Legislature(2013 - 2014)CAPITOL 106
03/04/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB301 | |
| HB324 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 324 | TELECONFERENCED | |
| += | HB 301 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 324-CONTROLLED SUBST. PRESCRIPTION DATABASE
3:31:07 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE BILL NO. 324, "An Act relating to the controlled substance
prescription database."
REPRESENTATIVE KELLER, as the bill sponsor, said that this was
not an attempt to state that there was an opiate abuse problem
in Alaska. He explained that the policy in question was whether
this data base was important enough to maintain, and, if so, how
to pay for the data base. He pointed out that there were not
general funds to continue payment for the existing data base.
3:32:45 PM
JIM POUND, Staff, Representative Wes Keller, Alaska State
Legislature, introduced the proposed bill, stating that it would
continue a service to help slow "the illicit, illegal opiate
trade business in Alaska," and that these prescription opiates
are a leading cause of overdoses and drug related deaths in the
country. He noted that these are not considered to be "the
normal drug culture type deaths." He reported that the federal
government had provided funding for a limited time to start an
opiate database in Alaska, but there was no longer any funding
in the state's Fiscal Year 2015 budget to continue operation.
He stated that the proposed bill would continue this database
for opiate prescription drugs, with operation and funding being
overseen by the Board of Pharmacy. He declared this to be a
crucial part in "slowing the ongoing opiate problem in the State
of Alaska." He reported that shoppers would go from doctor to
doctor for prescriptions, and then go from pharmacy to pharmacy
to have the prescription filled. He said the database would act
as a deterrent to this action. Directing attention to the
attached fiscal note for $57,000 [Included in members' packets],
he estimated that a full scale operation for the database would
cost about $150,000.
3:35:08 PM
REPRESENTATIVE REINBOLD stated her belief that the program was
absolutely critical, and she asked for clarification regarding
the fiscal note.
MR. POUND offered his belief that the fiscal note would pay for
the basic annual operation.
REPRESENTATIVE KELLER said that the Department of Health and
Social Services (DHSS) was available to speak to the fiscal
note.
REPRESENTATIVE REINBOLD stated that the data base was critical
as "these people are pretty darn sneaky."
REPRESENTATIVE KELLER referred to an amendment that he had not
yet proposed, which would change the wording on page 4, line 29,
deleting "provider" and inserting "practitioner."
MR. POUND explained that providers "are the ones who actually
provide the drugs" which is limited to the pharmacist in most
cases, whereas practitioner included everyone who had access to
the database.
REPRESENTATIVE SEATON expressed concern that the data base was
only for immediate input and was not immediately searchable. He
surmised that the purpose of the data base was to stop multiple
prescriptions, which would require an interactive database.
MR. POUND suggested that there would be an input page on the
computer in the pharmacy and a staffer would put your personal
information into the computer and the database. He compared the
technology to that of a search for the availability of a vanity
license plate. He clarified that the privacy information would
only be available to practitioners and pharmacists.
REPRESENTATIVE SEATON offered an anecdotal situation regarding
the usefulness of the data base.
MR. POUND replied that he projected the data base would have an
immediate response for any problems. He allowed that it was
debatable whether the pharmacist had the authority to not fill a
prescription which had been written by a doctor.
REPRESENTATIVE TARR asked for a comparison of the proposed and
the existing prescription drug databases. She asked if this
proposed bill would continue the funding for the current
database.
REPRESENTATIVE KELLER replied that his understanding was that
the current data base was not real time, whereas the goal was to
have a real time database.
MR. POUND added that, as technology was quickly changing, the
proposed bill allowed the department more flexibility.
REPRESENTATIVE TARR suggested that this could be a seamless
transition from one database to the next.
3:44:00 PM
DON HABEGER, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development (DCCED), in response to Chair Higgins, said
that real time was subjective, and that, by regulation, the
pharmacist in charge must report dispensed controlled substances
every thirty days and this information was uploaded into a data
base run by a third party vendor. This data was available for
immediate use, and could be reviewed for previous prescriptions
to a patient. He suggested that some of the larger pharmacies
may input on a daily basis.
CHAIR HIGGINS asked if this data base was being shut down due to
lack of funding.
MR. HABEGER replied that the database had been built using a
$400,000 grant from the US Department of Justice, with an annual
operating cost of $100,000. He relayed that, although that
funding had stopped in the previous year, DCCED and Department
of Health and Social Services had combined funding to
temporarily maintain the program through this year.
CHAIR HIGGINS asked if proposed HB 324 was trying to improve the
same database.
