Health 2.9.26

Let's give it just a few minutes so we get a few more members here. Okay. Let's come to order. We have enough members here to begin. Yeah.

Okay. We have enough folks here now to begin this meeting. I wanna begin with saying there's a sign up sheet at the end of this table. If anyone wants to speak to a bill, that's the sheet to sign up on. Number two, we're gonna have a rules change, and that is on line 10 in your committee folders on the health, committee rules.

Number 10, we're gonna change that two hours to one business day. We're getting substitutes all the way up to when we coming in this door, and, that's not fair to you. It's not fair to the people that are bringing these bills, and it's mostly not fair to the people we represent at home. We're not gonna force gump our way through health care legislation. We're gonna get it right.

So it will now be a business day. You can do short amendments, a line or two in committee. That will take the load off, legislative council. They just have to redraft these substitutes, and there's many substitutes coming, and sometimes it's just one line. We can handle that in committee.

Okay? If it that one line changes the bill substantially and you do not feel comfortable with voting on that bill, you voice that in committee. And, if that motion holds, or is felt by majority of this committee, we will hold that bill until you feel comfortable. You got elected to represent people at home, and that's what you get to do. Okay.

Enough said.

Let's change it to what?

We're gonna change it to one business day.

Okay. One business day.

Do I hear a motion? So moved. Do I hear a second?

Second.

All those in favor? Aye. All those opposed? Thank you very much. Okay.

Our first bill up today is gonna be HB970. Representative Townsend. Would you would you say the LC number for me, please? Yes. We need to go to a microphone.

Yes. One right there closest to you.

We'll have doctor Kim sit beside

me if that's okay.

Thank you, chairman Hawkins.

Oops.

Thank you, chairman Hawkins. It's l c six five zero zero zero six.

97. 97.

I don't have one going. Alright. I think I'll be pulling off the wrong line.

I'm sorry.

I read the wrong LC.

Yeah. I I read the wrong LC. Sorry, Chairman Hawkins.

Alright. Let's try let's do it again.

And it's not your seat mate playing a practical joke. I promise. LC650051S.

That's what I got. Y'all have that? Okay. Good.

Yeah. Thank you.

This is a really a cleanup bill. It's something that Georgia High School is doing. Just started, doing the past few years, and they endorsed this bill. This actually requires, students who are part of a high school organization such as Georgia High School, not limiting Georgia High School for, at a high school athletic sports to go through a physical. And the key points there is gonna have to be a doctor, a DO, doctor of osteopathic medicine, a nurse practitioner or PA conducting exams.

Plus, it's gonna have a cardiovascular prescreening to ensure, as much as we can, as you know, safety of the athlete. Unfortunately, as you know, we've had athletes, especially in fall football practice or other times, to fall to cardiac arrest or other areas in that, field. And, we're trying to eliminate that as much as we can. And so we do have support of quite a few people, including American Heart Association, of course, and the, well, again, Georgia High School as well. I'll be glad to answer any questions.

I can go more in-depth, but it's a pretty simple bill. They are doing that now. This would help them. This actually helped them tighten up their policy once we pass this law. They thanked us for doing this, And it's just really a win for students, which is the most important thing.

If you know anything as you guys agree with education, it's all about the kids, period. Then after that, this is also good for parents and, of course, the practitioners in the school schools as

well. Okay.

This is doctor Kim beside me. I apologize. You may give us a Yes.

Go ahead, doctor Kim. Oh, would you, tell the, committee who you are and your credentials?

Absolutely. And, actually, it's a it's a real privilege to be back here. I actually testified maybe a year and a half ago for Georgia House Bill eight seventy four. So, it's really a pleasure to be back. My name is doctor Jonathan Kim.

I direct sports cardiology at Emory University. I am involved also with the American College of Cardiology. I'm the chair of our Sports and Exercise Cardiology Council, there as well. And so, certainly, talking about screening for student athletes from a cardiac standpoint is, well within my arena of expertise. So I was delighted to hear about this, bill proposal, and really what it is stating to do is being consistent with what the guidelines are from the American Heart Association and the American College of Cardiology.

So there's really nothing new in this, as it relates to what certainly, hopefully, most high school student athletes or secondary school student athletes are already going through as it pertains to a history and physical. It's just codifying this to ensure that everybody's on the same page, and doing this the right way. We're just following through with the guidelines. And what we are asking to do is a, cardiac history very much focused on questions relating to when when exercises if there's specific cardiac issues, and these are all very well outlined in terms of the questions to ask. And then ensuring the physical exam is very focused to look for specific features that could be concerning for a cardiac, problem.

And then the last part along with the history is a family history, because many of the conditions that can cause cardiac arrest among young student athletes are genetic heart conditions, and so we wanna ensure that there's not an underlying family history that could be concerning. Now it is very important to emphasize prevent these, events, there's nothing that's gonna 100% eliminate, tragic events. But ensuring that we do this and then if there are abnormalities detected moving forward with the next battery of assessments and seeing the right providers is really important. And I think by doing this, and, I think one of the most important parts about this, this law this legislation is that we are stating that because things can change, of course, over time as it relates to science and what the best practices should be, is that, a very important emphasis here is that whatever is, mandated here is that, schools just comply with what the the national organizations recommend. And, again, that's the American Heart and the American College of Cardiology.

So there's not, new proposals that are against what these organizations are stating from a cardiac standpoint, and so that's really important as well. And and with that, I'd be happy to answer any questions.

There there is a question. Not sure which one it is. Representative Clark.

Thank you, mister chair, and thank you so much for this presentation and the bill. As the mom of a student athlete, I do understand how important this is. I do wanna ask very quickly if you could just kind of describe for us what these, cardiovascular prescreen screenings entail. Like, what are what's actually being done

Yeah.

And if these are, being conducted at a doctor's office or can they be conducted at the school?

Really important question. So what's entailed is asking a series of questions, checking vital signs, blood pressure, because capturing early hypertension can actually be really important even though that may not be a sudden death related. It's just good medical care. And then a physical exam, which is a stethoscope on the chest, and, of course, there's a whole body medical exam that should occur, but this is very much just focused on a cardiac exam. So stethoscope on the heart, feeling for pulses, looking at what the individual looks like because there can be some, conditions, called connective tissue diseases that come with characteristic physical features, that you wanna be able to ensure that you're capturing that could trigger some, alarms potentially, necessitating further evaluation.

So so that's it. And where it can happen can actually, be not just a cardiologist. So we're talking about a pediatrician, an internist, family practice, nurse practitioners, and physician's assistants as well. So this is, again, not something that should be an additional, kinda area of work or or imposing on workloads for busy practitioners out there because all of these things are already being conducted. Most of the time, you can certainly, there can be physicals performed on-site at schools if practitioners come to the school, but a lot of times students are going to their pediatrician beforehand and having forms filled out, or situations such as that as well.

If I can add to that.

Thank you, doctor Kim. If I can add to that for you too real quick. I've seen many type fiscals occur like what you talk just talked about in the schools. It's it's happened in gyms, cafeterias, classrooms. It's happened in doctor's offices.

And so it's really up to the parents. This we we're that's what we wanna keep it at too. A lot of your smaller systems will a lot of the kids will go to the schools for that. But as you get to a larger system, it's easier for them schedule wise to go to the doctor's office.

Yeah. Thank you.

Okay. We have someone, Lori Bracey, to speak to the bill.

No. You're good. Sure.

I am Laura Bracey with the American Heart Association and just wanna say that we support this and thank representative of Townsend for bringing it and ask for your support.

