Legislature(2023 - 2024)
2024-05-02 House Journal
Full Journal pdf2024-05-02 House Journal Page 2610 HB 226 The following was read the second time: HOUSE BILL NO. 226 "An Act relating to the Board of Pharmacy; relating to insurance; relating to pharmacies; relating to pharmacists; relating to pharmacy benefits managers; relating to patient choice of pharmacy; and providing for an effective date." with the: Journal Page HSS RPT CS(HSS) 6DP 1NR 1711 FN1: (ADM) 1711 FN2: (CED) 1711 FN3: (CED) 1711 L&C RPT CS(L&C) NEW TITLE 4DP 1DNP 1NR 2395 FN4: ZERO(ADM) 2395 FN5: ZERO(CED) 2395 FN6: ZERO(CED) 2395 Representative Saddler moved and asked unanimous consent that the following committee substitute be adopted in lieu of the original bill: CS FOR HOUSE BILL NO. 226(L&C) "An Act relating to insurance; relating to pharmacy benefits managers; relating to dispensing fees; and providing for an effective date." 2024-05-02 House Journal Page 2611 Representative Eastman objected. Representative Ruffridge moved and asked unanimous consent to abstain from voting because of a conflict of interest. Objection was heard, and he was required to vote. The question being: "Shall the House adopt CSHB 226(L&C)?" The roll was taken with the following result: HB 226 Second Reading Adopt Labor & Commerce CS YEAS: 37 NAYS: 3 EXCUSED: 0 ABSENT: 0 Yeas: Allard, Armstrong, Baker, Carpenter, Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mears, Mina, Ortiz, Rauscher, Ruffridge, Saddler, Schrage, Shaw, Story, Stutes, Sumner, Tilton, Tomaszewski, Vance, Wright Nays: Eastman, Prax, Stapp And so, CSHB 226(L&C) was adopted. Amendment No. 1 was offered by Representative Stapp: Page 1, following line 6: Insert a new bill section to read: "* Sec. 2. AS 14.40 is amended by adding a new section to article 1 to read: Sec. 14.40.118. Health care insurance plans. (a) If the University of Alaska offers a group health care insurance plan covering university employees, including by means of self- insurance, the university health care insurance plan, including the administration and management of pharmacy benefits under the plan, is subject to the requirements of AS 21.27.901 - 21.27.975 and AS 21.36.520. (b) In this section, "health care insurance plan" has the meaning given in AS 21.54.500." Renumber the following bill sections accordingly. 2024-05-02 House Journal Page 2612 Page 2, line 22: Delete "a new section" Insert "new sections" Page 3, following line 30: Insert a new section to read: "Sec. 21.27.908. Contract disclosure. (a) A pharmacy benefits manager shall exercise good faith and fair dealing in the performance of its contractual duties with an insurer. (b) Within 60 days after receiving a request from an insurer, a pharmacy benefits manager shall provide a copy of a contract between the pharmacy benefits manager and the insurer. Nothing in this subsection requires the disclosure of proprietary business information or protected health information. (c) A contract between a pharmacy benefits manager and an insurer must allow an insurer the right to request an annual audit. (d) A pharmacy benefits manager may require an insurer to sign a nondisclosure agreement acknowledging that the information obtained during an audit is proprietary information of the pharmacy benefits manager." Page 12, following line 21: Insert new bill sections to read: "* Sec. 14. AS 29.10.200 is amended by adding a new paragraph to read: (68) AS 29.20.420 (health care insurance plans). * Sec. 15. AS 29.20 is amended by adding a new section to article 5 to read: Sec. 29.20.420. Health care insurance plans. (a) If a municipality offers a group health care insurance plan covering municipal employees, including by means of self-insurance, the municipal health care insurance plan, including the administration and management of pharmacy benefits under the plan, is subject to the requirements of AS 21.27.901 - 21.27.975 and AS 21.36.520. (b) This section applies to home rule and general law municipalities. (c) In this section, "health care insurance plan" has the meaning given in AS 21.54.500. * Sec. 16. AS 39.30.090(a) is amended to read: (a) The Department of Administration may obtain a policy or 2024-05-02 House Journal Page 2613 policies of group insurance covering state employees, persons entitled to coverage under AS 14.25.168, 14.25.480, AS 22.25.090, AS 39.35.535, 39.35.880, or