MR. HABEGER explained that the database existed and was
operational; however, there was not any future funding and any
improvements as determined by the proposed bill would also be
necessary.
CHAIR HIGGINS asked if the cost for proposed improvements was
reflected in the fiscal note.
MR. HABEGER replied that there would be a new fiscal note. He
explained that there was already existing Board of Pharmacy
designated staff, paid through receipt supported services, in
the investigative section. He offered his belief that the
updated fiscal note would be for $105,000, which would include
the existing program and staff.
CHAIR HIGGINS declared that his use of the database had been
favorable, that it "is a very good commodity that the state has
and I would hate to see it go away because we're not giving it
money that it should have." He had concern for the lack of real
time, and he asked for the cost to make the database in real
time. He asked what would be the "reasonable fee" from the
prescribers to maintain the data base. He said "we should do
this."
MR. HABEGER said that he could not guess at the reasonable cost.
He expressed concern for the cause and effect of the licensing
statute, as it stated that non-payment would result in
forfeiture of the license. Directing attention to Section 7 of
the proposed bill, he asked if there should be an enforcement
action if the fee was not paid.
3:52:55 PM
REPRESENTATIVE TARR asked if any of these services would bill
Medicaid, and if there was any other health care database to
integrate with this database.
MR. HABEGER said that there were concerns with the original bill
for security and patient confidentiality. He did not know the
reason for contracting with a third party vendor.
REPRESENTATIVE SEATON asked if there were any pharmacies that
did not have access to this technology, and if so, was there an
exemption if they were not able to comply.
MR. HABEGER explained that the pharmacist had to first access a
web page, then sign in, and type in the information. He opined
that larger establishments could download into the database, and
that the use of an electronic system added clarity. He surmised
that no one was using a paper format.
REPRESENTATIVE SEATON asked if hospitals and clinics were
included in this requirement to use the database.
MR. HABEGER replied that he was not certain and he deferred to
the Board of Pharmacy.
REPRESENTATIVE SEATON, in response to Chair Higgins, directed
attention to page 3, line 9, "other than those administered to a
patient at a health care facility," which possibly relieved the
other facilities of the responsibility for use of the database.
He declared that he would like clarification of what was
covered.
MR. HABEGER again deferred to the Board of Pharmacy.
REPRESENTATIVE TARR, noting that other user groups paid
licensing fees which were typically used for training,
enforcement, and certifications, asked if it seemed unusual that
this fee was paid by the subscribers for the service, even
though it was a service to the patients.
MR. HABEGER replied that this was an anomaly, as the normal
licensing fees for this structure were included in Title 8, and
this proposed bill inserted the Board of Pharmacy's necessity to
collect the fees into Title 17. He stated that this would not
be under the auspices of his division.
CHAIR HIGGINS asked how many prescribing doctors were licensed
in Alaska.
MR. HABEGER replied that there were about 5,500.
CHAIR HIGGINS asked what would be a reasonable fee if it was
only paid by these licensed physicians.
MR. HABEGER said that the fee would be expanded to include all
the prescribers in Alaska, including nurse practitioners, among
others. He said the Board of Pharmacy would make that decision,
and he offered an assumption that the fee would be divided
equally.
REPRESENTATIVE SEATON asked if the fiscal note [Included in
members' packets] was being revised.
MR. HABEGER replied that a new fiscal note would change the
language to include the new license program.
4:02:18 PM
DIRK WHITE, Chairman, Board of Pharmacy, stated that there had
originally been intent language that pharmacists would not be
charged to maintain this program, and the pharmacists would
prefer to maintain that original intent and find another means
to fund this program. He said that pharmacists were already
under a financial burden to input the data.
CHAIR HIGGINS pointed to page 4, lines 27-29, and asked if the
Board of Pharmacy disagreed with the language.
MR. WHITE replied that pharmacists already incurred a financial
burden with having to gather and provide the data. He agreed
that the Board of Pharmacy would prefer this language was not
included in the proposed bill, as it was not the intent of the
original legislation for the pharmacists to bear the financial
burden to maintain the program.
REPRESENTATIVE KELLER relayed that the intent was "not to pick
on anybody." He opined that the House Health and Social
Services Standing Committee would do its best, and would forward
it to the House Finance Committee. He declared that "it was not
the intent, it's just that somebody's gotta pay."
REPRESENTATIVE REINBOLD suggested that Mr. White contact the
Administrative Regulation Review committee, of which she was the
chair.
