Legislature(2017 - 2018)BELTZ 105 (TSBldg)
04/14/2017 09:00 AM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB79 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 79 | TELECONFERENCED | |
SB 79-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES
CHAIR COSTELLO announced the consideration of SB 79. She stated
that her aide would present the proposed committee substitute
(CS) and Dr. Butler would provide his view of the changes.
9:36:38 AM
SENATOR STEVENS moved to adopt the work draft CS for SB 79,
labeled 30-GS1021\J, as the working document.
CHAIR COSTELLO objected for an explanation of the changes.
9:36:52 AM
WESTON EILER, Aide, Senate Labor and Commerce Standing
Committee, Alaska State Legislature, explained that the
administration brought the changes forward in response to the
concerns articulated by the Alaska pharmacist community. The
concerns relate to the administrative burden this bill and
Senate Bill 74 places on members of the profession. He directed
members' attention to the red line version of the bill that
helps lay out the changes to the original version A.
MR. EILER described the following changes:
Page 2, Section 1. The new Chapter 55 in AS 13 is
moved [to page 26, Section 31, of version J].
Conforming changes to AS 08.64.250 and AS 08.64.312
are found on page 12 of the red line version. [These
are found on pages 10-11, Sections 12 and 13, of
version J.]
Page 16 of the red line version changes the definition
of adult from "a person" to "an individual." [This is
found in Section 15, page 14, lines 20-21 of version
J.]
Page 17 of the red line version has new text amending
AS 08.68.100(a), as amended by sec. 10, ch. 25, SLA
2016. This pertains to advanced practice registered
nurses. Regulations for an advanced practice
registered nurse who holds a valid federal Drug
Enforcement Administration registration number must
address training in pain management and opioid use and
addiction. New text is also added to address concerns
raised during public testimony. On page 18, paragraph
(10) requires applicants under this chapter to submit
fingerprints and fees required by the Department of
Public Safety. This is intended to address concerns
about the connection between opioids used for pain
management and drug abuse. [This is found in Section
18, pages 15-16, of version J.]
Pages 21-22, Section 23, of the red line version adds
new text to [AS 08.72.140] relating to qualifications
for licensure as an optometrist. The regulations
governing these professionals must include
qualifications for licensees holding a valid federal
DEA registration number that address training in pain
management and opioid use and addiction. [Section 23
is found on pages 19-20 of version J.]
Page 27, Section 30, of the red line version covers
grounds for imposition of disciplinary sanctions for
abuse of prescription opioids, including animal care.
[Section 30, is found on pages 25-26 of version J].
The new Chapter 55 appears on pages 28-29 of the red
line version. It details some of the committee
concerns including definitions. It also includes some
of the amendments brought forward by the Alaska
Hospital community including prepack and other
prescription drugs issued from prescribers.
MR. EILER summarized that the CS intends to cover the
committee's jurisdiction over licensing pharmacists and
prescribing professions licensed under the Department of
Commerce.
CHAIR COSTELLO asked Dr. Butler to express his understanding of
the bill and the role he played in drafting the committee
substitute.
9:43:24 AM
JAY BUTLER, Chief Medical Officer, Division of Public Health,
Department of Health and Social Services (DHSS), Anchorage,
stated that SB 79 is part of a multi-faceted response to address
the current opioid epidemic. The bill specifically addresses the
flood of legal prescription opioids in Alaska communities and
improving patient safety.
9:44:38 AM
SENATOR GARDNER joined the committee.
DR. BUTLER said the first three amendments embodied in the CS
relate to concerns from the Alaska Pharmacy Association. First,
Section 28 brings the language pertaining to partial fills of
opioid prescriptions into alignment with the federal
Comprehensive Addiction and Recovery Act (CARA). It allows
partial fills without requiring the remaining quantity of the
prescription to be voided. Thus, the requirement to notify the
prescribing practitioner is moot.
