Legislature(2007 - 2008)HOUSE FINANCE 519
04/05/2008 12:00 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB196 | |
| HB337 | |
| SB229 | |
| SJR17 | |
| SB185 | |
| SB265 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 337 | TELECONFERENCED | |
| + | SB 185 | TELECONFERENCED | |
| + | SB 229 | TELECONFERENCED | |
| + | SB 265 | TELECONFERENCED | |
| + | SJR 17 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 196 | TELECONFERENCED | |
CS FOR SENATE BILL NO. 196(FIN) am
"An Act relating to establishing a controlled substance
prescription database."
12:56:42 PM
GINGER BLAISDELL, STAFF, SENATOR LYDA GREEN, presented an
overview of the bill. She indicated that the medical
community and the Alaska Pharmacy Association brought this
need to the attention of Senator Green. Ms. Blaisdell
described the legislation as a compilation of existing bills
from forty other states. She referred to the PowerPoint
presentation (Prescription Drug Monitoring Program and
Database, copy on file). She reported that:
All states have laws and regulations that govern the
distribution and handling of controlled substances.
Diversion of controlled substances and other
pharmaceuticals is generally recognized as a serious
problem throughout the United States.
Ms. Blaisdell referenced available support materials,
including letters from the White House designating drug
diversion as one of President Bush's top priorities. Ms.
Blaisdell expressed that:
States have found that Prescription Drug Monitoring
Programs (PDMPs) are among the most effective tools
available to identify and prevent drug diversion.
Ms. Blaisdell defined drug diversion:
Diversion is taking a legal prescriptive substance and
altering it to provide a different effect or
selling/giving it to someone other than the person to
whom it was intended.
Diversion affects the health of our citizens.
Diversion often promulgates other criminal activity.
Ms. Blaisdell indicated the goals:
Prescription Drug Monitoring Programs are intended to
promote pharmaceutical care while deterring diversion
through education and law enforcement.
Prescription Drug Monitoring Programs are aimed at
upholding statutory mandates in a manner that is most
supportive of and least disruptive to medical and
pharmacy practices.
Ms. Blaisdell noted it would only take two minutes a day to
download information from the database; the new legislation
is meant to be a helpful tool not a new mandated task. Ms.
Blaisdell described national ads produced for the $30
million U.S. drug awareness campaign. She stressed the
importance of education:
There is a national presumption that the misuse of
prescription drugs is safer than using illicit "street"
drugs.
Prescription and over-the-counter medications are fast
becoming the new "party" drugs for many teenagers and
adults.
Twenty-five to forty percent of MySpace users include
postings on how to get prescription medication on the
internet.
Ms. Blaisdell revealed the most commonly abused medications:
Pain Killers
Stimulants
Sedatives and Tranquilizers
Over-the-Counter Drugs
She described prescription abuse to include:
Children through elderly individuals abuse for themselves
or for personal profit.
Nearly seventy percent of prescription drugs are obtained
for free from friends and family.
Pain killers are the number one abused drug because of
the feeling of euphoria and/or high resale value.
Ms. Blaisdell stressed the importance of this legislation,
noting that:
The Department of Commerce, Community and Economic
Development (DCCED), Board of Pharmacy, currently
conducts research and licensee investigations regarding
drug diversion practices.
A Prescription Drug Monitoring Program will provide the
direction and tools for collecting accurate and timely
prescription drug information to assist in the prevention
of diversion and promote safe and effective health care
for Alaska's citizens.
1:03:24 PM
Ms. Blaisdell continued on the importance of this
legislation:
State and local law enforcement agencies are experiencing
a rise in prescription drug diversion criminal activity.
This legislation was requested by Alaskan pharmacists,
doctors and law enforcement officials.
With legislation, the state will be eligible for federal
funding.
Ms. Blaisdell reported that this legislation:
Establishes a Prescription Drug Monitoring Program within
the Board of Pharmacy.
Tracks all schedule I-V controlled substances in state
and federal law.
Data will be electronic rather than paper.
Ms. Blaisdell explained:
Data can be used by licensed prescribers who have the
authority to prescribe when caring for a patient.
Data can be used by a licensed or registered dispenser
who is considering a controlled substance to an
individual.
Data can be used by the personnel of the Board of
Pharmacy regarding licensing inquiries, and for database
management.
Data can be requested through the Board by law
enforcement entities with a subpoena or court ordered
warrant.
Ms. Blaisdell continued that data can be used to:
Improve health care for patients
Identify prescribing and dispensing practices that may be
of question; and
Identify individuals who show a pattern of inappropriate
use.
1:06:03 PM
Ms. Blaisdell revealed that the data is confidential and not
subject to public disclosure:
Health Insurance portability and Accountability Act
exceptions are allowed for state Prescription Drug
Monitoring Programs.
Patient privacy is secured by the details of the contract
for the vendor who will capture the data.
