Senate Insurance Committee

Feb. 7, 2023


Sen Hill Senator Murdock, is there anything you’d like to add?


Sen Murdock No, sir.


Sen Hill Okay. Moving right along. We have– I see Senator Hammer’s not here yet. Senator Wallace isn’t here. Senator Irvin, passing over that. Passing over SB 142. Senator Penzo, are we passing over yours?


Sen Penzo Yes.


Sen Hill Okay. Passing over SB 151. Passing over SB 178, another one by Senator Hammer. Passing over SB 183 as well, Senator Penzo?


Sen Penzo Yes.


Sen Hill Senator Boyd. SB 192. Senator Boyd, you’re recognized to present your bill.


Sen Boyd Mr. Chair, senators, this bill in my mind is a fairly simple bill. I’m happy to explain as much as I need to, but this goes to the step therapy legislation that was passed and it adds one thing to it under Section A. So on section 2h, there’s this, “a patient to try a generic equivalent interchangeable biologic product,” and then it adds “or biosimilar medical product.” So what biosimilars are are FDA approved medications that are very close to the originator product. So you might have Lantus insulin and you might have a biosimilar. And the reason they’re called biosimilars is because they’re made through a biological process. So these are larger molecules that might have a slight structural difference but are not anticipated to have any therapeutic difference. And so what this would do is it would allow an insurance company to say, hey, we like this biosimilar over the originator product or another biosimilar. I suspect you’ve received several letters of support from industry and elsewhere, like I have on this bill. So with that said, I really think I should just try to answer questions.


Sen Hill Senator Johnson.


Sen M Johnson Thank you, Mr. Chairman. Senator Boyd, without getting deep in the weeds, the fact that you and Representative Achor are on this bill, I would assume two pharmacists know what they’re talking about. But I just want to, just for my own information, ask you to clarify the difference between a generic interchangeable biologic or a biosimilar. I know a generic is the exact same drug, like a private label or a clone or whatever you want to call it, it is exactly the same. But what is biosimilar? It does exactly the same, but it’s structurally, as you said, molecularly, if that’s a word, slightly different.


Sen Boyd Okay. You’re exactly right. On a brand generic, those are small molecules and it’s an identical product. There’s not a difference. The active chemical and the base are the exact same. And there are thresholds about which it has to produce similar levels in the blood to qualify for that. And then an interchangeable biological product is really a biosimilar that has gone one slight step further and gone through and said this really is the exact same thing despite potential molecular differences, okay. So a biosimilar is an FDA approved product that has gone through all of the rigorous trials and all the things and said this is a safe and effective thing. It has the same dose as whatever else. There could be, and this could be true with the originator product, you’re using bacteria, you’re using a biological life form to produce these. And because of that, since it’s not done in a chemistry lab, there can be small variations. But that said, I would expect them, as a pharmacist, to have an identical process. Like if I had Lantus insulin and then the biosimilar of Lantus insulin, for all practical intents and purposes, I would expect the same therapeutic outcome. So, again, what this does is it allows the insurance company to say, hey, we like this one over that one. Right? It doesn’t force a change. It doesn’t do anything. The health care provider still ultimately decides which one the patient receives. But what this does is it really introduces competition. There’s 40 biosimilars. There’s only three interchangeable biologic products. And these are drugs that are in the hundreds and thousands of dollars. And if you can come down on that price a little bit, that can save the health care system a lot of money. So I really think– the competition is the reason I’m coming at this, and I think it’s a good thing.


Sen M Johnson Okay. Thank you, Senator. Thank you, Mr. Chair


Sen Hill I want you to expand a little bit on that, if you would. Just just talk about the economic side of it. Is this cheaper on the insurance company and more profitable for the pharmacy? What is the purpose of this?


Sen Boyd I don’t think that the pharmacy– I would have given a disclosure if I felt like the pharmacy were going to make more or less money. I don’t think this has anything to do with the pharmacy. In fact, I could say, well, the pharmacy might have to have more products in stock or something, but I don’t think any of that really matters for practical intents and purposes. What this does is if this drug is basically the same as this drug, it allows competition in the marketplace. So biosimilars are exactly what they are. They’re biologically produced that are similar in nature. So again, you would expect a similar thing. So again, this goes back to the step therapy and it allows an insurance company to say, I want this biosimilar on formulary rather than this biosimilar, whereas current law would limit it to just brand generic or just interchangeable biological products.


