MAC Meeting Minutes October 16, 2020

Texas HIV Medication Advisory Committee Meeting

Meeting Minutes
October 16, 2020
1:30 p.m.

Location: Microsoft Teams Live Event
 

Table 1: Texas HIV Medication Advisory Committee (MAC) member attendance at the Friday, October 16, 2020 meeting

Agenda Item 1: Call Meeting to Order, Welcome and Opening Remarks

Dr. Natalie Vanek, Chair, called the meeting to order at 1:40 pm and welcomed members, staff, presenters and public in attendance.

Agenda Item 2: Logistical Announcement and Roll Call

Mr. John Chacón, Facilitator, Advisory Committee Coordination Office, HHSC provided logistics announcement, called roll and asked members to introduce themselves, and determined a quorum was present.

Dr. Vanek notified the Committee that Consumer Member Ray Moore has passed away. Several Committee members spoke in his memory.

Agenda Item 3: Review and approval of the July 31, 2020 meeting minutes

Mr. John Chacón requested a motion to approve the July 31, 2020 meeting minutes. 

Motion: Ms. Nancy Miertschin motioned to approve the July 31, 2020 meeting minutes as presented. Dr. Yolanda Rodriguez-Escobar seconded the motion. Mr. Chacón conducted a roll call vote, and the motion passed unanimously with seven approves, no disapproves, and no abstentions.

Agenda Item 4: Commissioner’s Updates

Dr. Vanek introduced Mr. Felipe Rocha, MSSW Director TB/HIV/STD Section, DSHS, and he provided the committee with an update.

Highlights of the discussion and committee member discussion included:

• Associate Commissioner Imelda Garcia was not able to attend the meeting. Felipe Rocha provided the Commissioner’s Updates.
• DSHS submitted a Legislative Appropriation Request (LAR) for the FY 2022-23 biennium with a budget reduction of $33 million across the entire agency. To meet this reduction, DSHS will have to reduce General Revenue Funds within the HIV Program by approximately 2.45M each year in FYs 2022 and2023, for a total reduction of 4.9M across the biennium. The reduction would not go into effect until September 2021 (FY 2022).
• In FY 2020 all state agencies were asked to submit reduced budgets. DSHS was held harmless (exempt) from this request due to on-going public health response to COVID-19.
• In FY 2021 DSHS is not exempt from the proposed budget reduction.
• Federal laws administered by the Health Resources and Services Administration (HRSA) require “Maintenance of Effort” (MOE) for funds used to support Ryan White Services. MOE requires that agencies fund programs at the same level or greater to the two previous funding years. The proposed GR reductions will require submitting a request to HRSA asking that Texas be allowed to change how MOE is calculated. DSHS will request a rider to the state budget bill indicating that if HRSA does not approve the MOE calculation change, funds will be restored and appropriated from the state’s GR stream.
• No financial budget available for this meeting. Once the financial analysis of impact on program is complete DSHS will provide budget update.
• THMP has experienced an increased caseload, along with increased medication costs. DSHS is doing an analysis to determine what the financial impact has been of those two factors. The analysis is still in progress. As soon as the analysis is complete, DSHS will provide more information on impacts to THMP.
• Dr. Vanek and Frank Rosas expressed concern regarding potential budget cuts to ADAP.

Agenda Item 5: THMP Update

Dr. Vanek introduced Ms. Rachel Sanor, and she provided the committee with an update.

Highlights of the discussion and committee member discussion included:

• Some MAC appointments will be expiring at the end of December. Full terms are six years. Some existing terms were altered to stagger expiring terms. By-laws state that members may continue to serve until new appointments are made.
• THMP is developing the appointment process. THMP will provide an update at the January MAC meeting.
• Texas ADAP Medication Interface (TAMI) is an improved ADAP database implemented in September 2020. Upgraded data base eliminates issues from legacy system and allows for improved HRSA compliance. The system will bein place until HRAR database is finalized.
• Program experienced a 34% growth in enrollment compared to the same time period last year (March-August) due to COVID-19. The majority of the growth (50%) was seen in clients that are not employed.
• DSHS is analyzing the difference in patterns of growth in ADAP and Care Services to identify causation of program growth. THMP has applied for emergency relief funds to off-set program growth.
• THMP sent letters to all clients informing them of the program’s COVID-19 Emergency Response that includes an emergency application that is shortened and reduced documentation requirements. All clients currently on ADAP received automatic eligibility extensions through December 30, 2020. Most 30-day medications are automatically being filled for 60 days; however, this practice will be phased out.
• Laura Potter, previous THMP Regional Manager, has received a promotion in another area in the program. Christine Salinas, Team Lead, will serve as Acting Regional Manager.

