State of Minnesota Medical Services Review Board Jan. 20, 2005 443 Lafayette Road N. St.

Paul, MN

MSRB members present:

Beth Baker, M.D., Chairperson Lynn Ayers Philip Bachman, M.D. Sharon Ellis Charles Hipp, M.D. Gregory Hynan, M.D. Michael Goertz William Martin Andrea Trimble Hart Ellen Velasco-Thompson Barbara Baum Jeff Bonsell, D.C. Debra Olson Andrew Schmidt, M.D. Jon Talsness, M.D. Michael McGrail Robin Peterson Bruce VanDyne Jamie Anderson Kate Berger Debbie Caswell Beth Hargarten Rosaland Hoffman William Lohman, M.D. Julie Marquardt Terry Mueller Others present:

MSRB members excused:

MSRB members not present:

Staff members present:

Carolyn Blodgett, CompCost Louise Montague, ErgoResults/MOTA Mark Pixler, Medical Advanced Pain Specialist

1. Call to order, introductions, announcements Chairperson Baker called the meeting to order at 4:06 p.m. and noted there was not a quorum and they could approve the agenda after everyone arrived. Members introduced themselves to the group.

2. Assistant commissioner’s update Assistant Commissioner Hargarten noted that the legislative session has started and presented an update on the Workers’ Compensation Advisory Council. The council had a meeting scheduled, but it was canceled because they had not come to a complete resolution on what will be in their legislative package this year. Their next regularly scheduled meeting is Wed., Feb. 9, and she expects that they will finalize what will be in their proposal to the Legislature. There will be many of the same provisions in their proposal as has been in the bill the past two years and it has not been determined whether there will be any provisions regarding managed care or whether there will be any language for treatment parameters. She noted there are two bills that have been introduced to the Legislature that relate to workers’ compensation. One relates to the independent contractor portion of the law and the other is the annual bill presented by Sen. John Marty, which is technically in the OSHA statute, but will allow lawsuits against employers in certain circumstances. Baker asked Hargarten about some of the other items from the legislation last year, like pharmacy charges and fee schedules. Hargarten noted that the language that will most likely be in the bill is the proposal that allows the establishment of pharmacy networks. This language was in last years’ legislation. The department is still pursuing the pharmacy reimbursement language. Baker asked about the dispensing fees. Hargarten said it is not in the legislation, but in the rules. Baker asked about fee schedules. Hargarten said there has not been any discussion about fee schedules yet. Baker asked if there was anything else going through rulemaking. Hargarten noted they are still discussing the managed care proposals and what happens to the proposed managed care rules will depend on what happens during session. Hargarten gave an update on the proposed rehabilitation rules being worked on by the Rehabilitation Review Panel. The comment period ended yesterday and they did not have enough requests for hearing that would require them to go to hearing. They did have some comments and they will be reviewing the comments internally and having discussions about adjustments to the rules before they go through, but they will not be required to go for a hearing. 3. Treatment parameters task-force update Dr. Lohman passed out a memorandum that describes what the task force has accomplished so far. Once there is a recommendation that the MSRB feels comfortable with, it will be brought to the department and the department staff members will try to craft treatment parameter rules based on those recommendations. Then those draft rules will be brought back to the MSRB for final review. Lohman said we face more stringent requirements now than 15 years ago, in terms of being able to prove that what we say is correct. He thinks this process will make it easier for us to go forward in rulemaking and respond to critics because we will be able to show that we

considered the entire medical record in coming to the conclusions that we did with a very open, detailed process to show how they accomplished it. Hargarten asked Lohman if he thinks there is enough information available in all three situations to accomplish what we want to do. Lohman thinks there will be sufficient information for the three classes of drugs, since they have been a source of debate and research in the medical literature. Baker commented that there are some ancillary issues with the COX-2 inhibitors. Vioxx has been removed from the market and a lot of medical organizations are going to be sending letters to patients that are on Celebrex and Bextra advising them to consider stopping those drugs and recommending alternative medication. Lohman said that most of the articles for the third question about important subgroups are actually going to deal with the COX-2 inhibitor issue. Baker offered anyone a copy of the articles and Lohman noted that they are all available on the Web site created for the MSRB task-force at There was a comment that there is a suspicion that medications are being over utilized. Lohman said one of the conclusions of the Medical Cost Task-force was that brand named high-priced medications were used when cheaper, generic versions could have been used, and perhaps medications were given out in larger amounts than they needed to be. Baker noted that a lot of the questions of the Medical Cost Task-force were centered on opiates and narcotics. Lohman clarified that opiates and COX-2 inhibitors were the main questions that the Medical Cost Task-force discussed. Phil Bachman asked Lohman if part of his analysis, particularly with Oxicontin, centered on its vast abuse potential and the fact that there are many other things that can be used. Lohman noted that for each class of medication the MSRB task-force would be evaluating whether there are marked differences in effectiveness. If there is not a marked difference in effectiveness between brands at equipotent doses, then one can make the choice based on other factors. Also, there is a second question of whether there is a marked difference in safety. If one brand were much safer than another, then that would be the one you would want to choose. But, if there is not a marked difference in safety for most people, you can make the choice of medication based on things other than effectiveness and safety. The task force may want to recommend to the board that if there are no differences in safety and effectiveness, then the choice may be made on access and price. They may also recommend that for some people there may be differences in safety or effectiveness, in which case, you would then identify those subgroups as people for whom a different choice could be made. Hargarten noted that the materials from the Medical Cost Task-force are still available by going into the Worker’s Compensation section of the department’s Web site. Lohman noted that the Medical Cost Task-force Web page has all the materials that were presented at each meeting, as well as the final report. He also said that the new system report is available on the Research and Statistics page and that this year’s system report has some very detailed analyses of medical cost data, including drug costs, which update the materials that were provided to the Medical Cost Task-force. Lohman noted that the information was for 2002. Bachman asked if the studies will be clear and if they will be looking at efficacy and compliance. Lohman said these issues are addressed in many of the studies and the MSRB task-force will look at effectiveness, which is a combination of efficacy and compliance and follow through, so he believes that the effectiveness studies will address that issue.

Baker asked for a motion to approve the Oct. 14, 2004 minutes. Lynn Ayers made a motion to approve them and Ellen Velasco-Thompson seconded the motion. Motion carried. Baker asked if there was any new business or points to discuss. There was none. Baker noted that the meeting for the advisory council on Jan. 18 was canceled and was rescheduled for Feb. 9, where, perhaps, they will have the conclusion of what will be presented to the Legislature. Hargarten noted that they would most likely have a conclusion by Feb. 9. Hargarten said there would be negotiations and they will finalize what will be put in the bill for this legislative session. Hyman asked if there would be opposition to it. Hargarten said they wouldn’t know until they have finalized the provisions yet. Hargarten noted that most of the provisions from last year’s bill would be in it, because they are a repeat from last year and some are even from the year before. The two biggest medical cost containment issues have yet to be resolved. Those are the managed care proposals and the treatment parameter proposals. Hargarten noted if anyone has any other questions about what is going on in the Legislature, they should contact her. William Martin made a motion to adjourn. Valasco-Thompson seconded the motion. Motion carried. The meeting was adjourned at 5 p.m. Respectfully submitted, Rosaland Hoffman Executive Secretary