Sen Hill Thank you. Senator Dismang.


Sen Dismang And so, again, just kind of walk me through the process of who’s going to make the decision on if a biosimilar is used. Or, I mean, so what exactly are we doing here? I mean, we’re not injecting ourselves between the doctor and the patient or allowing someone to make a change. Do they have the ability to already prescribe the biosimilars?


Sen Boyd Yes.


Sen Dismang So what are we accomplishing exactly? I guess that’s where I’m confused.


Sen Boyd Okay. So you have to go back to the– it took me a little bit to figure out what this was doing. I had to go back to the step therapy and understand exactly where this fits into step therapy. If you follow it all the way down, there’s a clause concerning the application of exceptions of step therapy protocols. Right now the only exceptions are for generic equivalents for interchangeable biologic. The physician, the nurse practitioner, the physician assistant, they’re always in control because they can always write, do not substitute or do not therapeutically interchange. So if it’s important to the prescriber, they have full control at the point of writing a prescription to say, in this patient, I do not want this to happen. Okay? And then if they write that and then the insurance company says, we prefer this product, then what that would signal the pharmacy to do is say, hey, patient, or, hey, provider, insurance doesn’t want to cover this. It’s going to be a few thousand dollars. What do you want to do? And then the physician can go through a PA process or say, well, it wasn’t that important to me. So I’m just going to go with the one that they prefer. But in Arkansas, the prescriber always has that control when he or she writes the prescription.


Sen Dismang But they have to say specifically do not change whatever the word is. If they prescribe something, they have to say specifically– has that become the norm now that everybody understands that that’s the way that needs to happen? Or do we have prescriptions that are written where maybe they omit and forget today because it’s busy or whatever, check the box or whatever they’re doing anymore, that substitutions aren’t allowed?


Sen Boyd So let me clarify. There’s no more check the box, like, that’s out. That’s not been law for a long time. They’re on there. A lot of prescriptions have that. But it’s not been the law in Arkansas to allow a check the box since I’ve been a pharmacist now over 20 years ago. But they can write, do not substitute, do not therapeutic interchange. These are ones where I don’t think that there’s going to be an issue. I wouldn’t be sitting here if I thought they were. These are drugs that I expect that the vast number of physicians are going to think are going to work 99 plus percent of the time either way. And if they have a specific patient where they have a specific concern, the physician is always in control or the nurse practitioner, PA, whomever is always in control to say, I don’t want this product.


Sen Dismang But they’re always in control so long as they say they don’t want it to be substituted.


Sen Boyd Right.


Sen Dismang But if they don’t say they don’t want it to be substituted, then that’s when the control for the physician goes away.


Sen Boyd So what would happen in that situation is two pathways. So pathway number one, because you said, do you think this is well instituted in Arkansas or something like that? I’d say the answer is I don’t think most people understand this, or I would say most pharmacists, I don’t think understand this, but I could be wrong. So pathway number one is you go to fill the prescription and it says, whoa, we don’t want Lantus, we want whatever the biosimilar to Lantus is. And so the pharmacist at that point in time, pathway one, would send a fax to the physician and say, hey, insurance doesn’t want to cover this, this is the one they want. And most likely the physician in this case, I would suspect would say, okay, let’s give them what they want, because it’s going to save the patient a lot of money and I don’t really care. Pathway two is in the last General Assembly we passed legislation that allowed for therapeutic substitution. So the pharmacist could then therapeutically substitute and then notify the prescriber that had happened. So that’s Arkansas law right now. So that could happen regardless.


Sen Dismang And let’s just say in that number two scenario. And to me the question is going to be, where’s the liability? Let’s say we make a substitution and it’s the 1% and it doesn’t go well. Who’s liable for that? Is that the physician because they didn’t write, do not substitute. Is it just healthcare and we all move on and it’s a tragic incident and that 1% saved money? That’s what I don’t know.