Privacy is insured by the Class A misdemeanor and Class C
felony charges that would accompany inappropriate use of
the data.
Ms. Blaisdell referred to the fiscal notes from the
Department of Commerce, Community and Economic Development
and the Department of Health and Social Services.
Ms. Blaisdell indicated that statewide insurance providers
and individuals who self-pay are expected save $1.4 million
in the first year. She remarked that:
Senate Labor and Commerce adopted a committee substitute
that addressed almost all concerns voiced by the medical
community and government agencies. The side-by-side
document is in the bill packet.
Senate Labor and Commerce adopted intent language
regarding the impact of future funding. The intent memo
is in bill packet.
She reassured the Committee that after checking through the
bill with legislative legal every sentence and every
paragraph has some sort of privacy protection or data
security written into the bill.
1:09:14 PM
Representative Nelson questioned if the Native Health
Service would have access to this database. Ms. Blaisdell
replied that Maine is the only state to enter voluntary
contracts with military and tribal health providers.
Military and tribal health is governed by federal law rather
than state law so they are exempt from participating. She
added that those providers who choose to participate can
receive permission.
Representative Nelson asked if this would be phrased as
anyone who contracts and compacts with Indian Health
Service. Ms. Blaisdell agreed that most people are entering
into contracts.
1:10:28 PM
Representative Gara questioned if the main purpose of the
bill would be to provide a database accessible to all
pharmacists in the state. Ms. Blaisdell responded that the
database would be accessible to all pharmacists who apply to
have access to retrieve information. All pharmacists in the
state would be required to report any dispensing of
controlled substances.
Representative Gara asked if one of the purposes of the
database would be for pharmacists to check on the other
medications a patient may have been prescribed. He also
inquired if this information would be available to the
physician when prescribing a drug for a patient.
Ms. Blaisdell emphasized that not every prescription will be
in the database. The database will only indicate drugs in
Schedule I-V: painkillers, sedatives, tranquilizers, or
stimulants. She provided the example of an elderly person,
always going to the same pharmacy, would have a prescription
history at that pharmacy. A medical provider can access this
database to look at the person's history when they are
writing a prescription.
1:13:20 PM
Representative Gara inquired if pharmacists now have access
to a database to determine if there is potential drug
interaction.
Ms. Blaisdell responded that pharmacists are not the primary
individual trying to discover every drug interaction.
Discovering potential drug interactions will start with the
medical provider. She signified that patients who "doctor
shop" using multiple pharmacies could be tracked with this
database.
1:14:40 PM
Vice-Chair Stoltze questioned the access individuals have to
the database. He requested information on any fees involved.
Ms. Blaisdell remarked that any individual can request the
report of their own history in the database. She reported
that the fee will not exceed ten dollars but the patient can
also ask their physician to run a history. She revealed that
prescriptions listed in the database will use the medical
term for the medication not the brand name.
Vice-Chair Stoltze asked if the database would be available
to other professional boards, primarily for disciplinary
cases. He also asked for comment on how the large chain
pharmacies handle prescription information.
1:16:47 PM
Ms. Blaisdell reported letters of support from the National
Association of Chain Drug Stores (Safeway, WalMart, etc). A
large corporate drug store can share data within their own
corporate chain but not among different drug store chains.
The proposed database would capture all this information.
Vice-Chair Stoltze asked again about the availability to
other professional boards.
Ms. Blaisdell responded that this information is only
accessible by a court ordered warrant or subpoena.
1:18:32 PM
Representative Nelson referred to another database set up
for antihistamines that expunges the records after one year.
She asked if there was a time frame to expunge records in
this bill.
Ms. Blaisdell responded that there is a two year provision
to dispose of the information. The database is looking for
someone with a pattern of use, not a one-time incident.
Representative Nelson asked if pharmacists are privy to
patient's drug history through a patient's insurance
provider.
1:20:02 PM
Ms. Blaisdell responded that a patient's drug history can
not be obtained through their insurance provider. She noted
that the use of cash to pay for a prescription is one of the
key data elements that may reveal drug diversion.
1:20:50 PM
Representative Gara stressed concern about information
becoming accessible to the general public. He pointed to a
provision in the bill indicating that law enforcement may
obtain information from the database through a search
warrant or subpoena. He noted in civil cases information can
be obtained through a "discovery process" and voiced his
concern that information may be obtained in this manner.
1:22:11 PM
Ms. Blaisdell disclosed that the data is not accessible for
"discovery" or civil suits only through a court order,
warrant or subpoena. She cited an example that a medical
doctor could not provide a person's medical history to
another member of the family.
Representative Gara asked where in the bill it states
information may not be obtained through a discovery order.