REPRESENTATIVE SEATON directed attention to the aforementioned
consequence, and asked if the Board of Pharmacy had the
authority to adopt consequences if the fees were not paid.
MR. WHITE deferred to Mr. Habeger.
REPRESENTATIVE SEATON suggested a need for clarity to this,
before the proposed bill moved.
MR. WHITE offered to research the question.
4:08:25 PM
BARRY CHRISTENSEN, Pharmacist, Co-Chair, Legislative Committee,
Alaska Pharmacists Association, stated that the Alaska
Pharmacists Association represented pharmacists and pharmacy
technicians in Alaska. He declared that this proposed bill was
important to the membership. He relayed that the original
intent of the program was for it to be voluntary for the
pharmacist to access, as it was necessary to use professional
judgment to determine whether to access the data base. He
pointed out that pharmacists often did not immediately enter the
data for each prescription, and that logistical and technical
reasons had prevented the program from being real time. He
directed attention to page 2, line 31, [paragraph] (3), which
stated "in cooperation with the board, seek funding sources
other than the state for operation of the controlled substance
prescription database," and he asked for further clarification.
Moving on to page 4, line 19, he questioned the delegation of
authority to access the database, expressing concern for
unlicensed people, outside a pharmacy, being able to access this
database.
MR. CHRISTENSEN, in response to Representative Keller, suggested
that page 4, line 21, be changed to say "licensed employee,"
which would allow greater control over access to the database.
REPRESENTATIVE SEATON asked for clarification that it would be
an employee, and not specifically a "practitioner." He asked if
all the practitioners with access to the database would be
licensed.
MR. CHRISTENSEN replied that all the practitioners would be
licensed.
REPRESENTATIVE TARR asked how the database funding was being
addressed in other states.
MR. CHRISTENSEN replied that there were other funding
mechanisms, which included payment by all the prescribers in
Oregon, Medicaid settlements, private donation foundations, and
state general revenue funds. He asked about the cost for
collection and administration of the funds.
4:16:15 PM
CHAIR HIGGINS, noting the difficulty to forge computer generated
script [prescriptions], asked whether there were more hand
written or computer generated prescriptions.
MR. CHRISTENSEN replied that there were more computer generated
prescriptions, and that the number of forgeries had dropped
significantly. He declared that although there was still a
problem with people shopping from office to office, the database
program had helped to control this practice.
REPRESENTATIVE SEATON directed attention to page 3, line 28, and
he asked if there was any conflict with maintaining the database
in a secure file and the requirement on page 4, line 13, which
stated that the database should be purged after two years.
MR. CHRISTENSEN said that federal law, mirrored by state law,
required the two year controlled substance prescription data
purge, and he did not see any conflict.
REPRESENTATIVE SEATON asked for clarification for what portion
of the data base was purged.
MR. CHRISTENSEN said that the identifications and the
prescriptions were purged.
CHAIR HIGGINS asked if the information was purged every two
years for storage reasons.
MR. CHRISTENSEN offered his belief that this practice mirrored
federal regulations for how long a prescription needed to be
kept on file by a pharmacy. He clarified that the records were
actually kept by the pharmacies for ten years for Medicare
regulations. He opined that the cost for data storage and
maintenance could be the reason for the purge. He suggested
that people who were shopping for drugs were doing this
continually, and did not stop for a few years, and then start
again.
CHAIR HIGGINS noted that he was supposed to keep records for
seven years.
REPRESENTATIVE SEATON expressed his concern for page 4, line 13,
which said "shall be purged from the database," as he did not
want there to be conflicting requirements under the law.
4:22:40 PM
JOHN ZIPPERER, MD, Zipperer Medical Group, stated his support
for HB 324, noting that it was an important step forward,
although it could go even further. He said that the most
essential component was the ability for providers to access this
information, and that these databases have "done tremendous good
in preventing diversion of these substances." He offered
several anecdotes regarding patients seeking prescriptions and
the use of the prescription database. He stressed that the
database was for the benefit of the patient, and access to it
was critical for physicians. He concurred that the
practitioners should be charged a fee for use of the database.
He relayed a recommendation that a prescription drug monitoring
report should be made on every patient on every visit.
REPRESENTATIVE TARR asked if he was willing to pay a reasonable
fee to maintain the database, and if so, what would he suggest
for that fee.
DR. ZIPPERER said that a subscription service to the providers
for $40 to $50 each month would not be burdensome. He declared
that the price for not using the database was a lot higher, and
he suggested the opportunity for a physician to opt out of the
service if not they did not prescribe these controlled
substances. He declared that the database was "extremely
valuable to the patients and to the citizens of Alaska."