Agenda Item 6: Sub-committee Reports (Governance/Data, Eligibility, Formulary)

Ms. Nancy Miertschin provided highlights of the Governance and Data subcommittee discussion and committee member discussion included:

• The sub-committee met twice in the past quarter. Nancy Miertschin was formally recognized at the sub-committee Chair. Previously Nancy Miertschin was Acting Chair.
• A consumer member was officially removed from the MAC due to non-participation over 12 months. This position is now vacant.
• The sub-committee is in the process of recruiting a consumer member.
• The sub-committee reviewed data reports that were requested by the Eligibility sub-committee. Governance and Data also requested data on viral suppression among ADAP client’s vs overall state.
• Discussed revising the Medical Certification Form (MCF) to make it more accessible and user friendly to physicians.
• Also discussed increase in 90-day prescriptions during onset of COVID-19.
• The sub-committee requested a budget update from THMP at January MAC meeting.

Mr. Frank Rosas provided highlights of the Eligibility subcommittee discussion and committee member discussion included:

• Lionel Hillard has joined the sub-committee.
• THMP has kept the sub-committee appraised of THMP’s Public Health Response to COVID-19 and inquired about the phasing out of the automatic60-day prescription fills.
• THMP has kept the sub-committee appraised of development of the HRAR data system.

Dr. Natalie Vanek provided highlights of the Formulary sub-committee discussion and committee member discussion included:

• The sub-committee met twice during the last quarter. Discussed 90-day utilization and the Medical Certification Form (MCF). THMP is looking into Adobe DocuSign to assist with uptake in 90-day prescriptions.
• The sub-committee has had multiple discussions around Long Acting Cabotegravir/Rilpivirine (not currently approved by FDA). The medication is an injectable that also has pills with a lead-in dose and will require strategic planning for training and administration of medication.
• The sub-committee made changes to MCF, based on feedback from HIV Clinical Panel, for Top-10 medications. Changes include: identify various strengths and quantity of pills so providers can match prescriptions with MCF.
• An MCF Quick Facts Form was developed in an effort to communicate key ideas to providers about the MCF to help increase completion by providers when writing prescriptions.
• The pharmacist on the MAC, Margaret Adjei, reported no significant issues with the MCF. Most clients are happy with 60 and 90-day supply of medications.
• Lionel Hillard inquired about how ADAP assesses that clients are ready for Rapid Start. Mr. Hillard expressed concern about whether agencies adequately assess whether clients who may request Rapid Start are prepared for this regimen. Meeting clients “where they are” is important when assessing medication regimen. Dr. Lazarte indicated that most clients on Rapid Start have observed good medication adherence.

Agenda Item 7: Public Comment 

No public comment was offered.

Agenda Item 8: Action Items and agenda topics for next scheduled meeting, January 29, 2021 

Dr. Vanek, Chair, led the discussion on the action Items and agenda topics for next scheduled meeting, January 29, 2020.

• Felipe Rocha to provide a THMP budget update
• Felipe Rocha to provide additional information on HRSA’s response to maintenance of effort as it relates to proposed budget cuts.
• Updates on THMP’s Public Health Response to ongoing COVID-19 pandemic –MAC members would like additional information on how THMP would address another State of Emergency Declaration.
• Rachel Sanor to provide data on ADAP Treatment Cascade.
• Next meeting January 29, 2021.

Agenda Item 9: Adjournment

Dr. Vanek, Chair, thanked the members and the public and adjourned the meeting at 3:34 pm.

To view and listen to the archived video of the October 16, 2020 Texas HIV Medication Advisory Committee meeting in its’ entirety, click on the link below.

October 16, 2020 Texas HIV Medication Advisory Committee meeting