Thank you. That's quick enough. Who's number seven? Oh, Representative Mayviak. Thank

you, mister chair. I am a chiropractor by trade, and I have some chiropractors that are certified in sports chiropractic and they do some of this. Would you be opposed to adding their name to this if they're specifically certified.

Yeah. No. So I'd have to do research representative to to get that, confirmation of what's the normal practices around the the country and

When you when you put in best practices, that that's the standard of care. Correct, doc? Yes. So it would be it and I I've signed those forms myself that have specific, questions that the school system wants themselves. So that's why I'm asking.

Certainly, the questions, I think once you start getting into kind of a cardiac specific exam, which is Right. Again, that doesn't have to be a cardiologist, but at least a general medical practitioner. And, it to be honest, I don't wanna say anything I'm not a 100% sure as it relates to chiropractors doing these. I'm not a 100% sure if that is kind of standard across or if other, if others do that or just across the board if, some chiropractors are more comfortable or or knowing kinda what to to listen for. Again, the questions, I think, are ones that anybody who's trained in this understands the right questions, and all of these are outlined to go through.

And so, but I think it's more kinda that kinda cardiac exam because what you wouldn't wanna do then is for, individuals who aren't comfortable, all of a sudden doing it just because they're listed here. And then, and and then that could lead to potentially a situation where, maybe a practitioner is uncomfortable or if it's just not necessarily, the it kinda consistent with the best standards of care as it relates to doing these.

That's what that's where I saw it when you put, standard of the best practices standard of care. That's where it would be, some belt and suspenders there if that doc doesn't know those best standards. They shouldn't be doing it. That's

And it certainly hasn't that I mean, in general, chiropractors haven't been listed as it relates to kind of the list that we have here, which is, I think, kind of generally speaking, the the the individuals, who, have done these in the past, the licensed individuals that we've already that we've listed here.

Right. Well, when you added nurse practitioners, I thought, okay. Are they specific to heart cardiac two?

They can't. Absolutely.

Some of them? Absolutely. Okay.

I'll tell you what, representative. Let's go ahead and move the bill as is, and you can go work with the author in the future as it moves forward and and address your issue.

Thank you, sir.

Thank you. Representative Clark.

Yes. Thank you, mister chair. I just thought of another question as we're, thinking about this also because my daughter is an athlete. If I'm an athlete and I have my birthday is this month, February. I would get my physical this month, and I would not be due for another physical until February.

But if I do winter sports, technically, I would have a physical that is not under this current law. Would that person need to get a second physical that includes this prescreening? And if so, if they if they do, we might run into issues of insurance coverage. Because I can tell you, like, you get that one and they will not let you come back until exactly a year later. Otherwise, you have to pay a pretty significant amount.

So timing wise, we might need a little bit of a delay because winter sports starts in in, like, October.

Correct.

And they wouldn't be due for physical. So there will be a significant chunk of students that don't have a prescreening.

Your your if I can answer that one, your schools will will advertise this beginning in in the spring for your winter your fall and winter sports. It's good for if you look at line 23, then you'll see the underline portion. It talks about when the dates are, and it's very specific. Every now and then, a parent may get out of whack with the if they're they didn't make the school. School I haven't seen a school yet that hasn't offered physicals at their facility.

All systems do that. And so if they miss their school physical at the at the school facility in that time period, then they're on their own for going to the doctor to get that physical. If they meet those guy if they always do their school physicals at school itself or within the school system, this deadline won't be a problem at all. I had three girls who played softball and tennis and golf, and they were active. And there were one or two of them at times, We just missed the date, and we had we was like, oh gosh.

Let's get it done. And we're able to catch up. It it kinda knocked us out for one year. They didn't miss any sports. We just had to get the physical late, and then then we followed up the school physical later that spring or whatever else.

So that should not be a problem because it is offered plenty of time, and they've that I've never seen that. I've been involved in sports since, gosh, over twenty five years. And so I've never seen that issue itself.

So I guess I have. So there are times, for example, my daughter gets her physical in May. And because of getting the physical in May, if she wants to do summer ball, if we are even a little bit late, it can run into issues. And I don't know that we require all school systems to provide a physical at school. So that means they do have to go to the doctor.

And then just insurance wise, it's not covered. I love the bill. I just think I'm worried about the the handful of students that will not be prescreened in the 2026 winter sports just because they're they're getting screened today. And this bill is not in place today, and they will not be due again until next February, but they'll start playing sports

and October.

Date because if you look at line 24, it says, if conducted on or after April 1, the preceding applicable school year, school will remain valid through the following school year. So it's good for that following school year. It does that cover it?

On or after April 1. I'm talking about let's if they got it today. So I don't wanna maybe we can we can talk through this. Yeah.

Figure it out.

Yeah.

We'll put that calendar and make it

I just wanna make sure we're not leaving some students out that need to be screened.

I understand.

You have to make it.

I I'm sorry. I didn't mean to push that. I

waived. Okay.

Is there another question over there? Oh, okay. I thought I turned it off. Got got some glaring lights here. Okay.

I see no other questions.

Can I make one more comment then just because I do think of support? I thought somebody might have asked, which would be a great question. Like, does this mean that they have to get an EKG or an electrocardiogram? And the answer is no. The last thing we wanna do in the in the ACC and the 100% do not support required EKGs for a lot of different reasons, which I don't have to get into because nobody asked the question.

But part of the emphasis here is to note that this is stating that, Georgia should abide by what the and the ACC are recommending. And they've thought through in detail as to why required additional testing is not a good idea to require beyond kind of just a good medical exam, which is all this is saying. And so I believe we believe that this will help prevent some of these other type of laws, which I think can actually be harmful. Are there unintended harms that come with requiring tests? And so it's another important reason, to codify this.

So that was all I wanted to say.

Thank you very much. Okay. I see no other questions and no one else has signed up. Do I hear a motion? Second?

All those in favor, say aye. Aye. All those against, say nay. Well, congratulations. Representative Townsend, you have a due pass on HB970LC650051S.

Thank you, chairman. Thank you, committee. Appreciate it.

Thank you, mister chair. Thank you, committee.

Okay. We're gonna hear, HB1138 next. Representative Kemp. This is a hearing only.

Thank you so much, mister chairman and committee, for allowing me to be here today. We're looking at HB1138LC461351, and I would like to apologize. I am one of the latecomers that elicited the change in your rule, so please forgive me. That's one of the wonderful things in the general assembly is all of us know things get perfected over time, so, this is a work in progress. There have been some adjustments made, and we can discuss those after.

But introducing the bill, the increased access to contraceptives act allows expanded access to contraceptives. Number one, by allowing pharmacists to dispense self administered hormonal contraceptives like the pill, or the patch, and or administrable injectable hormonal contraceptions like progestin shots. It amends the state's insurance code to require that insurers provide coverage for extended supply of certain contraceptive contraceptives. It amends an article within the state's medical Medicaid and other state funded programs to cover certain contraceptives and extended supply. So this bill came to be because I do have a 25 year old daughter, and she is not here today.

She is, working. But, she had a challenge running out of a prescription and having to wait two months to see, unfortunately, her her doctor to get a refill on the prescription, which is a pretty common thing, believe it or not. Our OBGYNs are very busy people. They, they do a lot of wonderful work, and so this is certainly not a jab at them by any means, but having access to this already exist in 36 other states in some form where pharmacists are able to prescribe these forms of contraceptives. So for this reason, I bring this bill here today, and I'm happy to answer any questions.

Representative Clark, is that you?

Yes. No No one's before me. Alright.

Thank you, mister chair, and thank you for the bill. I I I like where this is going. My my two questions. The first question is, does this bill require a person to have already had a prescription for contraceptives from a doctor before a pharmacist is able to do this, or is this just like a person who's never had contraceptives before able to do it? Because that will lead to my second question.