Sen Boyd So what I would say to you is, first of all, with this list of 40 drugs and the whole concept that I’m bringing it here before you, I really don’t think that’s ever going to happen. But if it did, what I would say to you is if the pharmacist were working in his or her capacity as pharmacist and doing something, then he or she would need to dot every I and cross every T to make sure it was done within the manner of the law. And if not, then he or she would be accountable to the patient and to the Board of Pharmacy. What I would say is the physician did his or her job when he or she wrote the prescription. And so I don’t think that there would be liability on his or her end. I mean, I’m not an attorney, I’m not going to play one. But I don’t know in the practical world how that would play out to be an issue.


Sen Hill Senator Murdock.


Sen Murodck Thank you, Chairman. Senator Dismang hit most of my questions, but so the one component we hadn’t talked about is the end user, which is the patient. So how does– you have something?


Sen Boyd Oh, I was about to answer that, but finish your question.


Sen Murodck Well, I was just going to ask, how does this at the end of the day affect or what input even do the patients have in the choice of what happens in this situation, this scenario in terms of what– yeah, go ahead, answer that, address that.


Sen Boyd So let’s go down pathway two. So pathway two that we described where the pharmacist was going to make a therapeutic interchange that is perfectly legal in the state of Arkansas, then the patient has to be informed and agree to that. So the patient has to be consented. It can’t be more money for the patient, which it wouldn’t be. Nobody would therapeutically substitute, in their right mind, if it were going to cost the patient more money. So if you went down pathway two, then you’ve got to have a conversation with the patient and make sure the patient knows this is what the doctor prescribed and this is what the insurance company wants. Do you have any concerns? If not, we’re going to go through this thing.


Sen Murdock Okay.


Sen Boyd So pathway one, you might just fax the doctor because the patient might not be there. So you might just fax the doctor and or the nurse practitioner and say, hey, this is what the insurance company said, and they might send back and say, we’ll change it to that. Or theoretically, they could say, don’t change it. But again, these are drugs that are safe and effective and expected to have the same or very similar outcomes to the originator product.


Sen Murdock And with this being relatively new I guess to the industry or this letter that came saying to us, talks about 2015 as biosimilar medicine to the US in 2015. I guess my question would be is there another side of this pillow? Is there something agin-ers about this? What’s the other side of this, or this is all good from your perspective?


Sen Boyd I think that it comes back to competition, and these drugs are extremely expensive. If you want to see drugs continue to go up in price, then you don’t want to go down this path. If you want to see competition in the marketplace and see prices plateau and/or start to come down, this is a path we want to go down. This is good for the citizens of Arkansas and the people paying for the prescriptions of Arkansas because it allows for competition that the current law limits.


Sen Murodck Thank you.


Sen Hill Senator Irvin


Sen Irvin Thank you. I appreciate your comments. Question, and I’m not sure how you can answer this, but my concern with therapeutic substitution is it’s not always about money or saving money for the patient. And the doctor or the prescriber is the only one that actually has the full history and physical and chart on that patient, knowing what other medications that they may be on or issues that they may have to where they don’t want it to be substituted. And it’s not about money, it’s based on the health of that patient, the history of that patient, the medication history of that patient, the emotional history of that patient because we know that there are some medications that really have side effects that are stressors for folks that are dealing with emotional and social traumas and events like that. So I suppose my question to you is, is there any concern with the interaction of a product like this with other medications that the pharmacist may not be familiar with and the insurance company may not also be familiar with but that information resides in the physician’s medical chart with the history of the patient.


Sen Boyd Senator Irvin, thank you for that question. The answer is I would not expect that. These medications are virtually identical medications. That’s why they’re called biosimilars. I would not expect a drug-drug interaction to occur with one of these medications that wouldn’t occur with the originator product. I would not expect there to be some kind of allergy issue. And the pharmacy should be asking for allergy issues anyhow in case there was some random thing that  I wouldn’t expect. So I just don’t see in the case of biosimilars that this is an issue. Like the generic names are the same. It’s like Lantus is insulin glargine. The biosimilar is insulin glargine. I mean, there’s really no difference. But at the end of the day, if you want competition, which as a Republican, I believe competition will lower costs and have better outcomes in the long run, then this is a good thing. It is a small thing we as a state legislature can do to do that.


