL MINNESOTANS. THANK YOU REPRESENTATIVE DEMAND. THANK YOU; MME. SPEAKER.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM HENNEPIN REPRESENTATIVE HOWARD.>>REPRESENTATIVE HOWARD: THANK YOU; MME. SPEAKER. I WANT TO THANK REPRESENTATIVE MANN FOR BRINGING THIS BILL FORWARD AND REPRESENTATIVE HAMILTON FOR YOUR LEADERSHIP ON THIS ISSUE. THIS IS A FANTASTIC BILL. AND THERE HAS BEEN A LOT OF DISCUSSION THIS SESSION ABOUT THE COST OF PRESCRIPTION DRUG.. A LOT OF LEGISLATIVE EFFORT MOVING FORWARD AND I BELIEVE THIS BILL HAS THE GREATEST ABILITY TO GO DOWN THE PATH OF MAKING THIS SYSTEMIC CHANGE WE NEED IN OUR HEALTHCARE SYSTEM TO PUT PATIENTS FIRST. IT’S THE MOST IMPORTANT BILL; I BELIEVE. AND I’M REALLY OPTIMISTIC ABOUT THE CONVERSATION WE HAD THE SESSION AROUND PRESCRIPTION DRUGS BUT WE ARE DOING GREAT WORK TOGETHER ON A BIPARTISAN BASIS THIS SESSION WHEN IT COMES TO THE OPIOID BILL; WHEN IT COMES TO WORK TO ADDRESS AFFORDABLE INSULIN. AND I THINK THERE’S A SEACHANGE HAPPENING AND WHEN WE ARE RECOGNIZING THAT THE TIME IS NOW. THE TIME IS NOW TO STAND UP FOR MINNESOTANS THAT WE HAVE A RESPONSIBILITY AS LEGISLATORS TO STAND UP FOR THE MINNESOTANS THAT ARE ABSOLUTELY SICK AND TIRED OF THE SYSTEM THAT IS NOT WORKING AT A SYSTEM THAT IS DRIVING UP THE COST OF PRESCRIPTION DRUGS AND ENFORCING JOY SO THAT NO ONE SHOULD BE CONFRONTED WITH. IN THIS BILL IS AN EXCELLENT OPPORTUNITY. AND SPECIFICALLY; I WANT TO MENTION THAT; AS WE TALK ABOUT PHARMACY BENEFIT MANAGERS; THESE ARE BEHEMOTHS. THEY ARE ESSENTIALLY THREE THAT ARE CONTROLLING THE LION SHARE OF THE MARKET MINNESOTA AND ACROSS THE COUNTRY THREE OF THESE PBM’S THAT HAVE REVENUES OF OVER $100 BILLION A YEAR WITH A B ; AND JUST ONE OF THOSE WHEN THEY WERE RELEASING THEIR EARNINGS IN THE LAST QUARTER IN 2018; HIGHLIGHTED THAT IN THE FOURTH QUARTER IS A GROWTH OF 13% AND FOR THE FIRST TIME THEY’RE GOING TO TOPPLE OVER $100 BILLION AND GET YOU DO YOU KNOW THE REASON WHY? ON THE STRENGTH OF HIGHER PRICES FOR BRAND-NAME DRUGS. THAT’S HOW THE PBM WAS ABLE TO SEE THEIR EARNINGS SKYROCKET TO LEVELS THEY ARE NOT SEEM TO FORGET MEMBERS; THIS SYSTEM NEEDS REFORM. NEEDS ACCOUNTABILITY. AND TRANSPARENCY. IN THIS BILL IS AN EXCELLENT STEP AND WE ABSOLUTELY SHOULD PASS IT THIS SESSION. THANK YOU; MME. SPEAKER.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM HENNEPIN REPRESENTATIVE ELKINS.>>REPRESENTATIVE ELKINS: THANK YOU; MME. SPEAKER. I BEEN WORKING IN THE OFF YOUR INDUSTRY FOR ABOUT A DECADE NOW AND FAIRLY FAMILIAR WITH THE BUSINESS MODEL INVOLVED HERE. THE BASIC BUSINESS PROPOSITION BETWEEN THE PHARMACY BENEFIT MANAGER AND HEALTH INSURANCE COMPANY IS THAT THE PBM GOES TO THE INSURANCE COMPANY AND SAYS; LOOK; WE KNOW THE PHARMACY FACING BACKWARDS AND FORTH TO WORK; WE CAN NEGOTIATE BETTER DISCOUNTS WITH THE PHARMACEUTICAL MANUFACTURERS THAT YOU CAN THEN YOU CAN NEGOTIATE THEMSELVES. AND TO PROVE IT; WE ARE GOING TO HAVE YOU PAY US BY SHARING THE COST SAVINGS THAT WE ARE ABLE TO NEGOTIATE. SO THE REASON WHY THE PBMSHOULD BE A HAVE A FIDUCIARY LATE PATIENT UP TO THE HEALTH INSURANCE PLAN IS BECAUSE THE HEALTH INSURANCE PLAN IS THE CUSTOMER AND THE NATURE OF THE THREE-WAY RELATIONSHIP BETWEEN THE PHARMACEUTICAL MANUFACTURER; IS THE PBM’S; AND THE HEALTHCARE INSURERS IS SUCH THAT THE