former AS 39.37.145, employees of other participating governmental units, or persons entitled to coverage under AS 23.15.136, subject to the following conditions: (1) a group insurance policy shall provide one or more of the following benefits: life insurance, accidental death and dismemberment insurance, weekly indemnity insurance, hospital expense insurance, surgical expense insurance, dental expense insurance, audiovisual insurance, or other medical care insurance; (2) each eligible employee of the state, the spouse and the unmarried children chiefly dependent on the eligible employee for support, and each eligible employee of another participating governmental unit shall be covered by the group policy, unless exempt under regulations adopted by the commissioner of administration; (3) a governmental unit may participate under a group policy if (A) its governing body adopts a resolution authorizing participation and payment of required premiums; (B) a certified copy of the resolution is filed with the Department of Administration; and (C) the commissioner of administration approves the participation in writing; (4) in procuring a policy of group health or group life insurance as provided under this section or excess loss insurance as provided in AS 39.30.091, the Department of Administration shall comply with the dual choice requirements of AS 21.86.310, and shall obtain the insurance policy from an insurer authorized to transact business in the state under AS 21.09, a hospital or medical service corporation authorized to transact business in this state under AS 21.87, or a health maintenance organization authorized to operate in this state under AS 21.86; an excess loss insurance policy may be obtained from a life or health insurer authorized to transact business in this state under AS 21.09 or from a hospital or medical service corporation authorized to transact business in this state under AS 21.87; (5) the Department of Administration shall make available bid specifications for desired insurance benefits or for 2024-05-02 House Journal Page 2614 administration of benefit claims and payments to (A) all insurance carriers authorized to transact business in this state under AS 21.09 and all hospital or medical service corporations authorized to transact business under AS 21.87 who are qualified to provide the desired benefits; and (B) insurance carriers authorized to transact business in this state under AS 21.09, hospital or medical service corporations authorized to transact business under AS 21.87, and third-party administrators licensed to transact business in this state and qualified to provide administrative services; the specifications shall be made available at least once every five years; the lowest responsible bid submitted by an insurance carrier, hospital or medical service corporation, or third-party administrator with adequate servicing facilities shall govern selection of a carrier, hospital or medical service corporation, or third-party administrator under this section or the selection of an insurance carrier or a hospital or medical service corporation to provide excess loss insurance as provided in AS 39.30.091; (6) if the aggregate of dividends payable under the group insurance policy exceeds the governmental unit's share of the premium, the excess shall be applied by the governmental unit for the sole benefit of the employees; (7) a person receiving benefits under AS 14.25.110, AS 22.25, AS 39.35, or former AS 39.37 may continue the life insurance coverage that was in effect under this section at the time of termination of employment with the state or participating governmental unit; (8) a person electing to have insurance under (7) of this subsection shall pay the cost of this insurance; (9) for each permanent part-time employee electing coverage under this section, the state shall contribute one-half the state contribution rate for permanent full-time state employees, and the permanent part-time employee shall contribute the other one-half; (10) a person receiving benefits under AS 14.25, AS 22.25, AS 39.35, or former AS 39.37 may obtain auditory, visual, and dental insurance for that person and eligible dependents under this section; the level of coverage for persons over 65 shall be the same as that available before reaching age 65 except that the benefits payable shall be supplemental