Sen Irvin Thank you.


Sen Hill Senator Dismang.


Sen Dismang And if I’m being honest, this is one thing that I always struggled with on the original bill that we’re kind of piggybacking off of with this one is we’ve put the burden on the physician to specifically write out that it cannot be substituted instead of the opposite, that it could be substituted. And that’s my concern, in general, is that we put the burden on the physician and we allow a pharmacist or an insurance company in this case to make the decision related to the healthcare. So those with the profit incentive have the ability to make the decision. I’m just curious, if you don’t mind, just kind of rehash the history of why we did it that way. I mean, a fax machine and all of these things that we do are so weird to me because, I mean, now we don’t use fax machines. But why is it the reverse? Why don’t we just say, hey, if it says that you can substitute, then great. But instead we’re saying unless you specifically write on we have the latitude to make some of these adjustments.


Sen Boyd So, Senator, excellent question. And what I’m going to say is it’s efficiency. As   in healthcare, there’s an upward expectation of productivity and a downward ratcheting of margin. And when those two collide, it’s both challenging for a busy doctor’s office and a busy pharmacy to do. This is a small thing that can be done that will help lower cost and probably make for a more efficient physician office and a more efficient pharmacy. If I really thought that the average physician in Alma, Arkansas, really cared about this, I probably wouldn’t be here at the end of the table. I’m not going to tell you that somebody somewhere might go, hey, here they are taking power away again. But these are products that are so similar, I don’t think that the average practicing person really cares. This is just a way to introduce more competition into the marketplace. It’s really that simple, I mean, from my perspective. I realize there’s other people on the committee, but from my perspective, this is that. So but to answer that, let me go back to what your original question was. That’s a whole nother section of law that we didn’t pass in here that really has nothing to do with this other than therapeutic interchange is a legal thing that Lee Johnson,   Representative Johnson, had a bill and it was included in the bill. It was a compromise bill. And,   to my knowledge, there’s not been any real problem with that. Since we passed it last time, I’ve maybe therapeutically interchanged a handful of items because sometimes you go through and and sometimes that’s a good fit, sometimes it’s not.


Sen Hill Any other questions? Seeing none, is there anyone here to speak for or against the bill? Seeing no one signed up, would you like to close?


Sen Boyd I would like to close. Thank you, Mr. Chair.


Sen Hill Appreciate it.


Sen Boyd Thank you all for entertaining this bill today. This bill is a good way to introduce competition into the marketplace, create efficiencies that are not necessarily there. And I think with the price of drugs going up, competition is more important than ever, especially in drugs that cost hundreds to thousands of dollars. And so with that, I’d make a motion do pass and hope someone will give me a second.


Sen Hill Got a motion do pass. Have a second by Senator Penzo. So all in favor, say aye.  All opposed, same sign. Thank you, senator, your bill has passed. Senator Hammer. Yes, sir. Senator Hammer, you do have an amendment for this bill, correct?


Sen Hammer Yes, sir, I do have an amendment.


Sen Hill So committee, we’ll be presenting the amendment first.


Sen Hammer Mr. Chairman, with the chair’s permission, I’d like to have Booth Rand with the Insurance Commissioner’s Office sit beside me, and he’s going to help present the bill to expedite the process and make sure there’s clarity and understanding on what the bill does, with the chair’s permission.


Sen Hill Permission granted. And yours would be a little less controversial than the last one, is that correct?


Sen Hammer We’ll see. That’s my intent.


Sen Hill All right. You may proceed, sir.


Rand AID Thank you. My name is Booth Rand, and I’m general counsel–


Sen Hammer Mr. Chairman, do you want us to adopt your amendment first?


Sen Hill Yes, sir. Yeah.


Sen Hammer Do you want an explanation, or how would you like–


Sen Hill I’ll let you present it.


Sen Hammer All right. All right.


