 All right, we're back. It is 1012 on April 28th and we're going to go through. We're picking up on s 120 where we left off and now that we have ledge council with us we are going to go through the language and see what changes have been made or the improvements that have been made. Great. I will. Now can you let me share my screen. I will put up the language. All right. Jennifer Carby legislative council this is s 120 and we're looking now at draft 3.1 which I believe is posted, and specifically at the pbm and 340 be language. I've done a markup showing the changes from the earlier versions that we've looked at. This is still adding some language in title 18 and an existing section on pharmacy benefit managers pbms and their required practices with respect to pharmacies. In this new subsection D, it would say that a pharmacy benefit manager shall not. And then we took out this sort of broader language and stuck with the narrow to narrow provision so shall not require a claim for a drug to include a modifier to indicate that the 340 be drug unless the claim is for payment directly or indirectly by Medicaid or restrict access to a pharmacy network or adjust reimbursement rates based on a pharmacies participation in a 340 be contract pharmacy arrangement. It would prospectively repeal that on January 1 2023, which keeps it in effect through the end of 2022 and at midnight. As it turns to 2023 that's when they repeal would occur. So obviously you can change this date I think the way the language had been provided to you was that it would take effect immediately and would expire on this date and less run December 31 2022 unless it was extended. And it does the same thing, because the legislature retains that ability to modify or extend the date, but it sets it up to happen, and then it has DFR, and the Office of Attorney General so on or before January 15 2022 DFR. So the question with the Office of the Attorney General would report to this committee House health care and to the finance committee regarding national activity affecting participation in the 340 be drug pricing program, including recent changes to the program in which prescription drug manufacturers pay rebates to pharmacy benefit managers for prescriptions filed through 340 be pharmacies, the potential impacts of these changes on Vermont stakeholders including individual Vermonters, and possible state responses to prescription drug manufacturer and pharmacy benefit manager actions related to participation in the 340 be drug pricing program. And then finally in the effective date section. I struck out the language saying that the PBM 340 be provision would take effect July 1, and instead just says it takes effect on passage. So everything would take effect on passage. Okay, thank you and we do. We do have this on our webpage and the changes do begin on page seven so we're all set. We probably can take that down less committee questions on the language for Jen. That's there you go. That's good. All right. Committee discussion. Jen really thank you so much for working with folks on this. And it really does offer clarity is extremely helpful. You know, we, what we said before you got here was that these, these types of things come up at the last minute frequently. And fortunately, we were able to make some changes that accommodate the request hasn't been easy. It never is. But I think it does. It is important going forward. So, thank you for being with us on this one. Good. Okay. Any other questions discussion committee. Any other questions overall on s 120 discussion. I have one item. It was brought to my attention by diva. And diva was asking if the primary care study could the one that asks how much will it cost to what are the costs associated with two primary care visits for everyone without copays. The suggestion was to put that into the benchmark study with DFR. Unfortunately, the bill had already been through the budget process and was taken out of the bill that we have before us. And then I heard from the green mountain care board that it might cost some money to do the study that we have in there so that's that's that's hanging out there my suggestion to diva was to please take this to this to the house and perhaps to the appropriations committee as they negotiate the budget so it it's not something that we can deal with right now it's unfortunate. That one came too late for us to consider, but probably a good suggestion. So, at least in my mind. That one I'm just letting you know that that's out there and senator hooker you're you're on the hook for that one in some way because you're reporting the bill but go ahead. Right, so it's still included in this bill. No, the, which does the primary care primary care is in the bill absolutely it's in the bill. It is in the bill. The request from diva was to include primary care analysis. It's in the benchmark plan. Senator Cummings. Yesterday we had some talk about the administrative cost study and what it was going to include like the cost of complying with our are taking part in our. Health care reform, health care reform, the bill back for all right care. Just to make sure that it's not a yep it's gone up 20% but it's gone up 20% because have we covered that. There are no changes. I have not made any changes to the report requirement. So right now it still says just an analysis of the increase in administrative expenses with the increases in the CPI it doesn't. It doesn't break anything out. I think analysis might imply the type of information but are you would you like to see might be helpful to say, including but not limited to cost of participation with, you know, health care reform efforts. Cost that have been shifted from the general fund. We've, we've done that. Would it be helpful, Senator Cummings to have in this information that gets provided. So now the language is having the Green Mountain care board provide an analysis just of those increases do you want them to break out sort of which ones, nor what the increases are, both including and then excluding the, the bill back the premium processing. Yeah, administrative costs. The first assumption is oh everybody got a raise. Yes. Our a lot of raises and I think we