PBM MAY BE PLACED IN A POSITION BETWEEN THE NEGOTIATIONS THEY HAVE WITH THE PHARMACEUTICAL MANUFACTURERS NEGOTIATIONS THEY HAVE HEALTH INSURERS; WITH THE PHARMACEUTICAL MANUFACTURER MAY PLACE THEM IN A POSITION WOULD HAVE GOT A CONFLICT OF INTEREST. AND IN THOSE SITUATIONS; THE FIDUCIARY PROVISION IN THIS BILL WOULD ENSURE THAT WHATEVER CONFLICT OF INTEREST HAVE TO TAKE THE INTEREST OF THE CUSTOMER TO HEART AND NOT NECESSARILY THEIR OWN WHEN THE MANUFACTURER OFFERS THEM A DEAL THAT MIGHT ENRICH THEM BUT NOT TO WORK PERSON THE FROM THEIR WORKING ON BEHALF OF. I DON’T THINK WE SHOULD MAKE A BIGGER DEAL OUT OF THE FIDUCIARY THINK IT I THINK IT IS ACTUALLY APPROPRIATE IF YOU UNDERSTAND THE WAY THIS PART OF THE INDUSTRY WORKS AND OVERALL; THIS A REALLY GREAT BILL. IT MAY NOT SOLVE EVERYTHING THIS WHOLE VALUE CHAIN IS BROKEN BUT THIS IS A HUGE STEP IN THE RIGHT DIRECTION AND I URGE EVERYONE TO CAST A GREEN VOTE>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM ANOKA REPRESENTATIVE SCOTT>>REPRESENTATIVE SCOTT: THANK YOU; MME. SPEAKER. I WAS INTERESTED IN WHAT SOME OF WHAT REPRESENTATIVE ALBRIGHT’S COMMENTS WERE REGARDING THE DATA AND I DID LOOK AT THE BILL; AND IT DOES HAVE A REFERENCE TO SECTION 13.37 THE DATA PRACTICES ACT IN REGARDS TRA DE SECRET INFORMATION. SO I’M WONDERING IF THE AUTHOR OF THE BILL WOULD YIELD TO A QUESTION? C SPEAKER REPRESENTATIVE MANN; IT TALKS ABOUT THE WITHIN 60 DAYS UPON RECEIPT OF THE TRANSPARENCY REPORT THE COMMISSIONER SHALL PUBLISH THE REPORTS FROM EACH PHARMACY BENEFIT MANAGER TO THE DEFERMENT OF COMMERCE WEBSITE WITH THE EXCEPTION OF DATA CONSIDERED TRADE SECRET INFORMATION I N OUR 13.37. I AM WONDERING FIRST OF ALL; DID YOUCONSULT WITH REPRESENTATIVE LESCH; CHAIR LESCH; TO SEE IF THIS BILL WOULD’VE NEEDED TO COME TO THE JUDICIARY AND CIVIL LAW COMMITTEE?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. I DID NOT TO REPRESENTATIVE LESCH ABOUT THAT BUT WE HA VE BEEN SPEAKING WITH THE PBM’S AS WELL AS THE DEPARTMENT OF COMMERCE TO REALLY GET THAT LANGUAGE DOWN AS FAR AS WHAT IS OR NOT TRADE SECRET SO THEY WILL RUN INTO ANY ISSUES.>>REPRESENTATIVE SCOTT: THANK YOU; MME. SPEAKER. WELL GOT TO HEAR THAT. IF YOU COULD YOU SHARE WITH THE BODY WHAT YOU’VE LEARNED ABOUT THAT; OTHER GOVERNMENT PASSED BY TRACY GETS? BECAUSE WHAT I’VE LEARNED WITH A WHOLE TRADE SECRET LANGUAGE IS THAT THAT’S AN END AROUND HAVING TO REPORT CERTAIN INFORMATION. AND THAT IS HAPPENED WITH SOME OTHER ENTITIES WITHIN THE HEALTHCARE SPACE SHALL I SAY. AND IT’S ALLOW THEM TO REALLY SKIRT TRANSPARENCY TO THE LEGISLATURE AND TO THE PEOPLE OF THE STATE OF MINNESOTA. SO I AM WONDERING WHAT YOU’VE LEARNED IN THE PROCESS BUT THIS WHOLE TRADE SECRET LANGUAGE BECAUSE I DON’T WANT TO BE IN OUT FOR THEM .>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. I COMPLETELY AGREE WITH ISO-DO NOT WANT THIS TO BE IN OUT FOR THEM. SO THIS HAS BEEN REALLY BIG PART OF THE CONVERSATION AND WE ARE STILL ACTUALLY TALK ABOUT IT TO THE STATE OF ANOTHER MEETING TOMORROW ABOUT IT BECAUSE A; WE DON’T WANT IT TO BE IN OUT FOR THEM AND B WE DON’T WANT THE DEPARTMENT OF COMMERCE TO HAVE ANY ISSUES EITHER.