to any 2024-05-02 House Journal Page 2615 benefits provided under the federal old age, survivors, and disability insurance program; a person electing to have insurance under this paragraph shall pay the cost of the insurance; the commissioner of administration shall adopt regulations implementing this paragraph; (11) a person receiving benefits under AS 14.25, AS 22.25, AS 39.35, or former AS 39.37 may obtain long-term care insurance for that person and eligible dependents under this section; a person who elects insurance under this paragraph shall pay the cost of the insurance premium; the commissioner of administration shall adopt regulations to implement this paragraph; (12) each licensee holding a current operating agreement for a vending facility under AS 23.15.010 - 23.15.210 shall be covered by the group policy that applies to governmental units other than the state; (13) a group health insurance policy covering employees of a participating governmental unit must meet the requirements of AS 21.27.901 - 21.27.975 and AS 21.36.520, including requirements relating to administration and management of pharmacy benefits under the policy. * Sec. 17. AS 39.30.091 is amended to read: Sec. 39.30.091. Authorization for self-insurance and excess loss insurance. Notwithstanding AS 21.86.310 or AS 39.30.090, the Department of Administration may provide, by means of self- insurance, one or more of the benefits listed in AS 39.30.090(a)(1) for state employees eligible for the benefits by law or under a collective bargaining agreement and for persons receiving benefits under AS 14.25, AS 22.25, AS 39.35, or former AS 39.37, and their dependents. The department shall procure any necessary excess loss insurance under AS 39.30.090. A self-insured group medical plan covering active state employees provided under this section is subject to the requirements of AS 21.27.901 - 21.27.975 and AS 21.36.520, including requirements relating to administration and management of pharmacy benefits under the plan." Page 12, line 31: Delete "secs. 1 - 14" Insert "secs. 1 - 19" 2024-05-02 House Journal Page 2616 Page 13, line 9: Delete "Section 16" Insert "Section 21" Page 13, line 10: Delete "sec. 17" Insert "sec. 22" Representative Stapp moved and asked unanimous consent that Amendment No. 1 be adopted. Representative Carrick objected. Representative Stapp moved and asked unanimous consent to abstain from voting because of a conflict of interest. Objection was heard, and he was required to vote. The question being: "Shall Amendment No. 1 be adopted?" The roll was taken with the following result: CSHB 226(L&C) Second Reading Amendment No. 1 YEAS: 19 NAYS: 20 EXCUSED: 0 ABSENT: 1 Yeas: Allard, Armstrong, Baker, Carpenter, Eastman, Foster, Gray, Hannan, C.Johnson, D.Johnson, Prax, Shaw, Stapp, Stutes, Sumner, Tilton, Tomaszewski, Vance, Wright Nays: Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Galvin, Groh, Himschoot, Josephson, McCabe, McCormick, McKay, Mears, Mina, Rauscher, Ruffridge, Saddler, Schrage, Story Absent: Ortiz Gray changed from "NAY" to "YEA" And so, Amendment No. 1 was not adopted. Amendment No. 2 was offered by Representative Eastman: 2024-05-02 House Journal Page 2617 Page 1, line 1, following "Act" (title amendment): Insert "relating to disciplinary sanctions by the Board of Pharmacy;" Page 1, following line 3: Insert a new bill section to read: "* Section 1. AS 08.80.261 is amended by adding a new subsection to read: (c) The board may not deny a license to an applicant or impose disciplinary sanctions against a pharmacist for making a political statement, including criticism of a governmental agency or information disseminated by a governmental agency." Page 1, line 4: Delete "Section 1" Insert "Sec. 2" Renumber the following bill sections accordingly. Page 12, line 31: Delete "secs. 1 - 14" Insert "secs. 2 - 15" Page 13, line 9: Delete "Section 16" Insert "Section 17" Page 13, line 10: Delete "sec. 17" Insert "sec. 18" Representative Eastman moved and asked unanimous consent that Amendment No. 2 be adopted. Representative Sumner objected. The question being: "Shall Amendment No. 2 be adopted?" The roll was taken with the following result: 2024-05-02 House Journal Page 2618 CSHB 226(L&C) Second Reading Amendment No. 2 YEAS: 2 NAYS: 37 EXCUSED: 0 ABSENT: 1 Yeas: Eastman, Vance Nays: Allard, Armstrong, Baker, Carpenter, Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mina, Ortiz, Prax, Rauscher, Ruffridge, Saddler, Schrage, Shaw, Stapp, Story, Stutes, Sumner, Tilton, Tomaszewski, Wright Absent: Mears And so, Amendment No. 2 was not adopted. Amendment No. 3 was offered by Representative Eastman: Page 2, lines 17 - 18: Delete ", and each separate violation is subject to the maximum civil penalty under AS 21.97.020." Insert ". Penalties against a person under this subsection may not exceed an aggregate total of $25,000." Page 7, line 17, following "AS 21.27.440.": Insert "Penalties against a person under this subsection may not exceed an aggregate total of $25,000 during any three-month period." Representative Eastman moved and asked unanimous consent that Amendment No. 3 be adopted. Representative Sumner objected. The question being: "Shall Amendment No. 3 be adopted?" The roll was taken with the following result: CSHB 226(L&C) Second Reading Amendment No. 3 YEAS: 2 NAYS: 38 EXCUSED: 0 ABSENT: 0 2024-05-02 House Journal Page 2619 Yeas: Eastman, Prax Nays: Allard, Armstrong, Baker, Carpenter, Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mears, Mina, Ortiz, Rauscher, Ruffridge, Saddler, Schrage, Shaw, Stapp, Story, Stutes, Sumner, Tilton, Tomaszewski, Vance, Wright And so, Amendment No. 3 was not adopted. Amendment No. 4 was offered by Representative Eastman: Page 1, line 1, following "insurance;" (title amendment): Insert "relating to vaccines;" Page 1, following line 6: Insert a new bill section to read: "* Sec. 2. AS 18.15 is amended by adding new sections to read: Article 7A. Vaccines and Vaccinations. Sec. 18.15.520. Adverse events. A health care provider or health care facility that observes a patient experience an adverse event as a result of receiving a vaccine, or that receives a report from a patient or a patient's family member that the patient has recently experienced an adverse event as a result of receiving a vaccine, shall report the adverse event in a timely manner to the Vaccine Adverse Event Reporting System in the United States Department of Health and Human Services and record the adverse event in the patient's medical record. In this section, (1) "health care facility" means an office or institution that provides care or treatment for physical, mental, emotional, dental, physiological, or psychological diseases or conditions; (2) "health care provider" means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care services; in this paragraph, "health care services" means care, treatment, a service, or a procedure to maintain, diagnose, or otherwise affect an individual's physical or mental condition; (3) "vaccine" means a substance (A) used to stimulate the production of antibodies and provide immunity against a disease; 2024-05-02 House Journal Page 2620 (B) prepared from the causative agent of a disease or its products or from a synthetic substitute; (C) treated to act as an antigen to a disease without inducing the disease; and (D) that is designed to be administered to a patient only after the patient gives voluntary and knowing consent to receive the substance or, if the patient is a minor, only after a parent or guardian of the minor gives voluntary and knowing consent to administer the substance to the minor." Renumber the following bill sections accordingly. Page 12, line 29: Delete "This Act applies" Insert "Sections 1 and 3 - 15 of this Act apply" Page 12, line 31: Delete "secs. 1 - 14" Insert "secs. 1 and 3 - 15" Page 13, line 9: Delete "Section 16" Insert "Section 17" Page 13, line 10: Delete "sec. 17" Insert "sec. 18" Representative Eastman moved and asked unanimous consent that Amendment No. 4 be adopted. Representative Sumner objected. The question being: "Shall Amendment No. 4 be adopted?" The roll was taken with the following result: CSHB 226(L&C) Second Reading Amendment No. 4 YEAS: 4 NAYS: 36 EXCUSED: 0 ABSENT: 0 2024-05-02 House Journal Page 2621 Yeas: Eastman, Rauscher, Tomaszewski, Vance Nays: Allard, Armstrong, Baker, Carpenter, Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mears, Mina, Ortiz, Prax, Ruffridge, Saddler, Schrage, Shaw, Stapp, Story, Stutes, Sumner, Tilton, Wright And so, Amendment No. 4 was not adopted. Amendment No. 5 was offered by Representative Eastman: Page 1, line 1, following "insurance;" (title amendment): Insert "relating to the prescription