Ms. Blaisdell replied that there is no provision that says
it is not accessible through a discovery order because the
only provision for accessing this information, outside of
the physician or pharmacist, is through a court warrant or
subpoena
1:23:12 PM
DANIEL LYNCH, SOLDOTNA testified via teleconference and
voiced his concern about privacy information being
disclosed. He noted the widespread internet and database
theft. He cautioned that hackers have entered many national
corporate databases and a potential hacker into this drug
database would obtain personal information for possible
theft or sale to insurance companies or employers. He noted
the long-standing confidentiality between patients and
physicians and hoped privacy can be maintained. He wondered
if possible new hiring to enter these prescriptions will
raise the price of medications.
1:26:30 PM
PATRICIA SENNER, NURSE PRACTITIONER, ALASKA NURSES
ASSOCIATION testified via teleconference spoke in support of
the bill. As prescribers, the association welcomed the
opportunity of receiving accurate information for controlled
medication prescribed to their patients but warned that
someone in a physician's office, hospital or pharmacy could
go on a "fishing" expedition to locate private information,
noting the recent Britney Spears case. She suggested at
third layer manager who would give permission before any
information could be released from the database.
1:28:37 PM
LINDA BAREFOOT, REGIONAL DIRECTOR, PURDUE PHARMA testified
via teleconference in support of this legislation.
1:30:03 PM
BRIAN HOWES, INVESTIGATOR, OCCUPATIONAL AND PROFESSIONAL
LICENSING testified via teleconference and was available for
questions.
1:30:44 PM
Co-Chair Meyer CLOSED PUBLIC TESTIMONY.
Co-Chair Meyer MOVED to ADOPT Amendment 1 25-LS1092\V.2.
Page 2, line 25:
Delete "an inpatient in a licensed"
Insert "those administered to a patient at a"
Vice-Chair Stoltze OBJECTED for discussion.
Ms. Blaisdell explained that Amendment #1 clarified language
confusion in the bill.
Vice-Chair Stoltze WITHDREW his OBJECTION. There being NO
further OBJECTION, it was so ordered.
1:32:49 PM
Co-Chair Meyer MOVED to ADOPT Amendment 2, 25-LS1092\V.1.
Page 5, lines 7-9
Delete "The board may enter into agreements with
dispensers that are not regulated by the state and
practitioners in this state to submit information to
and access information in the database subject to this
section and the regulations of the board."
Insert "The board may enter into agreements with
(1) dispensers in this state that are not regulated by
the state to submit information to and access
information in the database, and (2) practitioners in
this state to access information in the database,
subject to this section and the regulations of the
board."
Vice-Chair Stoltze OBJECTED for discussion.
Vice-Chair Stoltze requested if there were any other
dispensers not regulated by the state.
Ms. Blaisdell disclosed that originally the paragraph only
mentioned military or tribal but it was broadened to include
the internet or medical doctors on ships inside Alaska
waters.
Vice-Chair Stoltze WITHDREW his OBJECTION. There being NO
further OBJECTION, it was so ordered.
1:34:58 PM
Co-Chair Meyer referred to the fiscal notes.
1:35:26 PM
Representative Gara questioned the date information is
removed from the database.
Ms. Blaisdell replied that it would be two years from the
date the prescription was obtained.
Representative Gara asked if there would be a problem
reducing it to one year. Ms. Blaisdell replied that forty
states have this database and most have a three year
provision. Representative Gara inquired about the
classification for the Class C and Class B offenses.
1:37:46 PM
Ms. Blaisdell deferred to legislative legal or the
Department of Law. She mentioned that the legislation is
written this way in other states and seems to be the
accepted nationwide practice.
Representative Gara pointed out that "knowingly" is only
written in regards to part of the crime. He wanted to make
sure that the legislation is properly written so someone is
not put in prison if they did not "know" what they were
doing was wrong.
1:39:02 PM
Ms. Blaisdell remarked that this issue was brought up before
in House Judiciary with the example that if a janitor finds
personal information that has been thrown in the trash of a
doctor's office, the office did not "knowingly" give it
away. But if the janitor then illegally uses that
information, then that would be classified as "knowingly."
Representative Gara wondered if someone who works for a
pharmacist and "unknowingly" gives the medication to an
improper individual would that be classified as "knowingly".
1:41:08 PM
Ms. Blaisdell remarked that in the federal grant there is a
significant emphasis on education for the proper use of the
database. There has been discussions if the access to the
database could be delegated to another individual on staff
in a pharmacy or medical office and the resounding answer
was no.
1:43:02 PM
Vice-Chair Stoltze MOVED to REPORT HCS CSSB 196 (JUD) out of
Committee, with a Letter of Intent, individual
recommendations and accompanying fiscal notes. There being
NO OBJECTION, it was so ordered.
HCS CSSB 196 (JUD) REPORTED from the Committee with a Letter
of Intent, no recommendations, and accompanying new fiscal
note from the Department of Health and Social Services, and
a previously published fiscal note from the Department of
Economic Development.
1:44:15 PM
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