Legislature(2021 - 2022)DAVIS 106

04/26/2022 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 10 Minutes Following Session --
+= HB 382 INSULIN COVERAGE:INSURANCE;MEDICAID TELECONFERENCED
Moved CSHB 382(HSS) Out of Committee
-- Testimony <Invitation Only> --
+= SB 132 CONTROLLED SUB. DATA: EXEMPT VETERINARIAN TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
        SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN                                                                    
                                                                                                                                
5:36:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY announced  that  the final  order of  business                                                               
would  be SENATE  BILL NO.  132 "An  Act exempting  veterinarians                                                               
from the  requirements of  the controlled  substance prescription                                                               
database."                                                                                                                      
                                                                                                                                
5:38:09 PM                                                                                                                    
                                                                                                                                
SENATOR  ROGER  HOLLAND,  Alaska   State  Legislature,  as  prime                                                               
sponsor, read the  sponsor statement for SB 132  [included in the                                                               
committee packet],  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Alaska's  25th  legislature  created  the  Prescription                                                                    
     Drug   Monitoring   Program   (PDMP)   in   2008.   The                                                                    
     legislative  intent behind  the  PDMP was  to create  a                                                                    
     database of prescriptions for controlled substances in                                                                     
     the   state.  The   PDMP  may   create  obstacles   for                                                                    
     individuals   seeking   opioids  to   obtain   multiple                                                                    
     prescriptions from  registered providers  and may  be a                                                                    
     useful tool for human doctors in combating the                                                                             
     opioid crisis.  Under the current  statutory framework,                                                                    
     Alaska's veterinarians  are required to  participate in                                                                    
     the  PDMP,   despite  the   irreconcilable  differences                                                                    
     between  human and  veterinary medical  practice. PDMPs                                                                    
     have been implemented  in all 50 states,  but 34 states                                                                    
     have   recognized  the   unsuitability  of   veterinary                                                                    
     participation in  the PDMP and  exempted veterinarians.                                                                    
     SB 132 would add Alaska to that list.                                                                                      
                                                                                                                                
     The majority  of states exempt veterinarians  from PDMP                                                                    
     because they  have recognized  that PDMPs  are designed                                                                    
     for  use in  human medicine;  and veterinary  exclusion                                                                    
     from  PDMPs  does  not increase  risk  to  the  public.                                                                    
     Alaska's  inclusion of  veterinarians in  the PDMP  has                                                                    
     produced  no identifiable  benefit;  yet  the PDMP  has                                                                    
     created  a   multitude  of  verifiable  harms   to  the                                                                    
     veterinary profession and the  Alaskans they serve. The                                                                    
     PDMP is  inappropriate and not  effective for  use with                                                                    
     animal  patients, as  animals do  not have  identifiers                                                                    
     such  as a  social security  number, and  veterinarians                                                                    
     must  view human  owners'  private  health data  before                                                                    
     treating an animal.                                                                                                        
                                                                                                                                
     Alaska  has the  highest veterinary  licensure cost  in                                                                    
     the  United  States.  Veterinary participation  in  the                                                                    
     PDMP contributes  to this unnecessary  financial burden                                                                    
     on a  profession already experiencing  extreme staffing                                                                    
     shortages,   decreasing   availability  of   veterinary                                                                    
     services  to Alaskans.  Moreso, a  recent survey  found                                                                    
     attempted veterinary doctor  shopping across the entire                                                                    
     United States is essentially non-existent.                                                                                 
                                                                                                                                
     Veterinarians  are   tightly  regulated  by   the  Drug                                                                    
     Enforcement  Agency, the  Know Your  Customer Act,  and                                                                    
     the State licensing  board. SB 132 seeks  to correct an                                                                    
     expensive overreach  so that  Alaskans can  have access                                                                    
     to  treatment  for   their  pets  without  compromising                                                                    
     public safety.                                                                                                             
                                                                                                                                