Rand AID I’m Booth Rand, general counsel at the Arkansas Insurance Department. Let me explain to the members the amendment. The original bill before the proposed amendment came through proposed that the Insurance Department fine PBMs $10,000 per violation of the PBM Licensure Act. And in addition, it also provided an unlimited power of the commissioner to enforce the subchapter. And some of the PBMs, including the lobbying organization for the PBMs, had some concerns about the fine amounts being too high and about the powers being given to the commission were too broad. So we met with the PBM Association last week over their concerns over the bill, and the Insurance Department agreed to reduce the penalty amounts as proposed originally from $10,000 to $5,000 and agreed to remove the unlimited power provision of the commissioner. That’s essentially what this amendment does, and it’s a result of negotiation and discussion with the PCMA and the PBMs. I’ll be glad to answer any questions.


Sen HIckey I understand this amendment– and maybe the appropriate time would be after we adopt it. But so let me ask you this, as the insurance commissioner, I can see you’re going to request this, but are you all allowed to do audits so that if you ever wanted to go in and look at it, would that be available to you? Or does this totally limit you from having any power whatsoever?


Rand AID We have audit power, Senator Hickey. We have examination powers. This is just an additional monetary penalty violation. So we already have statutory powers to do exactly what you said.


Sen HIckey Thank you.


Sen Hill Senator Boyd.


Sen Boyd Thank you, Mr. Rand. I’m just a little surprised there’s a reduction in the fine. These are   companies that are tend to be in the top ten most–


Rand AID Let me explain that. The fine doesn’t have a cap either. So the current are capped at $50,000 for intentional violations and $10,000 for unintentional. So this proposal actually exposes the PBMs to unlimited fine liability without a cap. I agree with you that those are multibillion dollar industries that might not likely be deterred from a small amount. But we don’t have a cap now.


Sen Boyd Thank you. That explains it.


Sen Hill Senator Murdock.


Sen Murdock So I’m trying to catch up to where we are with this. So historically, I know that we’ve had some ongoing conversations on issues, for lack of a better word, Senator Hammer, and we worked together on some of this over the last few sessions, terms. So as I look at some of these things, the controls that we wanted AID to have as a result to the relationships to make sure that we had the safeguards in place to protect all involved. So as I look at some of the language and just looking at the amendment now, so down here, the second part, where it talks about the powers of the insurance commissioner and in B it says “not subject to the Freedom of Information Act”-  proprietary confidential under– so we’re protecting the information, but the commissioner still can get whatever they need to make it– you can still get what you need to make decisions. Okay, and you answered the question about the fine amount. Okay, so I just want to make sure that we still have the safeguards in place that we worked so hard for because of the myriad of problems that we did have at one time, Senator.


Sen Hammer I would address that and Booth can back me up on it or correct me on that, either one. And that is, I do not think we’re weakening the process any at all. I think we’re taking the next step in a reactionary way because of the activity of the PBMs. And this is just one more tool in the toolbox or a bigger hammer in the toolbox or bigger screwdriver if you don’t like hammers that can be used in order to help bring them accountable.


Sen Murdock Thank you.


Rand AID To address the confidential proprietary language that you put your eyeballs on, that does not mean that we can’t see the data at the Insurance Department. I think the problem is that when we acquire the rebate data in the financial information from the PBMs, it is competitive information that would advantage competitors if they were to see it. But we can see it.


Sen Hill Okay. Any other questions on the amendment? The amendment only. Senator Irvin.


Sen Irvin If you could just read through line– page four. I’m confused on the amendment and what it does. On page 4, line 1 deleting, delete services and substitute services. And you’ll have to help me with this.


Rand AID I think that’s just a typographical change. It has really no meritable impact on any of the– I think BLR was just fixing that.


Sen Irvin Right. But services is a word that appears twice in line 1. So which one is it?


Rand AID Page 4.


Sen Irvin On page 4, line 1, services appears twice. So I’m just making sure that your amendment is correct because I don’t understand the purpose of having this in the amendment because if it’s the second one, it doesn’t change anything. If it’s the first one–


Rand AID I think she’s just making a grammatical change to make the sentence read better, honestly.