>>REPRESENTATIVE SCOTT: THANK YOU; MME. SPEAKER. I WILL BE INTERESTED TO SEE WHAT THE OUTCOME OF THAT IS AND IN ALL REALITY WILL PROBABLY NOT GOING TO KNOW WHEN TO THE FIRST REPORT COMES IN WHETHER THEY ARE USING THAT AS AN END AROUND REPORTING INFORMATION OR NOT. IT IS VERY CONCERNING UNDERSTAND PROTECTING TRADE SECRET THAT I DO UNDERSTAND WHY THAT’S IN THE DATA PRACTICES ACT ; BUT I ALSO KNOW THE HISTORY OF THAT WITHIN HEALTHCARE SPACE. SO THAT IS CONCERNING; BUT MEMBERS; I DO THINK THIS IS A GOOD BILL. FOR THE MOST PART IT BUT I THINK IT STILL DOES NEED WORK. THERE ARE SOME PROVISIONS HERE THAT I THINK DO CAUSE SOME PROBLEMS WITH IT AND I WOULD HOPE THAT WE CAN CAST A NO VOTE TODAY IN HOPES IT WILL COME BACK BETTER FROM CONFERENCE COMMITTEE. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM CHISAGO REPRESENTATIVE NEU>>REPRESENTATIVE NEU: C SPEAKER MEMBERS; THIS IS REALLY IMPORTANT REFORM. I ACTUALLY SIGN ON AS A CO-AUTHOR TO THE BILL. I LIKE IT. IT’S A GOOD BILL. BUT; IT DOES NEED JUST A LITTLE BIT OF WORK. THERE’S A COUPLE OF THINGS THAT ARE PARTICULARLY CONCERNING THAT WE TALKED A LOT ABOUT THE FIDUCIARY RESPONSIBILITY. AND I THINK MAYBE TO PUT THAT IN A LITTLE BIT MORE OF LAYMAN’S TERMS; WHAT THAT MEANS IS THAT THE PBM’S WILL BE LOOKING OUT FOR THE BOTTOM LINE OF INSURERS RATHER THAN CONSUMERS. THIS IS SOMETHING THAT NEEDS TO BE LOOKED AT AND FIXED FOR FINAL PASSAGE. THAT’S A BIG DEAL. LET’S BE CLEAR; THAT WILL RAISE THE COST OF HEALTHCARE FOR CONSUMERS. SO WE REALLY NEED TO LOOK AT THIS. WE USE THESE BIG WORDS AROUND HEREIN THIS LEGAL LANGUAGE AT THE BOTTOM LINE IS THAT THIS MEANS THAT THE PHARMACY BENEFIT MANAGERS BE LOOKING OUT FOR THE BOTTOM LINE OF INSURERS RATHER THAN CONSUMERS. THAT RACE IS THE COST OF HEALTHCARE. IN ADDITION TO THAT; THERE IS SOME QUESTION ABOUT THE KINDS OF RELATIONSHIPS THAT THE PBM’S WILL BE ENTERING WILL BE ABLE TO ENTER INTO. FOR EXAMPLE; RIGHT NOW; THEY ARE ABLE TO ENTER INTO AGREEMENTS;; ABLE TO MAKE AGREEMENTS; WITH A MAIL ORDER PHARMACIES; THINGS LIKE THIS. TO FIND BETTER DEALS FOR THE CONSUMER TO RIGHT NOW; WE GET SITUATIONS WHERE IF YOU PURCHASE A 90 DAY SUPPLY OF A MEDICATION; YOU CAN PAY TO CO-PAYS RATHER THAN THREE CO-PAYS. BY ENTERING INTO THESE DEALS BUT THERE IS A VERY I MEAN THE LANGUAGE IS NOT ENTIRELY CLEAR BUT IT APPEARS THAT THAT MAY BE PREVENTED IN THE LANGUAGE CURRENTLY IN THIS BILL AND IN ORDER TO GET THAT 90 DAY SUPPLY YOU WILL NOW BE PAYING FOR THREE COPAYMENTS. THAT IS A VERY DIRECT INCREASE IN THE COST OF HEALTHCARE. NOW; THE SAME TIME I THINK THESE ARE RELATIVELY MINOR FIXES THESE ARE FIXED IN THE SENATE LANGUAGE BUT I WILL BE VOTING NO ON THIS BILL TODAY AND I LOOK FORWARD TO THIS COMING BACK FROM CONFERENCE COMMITTEE CLEANED UP SO WE CAN HAVE A UNANIMOUS VOTE ON THIS. I THINK THAT IS WHAT IT WILL BE WHEN THIS LANGUAGE IS CLEANED UP. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM ROCK REPRESENTATIVE SCHOMACKER>>REPRESENTATIVE SCHOMACKER: THANK YOU; MME. SPEAKER. MEMBERS; THANK YOU REPRESENTATIVE NEU FOR BRINGING UP SOME OF THE POINTS ON THEM MAIL ORDER PHARMACY PIECE THAT HAVE NOT BEEN TALKED ABOUT TOO MUCH TO DO I JUST WANT TO HIT A COUPLE OF POINTS ON THE MAIL ORDER PHARMACY PIECE AND REALLY JUST EXPRESSED CONCERNS ABOUT THE FISCAL NOTE HAD IN IT THERE ON PAGE 10 [INAUDIBLE] IN THIS BILL WE TALK ABOUT THE MAIL ORDER PHARMACIES AND WHAT IMPACT THAT HAVE. THEY DO TALK ABOUT REPRESENTATIVE