State and Public School Life and Health Insurance Board 
Minutes
July 13, 2004 – 1:00 P.M.
Public Service Commission – Hearing Room One
1000 Center Street
Little Rock, AR.

The 58th meeting of the State and Public School Life and Health Insurance Board met on Tuesday, July 13, 2004 at 1:00 p.m. at the Public Service Commission, Hearing Room One, 1000 Center Street, Little Rock, AR.

Members Present				Members Absent

Preston Means				Charlie Campbell
Dr. Bobbie Davis				
Darrell Montgomery
Dr. Joseph Thompson
John Hartnedy
Vance Strange
Robert Watson
Renee Mallory
John Mattox
Nancy Sheehan
Shelby McCook

Sharon Dickerson, Executive Director, Employee Benefits Division, DFA.

Others Present

Doris Williams, Robert Sterling, Leigh Ann Chrouch, Susan Bumpas, and George Platt, Employee Benefits Division, DFA; Sheila Weddington, ABA; Diann Gwatney, AHTD; Rose Gantner, Corphealth; Ashley Hughes,NMHCRx; Walter Morrison and Jill Johnson, UAMS PBM Consultants; Patty O’Malley, Public Service Commission; Becky Walker, APERS; Eddie Freyer and Nicola Patterson, USAble Life; Wendy See, Caremark; Barbara Melugin, Blue Cross/Blue Shield; and Larry Carnes, FBMC. 

Call to Order

The meeting was called to order by Preston Means.

Approval of Minutes

A motion was made by John Hartnedy to approve the prior minutes.  Motion was seconded by John Mattox.  Motion carried. 

Financials

Leigh Ann Chrouch went over the financials which were distributed to the board. One board member asked if all the schools were up to date on their payments and her response was that they are.

PSE Retiree Legislation

Preston Means stated that we will discuss this at a later time. 

HRA Update

Sharon Dickerson gave an update on the Health Risk Assessment form.  She advised EBD is communicating with the new PBM, and stated there isn’t enough time to program in our system this year.  Dickerson recommends have our Health Risk Assessment data be handled by our new PBM, NMHCRx.  This PMB will have the capability to incorporate medical claims data in with the other data for our use.  Dickerson stated she had UALR look at the questions and have changed the order of the questions and a couple of words so would be standardized, but didn’t change the content.  There may be three various ways to access the HRA form.  

The PBM can pull the data from the medical claims and will be able to tell drugs on a particular person who would show behavioral lifestyles such as smoking, height, weight, etc.  One member asked Dickerson about the specific data and participants’ concern about confidentiality.  Dickerson stated EBD and this new PBM would not delve into the individual person’s level unless we wanted to go in and help that person via a specific intervention.  The board members voiced approval at having it done off site and not done by EBD.  Dickerson said normal HIPAA confidentiality would apply.  One member asked if we would need to have a new contract for the HRA, and Dickerson said we would not with the new PBM, but would have to have a new contract if we decided to use UALR.  We would modify the present contract with the new PBM.  One member asked costs?  Dickerson stated these are only estimates, but with UALR it would be around 
$25-30,000 and for the PBM around $25,000.  Dickerson stated it would be advantageous to go with the new PBM, so once they have obtained and programmed into their system, all types of reports or searches could be done in the future. One member felt there should be a personal live person in response and not an automated system.  Dickerson does like the live person response, but this would be more costly.  The most time consuming would be to get a new contract with UALR.  UALR does not do the interactive voice response but they would contract out with a third party. Top priority is getting it done as quickly as possible.

Resolution

Shelby McCook went over the resolution handed out to the board.  The resolution stated EBD is trying to help participants become healthier and will be sending out a Health Risk Assessment questionnaire, and would hope that it would be completed voluntarily so that EBD can help the participants to a healthier life. ASEA would award a $500 gift certificate for completing the assessment. Hartnedy made a motion to approve this resolution, and it was seconded by Thompson.  Motion carried.

Committee Reports

DUEC Clinical and Fiscal

Dickerson went over the changes on formulary differences in changing to a new PBM. The recommendations of the DUE Clinical Committee are as follows.  
1. Diovan is formulary with the new PBM, but Cozaar and Hazaar are non-formulary with new PBM.  Diovan is a superior product. The Clinical Committee recommends leaving Diovan on 2nd tier and move the other two drugs, Cozaar and Hazaar to 3rd tier.  Novartis has a promotion going on where information will be sent out to members currently taking Cozaar and Hazaar and we will try and get as many participants to change, but will  grandfather in those who don’t want to switch, and new members will be on only able to get  Cozaar and Hazaar on 3rd tier.  Dickerson advised that the Fiscal Committee is in agreement and are making the same recommendation.  Montgomery agreed. Hartnedy makes a motion to approve the recommendations just outlined by Dickerson.  The motion is seconded by Montgomery.  Motion carried.

2. A list of prescription drugs have been tagged to go to 3rd tier. The DUEC Fiscal recommends leaves SSRI’s, antifungal agents, and all respiratory products on 2nd tier.  Hartnedy makes a motion to accept the recommendations just outlined by Dickerson, and the motion is seconded by Montgomery.  Motion carried.