Well, if you're under the age of 18, I'm trying to find the line, it does say that you need to have a prior prescription. Okay. So so yes on that count. I do not believe that is the case on on everyone. I do believe it's just if you're under the age of 18.

And there are different provisions for injectable, as well.

Okay. And then my second question to that, if I am over 18 and I would like to, use this, maybe I don't have a primary care physician and so this is opening doors. Is there any concern about, estrogen, like, combination pills that contain estrogen, versus, like, progesterone only pills, which are sometimes, so for example, if a person has clotting disorders or or situations like that, estrogen is not recommended. But a person might not know that if they don't also have a PCP. But progesterone only can be used for that.

Is there any concern about making combination pills available to people who have not been counseled about those concerns?

Representative Clark, I thank you for your question because that leads into an important aspect of this. This also sets up a procedure where our pharmacist will be trained, and they will ask a series of questions. For example, do you have a history of various things, cancer in your family? Do you have, you know, history of clotting clotting issues in your family? There is a whole list of questions.

There are some individuals who are gonna go to their pharmacist. They're not going to be prescribed medication that day because they have conditions and that criteria that do not meet the requirements for the pharmacist to prescribe that day, and they're gonna be counseled to go see an a doctor, an MD, an OB GYN, a nurse practitioner, someone who can go and go down that road with them if they have a family history or a history themselves of of an issue.

So I

thank you for that.

Yeah. Yeah. If you look on page, what line 39 it talks about composite board of medicine and the state pharmacy board, writing a joint, protocol agreement, and I'm sure it'll be within that protocol of of what is reasonable for the patient.

Yes, sir. And

training also.

Exactly. And you can go to Tennessee has a very robust website, and you can seek some of the training, some of the questions that are asked there. It's that's one of the states that's already successfully doing this. You know, in our state, we have such a challenge with access for medical professionals, allowing pharmacists to operate at a higher scope of practice and especially rural communities or maybe in communities in more urban areas because there's a lot of pharmacies versus access to doctors' offices. So this is just really to me opening up a whole new stream of opportunities for women to be able to access contraception.

Right. Also, if you'll notice online +1 63, it holds the practitioner, they're they're not subject to civil liability or criminal or professional discipline. That's necessary because you have a protocol that's gonna go into way into the future. And any changes, you know, we'd hate to hold our physicians accountable for something that, may happen way in the future.

Yes, sir. And there could

be a delegation. There could

be a contraception in the future that, I mean, is as easy as chewing gum. We don't

we just don't know. Right.

I see no other questions. We do have someone that signed up to speak.

I have a question.

Oh, I'm sorry. I didn't okay. Go ahead.

Thank you, mister chair.

Yeah. Just a quick, question, representative.

How does this bill protect, patient privacy?

Well, it specifies that the location where the patient is counseled, the consultation is to take place in a private area. I think we all trust our pharmacist with our personal information. Honestly, my pharmacist knows all the medications that I'm on, without me even having to tell. And, you know, I go to another doctor and I have to write down the list of everything that I'm taking for other physicians. These pharmacies have this information.

I feel confident as licensed medical professionals in our state. They can keep it confidential. If they do not have room in their pharmacy, and we do have pharmacists like this, they don't have room in their pharmacy to have a private consultation for with someone, then perhaps this might not be what they need to offer. They're not mandated to do this. This is an option.

And I hope it's an option that, that our pharmacist will take if they do have that privacy available.

Thank you.

Oh, thank you.

That's it.

Seeing no seeing no other questions, we do have someone to sign up to speak. Jesse Levington. Why don't you go ahead and go to that, Mike? We're gonna have to do something about our renewal arrangement in the future. And I apologize about all the folks standing up, but we wanna do something with the tables and get more of those seats back out there, hopefully.

Go ahead.

Thank you, mister chairman, members of the committee. My name is Jesse Wellington. I'm the president of the Georgia Association of Health Plans. We're here today in support of representative camps house bill eleven thirty eight. We think this is a welcome measure that can increase access to quality affordable health care.

It's important for patients to have options in their communities. I couldn't agree more with your comments about, pharmacists being able to practice at the top of their license being an important, boost to access for patients in the state. So we think this is a welcome measure.

So you're okay with the twelve month supply?

We think that actually could save money.

That's what it looks like. Yeah. Great. Boy, it's nice that we we agree on something, isn't it? Supplies.

Yeah. Actually, this is a fine young man. I've known him for a long time. He's just in a tough spot now sometimes. Alright.

Any other questions? I see no other questions. This is a hearing only. Representative Camp does have a substitute that we did run into a little problems

of

getting that printed into folders. So, do you wanna speak to that? Is it just a couple lines if I understand that right?

Well, it's, upon a little bit further review, maybe just a few more lines. But one thing that was not addressed in the original bill was actually compensation. If a pharmacist is taking time out of their day to consult with a patient to go through, what we talked about with representative Clark, go through a checklist and make sure protocol is followed and also counsel the patient, then in other states there is there is a mechanism for compensation for that, So that's one thing to be discussed. Another thing had to do with continuing education, and so I'm happy to come back and speak to you again on those issues.

That's good points. And I hope mister Weatherington will stay on board with that. You're good. Okay. Great.

Okay. Thank you very much.

Actually, miss, chairman Hawkins

Yeah.

We've got a

I'm sorry. Go ahead.

I believe there's, another person that would like to speak if possible.

Oh oh oh, I'm sorry. I I missed it. Yes. Winnie Sophie? Thank you.

Good afternoon. Hi, Chairman Hawkins and members

of the committee. Thank you

for giving me the opportunity to speak today. My name is doctor Winnie Souffy, and I've been a practicing OB GYN at Northside Hospital for thirty years. And I speak for myself, and I'm also the serve as the legislative chair for the, Georgia OB GYN society. I'm here to speak on behalf of the society to express our strong support for House Bill one one three eight. This legislation is a critical step forward in expanding reproductive health care access by authorizing pharmacists to dispense self administered hormonal contraceptives and administer injectable contraceptives.

Sorry. I'm getting a cold, so my voice is. Our position is rooted in clinical evidence and aligns with the American College of Obstetrics and Gynecology, or ACOG. ACOG recognizes that pharmacists prescribe contraception as a proven, safe, and effective way to reduce the barriers many Georgians Georgia, women face, including scheduling delays, transportation hurdles, and limited clinical, hours, which was already expressed. Statistics often hide the real human struggle of our workforce crisis.

A colleague in rural Georgia recently told me a story that in her community, there were four OB GYNs and three of them, they lost three of the four OB GYNs. So she had to take care of, Medicaid patients, and she was the only practitioner for about nine months. Because of this, she could only accommodate patients that were high risk pregnancies and could not see the preventative, women, you know, taking care of women to refill their prescriptions. So as a result, there was a particular patient that she had that was looking to get an appointment and she couldn't get an appointment for six months. She had a baby and she was a nursing student.

She was a working woman and she also had two children. So needless to say, by the time she got in, she was pregnant again. So, this is again financial responsibility for her and loss of income. So this could have definitely been prevented. And having this bill present, this would have avoided this circumstance.

So, basically, it wasn't a, it wasn't her financial failure was interrupted not by her choice, but the lack of access. In 82 of Georgia's one, 159 counties, there's no OB GYNs at all. We must face this reality. By allowing pharmacists to provide these services joint protocol with the Georgia Composite Medical Board, we are not replacing the doctor patient relationship. We are ensuring that patients who cannot reach our offices still have the essential care they need to plan their futures.