NEU; THE 90 DAYS THEY WERE TALKING ABOUT THEIR IN THE CHANGING FROM THE TWO CO-PAYS TO THREE CO-PAYS. 50% MORE CO-PAYS IF YOU DO THE MATH THAT WAY. SO; [INAUDIBLE] MMB RAISE CONCERNS WITH [INAUDIBLE] OR WHAT KIND OF COST WILL BE RAISE BECAUSE OF THE CO-PAYS THAT ARE ADDED TO THAT. AND THEY ALSO NOTED MMB; DID ON BEHALF OF THE USE OF DIRECT MAIL DOES INCREASE PATIENT ADHERENCE TO THE DRUG RECEIVED AND THE BILL RESTRICTIONS ON THAT COU LD RESULT THIS WITH THE FISCAL NOTE SAYS COULD RESULT IN LOWER AND SUBSTANTIALLY HIGHER COST OF THE MEDICAL SIDE. THAT’S WHAT MMB IS REPORTING ABOUT THE OTHER [INAUDIBLE] MEMBERS COME I WOULD ASK THE REST OF THE PUBLIC WASABI EXPANSION THIS WOULD ASK YOU TO VOTE NO TODAY ON THIS BILL.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM OLMSTED REPRESENTATIVE LIEBLING.>>REPRESENTATIVE LIEBLING: MME. SPEAKER AND MEMBERS; I RISE TO RESPOND TO A COUPLE THINGS THAT ARE BEEN RAISED . FIRST OF ALL SOME TIME AGO THERE WAS A QUESTION ABOUT GOVERNMENT DOING THIS. I WANT TO TELL THE BODY THAT GOVERNMENT DOES THIS ALREADY IT ALREADY MANAGES THE FORMULARY.. I SEE REPRESENTATIVE GAROFALO IS NOT ON THE FLOOR ANY LONGER. THIS WAS HIS QUESTION BUT IN A MEDICATED FEE FOR SERVICE PROGRAM; PEOPLE ARE NOT ON MANAGED CARE; WE ALREADY AS A STATE DIRECTLY MANAGE PHARMACEUTICALS BUT WE DO IT WITHOUT A PBM AND WE DO IT IN A VERY TRANSPARENT WAY. ALL KINDS OF PUBLIC INPUT AND PUBLICLY PUBLIC MEETINGS THAT ARE HELD. SO THERE IS QUITE A MODEL FOR THIS ALREADY AND THERE IS IN FACT A PROPOSAL THIS YEAR TO EXPAND THIS. THE GOVERNOR HAS THIS IS PART OF IS ONE CARE PROPOSAL . THE BENEFIT PACKAGE TO PUT ALL OF OUR PUBLIC PATIENTS INTO ONE POOL AND MANAGE IT THE WAY WE DO NOW WITH OUR FEE-FOR-SERVICE PROGRAM. SO THE ANSWER IS; THIS WOULD NOT APPLY. WERE NOT HAVE TO APPLY BECAUSE WE ALREADY DO THIS IN A VERY TRANSPARENT PUBLIC WAY. SECONDLY; MEMBERS COME I JUST WANT TO RISE TO RESPOND TO SOME OF WHAT I HAVE BEEN HEARING HERE ON THE FLOOR. SOMEBODY WAS WORRIED ABOUT; THAT THIS BILL IS LOOKING OUT FOR THE BOTTOM LINES OF INSURERS. BUT LOOKING OUT FOR THE BOTTOM LINES OF INSURERS. EMBERS; IF YOU DON’T WANT TO DO THAT YOU SHOULD NEVER HAVE PASSED REINSURANCE. WE TOOK PUBLIC MONEY; GIVE RIGHT TO THE INSURERS TO UP THEIR BOTTOM LINE. SO BOY; THAT YOU NUMBER YOUR CONCERN. BUT OKAY; I DON’T THINK THIS BILL IS DOING THAT. BECAUSE ONE OF THE THINGS; TOO; REMEMBER; WE’VE MEDICAL LOSS RATIOS IN THE STATE.. SO YES; WE WANT TO CUT OUT THE PBM’S WHICH ARE REALLY SKINNING A LOT BUT LOT OF MONEY AWAY FROM THE INSURERS. THAT ENDS UP IN HIGHER PREMIUMS TO RAISE THE COST TO THE INSURERS AND ENDS UP AS BUYER PART OF HIGHER PREMIUMS NOT TO MENTION A HIGHER OUT-OF-POCKET COST FOR PEOPLE TRYING TO GET THE MEDICATIONS THEY NEED. AND SO; THIS BILL WOULD HELP TO REDUCE THE COST OF INSURANCE. THAT’S A BIG REASON TO DO THIS. A BIG REASON.. FINALLY; JUST WANT TO SAY I HEAR A LOT OF MEMBERS SAYING; I LIKE TO VOTE FOR THIS BILL BUT IT ISN’T PERFECT. I SURE WOULD LIKE TO VOTE FOR THIS BILL DOES A LOT OF REALLY IMPORTANT TO ME BUT IT IS IMPORTANT. IN MY EXPENSE; IF I WANT WITH THE BILL IS TRYING TO DO AND IT IS IMPERFECT TO MY VOTE FOR THAT BILL. BECAUSE THAT’S HOW YOU GET A BILL TO CONFERENCE COMMITTEE. NOT BY VOTING NO. VOTING NO MEANS DON’T SEND