I support the VPLC comment pointing out the removal of any consumer benefits from the current version. While it is important to learn more about the factors behind drug pricing and costs, it is just as critical that all Virginians can see some direct and immediate benefits at the same time.

Support Drug Transparency AND Lower Drug Costs for Consumers AMEND HB 2007 to restore a basic rebate-pass-through for consumers! HB 2007 is a significant FIRST STEP to require more drug pricing transparency from insurance plans, pharmacy benefits managers, and pharmacy manufacturers. However, there is NO FIRST STEP in the bill to protect consumers from exorbitant drug costs, EVEN WHEN INSURERS AND THEIR PHARMACY BENEFITS MANAGERS RECEIVE REBATES AND OTHER PRICE CONCESSIONS FROM MANUFACTURERS. HB 2007 only requires PBMs to give insurance plans an OPTION to pass through rebates. (see, lines 528-530) . The Virginia Poverty Law Center and many disease groups, whose members must have extremely expensive specialty drugs, believe an option isn’t good enough. The original bill REQUIRED a simple rebate pass-through for consumers. The following amendments are needed: Line 491 – delete “Option for rebates” and insert “Rebates” Line 528 - after “B” delete remainder of lines 528-530 and insert “An enrollee's defined cost sharing for each prescription drug shall be calculated at the point of sale based on a price that is reduced by an amount equal to at least 80 percent of all rebates received, or to be received, in connection with the dispensing or administration of the prescription drug.” This original language should be restored to give consumer some price relief while the state collects data and learns more about the very complex world of prescription prices and costs. Future reforms should be based on that data. Thank you. Jill Hanken, VPLC Health Attorney

Del. Sickles and Members of the Committee, AARP Virginia remains neutral on HB2007 due to inclusion of language on which we have no applicable policy. However, on the language directly related to price transparency beginning on line 330 of the current draft, we acknowledge a marked improvement on lines 491-492 in the initial price threshold for brand names and biologics being set at $100/year. Thank you for for your work on this issue. Respectfully submitted, Natalie Snider AARP Virginia State Advocacy Director 804-344-3063 nsnider@aarp.org

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

Del. Hope and members of the committee, AARP Virginia thanks Del. Sickles and the co-patrons of HB2007 for their efforts to bring transparency to the prescription drug pricing supply chain. As the bill is currently written, however, there are several sections where AARP has no applicable policy, so we will remain neutral in our position. As Del. Sickles has shared that this bill is a "work in progress", AARP Virginia respectfully recommends that the non-reporting penalty be increased to $15,000 per day and the 3-year reporting threshold be set at 40%. Prescription drug price transparency is an important foundational building block for other reforms, such as affordability boards, bulk purchasing, and other efforts. AARP Virginia is committed to this issue and will continue to work for meaningful reforms. Respectfully submitted, Natalie Snider AARP Virginia State Advocacy Director 804-344-3063 nsnider@aarp.org

I am for nurse practitioner to be able to practice without a doctor being there

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

The Virginia Academy of Elder Law Attorneys (VAELA) is comprised of approximately 200 attorneys throughout the Commonwealth of Virginia who practice in a variety of areas related to elder law, estate planning and administration, Medicaid and other benefits planning, disability planning, and adult guardianship/conservatorship. Many of our members also serve as guardians ad litem for incapacitated adults and/or routinely serve as counsel advising guardians and agents under powers of attorney as to their duties and powers. VAELA’s Public Policy Committee has reviewed HB 2107, relating to drafting regulations for virtual visits in nursing homes, and on behalf of VAELA, we want to register our support of this Bill. Access to loved ones in hospitals, nursing homes, and certified nursing facilities has been a matter of great concern to many of our clients throughout the COVID-19 pandemic. Regulations that would guarantee patients and residents of these facilities timely access to their loved ones through virtual visits, especially when in-person visits are not advised, would be very beneficial to the physical and mental health of facility residents and patients, as well as their loved ones. Thank you in advance for your consideration. - Amy E. McCullough (amcculloughesq@gmail.com) Rhona Levine (rlevine@opnlaw.com) Stephen D. Burns (stephen.burns@parksensenig.com), Public Policy Committee Co-Chairs, 2021

Thank you for considering the disabled in this state. I ask that you would support this bill.