Sen Irvin Okay, track with me. Page 4, line 1 says, “And goods and services, comma–“


Sen Dismang Period.


Sen Irvin Period. So it’s not correct?


Rand AID I think you’re right. I see what you’re saying. I’m sorry.


Sen Hill Senator Dismang.


Sen Dismang And just kind of a suggestion and maybe not just on this bill, but other bills, because where we are in the session, there’s no concern that– we could adopt an amendment on the floor, have it engrossed, sent back to committee, and everybody could read the bill as written instead of trying to do the piecemeal. You can hear everybody’s pencils lining out and trying to write in what’s happening. So just as a recommendation, not saying we have to do that today, but moving forward, hey, if you’ve got an amendment and you’ve got it for a week, go ahead and adopt it on the floor and we can see the full bill in here and not have to try to figure out if there’s been an issue. Because the worst thing that I think Senator Hammer’s going to want is to realize that we’ve adopted an amendment in this room, had it engrossed, realize it’s wrong, have to drop an amendment on the floor again, send it back here to have it voted again to come back to the floor.  Just as a– anyway .


Sen Irvin But your amendment. Do you see what I’m saying?


Rand AID I do. I do. And again, that did not come from the Insurance Department.


Sen Irvin I understand. But I don’t want to adopt your amendment when that I’m just going to make it wonky and weird.


Rand AID Yes, we will work on.


Sen Irvin And I think it’s–


Sen Hammer Mr. Chairman, may I make a recommendation.


Sen Hill Yes, sir.


Sen Hammer We’ll be available to answer any questions about the bill at this time if you’d like to shorten the process next time. Let me pull it back. I’ll get the amendment. I’ll just go ahead and do it at  members own, engross it in and and bring it about that way. But if the chair wants to exercise, we’ll be glad to answer any questions now to give members clarity or see if there’s something else, and then I’ll go about handling it that way.


Sen Hill Let’s do that.


Sen Hammer Okay. All right. So, Mr. Chair, we’re available for any other questions about the bill members may want to ask however the chair directs.


Sen Hill And just to make sure everyone understands we’re not going to vote on it today. He’s going to get it amended. But if you have any questions on the content of the bill. Senator Hickey. Oh, okay. Senator Irvin.


Sen Irvin Yeah. Thank you. I appreciate that. I think that’s a good idea. But I do want to make sure that when we do eliminate that you may examine the books and records of a PBM as necessary to determine, so you’re going to be limited to what’s subscribed in this bill under those lines 16 through 23 on page 3 and then 31 and down. In other words, I want to make sure you have the available flexibility that you need. And if it’s subscribed in the legislation, is that going to be an issue or a problem?


Rand AID No.


Sen Irvin Because you might want to look at something that’s not listed here or that might be necessary for you to do a full audit.


Rand AID So the provision that you’re looking at is pertaining to the rebates and how they are acquired by the PBMs. And it relates to the Insurance Commissioner’s power to review the particular rebate information and spread pricing practices. The Insurance Commissioner, Senator Irvin, already has separate statutory powers to examine the books and records of the PBMs outside of that. This is not going to limit our powers or limit us in a way where it might hurt the department, in my opinion.


Sen Irvin Okay. Okay. And so we don’t need to– okay. As long as that other statute, then, okay. All right. Thank you.


Sen Hill Any other questions? Seeing none, is there anyone here to speak for or against the bill?  Seeing no one here, Senator Irvin, did you have something to say? Yeah, go ahead.


Sen Hickey So that in no way limits us, since we’re just going to say that we may request the following information within this bill?


Rand AID I do not think it does, Senator Hickey, at all.


Sen Hickey Just as a question then, do we even need that?


Rand AID Let me tell you why that’s in there. If you want some background, because we’ve not really discussed why we’re amending that. The current law on the PBM Licensure Act requires the commissioner to collect spread pricing data and rebate data technologically and keep it at the department. We don’t have the staff to actually technologically acquire all that claims information. So what we decided to do was remove that particular requirement and just give the commissioner powers to audit the PBMs for that information should he or she want to do so. That’s what we’re doing in that proposal language.