THE BILL TO CONFERENCE COMMITTEE.THE LEAST THAT’S WHAT’S ALWAYS MEANT TO ME. SO I SUGGEST TO MEMBERS; IF YOU THINK THIS A REALLY IMPORTANT; WHICH OBVIOUSLY; A LOT OF US DO; A LOT OF US REALIZE BOTH SIDES OF THE AISLE AND BOTH BODIES; LOT OF US REALIZE THIS IS A SERIOUS PROBLEM AND IT’S TIME TO START SOLVING IT. I THINK THAT WILL MEAN A NICE GREEN BOARD. THERE SHOULD BE A COMPLETELY GREEN BOARD UP THERE . NOT ONE MEMBER SHOULD VOTE NO BECAUSE THAT USUALLY MEANS; DON’T SEND IT TO CONFERENCE. IT SHOULD DIE HERE. THAT’S WHAT IT MEANS TO ME. AND I WOULD THINK THE PUBLIC WITH THINK THAT; TOO.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM WRIGHT REPRESENTATIVE LUCERO>>REPRESENTATIVE LUCERO: THANK YOU; MME. SPEAKER. MY QUESTION IS FOR THE BILL AUTHOR IF YOU’D BE WILLING TO ANSWER? THANK YOU; MME. SPEAKER. TO THE BILL AUTHOR; WAS LISTENING TO THE EXTENT BETWEEN YOURSELF AND REP RESENTATIVE SCOTT AND I BELIEVE I HEARD YOU SAY THAT IN REGARDS TO TRADE SECRETS THAT LANGUAGE IS STILL UNDER DISCUSSION THAT YOU HAVE MADE A MEETING TOMORROW. SO MY QUESTION TO YOU IS; IF THE BILL LANGUAGE IS STILL UNDER DISCUSSION; TOMORROW DO YOU THINK IT’S THE BEST THAT WE VOTE ON IT TODAY?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. I MAY BE NEW HERE BUT I KNOW THIS ONLY BILL THAT PASSED OFF THE FLOOR THAT STILL BEING WORKED ON. SO ABSOLUTELY; WE SHOULD VOTE ON IT TODAY.>>REPRESENTATIVE LUCERO: THANK YOU; MME. SPEAKER. WITH THE BILL AUTHOR CONTINUE TO YIELD; PLEASE? THANK YOU; MME. SPEAKER. SO IS THIS A CASE WHERE I NEED TO EITHER VOTE FOR OR AGAINST IN ORDER TO FIND OUT WHAT’S IN THE BILL?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. I CANNOT HEAR YOU REPRESENTATIVE.>>REPRESENTATIVE LUCERO: 22 VOTING FOR THIS BILL TO FIND OUT WHAT’S IN IT?>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. NO; YOU CAN JUST READ IT.>>REPRESENTATIVE LUCERO: MME. SPEAKER WELL YOU JUST SAID REPRESENTATIVE MANN THAT THE LANE WHICH IS STILL IN DISCUSSION. SO IF I READ IT NOW AND VOTE ON IT NOW; IT’S GOING TO BE DIFFERENT TOMORROW POTENTIALLY. SO READING IT NOW DOESN’T NECESSARILY HELP ME WHEN YOU ADMITTED THIS IS STILL WORK IN PROGRESS. MME. SPEAKER; WOULD REPRESENTATIVE LIEBLING YIELD FOR A QUESTION? MENACE SPEAKER; REPRESENTATIVE LIEBLING I’VE BECOME INCREASINGLY FRUSTRATED WITH YOUR USAGE OF SOME THE GENERALIZATIONS YOU CONTINUE TO SPEAK ABOUT ON THIS FLOOR. MOST RECENT ONE YOU JUST SAID IN THE MOST RECENT COMMENTS WAS IN REGARDS TO REINSURANCE. YOU KEEP SAYING SOMETHING TO THE EFFECT OF YOU PEOPLE; YOU GUYS; THAT SIDE. AND YOU AND I HAVE HAD MME. SPEAKER; CONVERSATION ON REINSURANCE WERE I’VE CORRECTED YOU COULD I DO NOT SUPPORTED LAST YEAR. I VOTED AGAINST STATE THIS YEAR. SAMANTHA SPEAKER; REPRESENTATIVE LIEBLING; WHY DO YOU CONTINUE TO MAKE ERRORS IN YOUR REMARKS WHEN YOU GENERALIZE?