and dispensation of ivermectin;" Page 1, following line 3: Insert new bill sections to read: "* Section 1. AS 08.64.367(d) is amended by adding a new paragraph to read: (3) "chief medical officer" means the chief medical officer of the Department of Health. * Sec. 2. AS 08.64.367 is amended by adding new subsections to read: (e) A physician or the chief medical officer may prescribe ivermectin by standing order. A standing order issued under this subsection must (1) be written and signed by a physician licensed under this chapter or by the chief medical officer, as applicable; (2) specify a protocol allowing a pharmacist licensed under AS 08.80 to dispense ivermectin under the delegated prescriptive authority of the physician or the chief medical officer; and (3) include a plan for evaluating and treating adverse events. (f) An action may not be brought against a physician or the chief medical officer for damages resulting from the good faith standing order prescription of ivermectin under this (e) of this section." 2024-05-02 House Journal Page 2622 Page 1, line 4: Delete "Section 1" Insert "Sec. 3" Renumber the following bill sections accordingly. Page 1, following line 6: Insert a new bill section to read: "* Sec. 4. AS 08.80 is amended by adding a new section to read: Sec. 08.80.336. Standing order for ivermectin. (a) A pharmacist following a standing order issued under AS 08.64.367(e) may dispense ivermectin to a person in this state without a prior prescription. (b) A pharmacist following a standing order under this section may not (1) seek personal financial benefit by participating in an incentive-based program; or (2) accept an inducement that influences or encourages therapeutic or product changes or the ordering of tests or services. (c) A pharmacist shall provide each recipient of ivermectin under this section with a standardized information sheet written in plain language that includes information on the importance of follow-up care and health care referral information. The information sheet may not discourage the recipient from using ivermectin for the treatment of novel coronavirus disease (COVID-19). (d) An action may not be brought against a pharmacist for damages resulting from the good faith dispensation of ivermectin under this section." Renumber the following bill sections accordingly. Page 12, line 29: Delete "This Act applies" Insert "Sections 3 and 5 - 17 of this Act apply" Page 12, line 31: Delete "secs. 1 - 14" Insert "secs. 3 and 5 - 17" 2024-05-02 House Journal Page 2623 Page 13, line 9: Delete "Section 16" Insert "Section 19" Page 13, line 10: Delete "sec. 17" Insert "sec. 20" Representative Eastman moved and asked unanimous consent that Amendment No. 5 be adopted. There was objection. The question being: "Shall Amendment No. 5 be adopted?" The roll was taken with the following result: CSHB 226(L&C) Second Reading Amendment No. 5 YEAS: 6 NAYS: 34 EXCUSED: 0 ABSENT: 0 Yeas: Coulombe, Eastman, Rauscher, Tilton, Tomaszewski, Vance Nays: Allard, Armstrong, Baker, Carpenter, Carrick, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mears, Mina, Ortiz, Prax, Ruffridge, Saddler, Schrage, Shaw, Stapp, Story, Stutes, Sumner, Wright And so, Amendment No. 5 was not adopted. Amendment No. 6 was offered by Representative Eastman: Page 1, line 1, following "insurance;" (title amendment): Insert "relating to vaccines and vaccinations;" Page 1, following line 6: Insert a new bill section to read: "* Sec. 2. AS 18.15 is amended by adding a new section to read: Article 7A. Vaccines and Vaccinations. Sec. 18.15.500. Information on vaccine. (a) A health care 2024-05-02 House Journal Page 2624 provider or health care facility that recommends or administers a vaccine to a patient shall, before administering the vaccine, provide to the patient or, if the patient is a minor, to the patient's parent or guardian information that identifies the risks and benefits of the vaccine based on the patient's health record and the right of the patient or, if the patient is a minor, the patient's parent or guardian to accept or refuse the vaccine. (b) The information provided under (a) of this section must be in writing, must be signed by the patient or, if the patient is a minor, the patient's parent or guardian and must include (1) the name and manufacturer of the vaccine; (2) the ingredients of the vaccine, including