need to make clear that there are other factors involved in the increase in that cost. How we do that, I don't know. We could look. I mean, I think you can, I think we can, can have the the board present the information, you know, I think we can put language in that directs them to maybe to break out the different, either the different categories, you know, or exclude these types of expenses. You know, so they could give you an overall administrative costs, and then administrative costs, excluding these categories or the increase. So we know all of them but broken out by category cost drivers by category. That's good. How's that. I think that works. So, so just to say the board shell shell just trying to think of how to say it. The analysis shall include or will have Yeah, I don't know how to show categories of expenses related to increases over time something like that. I think Senator Cummings language about cost drivers is is appropriate and they should know what that means that that's a term that's used for what what is making the administrative costs increase and that works. Nolan is here. Yeah, you could instead of being specific you could say including causes drivers and other I just added a second sentence that says the analysis shall break out the administrative cost drivers by category. Is that, is that get at what you're looking for. That's great. Done. Good. Good reminder Senator Cummings thank you. Do you want to show it to us Jen briefly after you get it. Sure. Okay, yes I was just updating the number. Okay. So yes let me put it up. What does that make it 3.2 3.2 because I have to take out the highlighting and stuff anyway. So this is the new sentence here. So we have just analysis shall break out. Do you want to take out the word the before administrative cost drivers and just have it be administrative cost drivers by category that always implies that there's kind of a definitive number and I'm wondering whether that's possible. Could go into into micro categories. Well, we'll add inch maybe we'll add insurers. Yeah, in here so it's clear they don't have to compare the cost drivers in the CPI. Yes. I wonder if it should say so breakout administrative costs and cost drivers because you have your costs which are fixed. And I think of cost drivers as things that are constantly pressures. How's that. How's that work with our financial wizards. Is that good. Senator Cummings is that work for you. Where is she. It's so hard when we can't see each other. Ruth you're a good with that. I would just say the analysis shall break out insurers administrative cost drivers by category. Okay, so Nolan that's what I had. Yeah, that's what you had. So then Nolan suggested to put in administrative costs because there are some fixed costs. I think it's just redundant but you know I don't have strong feelings about it so you know either way is fine with me. Let's let's leave the Department of redundancy and for now. Okay, you know, still has a ways to go. Okay. Should we also in the in the area of redundancy, Senator Hardy all of this, but show the analysis shall identify and break out. I think it's I think that's redundant. Really. That was really redundant. Jen Jen gets paid by the word I'm just trying to help her. Oh, no. We go for conciseness. I think honestly I do think that the folks filling it out will know exactly what we're looking for and I think I think you're right. We don't need. Right, and this might be a yep. Okay, this is good. Are we good with that then. Anybody on the committee not good with it. All right. Let's. So Jen, does that make it then 3.2. Yes, and I also will stop sharing. Yeah. And I will take out the highlighting and the, you know, clean up. The PBM stuff. Okay. Okay. Any further discussion. Anything else. Now I would accept a motion. On draft 3.2. Yes. I move that we accept draft 3.2 of S 120 pending. Clean up. Yeah. Clean up has been completed. Clean up is completed. Can you send that to Nellie so it's on our webpage. That'd be good. That'll be the final, the final draft for the reporter. Okay. So are you suggesting that you'd like to pass this to the full Senate? Absolutely. Okay. Committee discussion. Questions. Senator Taranzini. Yes. Thank you, Senator Lines. I'll. Call the roll for S 120 draft 3.2. Starting with myself on me. Yes. Senator Hooker. Yes. Senator Harris. Yes. Senator Hardy. Yes. Senator Lines. Yes. I have a vote of five to zero, zero. Perfect. And Senator Hooker, you are the reporter. Yes, ma'am. Okay. And this bill. So in discussions, uh, various discussions, discussion number one, the bill will go to rules. And I understand that there is some interest on the part of, uh, rules we're hoping to move the bill out favorably to. The full Senate. So that. Senator Hooker, you may be invited into rules. I'm on that committee. Yeah. Huh. I'm on that. Yeah. Okay. Good. All right. And so it's either you or me, but you're perfectly capable. So the, um, And then the other issue on this bill is that. And talking with my Senate. Uh, Peer. About the bill to the, in the committee of jurisdiction in the, in the house rather. Um, there was huge concern expressed about the lateness of the bill. So, um, We're continuing a dialogue and I understand that there will be a dialogue going on, uh, in the. Other places as well. So just to let you know, this is a. This will be a heavy lift for house members. No, imagine our getting a bill right now that. Uh, I don't know. But it's not like they haven't known about it because I've been in conversation with representative Lippert now for a long time about the bill. So that's it. For that one. Good work. Thank you. Thank you, Nolan. Thank you, Jen. Um, committee. Uh, thank you folks who are still with us, uh, Helen and, um, I appreciate it. It's good. Okay. Anything else committee? Cause I think we're really, uh, I don't have anything else on the agenda for us today. As I said, keep your eyes open for Friday. We may have an update from, uh, CDD, uh, DCF on, um, residential children's residential care facilities. So thanks, Jen. Um, okay. So we're good. Excellent. Now you have some time to, uh, Get ready for the floor. I know that there are a lot of bills of ours coming up.