>>REPRESENTATIVE LIEBLING:>>HOUSE SPEAKER HORTMAN: REPRESENTATIVE GENERALLY NO LONGER WISHES TO YIELD REPRESENTATIVE LUCERO>>REPRESENTATIVE LUCERO: MME. SPEAKER [INAUDIBLE] THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM WASHINGTON REPRESENTATIVE JURGEN>>REPRESENTATIVE JURGENS: THANK YOU; MME. SPEAKER. MANY OF THE COMMENTS I HAVE OF ARTY BEEN MADE SO I WANT TO GRANNY GRADY JOHNNY THEM BUT THANK YOU REPRESENTATIVE MANN FOR BRINGING THIS FORWARD APPEARED THIS IS IN GENERAL A VERY GOOD BILL. WITH RESPECT TO MY FRIEND AND COLLEAGUE REPRESENTATIVE HAMILTON FOR THE WORK YOU’VE DONE ON THIS IN THE PAST I APPRECIATE THAT AND THANK YOU.. MY BIGGEST CONCERN IS THE SAME AS WHAT WE HAVE HEARD HAVING TO DO WITH SECTION 4 AND THE FIDUCIARY TO THE INSURERS. MY FEAR AS REPRESENTATIVE NE U SAIDIT WILL RAISE THE COST OF HEALTHCARE BIC WHEN YOU TO CHOICE AND WE CAN EITHER VOTE YES TO GET THIS TO CONFERENCE COMMITTEE AND HOPEFULLY IT GETS FIXED OR WE CAN VOTE NO. KNOWING THAT’S GOING TO LIKELY GETS TO CONFERENCE COMMITTEE AND HOPE THAT IT GETS FIXED. I EXPECT AND I HO PE THAT IF AND WHEN IT DOES COME BACK TO CONFERENCE COMMITTEE WITH THE LANGUAGE SPECIFIC TO THE FIDUCIARY BEING RESPONSIBLE TO THE INSURERS; THAT WE WILL HAVE AN ALL GREEN BOARD BUT TODAY; BECAUSE OF THAT SECTION I’LL BE VOTING NO HOPING THAT THAT LANGUAGE GETS CLEANED UP BECAUSE I THINK THAT ALL AND ALL; THIS IS A GOOD BILL.. ALL IN ALL; THE REFORMS ARE MUCH NEEDED. SPECIFICALLY I’M HAPPY TO SEE THAT THE GAG CLAUSE IS BEING REMOVED. I THINK IT’S VERY GOOD AND VERY LONG OVERDUE. SO I’LL BE VOTING NO TODAY AND HOPEFULLY THIS COMES BACK WE WILL ALL BE ABLE TO VOTE GREEN ON IT. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM REPRESENTATIVE BAHNER>>REPRESENTATIVE BAHNER: THANK YOU; MME. SPEAKER. THANK YOU MEMBERS. FIRST I WANT TO THANK REPRESENTATIVE HAMILTON. I KNOW THAT YOU HAVE PUT A GREAT DEAL OF EFFORT INTO THIS BILL AND I KNOW THAT A LOT OF THAT HARD WORK IS THE RESULT THAT WE SEE TODAY. I KNOW YOU’RE PASSIONATE I WANT TO THANK YOU FOR THAT. I ALSO WANT TO THANK SEN. JENSEN FOR ALL OF HIS HARD WORK. THIS IS BEEN A VERY LONG BUT BIPARTISAN EFFORT AND I KNOW THAT REPRESENTATIVE LONG HAS CONTINUED TO WORK TIRELESSLY DAY AFTER DAY AND REALLY WORKING TO REFINE THIS LANGUAGE TO MAKE IT SOMETHING THAT WE CAN REALLY VOTE FOR AN LIGHT THAT BOARDED GREEN. THIS BILL IS ABOUT PUTTING PATIENTS FIRST. IT’S ABOUT OUR SENIORS. IT’S ABOUT OUR FAMILY. OUR YOUNG FAMILY. PUTTING THEM FIRST. NOT SECOND; NOT THIRD AND DEFINITELY NOT LAST. THAT IS EXACTLY WHAT THE SYSTEM HAS BEEN DOING AND IT’S TIME FOR REFORM. THIS IS NEEDED. MEMBERS; WE KNOW THIS. THIS IS NOT GOING TO SHOCK ANYONE IN THIS ROOM. THIS IS ONE OF THE MOST SWEEPING REFORMS WE’VE EVER SEEN ON THIS FRONT. THIS IS BEEN WORKED ON FOR YEARS . IT IS TIME TO PASS IT.. IT’S TIME TO PUT OUR PATIENTS BACK IN THE DRIVER SEAT AND PUT MONEY BACK IN THE POCKETS OF THE PEOPLE IN OUR COMMUNITIES THAT WE REPRESENT. THIS BILL ISN’T JUST ABOUT FLOWERY LANGUAGE. IT’S ABOUT REAL PEOPLE. AND I DON’T KNOW ABOUT ALL OF YOU IN THIS ROOM BUT WHEN I WE NT DOOR-TO-DOOR TALKING TO FOLKS IN MY DISTRICT; I HEARD SENIORS WHO WERE [INAUDIBLE] THEY CAN’T AFFORD TO PAY THEIR PRESCRIPTION DRUG. THEY ARE WORRIED ABOUT THEIR OTHER GET TO MANAGE THEIR EXPENSES. THEY CAN MANAGE THEIR HEALTH CARE. THE SE ARE FOLKS WHO SHOULD BE WORRYING ABOUT WHEN THEY ARE GOING TO SPEND THEIR NEXT DAY OUT WITH HER GRANDCHILDREN; NOT WHETHER THEY CAN AFFORD THEIR PRESCRIPTION. THESE ARE YOUNG FAMILIES WERE WORRIED ABOUT PUTTING MONEY ON THE TABLE AND PAYING FOR DAYCARE. THEY CAN’T BE PUT LAST ANYMORE.. THAT IS UNACCEPTABLE MEMBERS; I URGE YOU NOT ONLY TO VOTE GREEN FOR THIS BECAUSE IT IS TIME BUT BECAUSE IT IS TIME FOR US TO RECOGNIZE THAT IT IS TIME TO PUT PATIENTS BACK IN THE DRIVER SEAT AND PUT THEM FIRST. THANK YOU.