Second, the CS clarifies the role of the prescribing provider
and the pharmacist. The prescribing provider is responsible for
checking the prescription drug monitoring program prior to
writing a prescription for a Schedule II or Schedule III
controlled substance. The pharmacist is responsible for
populating the Prescription Drug Monitoring Program (PDMP) when
they dispense prescriptions for these controlled substances.
This aligns with the intention of both this bill and SB 74 that
passed last year.
Third, the CS delays implementing the requirement for daily
updates of the PDMP until July 2018. The CS also expands the
liability waiver for the advance directive to include events of
an inadvertent administration of an opioid to someone who has an
opioid advance directive. The concern was that in emergency
situations it may not always be feasible to follow an opioid
advance directive.
9:48:39 AM
CHAIR COSTELLO asked what the Comprehensive Addiction and
Recovery Act (CARA) does and how the CS brings state law into
alignment with that federal Act.
DR. BUTLER said the language in the original bill authorized
pharmacists to partially fill a prescription, but the remainder
of the prescription was voided. The pharmacist was also required
to notify the prescribing provider of that voiding. Federal law
under CARA 2016 allows partial fills without voiding the
remainder of the prescription. This removes a potential barrier
to partial fill that the original language may have created. The
administrative burden on the dispensing pharmacist is also
decreased because they would no longer have to notify the
prescribing provider.
CHAIR COSTELLO asked him to talk about the report that compares
the rate that different providers in a community prescribe
opioids and the importance of knowing the scope of opioid
prescriptions.
DR. BUTLER explained that the provider community introduced the
concept of providers receiving a regularly scheduled report from
the Department of Commerce that provides feedback on the
quantity of opioids they prescribed during the prior year
relative to their peers. The reason for this is that some
providers may not realize how much they are prescribing. The
intent is not punitive but to help providers review their
practices and perhaps rethink their approach to treating
patients that experience pain.
CHAIR COSTELLO asked him to talk about the training requirements
in the bill to help educate providers about the different
options for pain management.
DR. BUTLER said the bill includes requirements for continuing
professional education for each prescriber group under the
different boards. These include the Medical Board the Board of
Nursing, the Board of Veterinary Examiners, and the Board of
Pharmacy. For example, when he renews his medical license every
two years he must document that he received credit for 40 hours
of continuing medical education. SB 79 requires that two of
those hours be designated to issues related to addiction or pain
management. He highlighted that the topic of physical dependency
and addiction is broader than just opioids.
9:56:35 AM
CHAIR COSTELLO noted that the CS requires weekly reporting for
hospital pharmacies. She asked him to talk about how hospital
pharmacies differ from a pharmacy she and her family might use.
DR. BUTLER said it appears that the way that opioid pain killers
have been used in the outpatient setting is an important
determinant in the creation of the opioid epidemic. By
comparison, hospital pharmacists and emergency departments
dispense small amounts at a time and do not account for a large
volume of opioids going into the community. He said the CS
intends to bring the requirements for updating prepacks in line
with what is required of prescribers when small volumes are
dispensed and in line with the way that inpatient prescriptions
are managed.
CHAIR COSTELLO asked how the bill affects the professional
requirements for pharmacists working with the Department of
Corrections (DOC).
DR. BUTLER explained that an inmate who receives care inside the
prison walls is considered an inpatient and the same rules would
apply as an inpatient in a hospital. Data does not need to be
put into the PDMP and the PDMP doesn't need to be accessed in
advance of dispensing. However, if an opioid is prescribed at
the time of discharge from the prison system, the rules for
outpatient prescribing would apply and the prescriber would need
to use the PDMP.
10:00:58 AM
SENATOR STEVENS asked if a physician can prescribe a partial
fill.
DR. BUTLER said it's unlikely a prescriber would do that because
of the cost of prescribing repeated small prescriptions.
SENATOR STEVENS read paragraph (9) on page 28 and asked if there
can be a disciplinary sanction if someone simply overprescribes
a drug. He observed, "That's replacing a physician's decision or
judgement with someone else's."