House bill one one three eight helps close critical gaps and access using our existing highly trained health care workforce. On behalf of the Georgia OB GYN society, I urge you to support this bill. Thank you.

Thank you very much. Appreciate

that. Thanks.

Okay. Cool. We have no other questions. No one else to speak. So let's move on to our next bill, which is h b eight ten.

That's l c 461418 s. Representative Jaspers. Yeah.

Glad I

used them.

I don't wanna see them

here. Yeah. Yeah.

This one is ready? When you're ready.

Hey. Thank you, mister chairman and committee for hearing this important bill. Like I said, this is LC1418S. I just first wanna start out thanking our, legislative council, Vince. There's been a lot of hands and work in the kitchen working on this bill.

And, council, we appreciate you so much. You're a gentleman, scholar, and, we appreciate what you've worked with all of us on. You know, I grew up in a drugstore in, Kohl's in Kingsport, Tennessee. My father, Don Jaspers, was the pharmacist or the druggist at the time, and I saw firsthand what a pharmacist can do and does for patients. In my world, I made ointments, filled capsules, and I cleaned the milkshake machine.

And so and this is why that this issue is very passionate for me, and I've taken work in this for years. But in current times, I became friends with the pharmacist, Katie Bell, when she reopened a stand alone pharmacy that had been opened in this one site for over seventy years in Sweet Little Tate, Georgia. That's where the marble in this building comes from. It's where the marble in the new building that we're building comes from. And Katie offered service and care

to her

community. During COVID, she was the community's connection to vaccine. You know, due to her persistence in keeping a waiting list and working to get the vaccine, she made a difference. But the clouds were on the horizon for her shop and the same clouds that my longtime pharmacist and award winning pharmacist, Jack Dunn, of Jasper Drugs, told me many years in the previous in previous talks, she closed her doors. You know, both of them told me pharmacy benefit managers will make it nearly impossible to keep the doors open.

Members, we have an unfolding crisis that's happening behind the pharmacy counters across our state. Since 2015, 200 pharmacies have closed their doors. For too long, we've allowed the middle man system to operate in the shadows. The pharmacy benefit managers were supposed to lower cost. Instead, they become a gatekeeper of our health care.

But the most dangerous tactic they use isn't the high price difference in prices. It's the underpayment to our local pharmacies. Right now, many of our pharmacist chains and independents are being reimbursed for less than what it actually cost them to buy the drug. So imagine $3 for a to you have to sell milk for $3, but you gotta buy it for 4. You know, it doesn't last long.

No business can operate like that. And that's what this bill does. We're we're fighting for a flat reimbursement right floor, and that's what house bill eight ten does. A reimbursement reimbursement floor is simple. Common sense line in the sand.

It ensures that pharmacies can stay open. We stop pharmacy deserts before they start. When a local pharmacy closes, seniors and others have to drive long, many miles to get their medication. Patient care comes first. When pharmacists aren't fighting to keep the doors and lights on, they can focus on what they do best, counseling patients, saving lives.

And Fair Play, we're into the practice where PBMs underpay local pharmacies while steering patients toward their own pharmacy. The pharmacies are simply asking for fairness. We are asking for a health care system where the middle man doesn't profit by starving the provider. It's time to pass this reform, protect our pharmacies, and pet our patients first. As a reminder, house bill one ninety six by mister Kelly was passed last year and created the same reimbursement model with claims under the state health benefit plan.

This simply expands it to all commercial plans. Kentucky and Virginia have done this. Now with me, I have miss Stephanie Katz. She's with the National Association of Chain Drug Stores and also miss Dickey Bryant who's not a stranger to this committee at all. She's a pharmacist at Adams Family Pharmacy in Preston.

And, mister chairman, if it's okay with you, I I have miss Stephanie will kinda go over the the nuts and bolts of this bill to make sure the committee understands it.

Absolutely.

Of course.

Go ahead.

Hi. Thank you for having me today. Stephanie Katz, again, the National Association of Chain Drug Stores. I am, I guess, a lawyer by trade, not licensed in in Georgia to and trying to keep my license here, but also have a master's in public health policy. So I've been doing this work for a long time, and I appreciate the your time today.

I'm just gonna walk through the bill just a little bit. It's a nice short bill. It won't take me long. But if I can draw your attention to lines 12 through 16, I think this is an important part of the bill to highlight because what we are talking about here is a very long list of different types of fees. This may be a little unusual in what you would see in a specific rate floor bill.

But the reason you are seeing this is that pharmacy reimbursement has to consist of the actual actual money that pharmacies are not only receiving, but that they retain. What we see with PBMs is a long list and this is a not limited to different ways that pharmacies are paid money and then that money is clawed back from them at a later later date. This makes it incredibly difficult not only to keep the doors open, but also to budget, to see what things are gonna look like next quarter. You don't don't know when this recoupment is coming. So this bill very wisely make sure that this pharmacy rate floor stays in place after all of those fees have been taken care of.

So if we can down down to line 16, you'll see the beginning, which is where we're talking about the way we're gonna reimburse burst drugs, and that's the national average drug acquisition cost. This is a very large survey. It's conducted by CMS. It is has long since been used. It gives us the average drug cross our cost across the nation.

And this is where you will see frankly, you will actually see a reduction typically in ingredient costs here. WACC things sorry. I shouldn't say WACC wholesale acquisition costs, things like that tend to be higher. But the NADAC is something we're seeing used across the country, and pharmacies will report in what they are paying for drugs. And then the government creates a file, essentially, where you can see what the cost of drugs are across the country.

Really importantly though here is the dispense fee, and I know this tends to be the question people have here. The dispense dispense fee acknowledged here is gonna be $10.64. A lot of people will call this a tax, they call it a fee. It is not a fee. This is simply paying a pharmacist for their time.

They are being paid for exactly what you've been hearing about today, counseling a patient, taking their time to walk them through their other medications. Really importantly, what they spend time doing is detecting drug interaction is incredibly fatal, frankly, if this is missed. And this is incredibly expensive on the rest of the health care system. There is a lot of money saved to the system when a pharmacist who is well trained, of course, and well educated is able to detect what is going to be a what is sometimes deadly and not always, of course, drug interaction. And that is a piece of that ten sixty four that we're seeing.

We are asking without that rate floor that we're seeing, without people saying we don't we we can't have this dispensing fee. We are asking pharmacists to be one of the only professions in this country to do their job and not be paid for it. And as you heard earlier, they are typically being reimbursed for that drug under the cost. So they are not coming in at a $10.64 moment for their time. Going through the bill a little bit further here, you see that we are asking for this to be taken into account before effective rates.

Effective rates are contract terms that pharmacies will often engage into with PBMs. I say engage. I I it's a tough word to say because, typically, there is no leverage for a pharmacy when it comes to a contract. They are engaging in contracts that are take it or leave it contracts. And if they leave that contract, they are not part of that network.

All of those patients can no longer go to that pharmacy. They can't get reimbursed for those for those patients, and the patients have nowhere to go. So when we say engaging in negotiation, I think that's a little bit of it is frankly, it's hyperbole at this stage. These are take it or leave it contracts. And so this these effective rates are basically prenegotiated.

So if a NADAC came in at twelve and the prenegotiated down to 10. Right? So that pharmacy would lose that $2 if the NADAQ was higher. The reason pharmacies will engage in these contracts is it offers them some level of predictability that they cannot receive right now when they're working with PBMs. They can at least move forward budget and look at their business model with knowing, okay, we're gonna get $10 per prescription.

So there's downside and upside risk to this. In this case, this would take those contracts and bring them to a point where they would again get NADAC plus the dispense. Of course, again, then the effective rate going in in July 1. Just to note, you know, quickly before we go, this is so incredibly important because as the gentleman that spoke on the last bill, and thank you for that indicating that pharmacists should be able to practice at the highest scope of practice. They can't do that if they don't exist.