>>HOUSE SPEAKER HORTMAN: I RECOGNIZE THE MEMBER FROM FILLMORE REPRESENTATIVE DAVIDS.>>REPRESENTATIVE DAVIDS: THANK YOU; MME. SPEAKER. I WOULD LIKE TO COMMENT ON A COUPLE OF ISSUES HERE. THE FIRST ONE IS A COUPLE OF DAYS AGO WE HAD A BILL ON LANDLORD-TENANT RELATIONS BUT I THINK IT HAD TO DO WITH SOME LANGUAGE FROM REPRESENTATIVE NOOR. I BELIEVE IT WAS. AND ONE OF THE MEMBERS FROM THIS BODY STOOD UP AND SAID WELL I DO WANT TO YOUR FROM LANDLORDS OR SLUMLORDS BECAUSE I DON’T HEAR FROM THEM BECAUSE OF A CONFLICT OF INTEREST. HERE; WE HAVE A CASE WHERE WE HAVE A MEDICAL DOCTOR CARRYING LEGISLATION ON MEDICAL ISSUES. NOW; IS THAT A CONFLICT OF INTEREST TO THE MEMBER WHO BROUGHT THAT UP EARLIER? I SAY; NO IT’S NOT. I OWN A FARM BUT WHEN WE TALK ABOUT AG STUFF MY TO HAVE A CONFLICT OF INTEREST BECAUSE I VOTE ON FARM BILLS IN THE FINANCIAL SERVICE; ETC. I THOUGHT IT WAS PRETTY RECKLESS WHEN I WAS BROUGHT UP SAYING THAT LANDLORDS TALKING A BILL OF A CONFLICT OF INTEREST. OF COURSE THAT SIMPLY NONSLIP NOW AS FAR AS THE ISSUE OF REINSURANCE; REINSURANCE WORKS. IT WORKED BEAUTIFULLY.. INSTEAD; THERE ARE THOSE FRIENDS ON THE OTHER SIDE OF THE OTHER WANT TO SET UP A SYSTEM HIGHER 50 PEOPLE TO SEND CHECKS DIRECTLY TO INSURANCE COMPANIES. SO OBVIOUSLY; THAT ARGUMENT HAS A ZERO MERIT WHATSOEVER. THEN I WAS A BIT PERPLEXED BY SOME OF WHAT REPRESENTATIVE HOWARD’S COMMENTS HAVING TO DO WITH THIS BILL NEEDS TO BE PASSED BECAUSE COMPANIES WE ARE DOING WITH OUR REALLY REALLY BIG. WHO CARES? WHO CARES ABOUT THE SIZE OF THE COMPANY? MCDONALD’S IS BIGGER THAN A PBM AND THEY PUT OUT A REALLY GOOD PRODUCT THEY LIKE I LIKE AND I MADE A LOT OF MONEY OFF ME. A LOT. SO I DON’T UNDERSTAND THE LOGIC OF BECAUSE THE COMPANY IS BIG IT’S BAD. BECAUSE THAT’S NOT THE CASE BUT NOW; ON THIS BILL; THERE ARE SOME REALLY BAD THINGS IN THIS BILL BUT THERE’S A LOT OF REALLY GOOD THINGS IN HERE; TOO. AND SO I THINK YOU HAVE TO I’M VOTING FOR THE BILL TODAY HOPEFULLY; THE SENATE CAN CLEAN UP THE FIDUCIARY ISSUES THAT ARE VE RY PROBLEMATIC THEY ARE PROBLEMATIC AND I WOULDN’T DIMINISH THOSE ISSUES WHATSOEVER. AND OF COURSE; I MUST CLOSE ON SOMETHING THAT IS VERY PERSONAL TO ME BECAUSE WE HAVE ALL BEEN THROUGH IT HERE. EVERYBODY AT ONE TIME OR ANOTHER WAS A FRESHMAN. IS WHEN A FRESHMAN GETS UP ON THIS LAWRENCE AS WELL IT’S BECAUSE I AM A FRESHMAN ; PLEASE DON’T SAY THAT BECAUSE IT’S QUITE OBVIOUS TO US.>>HOUSE SPEAKER HORTMAN: WITH ANY OTHER MEMBER WAS TO SPEAK ON THE BILL BEFORE ANYONE WANTS A SECOND BITE AT THE APPLE? I RECOGNIZE THE MEMBER FROM HENNEPIN REPRESENTATIVE HERTAUS>>REPRESENTATIVE HERTAUS: THANK YOU; MME. SPEAKER. I WANTED TO TALK ABOUT THIS BILL AND THE DISCOURSE THAT’S GOING ON TODAY. I JUST WANT TO COMMENT ABOUT THE ABUNDANT KNOWLEDGE AND WEALTH OF INFORMATION THAT EACH OF THESE MEMBERS IN THIS BODY HAVE TO CONTRIBUTE WITH REGARD TO THE DECISIONS WE MAKE ON LEGISLATION. REPRESENTATIVE ELKINS; APPRECIATED THE FACT THAT YOU GOT UP AND TALK ABOUT YOUR 10 YEARS IN THE INDUSTRY AND YOU ARE GIVING YOUR TESTIMONY IN YOUR PROFESSIONAL EXPERTISE IN YOUR OPINION ABOUT HOW THIS LEGISLATION COULD BE INFLUENCED BY WHAT YOU HAD TO CONTRIBUTE TO THOSE COMMENTS. AND