We support Delegate Tran’s initiative to ensure that individuals with a mental or physical impairment have the support that they need while in a medical care facility. For the individuals supported by the member organizations of the Virginia Network of Private Providers, support means assistance with communication, personal care, personal supervision to prevent unnecessary chemical or physical restraints, and activities of life (such as eating, or toileting). All of these functions may be beyond the capabilities of the individual to do on their own and, if not assisted by a designated support person, the length of stay will likely increase, the outcome will be less successful and the stress on both the individual and the hospital staff will be significant. What had been relatively “normal” has suddenly become extraordinarily difficult in “COVID” times, but this is not just about the restrictions placed because of the pandemic, this is an ongoing issue and one we hope you will address by passing this bill.

STATEMENT ON HB 2251 I am writing in support of HB 2251, a bill to add some policy principles and standards for the exercise of certain emergency authorities by the Executive Branch. For background, I worked in the U.S. House of Representatives as Committee Staff for about 17 years including work on issues like emergency and pandemic preparedness as well as many regulatory programs. I also worked in the Office of General Counsel for the Environmental Protection Agency for about 7 years with respecting to many rulemakings. I have reviewed a great deal about the applicable law and positions of the Executive Branch regarding these authorities. For months on end, the Governor and the Commissioner of Health have signed orders with constantly shifting standards, to subject millions of Virginians and tens of thousands of Virginia businesses to harmful and burdensome regulations, most carrying the threat of criminal penalty, and nearly all without legal precedence, justification, or authority. The Governor and Health Commissioner want to wield, unilaterally and indefinitely, unbridled power over every citizen, household, business and church under color of a declared “emergency.” The mandates of the Governor and Health Commissioner in these orders infringe on multiple fundamental rights including their freedom of assembly, freedom of association, free exercise of religion, free speech, privacy, and due process of law. The infringements on these rights are further compounded by an entire scheme of unequal treatment. There has been no public comment, no public docket, no economic impact analysis, no regulatory flexibility analysis for small businesses. I have never seen a situation where one or two individuals can sign orders that operate as rules for months and which impose criminal sanctions for violations. The Executive Branch has a a government definition of who must distance and who may sit, stand or be together for ordinary conversation within 6 feet, in certain settings. In certain settings the definition is "family" or "household" which are government definitions that define association for purposes of distancing. A government definition of association is extraordinary and not well thought through. Defendants also set limits on the size of gatherings with no exceptions for political gatherings and political speech, among other problems. This bill would try to prospectively address certain issue by bringing some legislative guidance to these issues and by limiting the longer-term use of emergency authorities without further engaging the legislative branch. Separation of Powers belongs to everyone in Virginia. It is important that the General Assembly respect this element of the Virginia Constitution and provide the type of guidance and limitations that are required before threatening millions of Virginians, hundreds of thousands of Virginia businesses, and tens of thousands of religious institutions with criminal sanctions. These provisions are common sense standards and by no means prevent the exercise of such authorities as appropriate. Open-ended Executive authority that proceeds for months at a time is not appropriate. Virginia has suffered under unitary rule for 11 months. It is long past time to end this approach that is deeply antithetical to the Virginia Constitution and the rights of all Virginians. Nandan Kenkeremath,

Why would you force a vaccine when hyrdroechloraquin and other drugs heal people. CDC says 99.9% of people recover. Why are you using the tool of fear. What is in it for you. It’s being said that covid is just the first part of this bio weapon. The next part will kill those who were diagnosed with it. If you keep this up there won’t be any one to vote. Oh that’s right. Depopulation is part of the plan. You reap what you sow.