And right now, we are seeing pharmacies close between four and six a day depending on your estimate, not in the state of Georgia, but nationally. We are not seeing pharmacies able to stay open at this stage. So in order for them to practice at the top of that scope, they need to stay in business, and we are asking for, frankly, the fairest and lowest level of reimbursement we can at this stage.

I wanna thank all of you for allowing me to come today. And I know most of you, you've heard my stories through the years, and I wanna tell you how much I appreciate your support in the past. Because the only way that I am sitting here saying that I own a pharmacy is the work that we've done so far. Georgia has been really blessed to have PBM reform in the past that has helped me to be here. But there is a problem.

I have two pharmacies, one in Webster County and one in Randolph County. In Randolph County, I have, started baking to stay open. You know my story. I get up very early. I bake homemade biscuits every morning, cookies and cakes, and that's what's keeping my doors open.

But the plan mix between those two stores is very different. In Preston, we have a very, very poor plan mix, And there's some commercial plans in Preston that are outweighing government plans that are regulated. And when I fill a prescription for a company, a government, employee that works for my county, that has a county insurance plan, and I lose thirty to forty dollars on their brand name prescription, I have to fill three Medicaid prescriptions or now three still state health benefit prescription just to get to the surface again. One prescription can offset three good reimbursing prescriptions. In my other store in Cuthbert, we have three corporations now who have moved their business to a transparent PBM model and are now reimbursing based on NADAC plus eleven fifty on their own accord.

One of those organizations is the is the banking association, and they are doing that without having to be legislated to do so. It has tremendously stabilized helped to stabilize my pharmacy. I'm I'm not saying that I'm gonna go out and buy a beach house or a mountain house, but the stress in that store is so much less for me just from three companies changing the way that that their prescriptions are reimbursed from their employees. And I I have to use those those prescriptions, that that baking, all of that to keep my other pharmacy open because it is dying. There are 48,000,000 Americans in this country that live in a pharmacy desert.

I live in an area, my pharmacies, we have patients in twelve twelve counties that we do through delivery. Two of those counties have no pharmacy. Two out of six counties in this state that have no pharmacy are mine. And, you know, we have to survive to dispense our control. Like, I was sitting over there listening to that and I was thinking, another responsibility for me for patient access, which is fine.

I love it. You know, advocating for patients and having access for them. I love those being able to provide those, but I have to be there physically to do that. And, you know, I I love my patients and I I wanna be there for them. And this this bill is essential for that.

We have to have some guardrails because PDMs have not shown that they are responsible enough to care about patient access. And, you know, they're they're responsible for Wall Street, and they don't care if my patients have access, and that's evident across this country. And so I just I'm I'm begging you to please consider this legislation, because pharmacies in this state depend on it for to survive.

Thank you. I appreciate those comments. When I was in graduate school, I took a course over the pharmacy school and had a number of friends over there. And I can't I I tell you, to to get into pharmacy school, you gotta be at the top of your class. It's tough.

Mhmm. And these are very smart people, and they deserve to do what will make a a good living. Mhmm. Representative Mitchell.

Thank thank you, mister chairman. And certainly, Chairman Jasper makes a compelling case for independent pharmacies. But but let me ask you, someone can, straighten this out for me. Mhmm. The professional dispensing fees

Mhmm.

They're currently $10.64. But who is going to pay that? Certainly not the PBMs. Is this a cost that will be passed on to the consumer?

Mhmm. I think I think there's a a bigger question there. Right? And it's the fact so I did a little fast math for you guys before we started here. But when we think that the three we come with the the three big.

Right? The the big three PBMs. We indicate they cover 80% of lives in The United States. I know there's some there's been some discussion recently that it's not that high. So for I I defaulted down to 70%.

So it's 234,500,000 Americans are covered by these PBMs. The problem is the PBM doesn't stand alone. It also owns that same PBM. So if that money is being passed on to the patient, that is because of a vertically integrated system that is monopolized by the same three companies that own two of the biggest portions of the chain. They also pharmacy counter?

Right? And now we have to add in the dispense fee. Well, where this differs is there is no gag clause that exists in the state of Georgia. So as a pharmacist and we educate them to do so, they can see that patients co pays $15 for this drug if I advise this patient not to use the insurance company that chose to set their co pay for a $4 drug

at $15 at the

behest of both that insurance company and that PBM. At the behest of both that insurance company and that PBM. So the question is, I think, why we are allowing this to be passed on to the patient. We're asking the pharmacy to do the job for free so that the PBM and the insurance company who set the rate for the drug and the co pay can actually extract benefit out of the system and then have their own patients pay the bill. Uh-huh.

I think that's where the real problem exists.

And the dispense fee is to keep my lights on. So it's saying we're gonna pay you the cost of the drug and we're gonna give you $10 extra. So if the cost of the drug is $4,000 like an HIV drug, and I only make 10, that margin is not very much. I spent $220,000 last year on HIV medications in my Cuthbert store. I profited 320.

200 and and 20,000, and I made $320 based on dispense fees because I got the cost of the drug plus $11.50. So it's the label, the bottle, the lights, the payroll, the rent. All of the things has to be taken out of that $10.64 on that prescription. It's not it doesn't even it doesn't even it's not just for my time. It's the overhead that my business incurs of even operating.

Representative Scofield.

Yeah. I I feel your pain. I I honestly do. I mean, PBM reform is necessary. But this my question is, how how does this bill address that?

Does it stop the problem? And what else do we need to do to fix it? It would Does this bill do that?

It would stabilize the problem. It would because this bill has a floor, it's equal to NADAC. So that means that the PBM can't reimburse me less than NADAC, but they also can't reimburse me over NADAC. And the FTC found in their study last year that specialty drugs were being reimbursed hundreds of times over NAIDAC. Mhmm.

So to say that this bill won't save money, it will. Because after when you bring those specialty drugs down to NAIDAC, even if the ones that come up to NAIDAC, we're still saying we showed a savings and state health plan last year. So

Representative Gesler.

Thank you, mister chairman. I just have a tactical question for you. So so it says that the reimbursement, needs to be equal to the national the the NADAC price, at the time that such drug was dispensed. And I'm wondering how often does that price that cost change, and does that create an administrative burden that works against the goal?

NAADAC updates every fourteen days. Mhmm. And every plan that is based on NAADAC, we have we have PBMs that reimburse Capital Rx reimburses that NAADAC right now in in some plans in my store. Okay. And Georgia Medicaid reimburses based on NAADAC.

Fee for service Medicaid reimburses on NAADAC. Mhmm. So whenever there's a NAADAC change, and it does change about every fourteen days, CMS has on their website what the Medicaid and ADAC pricing is. It's published. It's out there.

It's built in.

It's not a mystery. Yeah. And it's it's set. And those plans update their pricing when there is an ADAC change.

K. Thank you. Again, I like the moment.

Thank you, mister chairman. Chairman Jasper, thank you for bringing this legislation. I know I was honored to get to work with you last year as we did this for state health benefit, plan for the state health benefit plan, and we have seen some success with it. And simply all and and that passed unanimously right last year through the house. And, I'm just glad to know that we're taking a step here to, to expand this across all of our all of our plans so that, we can see this benefit not only for those covered under our the state health benefit plan, which most of us are on, but I think it should be spread across Georgia.

So thank you for thank you for bringing this.

Representative Clark.

Thank you.

I have

two very short questions. One is just a clarifying question. You just mentioned that, sometimes they for some specialty drugs Mhmm. They reimburse above NADAC. Mhmm.