DR. BUTLER said the Medical Board historically has investigated
disciplinary issues based on patient complaints. He deferred to
Ms. Chambers or the Medical Board for further comment.
SENATOR STEVENS expressed concern about the potential abuse of
disciplinary sanctions. He asked Ms. Chamber if overprescribing
a drug is grounds for disciplinary sanction.
10:04:20 AM
SARAH CHAMBERS, Deputy Director, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community and Economic Development (DCCED), Juneau, explained
that each of the boards that governs prescribers would initiate
disciplinary action if there was a violation of law, but at this
point Alaska law has no prescription limits for opioids. Last
year these boards-except the veterinary board-worked with
legislative committees to develop reasonable guidelines for
prescribing, but those are not codified in statute or
regulation.
Speaking to Senator Steven's concern about the potential for
misuse of disciplinary sanctions, she said the PDMP is intended
to be used as a tracking and educational tool. However, it's
possible that at some point in the future the PDMP could be used
as evidence if there is a complaint. Any discipline would be
done by the governing board.
SENATOR STEVENS said he likes the idea of the partial fill and
the nonpunitive approach to getting data to doctors about
prescribing habits.
MS. CHAMBERS said what this bill and Governor Walker hope to
achieve is to continue to appropriately manage the diversion of
prescription medications. She suggested that Dr. Butler could
speak to a new program called "Mind Your Meds" that is focused
on how to manage prescription medications in the home medicine
cabinet. "I think this bill does go a long way to address some
of those things that I think we can control."
10:08:56 AM
SENATOR MEYER expressed support for the CS and agreement with
Senator Stevens' concerns. He noted that stakeholders were not
present today and expressed hope that they were involved in
drafting the CS and that everyone agrees with this approach.
CHAIR COSTELLO asked Mr. Butler to address Senator Meyer's
concerns.
DR. BUTLER stated that part of the planning for the bill was to
contact various organizations and health professionals in the
state. He said that pharmacists were difficult to reach when the
CS was drafted, but their early participation during public
testimony was valuable.
He said he's heard that the CME [continuing medical education]
requirements have raised questions among providers that don't
prescribe opioids, but he believes those requirements may be
misunderstood. They are part of what is primarily an opioid bill
and the broader issue in terms of addiction and substance abuse
is important.
DR. BUTLER said too many in the medical profession haven't
recognized the medical aspects of substance abuse and addiction.
They aren't aware of the number of people who live in recovery
and that this special population needs appropriate care. He
reported that about 8 percent of the U.S. population meet the
formal definition of some type of substance abuse disorder, but
just 10 percent have received any specific treatment. This
includes alcohol, opioid, and other drug abuse and addictions.
SENATOR MEYER asked if those are national statistics.
DR BUTLER said yes.
SENATOR MEYER asked if Alaska statistics are similar.
DR. BUTLER said he doesn't have exact data but the recent report
on the cost of substance misuse and addiction suggests that
Alaska is no better than the rest of the country in addiction
rates. However, Alaska does have a larger proportion of overdose
deaths related to opioids compared to the rest of the country.
SENATOR MEYER said he wondered if overprescribing is as serious
a problem in Alaska as the Lower-48, but it doesn't really
matter because even one is too many.
CHAIR COSTELLO commented that SB 74 will provide the information
members are looking for. She noted that a recent Twitter feed
reported that 144 people in the U.S. die every day from a drug
overdose. She expressed support for SB 79's focus on education
and the fact that the report to prescribers is confidential. The
idea is to turn the focus from a pain free society using drugs
to one that won't put patients at risk of becoming addicted to
prescription medications that are supposed to make them better.
10:15:58 AM
SENATOR STEVENS questioned the zero fiscal notes. "Can we
honestly say there is a zero-fiscal note here or are we just
kidding ourselves?"
