Legislature(2017 - 2018)HOUSE FINANCE 519
04/18/2017 09:45 AM FINANCE
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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.
|SB 88 - Opposition Document 4.18.2017.pdf||
HFIN 4/18/2017 9:45:00 AM