4:28:55 PM
RICHARD HOLM, Pharmacist, reported that he was the immediate
past chair of the Board of Pharmacy. He suggested that it was
necessary for the practitioner to have the opportunity to
delegate staff to look up this information. He pointed out that
HIPAA regulations necessitated that all pharmacy staff be
licensed and regulated by the Board of Pharmacy, and he
suggested a change to the wording of the proposed bill as
previously mentioned by Mr. Christensen. He stated that many
individuals benefited from this program, including pharmacists
and prescribers, as well as system benefits to the patients and
different agencies of the state. Because of this widespread
benefit, he suggested use of the general fund to pay for the
program. He reminded the committee that a fee on the
prescribers was not fair, as not all prescribers dispensed these
substances. He pointed out that the cost for maintaining the
system was already paid by the pharmacists, although they were
not mandated to use the system. He reported that there was
still some paper reporting in the system from small dispensers,
veterinarians, and dentists. He noted that the system also
covered out of state pharmacies licensed in Alaska, although
some would request exemptions as they did not send any
controlled substances into Alaska. He suggested that it would
be difficult to pinpoint the exact users of the system.
REPRESENTATIVE REINBOLD asked for clarification regarding mail
order pharmacies.
MR. HOLM said that some out of state licensed pharmacies did not
send controlled substances to Alaska. He discussed the
difficulties for real time as it depended on the definition, and
he offered some scenarios regarding distribution of
prescriptions, declaring that, until a prescription was picked
up by the patient, it was not truly dispensed. He stated that
the database was developed for informational purposes, and he
offered his belief that real time made it an enforcement tool.
4:40:11 PM
PATRICIA SENNER, Alaska Nurses Association, reported that the
Alaska Nurses Association had testified in support of creation
of this data base in 2008, while expressing concern for the
necessary safeguards for privacy. At that time, the association
had requested that only licensed providers be allowed to access
the database, and that personal addresses not be included in the
database, which was not approved at that time. She expressed
concern for the release of personal information. She reported
that nurse practitioners required authority from the Board of
Nursing to prescribe controlled substances, and, as these were
prescribed on an intermittent basis, the fees should reflect the
actual use of the database. She said that a small amount could
be included in licensing fees, with the various boards having an
enforcement role.
REPRESENTATIVE TARR asked about any other cautionary issues to
consider.
MS. SENNER replied that there was the threat of blackmail using
the database information, with the threat to release medical
records.
4:44:02 PM
CHAIR HIGGINS said that the bill would be held over, as the
sponsor wanted to continue work on the bill. He suggested an
opt out clause, or a monthly fee to access the database, so that
only those who needed to use it would pay for it. He declared a
need for more discussion regarding who could access the
database. He declared his support for the database, and that
general funds would be the best route to pay for it. He
expressed understanding for the pharmacists' reluctance to pay
for the database, as they already had to input the data and
maintain it.
CHAIR HIGGINS kept public testimony open.
REPRESENTATIVE SEATON, in response to Representative Keller,
said that he wanted more clarity for page 3, line 9, as to what
was included as "administered to a patient at a health care
facility." He opined that Section 3 was an opt in scenario,
because if you were not distributing any of the listed
controlled substances, you were not required to submit. He
suggested that this could be the mechanism to define those who
would opt-out, and not be required to pay a fee.
CHAIR HIGGINS said that dentists were included in these
schedules for the controlled substances, and that it covered a
lot of people. He stated that not everyone would use the
database, if there was not a need, as they did not prescribe the
controlled substances. He suggested writing opt-out language.
REPRESENTATIVE SEATON asked for clarification regarding the
purges from the database after two years, and if there was any
conflict with the maintenance of these records for ten years.
CHAIR HIGGINS shared that he kept his patient records and copies
of prescriptions for more than seven years. He said that he did
not know how important it was for the two year purge.
REPRESENTATIVE TARR asked for clarification for the necessary
speed for recording the information and the definition of real
time.
REPRESENTATIVE SEATON pointed out that, as there were still
written prescriptions, it might be necessary to include a
provision regarding limited prescriptions and rural areas.
CHAIR HIGGINS clarified that it was pharmacists who input the
data, not those who write the prescriptions.
REPRESENTATIVE SEATON replied that he was referring to earlier
testimony for dispensing by rural doctors and veterinarians.
4:51:59 PM
[HB 324 was held over.]