MS. CHAMBERS said DCCED is receipt supported so there are no
general funds associated with the bill. She related that the
department has successfully partnered with the Department of
Health and Social Services (DHSS) to support the legislature's
intent language to create the PDMP in 2008 and seek federal
grant funding to support education and the functionality of the
PDMP. "If there were any expenses that were to be incurred on
the Commerce side, it would all be expenditure authority and not
UGF, as we look at this bill."
DR. BUTLER confirmed that the departments have been working
together aggressively seeking grants and even donations to
support this effort. He cited the example of a donation of
several thousand drug disposal bags that will help people
deactivate excess medications at home making them safe to throw
away.
SENATOR STEVENS said he appreciates the effort to get grants,
but "whether it costs money or not we need to move ahead with
it."
CHAIR COSTELLO highlighted for the record that the Medicaid
reform bills the legislature has passed have added positions to
DHSS, and a recent bill adds a position to the Board of
Pharmacy.
10:20:04 AM
SENATOR GARDNER raised the question of confidentiality regarding
the language on pages 32-33 that allows federal, state, and
local law enforcement authorities access to the database.
DR. BUTLER suggested Department of Law address the question.
10:21:19 AM
STACY KRALEY, Chief Assistant Attorney General, Civil Division,
Human Services Section, Department of Law, Juneau, explained
that the amendment is a technical correction. A prior version
omitted a reference to the federal government. The information
in the Alaska Prescription Drug Monitoring Program (PDMP) would
be provided to those entities if a valid court order or search
warrant is presented. The information would not be shared with
anything less than that.
CHAIR COSTELLO solicited public testimony on SB 79.
10:23:27 AM
JEANNIE MONK, Alaska State Hospital and Nursing Home
Association, pointed out that an amendment that was supposed to
be included in the CS-and was approved in the House version-did
not end up in the bill. It relates to inpatient pharmacy and
emergency department prescriptions.
10:24:08 AM
At ease
10:40:13 AM
CHAIR COSTELLO reconvened the meeting and asked Ms. Monk tell
the committee about the provision that was inadvertently
omitted.
10:40:35 AM
MS. MONK said the amendment ASHNHA requested relates to
outpatient dispensing of a controlled substance from a hospital
pharmacy or emergency department. She noted that hospitals are
already exempt from reporting when prescription medications are
administered to inpatients. The proposed amendment exempts a
hospital pharmacy or emergency department from reporting
requirements when they send someone home with an outpatient
supply of 24 hours or less. The regular reporting requirements
apply if the supply is more than 24 hours.
10:41:24 AM
SENATOR GARDNER moved Conceptual Amendment 1 to version J. Add
the language in Section 41, subsection (u) of CSHB 159, version
O.
Section 41
(u) A practitioner or a pharmacist is not
required to comply with the requirements of (a) and
(b) of this section if a controlled substance is
(1) administered to a patient at
(A) a health care facility; or
(B) a correctional facility;
(2) dispensed to a patient for an outpatient
supply of 24 hours or less at a hospital
(A) inpatient pharmacy; or
(B) emergency department.
10:42:33 AM
CHAIR COSTELLO objected to asked if the conceptual amendment
includes any confirming language that may be needed.
SENATOR GARDNER said yes.
CHAIR COSTELLO removed her objection and Conceptual Amendment 1
was adopted. She removed her objection to the CS and version J,
as amended, was adopted.
SENATOR MEYER asked if there was additional public testimony.
10:43:08 AM
CHAIR COSTELLO found no further public testimony on SB 79 and
closed it.
10:43:21 AM
SENATOR STEVENS moved to report SB 79, as amended, from
committee with individual recommendations and attached fiscal
note(s).
CHAIR COSTELLO announced that without objection, CSSB 79(L&C)
[30-GS1021\J, as amended] moved from the Senate Labor and
Commerce Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 79 - Red Line Ver. A to J.pdf |
SL&C 4/14/2017 9:00:00 AM |
SB 79 |
| SB 79 Ver. J.pdf |
SL&C 4/14/2017 9:00:00 AM |
SB 79 |