So by this bill writing that it has to be equal, are we maybe cutting into some PBM profits? Yeah. Or I'm saying the pharmacy.

So I think what's important to note is part of the FTC report was indicating so when we we were talking about vertical integration before, sorry to to bore everyone to death, but so the big three also owned pharmacies. Right? And so these specialty drugs were being steered to their own pharmacies, and then they were over reimbursing their own pharmacies. I

get it.

Okay. We were getting a a windfall from this specialty overpricement, which at many times was in the thousands of percents that these drugs were being, over reimbursed.

Retail pharmacies aren't allowed I mean, most of them aren't allowed to fill specialty, drugs. They're sent to a specialty pharmacy. Mhmm. And most of those are owned by a PBM. Right.

Okay. And then my second question is, about the fees that, a lot of these fees that you mentioned, some of them are due earlier than others and some of them are due later than others. But the way the bill is written, the reimbursement needs to be at least that. So, I guess the question is, does that delay reimbursement at all? Because some of these fee like, or do we know how much these fees are gonna be even if they're not due until later?

Right. Yeah. So just,

like, admin fees, things like that that people know what they're paying ahead of time right in the admin fee space. I think what we're really looking at is what we tended to see was a clawback later, and that could be done by, saying, you know, I'm trying to think of which like, performance based fees that are often barely opaque. They can change frequently. And so what this is really ensuring is that once you get that NADAC plus dispense, you're not gonna get someone clawing back that money from you because it would be illegal under this bill for them to work that way.

So it basically eliminate some of these fees versus the fees being due and then them having to try to figure out how to reimburse based on fees that were due later.

Where it's also well written is to really kind of let people know that there's a lot of different avenues for these fees to exist, and what we're trying to do is also eliminate these extra fees. Because what we don't want, right, is money that's going into a pharmacy being taken somewhere else. Like, typically, you know, people aren't excited about a a profit margin decrease. Right? And so what we're trying to ensure here is that getting trying to reimburse itself for fail for a fair payment does not come out of the pharmacy's pocket.

Thank you. Okay.

I see no other questions. We have two people who signed up to speak to the bill. First is Jesse that mic's working. Maybe could y'all sit back

Yeah. Sure.

And go ahead and and take one of those mics over there right now. What?

Can we go?

Can we go? You're on.

Yes. Thank you again, mister chairman and members of the committee. Once again, I'm Jesse Wethingston. I'm here as the president of the Georgia Association of Health Plans. So we have a couple of concerns, with house bill eight ten as written, understanding that there was a substitute bill that differed in some key respects from the original bill, that we're still kinda wrapping our heads around today.

But, primarily as health plans, we have two changes that we're requesting in house bill a 10. One would be a change of the effective date. Right now, it reads to become effective in July 1 of this year. Almost all of our health plan contracts are issued on an annual basis that begins in January 1. And so we would request that should this bill move forward, that be adjusted kinda just to reflect the reality of how coverages work and their start and end dates.

It'd be very difficult operationally for us to price correctly, for such a big change in the risk profile and the pricing for prescription drugs, which you're all aware is one of the largest and fastest growing elements of health care expenditure in The United States. The second is, as this committee is also well aware aware and has, treated on these issues a number of times over the recent past, OCGA thirty three sixty four, is a broad and, in-depth PBM regulation that the state and the general assembly have added to over the recent years. There is no explicit exemption for, self funded ERISA plans, so national self funded plans for large companies, that have lines of business in many states. We would want that as is typical in many bills to have an explicit ERISA exemption, to demonstrate that it doesn't apply to those plans. ERISA preemption issues is sort of a bedrock issue for our association and our members.

So we would ask that that be addressed explicitly as it is in many other mandate bills, that the general assembly has considered in recent years. So those are the two changes that we're requesting for the bill. In terms, and, you know, we could administer this bill should you pass it. I would ask you to be cognizant of, you know, who are you helping and who are you hurting, who is going to foot the bill for these changes when you do them. Our contention is it's going to be the rate payer, the individual insured, and the employer who's typically covering the cost of that business.

So we feel it's incumbent upon us to speak up for that interest because affordability, again, critical issue, particularly as it relates to health insurance this year. It's on the front of mind for everybody, and we would want you to look before you leap. This is the, again, state of Georgia coming in and instituting a price floor for a good that's exchanged between two private entities. I would suggest that you may be a little bit more reticent to do that if this was in any other policy area, but, you know, the words PBM come up and everybody wants to do something. Again, there is a very detailed report on price indexes and over or underpayments that has been instituted by thirty three sixty four nine point two that the Department of Insurance collects four times a year.

I would be curious if anybody in this committee has asked the Department of Insurance to look at that report, and it will kinda shed light on, okay, what is the over and the underpayment on these threshold is 10% over and under, the NAADAC cost report. So please take a look at that. And, again, we wanted to raise the concerns around employer and insurer affordability, but really just to emphasize that we'd request a change in the effective date and explicit carve out for ERISA plans. Okay.

So as far as profitability of PBMs, that's that's an issue or not an issue?

Well, then you're gonna hear from the the association for PBMs. But, again, our

our members

We would. We have three members who are integrated, you know, vertically integrated PBMs. We have nine total members. And so, again, they're not all vertically integrated. They contract with the PBM or that employer does so independently as a plan sponsor to go and do a job, and that's to manage the cost of prescription drug risk for insurance.

Alright.

Chairman Jaspers, would you like to address those two issues?

Yeah. I have certainly no problem with the effect today on the ERISA.

Well, I

will I will note. You know, we mentioned, like, a fiscal year, beginning of fiscal year. Luckily, this has 10/01/2026, the very beginning of that next fiscal year as when these negotiated contracts need to abide by this. So fiscal year. The other thing that was mentioned, ERISA, I'm really glad this was brought up.

The Supreme Court took care of this problem for us. In a unanimous decision, they found that the Arkansas bill that required a similar rate floor was, in fact, completely legal and did not violate ERISA because it was about cost. This bill luckily mirrors that cost containment issue or the cost issues here. The real issue when we run into ERISA is if we are dictating benefit design. And the way to stay away from dictating benefit design is to focus your bill on cost.

So luckily, the Supreme Court has taken care of this little issue for us. Okay. Anything else you were curious?

Would you like to respond?

So just so it's clear, the intent of this bill is to rope in large self funded multistate plants.

The intent of the bill is commercial is is commercial reimbursement.

Appears that it would include them. Mhmm. Yep. And I apologize about you not knowing about the date. One reason we're changing our rules that that these subsidies will be in because we have to be fair to everyone.

Sometimes we don't agree, but we still have to be fair. Mhmm. Representative Davis.

Well, a lot of my question was already answered, but I was wondering, when we looked over this issue, a number of independent pharmacies were put out of business. Are you saying that changing the rules or changing the law would flip it to your side, and we may see the same thing happening to you?

No, ma'am. My contention was that there's detailed data on NAADAC claims payment over and under that the Department of Insurance already collects. None of that has been brought up in the course of this hearing, so we would urge you to look at that. The plans are going to pass this along to the insured. And so who is paying for the additional revenue that's gonna go into the pharmacy?

Like, attention is not gonna be the PBM or the health plan necessarily. It's gonna be the insured or the employer.

Follow-up question.

Yes, Jeremy.

Well, then I guess I'm I'm looking at this and seeing if this is basically a white paper that you're talking about or a study that was done.

It's a it's a report we have to give to the Department of Insurance under the exam authority, four times every year.

Okay. Then, I'm trying to say if it was balanced, wouldn't that have stopped so many

reimbursement they wind up getting. It does paint a picture of what is above and below NAIDAC, 10% above and 10% below.

