Legislature(2017 - 2018)HOUSE FINANCE 519
04/18/2017 09:45 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB25 | |
| SB88 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 25 | TELECONFERENCED | |
| += | SB 88 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 25
"An Act relating to insurance coverage for
contraceptives and related services; relating to
medical assistance coverage for contraceptives and
related services; and providing for an effective
date."
9:53:39 AM
Co-Chair Foster OPENED Public Testimony.
9:54:17 AM
ROBIN STEVENS, SELF, JUNEAU, supported HB 25. She shared
that she took birth control pills for 22 years due to her
inability to find a doctor who would perform a tubal
ligation. She explained that her insurance only allowed her
3 days to refill her birth control prescription before
beginning the next month's dosage. She believed that the
women most in need of birth control had the most barriers
to access due to lack of transportation, or inability to
take leave from work. She felt that avoiding pregnancy
should not be difficult. She urged members to remove the
barriers to birth control. She stated that a year's worth
of birth control was much less expensive and safer than the
cost of childbirth. She did not "subscribe to the theory
that it took two to tango and would never put her
reproductive future in the hands of her sexual partner."
Representative Guttenberg asked whether she could not get
her prescription refilled until she was out of birth
control. Ms. Stevens replied in the affirmative. Ms.
Stevens reported that birth control prescriptions were on a
28-day cycle. Her insurance through the Affordable
Healthcare Act (ACA or Obama Care) specified that she could
only obtain a refill every 25 days.
Vice-Chair Gara asked how long her prescription lasted or
whether she periodically had to coordinate through her
doctor and the pharmacy. Ms. Stevens stated that typically
a prescription was written for a period of 15 months.
9:58:42 AM
Representative Wilson asked about her insurance policy and
whether it was private or a federal program. She wondered
whether she was subject to a private insurers rule or
federal law. Ms. Stevens had been able to access private
insurance due to the ACA. Representative Wilson asked
whether the 25-day rule was the insurers or a federal
guideline. Ms. Stevens indicated that her health care
provider had mentioned that the insurer established the
rule. Representative Wilson asked why the tubal ligation
procedure was not authorized. Ms. Stevens answered that she
was not able to find a doctor to perform the surgery
because she might change her mind.
10:00:12 AM
LISA EIGAN LAGERQUIST, SELF, DOUGLAS, spoke in support of
HB 25. She provided information about her personal use of
birth control. She thought it was very important that other
contraceptive options were covered besides "The Pill." She
spoke about the inconvenience of having to get a monthly
prescription refilled. She thought that anything that could
be done to help people choose "intended pregnancies" was
imperative. She emphasized that anyone that wanted birth
control should have access to it. She urged support for the
bill.
10:02:58 AM
BARRY CHRISTENSEN, ALASKA PHARMACISTS ASSOCIATION,
KETCHIKAN (via teleconference), spoke in favor of the
legislation on behalf of the organization. The association
believed that the bill was good public policy. He explained
that insurance plans typically restrict all prescriptions
to 30 or 90 days. He indicated that vacation overrides were
only available on some plans and were "fairly problematic."
The insurers required very specific information about dates
of travel and limited the supply to the length of travel.
Additionally, ferry workers whose job time on the boat was
extended were denied overrides if the pharmacist mentioned
the refill was necessary for work and not a vacation. He
referenced previous testimony regarding "refill parameters"
and delineated that typically 75 percent of a prescription
had to be used before refills were allowed but some plans'
parameters were more restrictive.
10:05:26 AM
Representative Guttenberg mentioned that prior discussions
focused on who mandated quantities of prescriptions; the
federal government or private insurers. He asked Mr.
Christiansen to speak to prescription drug managers and
their role. Mr. Christiansen explained that pharmacies
contracted with prescription benefit managers (PBM) and the
PBM's contracted with the group or individual insurer.
Every prescription at the "point of sale" was based upon
the insurance plans' parameters. He indicated that all the
pharmacists' conversations regarding prescriptions were
with the PBMs. Representative Guttenberg asked how much
control the PBMs had over the actions of the pharmacists.
He remarked that the PBMs were determining what the
pharmacists could do. MR. Christiansen agreed with the
statement. He related that except for self-paid
prescriptions, which were rare, every decision regarding
prescriptions was "dictated" by the PBM's. Everyday his
staff spent "numerous, numerous hours" on the phone and the
computer with PBM's trying to get people their medications.
He characterized the situation as "challenging."