Honorable Delegates – First I would like to share some factual historic background on “how we got here,” so-to-speak, and also my thoughts on strengthening the intended consequences for this life-saving legislation. In the mid ‘90s prescription opioid manufacturers marketing and lobbying efforts were widespread. “In 1995, Dr. James Campbell addressed the American Pain Society urging that health care providers treat pain as the “fifth vital sign.” “In 2001, as part of a national effort to address the widespread problem of underassessment and undertreatment of pain, The Joint Commission (formerly The Joint Commission on the Accreditation of Healthcare Organizations or JCAHO) introduced standards for organizations to improve their care for patients with pain. For over a decade, experts had called for better assessment and more aggressive treatment, including the use of opioids. Many doctors were afraid to prescribe opioids despite a widely cited article suggesting that addiction was rare when opioids were used for short-term pain...” ”Delegates at the 2016 American Medical Association (AMA) meeting voted to stop treating pain as the fifth vital sign because they believe it is likely that the initiative, along with other factors, have exacerbated the opioid crisis. Clearly many factors have contributed to the opioid crisis, including aggressive marketing by pharmaceutical companies, increased number of prescriptions written by providers…” My point being some opponents to HB2300 recently touted their professional credentials being challenged by HB2300’s initial language regarding naloxone (NARCAN®), such that it now reads ”may include, for patients who have been treated for substance use-related 201 emergencies, including opioid overdose, or other high-risk patients, (a) the dispensing of naloxone or other opioid antagonist used for overdose reversal.” This “may” needs to be a “shall!” An overdose victim is typically not a casual, recreational or social opioid user. They are more likely addicted, and releasing them to their soon to become “dope-sick” again selves without this potentially life-saving drug just doesn’t make sense…common sense! I use the “history lesson” above to demonstrate medical professionals have been wrong in this arena previously…dead wrong. It took 21 years for them to admit they were wrong about pain as the fifth vital sign. Many view the professional and institutional adoption of the fifth vital sign as an embryonic moment in the genesis of our current opioid epidemic. We don’t have to wait another 21 years to admit they are wrong about naloxone here. Secondly and lastly, I take issue with again, a “may” that needs to be a “shall” here – “Such protocols may also provide for referrals of individuals experiencing a substance use-related emergency to peer recovery specialists and community-based providers of behavioral health services, or referrals for to providers of pharmacotherapy for the treatment of drug or alcohol dependence or mental health diagnoses.” Releasing an overdose patient, as I mentioned above, back to the streets, is simply not a good idea. I say that as an individual accumulating over 29 years of sustained continuous recovery from substance use disorder (SUD). Prior to that time, I was the hamster on the wheel. Since then, I’ve seen more than my fair share of deaths because addicts weren’t immediately engaged with recovery services when they most need it.

I am writing in support of HB 2300 Naloxone dispersal to every Virginian that is seen in an ER during an opioid overdose. This bill saves lives, it prevents families from getting the dreaded phone call that a family member has passed away due to an avoidable overdose. This bill helps ensure that those suffering from substance use disorder are given the necessary, life-sustaining medication.

HB2300 - As an individual with over 29 years of sustained continuous recovery from Substance Use Disorder (SUD), I strongly support this life-saving legislation.

Mister Chair, members of the subcommittee. My name is Nathan Mitchell and I am a person in recovery from a substance use disorder. I serve as a state organizer with the Virginia Recovery Advocacy Project representing recovery organizations and thousands of individuals throughout the Commonwealth. We support HB 2300 and ask the members of this subcommittee to report. As outreach coordinator with The McShin Foundation, I work daily with individuals in or seeking recovery from a substance use disorder to provide immediate access to vital recovery support services. Addiction is a brain disease. Not a moral failure. Individuals caught in the grips of addiction deserve our compassion not our scorn, and our help when they are not able to help themselves. There is no mincing words here, the number of overdose emergency department visits continues to grow each year with an alarming spike during the COVID-19 pandemic. Emergency departments are often only able to treat the immediate emergency without considering other short- and long-term addiction treatment options for the patient. HB 2300 seeks to solve some of this problem by screening or assessing individuals experiencing substance use related emergencies, providing information on appropriate community-based providers of behavioral health services upon discharge, and most importantly, providing take-home naloxone or other overdose reversal medication immediately upon discharge (NOT a prescription which may never be filled). Our people are dying, and emergency departments are on the frontline. We must give emergency departments the tools they need to save lives and introduce individuals to a lifetime of recovery. Please support HB 2300.

Mister Chair, members of the subcommittee. My name is Nathan Mitchell and I am a person in recovery from a substance use disorder. I serve as a state organizer with the Virginia Recovery Advocacy Project representing recovery organizations and thousands of individuals throughout the Commonwealth. We support HB 2300 and ask the members of this subcommittee to report. As outreach coordinator with The McShin Foundation, I work daily with individuals in or seeking recovery from a substance use disorder to provide immediate access to vital recovery support services. Addiction is a brain disease. Not a moral failure. Individuals caught in the grips of addiction deserve our compassion not our scorn, and our help when they are not able to help themselves. There is no mincing words here, the number of overdose emergency department visits continues to grow each year with an alarming spike during the COVID-19 pandemic. Emergency departments are often only able to treat the immediate emergency without considering other short- and long-term addiction treatment options for the patient. HB 2300 seeks to solve some of this problem by screening or assessing individuals experiencing substance use related emergencies, providing information on appropriate community-based providers of behavioral health services upon discharge, and most importantly, providing take-home naloxone or other overdose reversal medication immediately upon discharge (NOT a prescription which may never be filled). Our people are dying, and emergency departments are on the frontline. We must give emergency departments the tools they need to save lives and introduce individuals to a lifetime of recovery. Please support HB 2300.