Something.

And I

know it it's helpful to say that in the NADAC is the ingredient cost. Right? So the pharmacy first has to purchase the drug. So when we're talking about the NADAC, the what the pharmacy is asking to do is to break even. 10% or below or 10% above is not keeping this pharmacy open.

What they're not getting through commercial reimbursement right now is that dispensing fee. And just the dispensing fee is what's gonna keep the pharmacy open. So I know there's a lot of

focus on this report about

NADAC, but it's not the ingredient cost that's keeping the pharmacy at they're they're usually break I would say very typically, we're typically underpaid for the drug. Right? We're paying more for the drug than we're being reimbursed for it, but there are out liars there. However, that all ends up coming up at a net zero. It is that dispensing fee that is keeping the pharmacy open.

And and just to meant, like, the pharmacies, we've done a recent study that, you know, we'd be glad to, I think, provide as soon as it's published. But when we talk about a a pharmacy margin, we're talking about under one half of 1%. So the idea that the pharmacy can continue insurance industry should be absorbing is relatively, I think, laughable that we could be afford to be the ones to take that hit again.

Well, excuse me, chairman. If if can they forward the study to us?

I'm sorry.

Is it okay if they forward the study or the the document he was saying to us?

Sure. Sure.

Sure. Sure. Let me make sure

that happens.

Yeah. Thank you.

I I do wanna say that, I spoke with the, or conversed with the insurance commissioner's office this morning on that Rutledge case versus PCMA. Mhmm. They said their answer was on the surface of this that they would agree that this is outside the plan design and reimbursement. So Thank you.

Chair.

You say that again? Alright.

I see no other questions. We have someone else to to speak?

There was. Yeah. What?

I didn't see a like. Sorry. Okay. Okay. Up next, Michael Power.

Yes, sir. Thank you. I'm trying to be ready for you. Yeah. Mister chairman, members of the committee, my name is Michael Power.

I am with the Pharmaceutical Care Management Association. We are the national trade association that represents pharmacy benefit managers. There are 70 full service PBMs that operate in this country today, a number of which are licensed here in Georgia. I think most of the conversation is largely focused on the big three. It is important to note, I think, it was noted earlier, the claims processing number was sort of everyone talks about the big three controlling 80% of the marketplace.

It's actually based on claims that are processed. That's where we get to the 80%. But what's important to note is many of the smaller PBMs that don't have the resources or the means to develop that software technology, that platform to process those claims rely on the larger PBMs to process those claims for them through their electronic process. And so that's where that number gets a little inflated in the understanding that PBMs the three the big three control 80% of the marketplace. PBMs today serve actually 290,000,000 Americans, through the variety of services that they provide.

Many PBMs either offer operate in a certain geographic area, may only offer certain niche services, but they all sort of scale those and tailor those based on their clients. We're here today respectfully opposed to hospital eight ten. We just wanna make sure that we make the point that as written, the cost of this proposal will be borne by the plan sponsor and then ultimately the patient at the counter. Alabama did pass similar language last year. I actually met with the Department of Insurance two weeks ago, and I'll sort of paint an example.

So if you were a patient that had a $3 generic and your co pay was $15, now at the counter, you're paying $13.49. Their Medicaid rate is ten forty nine. So the $10.49 was added to the $3 generic, and now that patient is paying $13.49 at the counter because their co pay by their plan is $15. And so we just wanted to make sure that as a third party administrator, the person who serves the city government, the county government, small businesses, large businesses, we wanted to make sure that you understood that this bill won't hurt us. It'll hurt those entities that that voluntarily provide a benefit here in the state.

Happy to take any questions.

Yeah. Judge Douglas.

I've been going back and forth with these PBMs for years now, but if it's gonna hurt the people,

why are you here?

Why am I here? Yeah.

If it's gonna hurt the people, let the people deal with that.

So You

wouldn't be here if if it was just if it wasn't affecting your bottom line. That's all I'm trying to say.

No. And that's

If it's if it can I finish? I'll let you speak.

I'll try

to interrupt. Sir.

If the people are gonna be affected by this, let the people be in a up and up role about this. You could like you said, you guys can control 80% of a monopoly. You wouldn't be here today if it didn't affect you. That's all I'm saying. And you're closing down all these private, pharmacies.

I've had two or three close in my area. People I've been getting my stuff from for twenty years, and now they're out of business. They used to make my stuff right there on the counter. And, I'm about I'm always for the little guy. And if you're gonna put all my little guys out of business, that's not fair.

It's not equal opportunity to make a living. And, I'm a wrap it up. I always get kinda sensitive when you're you're talking about a way of life in people's business. If you were about the small guy guy and helping the small guy, you wouldn't be here today, and that's my final decision and my my output. Thank you.

Thank you. Thank you. Okay. I have no other lights lighting up. Thank you, Michael, for Thank you, sir.

Do I hear a motion?

Do pass.

Do I hear a second?

Second.

All those in favor, say aye.

Aye.

All those that disagree? Okay. You have a due pass, chairman Jaspers, and that is LC461418S. Thank you. Thank you.

Alright.

Thank you all so much.

Yes. Congratulations. Thank you. That's okay.

Alright. Now we're hearing, represent made the ax bill.

Another day. Stephanie.

Oh, oh, oh, oh, oh, okay.

Thank you.

Now let let's go ahead and do a representative, Olstein.

I'll come down and hang out with you anytime.

How you doing?

Thank you. Thank you. It's my pleasure.

These two. Well, I'll do I'll do this.

I'll I'll step out and get a water there every day.

You want to bring me a bucket of beer? Yep.

A chair while you're when you go for the inside

of the earring? I'll do it for a mix.

No. Six six two.

After we do that, I guess.

Yeah. Yeah. I don't know. Yeah. I I

think everyone knows what's Alright.

Yes. My pharmacist back home is gonna kiss you in the mouth.

Oh, I love that for me.

It's gonna be great. I'm telling you.

Oh, I know?

Yes. I'm telling you.

Thank you. Thank you. Thank you. Yes. Thank you.

You go. Alright. Have a good good good day.

Let's go ahead and settle down. Representative Holstein.

Okay. Yeah. I'll keep everything

Your mic is on.

It won't mine shouldn't take long.

Okay. Representative Volstein. Go ahead.

Yes, sir. Thank you, chairman. I appreciate you and the committee here in this bill. First of all, I have got to, make this comment to representative Douglas for him to talk about appreciating the small guy, knowing what a big giant you were at UGA. I loved watching you play football.

It is great. I am so glad to hear that you're interested in the small guy because that is exactly what this bill is for. Y'all know that, I'm a nurse by training. I haven't practiced in several years, but, I am from rural Georgia, and my heart is to keep open rural hospitals. We have got them closing by the droves, and, this bill helps kind of stabilize some of these hospitals.

It is just to adjust our, Georgia heart program. We wanna update the eligibility requirements for rural hospital tax credit, and I have got Anna Adams here with me from Georgia Hospital. She is gonna speak to this bill, and I also wanna give a nod to Monte Vesey over here. He with Alliance also supports this bill. So I'm gonna let Anna give you the the nuts and bolts of it.

I don't think mine is nearly as interesting as the other bill.

Mister chairman. I love that. I'm Anna Adams with the Georgia Hospital Association. We have been fortunate to work with representative Osteen on this bill, and there are a couple of changes to the rural hospital tax credit that many of our members would like to see see made so that they can continue to participate in the program. Hats off to you all as a general assembly because we are the first state to have done something like this.

So I think it was always gonna be we're building the plane while we're flying it, and we live and learn. The version of this bill, the substitute that you

have Sorry.