Sen Hickey Okay. And I think that makes sense. I mean, but should, as an abundance of caution– and if you don’t think so, is fine– but should we put in there that you all retain your audit ability or something like that?


Rand AID That’s not a bad idea. It’s not.


Sen Hickey Right. I mean, since we’re going to have–


Rand AID An amendment anyway.


Sen Hickey Since we’re going to have an amendment anyway. Unless staff sees some issue with including it that way.


Rand AID Right. Yes.


Sen Hill Senator Irivn.


Sen Irvin Actually, that’s what I was going to suggest, too, is perhaps just reference back, put in this and reference back that you maintain that power under that code. And just referencing that here, I think, just would be a good idea.


Rand AID It wouldn’t hurt.


Sen Irvin It wouldn’t hurt. Thanks.


Sen Hill Any other questions? Seeing none, we have one signed up to speak. State Chamber against. Remember, members, we’re not voting now. We’re going to go ahead and hear the testimony and we will vote whenever the amendment is corrected.


Chamber representative Senator, I’ll wait until we get a chance to review the amended bill and get a good legal opinion. Our concerns about Arissa, from 9:20 until now I’ve haven’t been able to drag up a lawyer to give me a description. So we’ll do that. I’ll get back to Senator Hammer if we still have problems. Thank you.


Sen Hill Okay, thank you. Okay, Senator Hammer, you’re going to pull a bill down and have it corrected and bring it back and we will vote on it.


Sen Hammer Yes, sir. What I’ll do is I’ll pull it down. I appreciate the things that you pointed out today, and I’ll do a member’s own so it will be engrossed in the bill before it comes back here. And then anybody that wants to can see it as it is drafted.


Sen Hill Okay. Thank you.


Sen Hammer Thank you, members.


Sen Hill Appreciate it. Senator Wallace. Senator Wallace is here for HB 1042.


Sen Wallace Good morning, Mr. Chairman. Senator Dave Wallace, District 19.


Sen Hill Go ahead, Senator Wallace. Present your bill.


Sen Wallace Thank you, sir. Members, very simple bill. There’s no fiscal impact. The process is already being done. There’s no known opposition. And what this does is it just enhances the prostate cancer screening. And it simply amends the current law makes sure that it meets the current National Comprehensive Cancer Network guideline. This improvement is already saving lives. And with that, sir, I stand by for questions.


Sen Hill Any questions for Senator Wallace? Go ahead, Senator Dismang.


Sen Dismang What are we doing again? Make sure I understand. I mean, I see we’re moving the effective date out to be able to add, I guess, so it catches this new language. Is that–


Sen Wallace That’s what it’s doing is it just makes sure that– we are amending this law to make sure that it meets the current network guidelines that they put out, which ensures that people– or that our fellows have the opportunity to do this.


Sen Dismang All right. Thank you.


Sen Hill Senator Hickey.


Sen Hickey Just one, Senator Wallace. By putting this additional language in here, I mean, is this required for people to get any type of reimbursement or anything? Is there any cost somewhere that this is going to create that you’ve heard of?


Sen Wallace None that I know of, but I’ll find that answer for you and then I’ll get that answer back to you. I was told there’s no fiscal impact at all.


Sen Hickey To the state. I mean, the only thing I guess with the state would be if it was something to do with our Medicaid program or something like that, if it tied back to it. But, again, I’m gonna be fine with the bill today. But just if we could just make 100% sure of that before we–


Sen Wallace I will. I will, Senator.


Sen Hickey Thank you.


Sen Hill Senator Johnson.


Sen M Johnson Thank you, Mr. Chairman. And Senator Wallace, because this is sponsored by my friend Representative Allen, who has suffered with prostate cancer and is winning and we continue to pray for his good health, I’m almost knee jerk yes. I’m for this. I just want to ask the question is that, this is prospective when it says, “if additional clinical recommendations are recognized.” So it’s like if we discover or scientists discover something more helpful, this gives the commissioner the authority to just sort of add that to what is already there as far as better screening, maybe more economical screening. Because a lot of things that we know about– well, I don’t want to talk about too much. But the way they used to check you for prostate cancer versus the PSA test, is this sort of to give that discretion to the commissioner to if the newest equivalent of PSA test comes along, he could put that in by rule?