10:09:05 AM
Representative Ortiz thanked Mr. Christiansen for all his
contributions to the field. He asked whether birth control
refill prescriptions typically required doctor's visits.
Mr. Christiansen responded that typically providers
authorized refills for 11 months after the initial one-
month prescription and shorter prescriptions were most
often easily refilled. He deduced that if HB 25 passed, the
pharmacists would likely have to inform the providers that
12-month prescriptions were allowable. Representative Ortiz
asked whether in Mr. Christiansen's experience, issues
around access to birth control were more problematic in
rural areas rather than urban areas, and if HB 25 was more
beneficial for rural residents. Mr. Christiansen answered
in the affirmative. He relayed that his pharmacy served
outlying rural areas and he could see how the legislation
would help residents in rural areas.
Co-Chair Foster asked Mr. Christiansen to expand on his
answer regarding the difficulties with prescription access
in rural villages. He spoke to the challenges in small
villages regarding healthcare delivery and access to
prescriptions. He wondered whether there was a higher
number of pregnancies in rural villages due to a lack of
services and if he knew of any attempts to address the
challenges. Mr. Christiansen responded that he did not have
information or insight specific to the representative's
district but offered to ask pharmacists from his area to
address the questions. He related that in the rural areas
he served around Ketchikan the difficulty was in rural
residents receiving medications in general and that birth
control was typically prescribed for longer periods of
time. He understood that other parts of Alaska might face
some unique challenges that he was unable to address.
10:14:37 AM
ROBIN SMITH, SELF, ANCHORAGE (via teleconference), spoke in
favor of HB 25. She spoke of the higher out-of-pocket
medical costs that women encountered versus men due to
contraceptive coverage. She relayed that birth control
coverage was expanded and co-payments were eliminated
through the ACA. She was concerned about potential changes
in the Affordable Care Act which currently covered
contraception due to the current administration and
Congress in Washington. She advocated providing a variety
of birth control including vasectomy. She thought that the
ability to choose pregnancy empowered women and their
families and provided the best outcomes for the child. She
voiced that increased access to contraceptives was the
"key" to reducing the number of unwanted pregnancies in
Alaska. She spoke to the high number of spousal and child
abuse in the state. She argued that one avoided pregnancy
would help to pay for a significant amount of birth control
for many others. She relayed her personal experience
regarding the inconvenience of attaining her birth control
prescriptions. She responded to Representative Wilson's
questions regarding the impact of HB 25. She agreed that
one "key limitation" of state plans was their inability to
affect nationwide or self-insured scope of coverage. She
suggested that if enough states adopted changes the action
would potentially set off a ripple effect across the entire
insurance industry. She urged members to support HB 25.
10:20:27 AM
SARA CLARK, SELF, ANCHORAGE (via teleconference), spoke in
support of HB 25. She thought it was important to support
women having control of their reproductive health. She
asked members to vote in favor of HB 25.
10:21:42 AM
Co-Chair Foster CLOSED Public Testimony.
Representative Wilson asked whether the Department of
Health and Social Services (DHSS) had found anything in
statute that prevented Medicaid from filling 12-month birth
control prescriptions.
10:22:05 AM
MARGARET BRODIE, DIRECTOR, DIVISION OF HEALTH CARE
SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
responded in the affirmative and noted that AS 47.47.065
outlined the regulation. She read the following language
from the statute:
? by regulations adopted by the commissioner in
conformity with applicable federal regulations.
Representative Wilson asked if there were any state
regulations that prevented a 12-month prescription from
being written through Medicaid. Ms. Brodie responded in the
negative. Representative Wilson referred to Page 5, lines
28 through 29:
(13) a group health insurance policy covering
employees of a participating governmental unit is
subject to the requirements of AS 21.42.427.
Representative Wilson inquired whether the University's and
the largest state union's plans were covered under the
provision. Ms. Brodie was unable to answer the question.
Representative Wilson reiterated the question and wondered
whether the following bill language from page 6, lines 6
through 8 also applied:
A self-insured group medical plan covering active
state employees provided under this section is subject
to the requirements of AS 21.42.427.
REPRESENTATIVE MATT CLAMAN, SPONSOR, responded that he was
unfamiliar with the various health plans for the University
and was unable to provide the answer. He offered that if
the plan was a union trust type of health insurance plan,
the federal Employee Retirement Income Security Act (ERISA)
exempted union trusts from state regulations and therefore
state law could not impact a union health trust
administered plan.