Oh, my bad. Do that?

Go ahead. No. Go

ahead. Okay. That you have in front of you, first, in the first couple of lines, house bill six sixty two, it's LC number 461401 s. On lines ten and thirteen, it opens it up to rural emergency hospitals. You probably remember this bill from last year.

We only have one rural emergency hospital in Georgia. It is in Irwin County. We had another that recently converted back, but this just allows those hospitals to participate in the program. Line 15 is cleanup to capitalize Medicare. And then on the back of the bill in section d, it changes, the part of the bill where it adds, is licensed by the department to provide maternal and newborn services.

This is really important because our rural hospitals are finding it really difficult to continue to offer this service. And with all of the attention that you all have placed on maternal mortality and access to care in maternal areas. This ensures that those rural hospitals don't give up that service line when they're choosing how to tighten their finances. Just beneath that, it changes 10% to 5% of its annual net revenue categorized as indigent care. This is still way above the statewide threshold that is required, but because of patients going in and out of insurance, because Medicaid covers births, this allows for, any kind of wiggle room there to keep those hospitals in.

And then finally, section h at the bottom has a three year average patient margin. This is reads like a stereo manual, of three years excuse me. Standard deviation above the state wide three year average of organizations. We're striking that section because, again, this penalizes facilities that have done what they need to do financially to improve. It also penalizes those facilities that have grown and have potentially used their rural hospital tax credit dollars to add new service lines.

We wanna make sure that they aren't disincentivized from providing additional care and access within their communities. And That's a very good explanation. $100,000,000

that the general assembly has set aside for this. 79,000,000 was used last year, so it was 21,000,000 that just went nowhere, and this would have been a lifeline to these hospitals. Right. There are five six hospitals, possibly five hospitals. Seven, I think.

Seven hospitals that this will directly affect.

Right. Yes. Representative Kelly.

I think you may have just answered my question, but I wanna make sure.

Okay.

How many hospitals today are not covered that will be covered under this expanded version? Is it seven? Seven. Is that what I just heard? Okay.

And where are they located?

One of them happens to be in your district, chairman Kelly. I can read the list to you if that helps.

To read the list.

Well, I'm surprised because I thought I wrote them in when we did this back in 2016

or whatever.

That's part of the challenge here with that section h language is that it's gonna fluctuate annually based on how the hospitals are comparing to other hospitals because of that standard deviation formula. So this gives a little bit more consistency in that they're not gonna be compared to their peers every year for making sound financial decisions.

K. Thank you.

They fell out.

Do you

want us to

name those hospitals?

Would that

be helpful? I

think it'd be good

to know. Okay. Alright. Okay. AdventHealth Murray in Chatsworth, Archibald Grady in Cairo, AtriumHealth Floyd Polk, Medical Center in Cedartown.

Is it Chatug? Mhmm. Regional in Hiwassee, Piedmont Mountainside in Jasper, Union General in Blairsville, and Irwin County Hospital.

Also known as the chairman gunter. I'm in for that card. Okay. I've got another light representative. I'm not sure.

Maybe me. Westbrook?

Yes, sir. Yeah. I just wanted to thank you for doing this. You know, I because I noticed recently in the last last heart, declaration of who is eligible, Piedmont, Mountainside, and Jasper fell out.

Mhmm.

And this will bring them back in and, you know, they're one of those unique rural freestanding clinics in LJ. They have in LJ that's been a game changer. It's made a huge difference. And as members are driving up to LJ to Blue Ridge, you'll see it on the left. It went from a very small thing to a great care system, and, this will help them a lot.

Absolutely.

Hey, Bill. Representative is Gisler. Gisler. Gisler.

Gisler. Gisler.

You got

it. Yeah.

Yeah

one of the reasons that we included that in your folder today is because there seems to be a lot of confusion about the federal funding dollars that are coming down and what they can be used for. Mhmm. The rural hospital tax credit is different from what is coming down from the feds in the rural health transformation program, and those funds cannot necessarily be used for the same things. So I just wanted you to have that background on the federal program and how it's gonna be used so that you didn't feel like this was duplicative.

Okay. Thank you. Alright. I

see no other questions. Do I hear a motion?

I do.

Do I hear a second?

Second. Thank you.

All those in favor, say aye. All those against, say nay. Congratulations. You have a due pass on LC461401S.

Thank you so much. Thank you.

Thank you. Alright. That brings us to our last bill. Representative Mavic.

You want me to mail?

I I you you're fine to do it right there if you feel more comfortable. Thank you. This is a hearing only.

Yes, sir. Today, I'm and I'm working off of l c 520943. This, was brought to me by, constituents. Yeah. Really all over the, really all over the state.

But what it's what it's looking at is, controlled substances provided, so that we can provide ivermectin over the counter. Ivermectin is an anti parasitic drug and it was developed in 1980 and, approved with the FDA in '87. What it does is paralyze and kill parasites and different organisms. It does have an excellent safety profile and it actually won a Nobel Prize. I and shoot, I had that written down.

Nobel Prize in 2015, by doctor William Campbell and Atashi Amira for improving the and they'd say it improved lives around the globe. So Ivermectin This also treats external parasites such as head headlights and rosacea, and it can treat animals for internal and external parasites. And that's where you really see it right now was in our, farm, stores, like, Tractor Supply, and I have a private, farm supply in my town. So that's where people are buying this and I propose to be able to have the human, ivermectin in our pharmacies over the counter so that they, you know, our, citizens won't have to have a prescription. I want I do wanna say this, that the FDA and a lot of people talk about COVID nineteen and how the and ivermectin being used in the treatment of COVID nineteen.

FDA has not approved that, but it is being used. So I kinda wanted to bring that up. And then people asked me what the contraindications were, and the biggest was pregnancy, breastfeeding, and if you're on Coumadin, or a solid organ transplant medication, it's contraindicated there. It's very prominent in antiviral activities and common viruses. There's about a 100 published studies.

Frontier in pharmacology listed 15 cancers as successful treatment, so that tells you right there that it is being investigated and is being, looked at for other, purposes. Four states have already made this available, Tennessee, Idaho, Utah, and Arkansas. And I will yield for questions.

You're lucky. I see no questions.

So I did a good job then?

Nope. Nope. Scofield. Reps in for Scofield. I bet.

I I just have a thank you, mister Choir. I have a question about, the warning labels. Is there any warnings or

There probably will be. Yes. Alright. I will I'm gonna assume that there's some now. Okay.

Thank you.

That's alright. More to be heard at a later date.

Thank you, sir.

Thank you. You have a question?

I I

have one. A question. I I have a question. Yeah.

So as I understand it, today, the FDA does not recommend ivermectin without a prescription for humans. Is that right?

What happens now is people are buying in out of, tractor supply and farm supply houses and dosing by weight Yep. By the patient's weight.

With all due respect, that wasn't my question, though.

Oh, I didn't that's what I thought I

heard you say. What

was? I'm sorry.

The FDA does not recommend this without a prescription for use in humans today. Correct?

No. There is it's it's virtually for animals is what it's for. What I'm proposing is to bring in the human formulation

But I

mean, there there is a without a prescription. There is a medication today, but it requires a a or the FDA requires a prescription for it. Right?

No?

No. Okay. Alright. Thank you.

Thank you. I'm asking for it just to be over the counter.

Okay. That's all the questions. I wanna thank the committee today Okay. For all the work and the good legislation that we've added on and passed today.

Mister mister chairman, before Yes.

Mister chairman, before we leave, I do wanna thank you for the way you conduct the meetings here. So I think this is a opportune time for me. I think I got the support here. I moved that we expand Medicaid. You're out of

order. Thank you.