Sen Wallace That my understanding is, as hopefully as improvements do come along, the commissioner will have the flexibility.


Sen M Johnson Okay. All right. Thank you, Senator. Thank you, Mr. Chairman.


Sen Hill Seeing no one signed up to speak for or against the bill, what’s the will of the committee? Do pass? And a second, Senator Boyd. All in favor, say aye. Opposed, same sign. Senator Wallace, HB 1042 has passed.


Sen Wallace Thank you, Mr. Chairman.


Sen Hill Seeing no one else here to run a bill, I think Senator Johnson had something he wanted to cover for all of us for an announcement. Senator Johnson.


Sen M Johnson Thank you, Mr. Chairman. And I’m honored to be able to do this. Some of you may have had the opportunity to meet with Mr. Tom Considine with NCOIL when he was visiting a couple of weeks ago. For those who don’t know, NCOIL is the National Council of Insurance Legislators. It is a nonpartisan, or maybe I should say bipartisan group of legislators. Of course, we know the importance of state regulation because insurance is one of the few industries that is almost exclusively regulated at the state level. We’re honored that Representative Deborah Ferguson is the current president. Senator Jason Rapert is a past president of NCOIL. Those of us that go to legislative meetings around the country, we can be a little critical of how they run the meetings. Even good meetings can get a little tedious. NCOIL is probably the most efficient organization as far as presenting a lot of information in a well-organized manner in a relatively short period of time. So I wanted to call everyone’s attention to how they help us.


Sen M Johnson The national model bill, they take model bills when states develop something that works very well. They proliferate that as a model bill for other states. As a matter of fact, the PBM legislation that Arkansas passed, Senator Caldwell sponsored this one, if you remember, went all the way to the U.S. Supreme Court, and then Attorney General Rutledge appealed it and we won. Unanimous decision in favor of upholding the law. So I just want to talk about this is a good organization. I would encourage all of you to be involved in it. They don’t overwhelm me with information, but they give you a great way to understand it and keep you informed about it. NCOIL’s national meetings this year are March 9-12 in San Diego, July 19-22 in Minneapolis, Minnesota, and November 15t-18 in Columbus, Ohio. And I’m sure that the chair and the staff can give you additional information if you’re interested in this. This was actually the first legislative meeting out of state of any kind that I attended. And they kind of set the curve. And I’ve enjoyed a lot of our meetings where we meet with legislators from other states and learn things. I have to say that NCOIL is right there at the top. What a good job they do. So thank you, Mr. Chairman. And I guess we can let anyone that wants to know more about it talk to you.


Sen Hill Okay. Thank you. For anyone interested in attending that, please get with either myself or staff. And we’re going to back up on one thing. Senator Hammer has one more.


Sen Hammer Okay, So this is regarding Senate Bill 178. We put an amendment which added Representative Vaught to it last time. And then after the meeting or during the course of the meeting, Senator Irvin asked to be added to it. But just about 5 minutes ago, I had the Arkansas Medical Society come to me with a proposed amendment to go on it, which I’m agreeable to. So what I’d like to ask, Mr. Chair, is if the committee would expunge the vote by which the amendment passed last time, which was just simply adding Representative Vaught to it. Then what I’ll do is I’ll take this, I’ll engross it and run it members own, add Senator Irvin. And this proposed recommendation has been brought forward this morning to me and I will send it back in here as a clean bill with this amendment in it so when the committee looks at it next week, then it’ll be totally engrossed. You’ll have Senator Irvin’s name on it. It’ll have these recommended additions in it. And it would be a cleaner way to look at it. But if I could get that expunged, then I could do all that at one time, adding her and the other one.


Sen Hill Motion by Senator Irvin to expunge the amendment that passed. Second by Senator Johnson. All those in favor, say aye. Opposed, same side. It has been expunged, sir.


Sen Hammer Thank you, sir. Thank you, Committee members.


Sen Hill Appreciate everyone’s time. Appreciate you coming in. And we’re going to adjourn before someone has something else.