10:26:07 AM
Representative Wilson deduced that the general union plan
[General Government Unit (GGU)] was most likely exempt from
the legislation. She remarked that the state paid for the
plan, but did not manage it. She believed that the fiscal
note should be updated because according to Ms. Brodie's
testimony the state could administer 12 month contraceptive
prescriptions for Medicaid. She asked Ms. Brodie for the
reasons why the state had not done so, especially since the
fiscal note identified savings in the Medicaid program
under the bill. Representative Claman offered to provide
the additional information.
Co-Chair Seaton suggested that the legislature could only
act through statute. However, the legislature could advise
the administration through a resolution. He remarked that
the only way the legislature could override a regulation
was through statute.
Representative Wilson pointed out that there was no
statute. She confirmed with Ms. Brodie that DHSS had not
written a regulation either. She declared that under
current regulation or statute there was nothing that
prevented 12 month prescriptions under Medicaid and the
Alaska Care plans with or without the bill.
Representative Guttenberg asked that in the absence of
state statute, regulations, or a plan directive,
prescription parameters were left up to the PBM's to
contain insurer's costs. Ms. Brodie confirmed that the
reason the limit was in place for most plans and Medicaid
was cost containment. She commented that Medicaid
recipients revolved in and out of the program and the state
did not want to pay for ineligible prescriptions.
10:30:37 AM
Vice-Chair Gara wanted to ensure that the bill remained in
statute for as long as possible. He mentioned a prior
discussion that the bill would only remain effective if the
ACA remained intact. He asked whether the provisions would
remain in statute regardless of changes to the ACA.
Representative Claman cited page 3, lines 5 and 6,
Subsection (1) and noted that the bill referenced the ACA
as amended. He thought if the ACA was completely repealed,
Alaska statute could possibly be affected. He did not see
any likelihood of repeal of the ACA. He thought that the
language in the bill "was more than adequate" to ensure
that HB 25 would continue in the state. Vice-Chair Gara did
not want to "play Vegas odds with the bill." He wondered
whether the contraceptive provisions in the bill would
remain if Congress removed the ACA provisions regarding
contraceptive care. Representative Claman did not believe
that the bill was "dependent upon" the ACA and informed the
committee that the ACA references in the bill were specific
to religious exemptions. He believed that the bill would
continue to be applied even if the ACA was repealed. He
discerned that the ACA religious exemptions were so broad
that creating religious exemptions in state statute may
cause problems, especially if the exemption was narrower
than the ACA's. He felt that the endeavor to craft statutes
based on what possibly could happen with the ACA created
confusion.
10:34:57 AM
Vice-Chair Gara asked whether the 12-month requirement
would remain regardless of the ACA. Representative Claman
answered in the affirmative. He clarified that the 12 month
requirement only applied if the provider wrote a 12 month
prescription. Vice-Chair Gara understood the "hazards" if
the state developed its own religious exemption. He
reported that relying on the current religious exemption
under ACA would disappear in state stature if the ACA was
repealed. He wondered why the bill did not specify that the
provisions were relying on the current ACA religious
exemption in 2017. He suggested inserting language such as:
"under the ACA religious exemption as written as of January
1, 2017." Representative Claman would not object to the
amendment. Vice-Chair Gara asked whether the language would
be added on page 3, line 6 of the bill. Representative
Claman recommended that the language broadly applied to
Subsection (g) on page 2, lines 31 through page 3, line 10.
10:37:22 AM
Representative Wilson interpreted the bill language on page
2, line 3 that the bill did not prohibit a 15 month
prescription from being filled.
LIZZIE KUBITZ, STAFF, REPRESENTATIVE MATT CLAMAN, responded
that there was a federal law limiting the period of a
prescription to 12 months. Representative Wilson was not
concerned about the federal law and was only concerned
about the interpretation of the bill's provision. Ms.
Kubitz responded that she was correct. Representative
Wilson read page 1, lines 6 through 8 of the bill:
Sec. 21.42.427. Coverage for contraceptives. (a) A
health care insurer that offers, issues for delivery,
delivers, or renews in the state a health care
insurance plan in the group or individual market
shall?
Representative Wilson noted the use of the word "shall."
She asked whether the bill only applied as listed above to
entities that provided contraceptive coverage. Ms. Kubitz
responded affirmatively.
HB 25 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 88 - Opposition Document 4.18.2017.pdf |
HFIN 4/18/2017 9:45:00 AM |
SB 88 |