LIKE REPRESENTATIVE DAVIDS IT JUST MENTIONED;AYE; TOO; WAS THINKING ABOUT THE CONTEXT OF THIS DISCUSSION AND DEBATE AND SOME OF THE COMMENTS THAT HAVE BEEN MADE AND WE SHOULD RESPECT EACH OTHER A LITTLE BIT MORE FOR THE CONTRIBUTIONS THAT WE CAN CONTRIBUTE; WHETHER YOU ARE A BUILDER OR WHETHER YOU ARE A YOUR SCHOOLTEACHER OR WHETHER YOU ARE AN INSURANCE AGENT OR WHETHER YOU ARE A LANDLORD OR DOCTOR. WE ARE REPRESENTATIVES AND A MERE OF THE PEOPLE WHO SENT US HERE. SO WE SHOULD TAKE WHAT WE HAD TO CONTRIBUTE; WHAT WE HAVE TO OFFER THEM ABOUT LEGISLATING AND THE COMMENTS THAT OTHER MEMBERS HAVE SERIOUSLY. I WOULD ALSO LIKE TO COMMENT ABOUT THE STATE BEEN MADE ABOUT REINSURANCE. REINSURANCE IS NOT A HANDOUT TO INSURANCE COMPANIES COULD REINSURANCE IS THERE FOR THE EXPLICIT PURPOSE OF REDUCING RISK AND THEREFORE; PRICING A PRODUCT MORE CHEAPLY FOR THE PEOPLE THAT W E ARE REPRESENTING. SO WITH THAT MEMBERS; THANKS FOR THE DEBATE . YOU EACH WILL MAKE YOUR OWN DECISION WHETHER IT IS TIME TO VOTE GREEN OR RED ON THIS B UT IT CERTAINLY HAS BEEN BETTER THAN THE LAST FEW DAYS. THANK YOU.>>HOUSE SPEAKER HORTMAN: ANY FURTHER DISCUSSION ON THE BILL? ANY CLOSING COMMENTS FROM THE AUTHOR OF THE BILL? REPRESENTATIVE TOO MANY>>REPRESENTATIVE MANN: THANK YOU; MME. SPEAKER. SO FIRST OF ALL; THIS BILL HAS NOTHING TO DO WITH GOVERNMENT HEALTHCARE AND SINGLE-PAYER . JUST WANT TO CLEAR THAT UP.TWO; THERE IS A COMMON SURROGATE MADE ABOUT HOW IF WE FIRST ONE HE SAYS. CURRENTLY; THE PBM’S TO NOT HAVE ANY SENSIBILITY TO ACT IN THE BEST INTEREST OF THE HEALTH CARRIER OR THE PATIENT. SO THERE’S A COMMENT EARLIER MADE ABOUT WE ARE GOING TO MAKE THEM ACT IN THE BEST INTEREST OF THE CARRIER VERSUS THE CONSUMER. THAT’S NOT THE TRUTH. WE ARE GOING TO ASK THEM TO ACT IN THE BEST INTEREST OF THE CARRIER VERSUS THEMSELVES WHICH IS WHAT IS CURRENTLY IS HAPPENING. THIRD; AND THIS IS SOMETHING I SAID BEFORE; BUT THIS NARRATIVE OF THIS BILL DOESN’T DO ENOUGH ; IT DOESN’T GO FAR ENOUGH WITH THERE’S AN ISSUE WITH IT SO WE WOULD VOTE NO ON IT. WELL WHAT YOU ARE DOING IS VOTING TO KEEP THE STATUS QUO. WHAT YOU ARE DOING IS TO KEEP DETECTING THE BILLIONAIRES AT THE EXPENSE OF THE PEOPLE OF THE STATE. THAT’S WHAT IT MEANS . WHEN THINGS AREN’T GOOD ENOUGH. WHEN YOU WANT MORE FROM A BILL. BECAUSE HOW DO GET MORE IF YOU DON’T START SOMEWHERE? SO THE REASON WHY I RAN FOR OFFICE IS BECAUSE STORIES LIKE REPRESENTATIVE HAMILTON.. BECAUSE I COULD NOT HEAR ANY MORE STORIES OF PEOPLE SUFFERING AT THE HANDS OF BILLIONAIRES; A BIG PHARMA ; PBM’S IN THIS COUNTRY AND IN THE STATES. AND I UNDERSTAND THAT BIG PHARMA IS COMING AFTER ME AND HAS REACHED OUT TO MANY OF YOU HERE I N THE MINNESOTA CHAMBER OF COMMERCE AND ALL THOSE OTHER ORGANIZATIONS; AND I WANT IT TO BE VERY CLEAR; THAT I DON’T CARE. AND THAT I’M GOING TO STAND UP FOR THE PEOPLE THAT ARE SUFFERING IN MY COMMUNITY AND I WILL NOT STAND UP TO KEEP THE STATUS QUO AND TO KEEP PROTECTING PEOPLE WHO BENEFIT OFF OF THE SICK PEOPLE IN THE STATE. I AS K FOR YOUR SUPPORT.>>HOUSE SPEAKER HORTMAN: THE CLERK WILL TAKE THE ROLL ON THE BILL.>>>>[ROLL CALL VOTE]>>>>[ROLL CALL VOTE]>>HOUSE SPEAKER HORTMAN: THE CLERK WILL CLOSE THE ROLL. THERE BEING 87 AYES AND 42 NAYS THE BILL


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