5:41:24 PM                                                                                                                    
                                                                                                                                
NIKKI   ROSE,  Staff,   Senator  Roger   Holland,  Alaska   State                                                               
Legislature, on  behalf of Senator  Holland, prime  sponsor, gave                                                               
the  sectional analysis  of  SB 132  [included  in the  committee                                                               
packet], which read as follows [original punctuation provided]:                                                                 
                                                                                                                                
     Sec.  1 AS  17.30.200(o),  relating  to the  controlled                                                                    
     substance   prescription   database,  is   amended   by                                                                    
     deleting  the Board  of Veterinary  Examiners from  the                                                                    
     list of required notification by  the Board of Pharmacy                                                                    
     when a practitioner registers with the database.                                                                           
                                                                                                                                
     Sec. 2 Adds veterinarians  to the list of practitioners                                                                    
     not required  to comply  with the  controlled substance                                                                    
     prescription database under AS 17.30.200(t).                                                                               
                                                                                                                                
     Sec.  3  Adds  a  definition of  "practitioner"  to  AS                                                                    
     17.30.200(u)                                                                                                               
                                                                                                                                
     Sec.  4 Repeals  AS  08.98.050(a)(10), which  obligates                                                                    
     the board of veterinary  examiners to require licensees                                                                    
     to register with  the controlled substance prescription                                                                    
     database.                                                                                                                  
                                                                                                                                
5:42:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked who manages the PDMP.                                                                                   
                                                                                                                                
SENATOR HOLLAND explained  that the expert who  could answer that                                                               
question was no longer available.                                                                                               
                                                                                                                                
CO-CHAIR  ZULKOSKY directed  the question  to Sara  Chambers from                                                               
the  Department of  Commerce,  Community  & Economic  Development                                                               
(DCCED).                                                                                                                        
                                                                                                                                
5:43:35 PM                                                                                                                    
                                                                                                                                
SARA CHAMBERS,  Director, Division of Corporations,  Business and                                                               
Professional  Licensing,  Department  of  Commerce,  Community  &                                                               
Economic Development (DCCED), replied  that the PDMP is monitored                                                               
by DCCED staff  through the Board of Pharmacy which  is in charge                                                               
of PDMP implementation.                                                                                                         
                                                                                                                                
5:44:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   MCCARTY   asked    for   confirmation   of   his                                                               
understanding that  when a pet  is owned by multiple  parties, as                                                               
in  a family  pet, whoever  brings  the pet  to the  veterinarian                                                               
would  have their  identification  (ID) number  entered into  the                                                               
PDMP.                                                                                                                           
                                                                                                                                
SENATOR HOLLAND explained that the  ID number could come from any                                                               
person who  drops off a pet  when the prescription of  opioids is                                                               
necessary; it does not have to be  the owner.  He stated that the                                                               
regulations simply require a number to be entered.                                                                              
                                                                                                                                
REPRESENTATIVE  MCCARTY   stated  that   this  seems   to  dilute                                                               
effectiveness  of the  PDMP since  multiple identifiers  could be                                                               
listed for the same animal.                                                                                                     
                                                                                                                                
SENATOR HOLLAND  explained that due  to time constraints,  he had                                                               
not  been  able  to  use   the  prepared  PowerPoint  during  his                                                               
presentation, and  he noted  that it is  a valuable  resource for                                                               
answering many of the basics about the bill.                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked what collaboration has  occurred between                                                               
DCCED and veterinarians to solve issues with PMDP.                                                                              
                                                                                                                                
5:46:59 PM                                                                                                                    
                                                                                                                                
MS.   CHAMBERS   responded   that  DCCED   has   conducted   many                                                               
conversations  with  the  Board  of Pharmacy  and  the  Board  of                                                               
Veterinary Examiners to address how  regulations should be set to                                                               
conform  with statute  and whether  or  not statute  needs to  be                                                               
changed.  She said that there  have been varying levels of follow                                                               
through among  the different entities that  have a responsibility                                                               
to  participate in  these  discussions.   She  reported that  the                                                               
department has  published instructions  on how  veterinarians can                                                               
use the  PDMP and  that she had  received positive  feedback from                                                               
veterinarians  that   the  instructions   made  using   the  PDMP                                                               
possible.   However, she mentioned that  many veterinarians still                                                               
have  concerns  about how  to  align  day-to-day operations  with                                                               
statute.                                                                                                                        
                                                                                                                                