adjuvants and excipients; in this paragraph, (A) "adjuvant" means a substance that enhances the pharmacological effect of a drug or increases the ability of an antigen to stimulate the immune system; (B) "excipient" means an ingredient that is intentionally added to a drug for a purpose other than the therapeutic or diagnostic effect at the intended dose; (3) the Internet website of the manufacturer for access to the vaccine manufacturer's product insert for disclosed contraindications and adverse events and any related information; (4) the Internet website of the United States Health Resources and Services Administration for access to the vaccine injury compensation program and the vaccine injury table and information regarding reports of adverse effects and recalls of vaccines; (5) the Internet website of the United States Food and Drug Administration for access to vaccine recall information; (6) information regarding patient exemption rights, including the right to an exemption from a vaccination for a medical, personal, religious, or other reason; (7) information regarding rights concerning vaccination data collection by the department; (8) information regarding limitations on liability for a person who administers a vaccine; (9) information regarding incentives received by the health care provider or health care facility related to vaccination services; (10) information regarding the risks of contracting the 2024-05-02 House Journal Page 2625 disease or illness for which the vaccine is given; (11) the name, manufacturer, and ingredients of any vaccine scheduled to be administered to the patient at a future appointment; and (12) a notification of any potential right of action the patient may have against a vaccine manufacturer for an injury resulting from the vaccine that was not specified in the manufacturer's product insert. (c) If the department publishes an advertisement that promotes a vaccine, the department shall list potential adverse reactions associated with the vaccine and identify persons for whom the Centers for Disease Control and Prevention, United States Department of Health and Human Services, recommends against receiving the vaccine. (d) In this section, (1) "health care facility" means an office or institution that provides care or treatment for physical, mental, emotional, dental, physiological, or psychological diseases or conditions; (2) "health care provider" means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care services; in this paragraph, "health care services" means care, treatment, a service, or a procedure to maintain, diagnose, or otherwise affect an individual's physical or mental condition; (3) "minor" means an individual under 18 years of age whose disabilities have not been removed under AS 09.55.590; (4) "vaccination" means treatment with a vaccine; (5) "vaccine" means a substance (A) used to stimulate the production of antibodies and provide immunity against a disease; (B) prepared from the causative agent of a disease or its products or from a synthetic substitute; (C) treated to act as an antigen to a disease without inducing the disease; and (D) that is designed to be administered to a patient only after the patient gives voluntary and knowing consent to receive the substance or, if the patient is a minor, only after a parent or guardian of the minor gives voluntary and knowing consent to administer the substance to the minor." 2024-05-02 House Journal Page 2626 Renumber the following bill sections accordingly. Page 12, line 31: Delete "secs. 1 - 14" Insert "secs. 1 and 3 - 15" Page 13, line 9: Delete "Section 16" Insert "Section 17" Page 13, line 10: Delete "sec. 17" Insert "sec. 18" Representative Eastman moved and asked unanimous consent that Amendment No. 6 be adopted. There was objection. The question being: "Shall Amendment No. 6 be adopted?" The roll was taken with the following result: CSHB 226(L&C) Second Reading Amendment No. 6 YEAS: 5 NAYS: 35 EXCUSED: 0 ABSENT: 0 Yeas: Allard, Eastman, Rauscher, Tomaszewski, Vance Nays: Armstrong, Baker, Carpenter, Carrick, Coulombe, Cronk, Dibert, Edgmon, Fields, Foster, Galvin, Gray, Groh, Hannan, Himschoot, C.Johnson, D.Johnson, Josephson, McCabe, McCormick, McKay, Mears, Mina, Ortiz, Prax, Ruffridge, Saddler, Schrage, Shaw, Stapp, Story, Stutes, Sumner, Tilton, Wright And so, Amendment No. 6 was not adopted.