Singulair 

3. Dickerson advised that all claims statistics show this drug is being used inappropriately for allergy rhinitis.  The DUE Fiscal Committee recommends   step therapy on Singulair. The criteria are a short acting beta agonist and an inhaled cortico steroid.  If the participants do not meet these criteria, they will not have it covered by the plan.  Participants under 18 years of age will not be changed. Look back 6 months in their claims history to verify the short acting beta agonist and inhaled cortico steroid and not grandfather anyone in. Fiscal committee agreed with the recommendation. A motion was made by McCook to approve these recommendations as outlined by Dickerson. The motion was seconded by Hartnedy.  Motion carried.

Actiq

4. Dickerson went over Actiq, which is used for pain relief.  She advised the board that EBD is going to go back and look at which physicians are prescribing this medication, the diagnosis and other utilization information in an effort to see if the drug is being used inappropriately.  This drug was developed for cancer pain, but it might be prescribed for physicians for other uses which might not be appropriate. No recommendations on this product today.

Ambien

5. Ambien is a sleeping aid tablet.  The Clinical Committee recommended that it be limited to 15 tablets a month at 10 mg.  It will be 3rd tier with the new PBM but the Clinical Committee recommends leaving it on 2nd tier and limit the number of pills and dosage per month.  The Clinical Committee also recommends a limit of 15 tablets per month on Sonata and 20 mg.  Dickerson advised the board that the Fiscal Committee agreed with the recommendations of the Clinical Committee.  Watson made a motion to approve these recommendations as outlined by Dickerson, and the motion was seconded by Hartnedy.  Motion carried.

Cox 2 Inhibitors 

6. Vioxx is 3rd tier with the new PBM.  The Clinical Committee recommends moving Vioxx to 3rd tier, limit to 1 tablet a day and on the 50 mg. dosage to limit to 5 days of therapy a month.  Celebrex and Bextra are on 2nd tier.  The Clinical Committee stressed these Cox 2 inhibitors have not been proven as more effective in pain relief, but it is recommended to take a Cox 2 inhibitor instead of ibuprofen or aspirin, because of the protective aspects of the drug on the stomach.  It was also noted that with taking Vioxx you can have complications, such as increased blood pressure and edema.  It is also recommended that Bextra will be moved 2nd tier. It has been 3rd tier on Caremark’s formulary.  Step therapy is in place and will not be changed.   McCook made a motion to approve the recommendations outlined by Dickerson.  The motion is seconded by Hartnedy.  Motion carried.  Motion carried.  

Allegra 

7. Dickerson advised that the Clinical Committee looked at Zyrtec a few months ago, and Jill Johnson stated Zyrtec is a superior drug as compared to Claritin or Allegra.  Zyrtec is mildly sedating.  It was the recommendation of the Clinical Committee to move Allegro to 3rd tier.  It is presently on 2nd tier.  Presently Zyrtec is on 3rd tier and the Clinical Committee is recommending moving it to 2nd tier.  Dickerson advised the board that the Fiscal Committee did not agree to go along with the recommendation of the Clinical Committee.  Jill Johnson stated that Allegra and Claritin are about the same and Claritin is over the counter.  Dickerson said she felt the Fiscal Committee objection was that they thought this drug did not meet the needs of some of the people.  It was noted in the Clinical Committee that sometimes the drug would continue to work, if taken off for 2 or 3 days and then getting back on it, it would improve the function of the drug.  One member stated if we did a good job of advertising the information on Allegra and Claritin being about the same and one is over the counter (Claritin) and Allegra is on 3rd tier the members would see that their needs could be met by Claritin and Zyrtec.  A motion was made to move Zyrtec to 2nd tier and move Allegra to 3rd tier.  This motion was made by McCook, and was seconded by Thompson.  Motion carried.

Dr. Morrison stated the information about possible edema and blood pressure control problems by taking Vioxx should be conveyed to those presently using it, and that the reason we are doing it is not for cost but for looking out for the participants.  

Dr. Thompson has a suggested spreadsheet on the information on the drugs and numbers and one sheet with the information be given out to the Committee in this format on one sheet.  Dr. Morrison asked the new PBM to give EBD a spreadsheet with numbers of individuals taking each one, etc.  When the new PBM gets the medical and pharmacy claims information, by incorporating the data, the new PBM will be able to give more information to us.  Dickerson feels the medical claims and the pharmacy claims should get grouped together as soon as possible.  The cost is approximately from $.25 to $.92 per contract.  

Darrell Montgomery advised that Robert Watson has been elected vice chairman of the Fiscal Committee and Matthew Hadley will be the vice chair for the Clinical Committee. Hartnedy asked both groups to take a look at drugs and report to the board a recommended drug to have on formulary in each category.  

Director’s Report

Dickerson advised there are more than 90 meetings scheduled with the school employees around the state.  Open enrollment for school employees begins next Monday. 

Preston Means brought up the fact that we really don’t have any rules in this board.  He asked the members to think about whether we want to work at establishing some type of rules.  Walt Morrison suggested quarterly meetings instead of monthly for the DUE Committees.  

Dickerson recommended having an annual agenda.  

There being no further business, the meeting adjourned.