5:49:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX  asked  how  long the  department  has  been                                                               
working with veterinarians to fix the issue.                                                                                    
                                                                                                                                
MS. CHAMBERS answered since the legislation passed in 2016.                                                                     
                                                                                                                                
5:49:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER shared her understanding  that many of the issues                                                               
veterinarians  have been  experiencing  with PMDP  relate to  the                                                               
navigability  of the  database itself.   She  asked what  kind of                                                               
changes have  been made  to the  database to  make it  more [user                                                               
friendly].                                                                                                                      
                                                                                                                                
MS.  CHAMBERS  voiced her  belief  that  there had  been  changes                                                               
implemented but directed the question  to Laura Carrillo for more                                                               
details on PMDP.                                                                                                                
                                                                                                                                
SENATOR HOLLAND  also referred the  question to Michaela  Dick, a                                                               
veterinarian who  has had a lot  of experience with the  PDMP and                                                               
has been advocating for change.                                                                                                 
                                                                                                                                
5:51:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER restated  her  question about  what changes,  if                                                               
any, have been made to the database since 2017.                                                                                 
                                                                                                                                
MICHAELA   DICK,   DMV,   Past   President,   Alaska   Veterinary                                                               
Association, replied that "we haven't  really been working on it"                                                               
and that  there has been  more of  a focus on  conversations with                                                               
the department  and the  boards due  to investigations  that have                                                               
been launched on veterinarians not  being able to use the system.                                                               
She  explained  that  because  veterinarians  work  with  animals                                                               
rather than  people, they are unable  to look up anything  in the                                                               
database  since   their  patients  do  not   have  identification                                                               
numbers.  She opined that any  fixes made to the database did not                                                               
solve the  core problem of  veterinarians being unable  to comply                                                               
with statute.                                                                                                                   
                                                                                                                                
5:53:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  asked what  changes to  regulation have                                                               
been  discussed   to  make  the   PDMP  more   user-friendly  for                                                               
veterinarians  while  still meeting  the  public  health need  of                                                               
tracking  opioids.    First,  she  posited  that  vets  could  be                                                               
required  to login  only  on days  that  they prescribe  opioids.                                                               
Second, she suggested  making the only ID  number associated with                                                               
the animal be connected to the responsible financial party.                                                                     
                                                                                                                                
5:55:16 PM                                                                                                                    
                                                                                                                                
LAURA CARRILLO,  Administrator, Board of Pharmacy,  Department of                                                               
Commerce,  Community, and  Economic  Development, explained  that                                                               
the  department  has had  "very  fruitful  discussions" with  the                                                               
Board of  Veterinary Examiners but  the discussions have  not yet                                                               
resulted  in  policy  suggestions.    She  voiced  concern  about                                                               
comingling of data  and explained that DCCED  has adjusted coding                                                               
within the  database to clarify species  and published guidelines                                                               
to help veterinarians know which codes  to use.  She deferred the                                                               
question  about regulations  around discerning  pet ownership  to                                                               
the veterinarians.                                                                                                              
                                                                                                                                
CO-CHAIR ZULKOSKY announced that SB 132 was held over.                                                                          

Document Name Date/Time Subjects
HB 382 Amendment #1.pdf HHSS 4/26/2022 3:00:00 PM
HB 382
SB 132 v.A.PDF HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Fiscal Notes DCCED 2.1.22.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 AKVMA White Paper.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Letters of Opposition as of 4.8.22.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
SB 132 Lincoln University Study PDMP Custom Tailoring is needed 2014.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Letters of Support as of 4.13.22.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
SB 132 Presentation 4-14-22.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Sectional Analysis.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Sponsor Statement.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
HB382 DOI Response to Question from (H)HSS Committee 04.26.2022.pdf HHSS 4/26/2022 3:00:00 PM
HB 382