Legislature(2013 - 2014)CAPITOL 106

03/27/2014 03:00 PM HEALTH & SOCIAL SERVICES

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        SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS                                                                    
3:04:48 PM                                                                                                                    
CHAIR HIGGINS  announced that the  first order of  business would                                                               
be CS FOR  SENATE BILL NO. 169(FIN), "An Act  establishing in the                                                               
Department   of   Health   and  Social   Services   a   statewide                                                               
immunization program  and the  State Vaccine  Assessment Council;                                                               
creating  a  vaccine  assessment  account;  requiring  a  vaccine                                                               
assessment   from   assessable   entities   and   other   program                                                               
participants for statewide  immunization purchases; repealing the                                                               
temporary  child and  adult immunization  program; and  providing                                                               
for an effective date."                                                                                                         
3:05:44 PM                                                                                                                    
DAVID  TEAL,  Legislative  Fiscal  Analyst,  Legislative  Finance                                                               
Division, Alaska  State Legislature,  referred to Fiscal  Notes 6                                                               
and 7 [Included  in members' packets], and  explained that Fiscal                                                               
Note 6  was for the  fund capitalization,  and Fiscal Note  7 was                                                               
for epidemiology.   He directed  attention to Fiscal Note  7, and                                                               
pointed to the almost $4.5  million in the governor's Fiscal Year                                                               
2015  budget from  general  funds,  which was  also  listed as  a                                                               
negative  figure in  the requested  appropriation.   He explained                                                               
that $4.5 million was being  taken away from epidemiology and the                                                               
Division  of Public  Health,  Fiscal  Note 6,  and  moved to  the                                                               
Vaccine Assessment  Account fund,  Fiscal Note  7.   He clarified                                                               
that there  was not any spending  of new general funds,  that the                                                               
purpose  of the  funds remained  the  same, and  that this  would                                                               
create a more  permanent program.  Referring back  to Fiscal Note                                                               
6, he  pointed to the  almost $27  million from the  general fund                                                               
receipts,  which   were  raised  from  the   assessment  fee  for                                                               
vaccines.   He explained that  these funds  are used to  buy more                                                               
vaccine, which was distributed after  payment of assessment fees,                                                               
and then these fees were sued  to maintain the cycle.  He pointed                                                               
out  that there  would not  be  any need  for additional  general                                                               
funds, as long as the assessment  fees were used to replenish the                                                               
fund.  He  had questioned whether the $31 million  in Fiscal Note                                                               
6 was  sufficient, and Department  of Health and  Social Services                                                               
had assured him  that the $31 million would not  be exceeded.  He                                                               
concluded that  the net effect on  the general fund was  zero, as                                                               
money was simply being moved from one place to another.                                                                         
3:10:04 PM                                                                                                                    
JILL LEWIS,  Deputy Director -  Juneau, Central  Office, Division                                                               
of  Public  Health, Department  of  Health  and Social  Services,                                                               
clarified that the vaccine was not  sold or re-sold, but that the                                                               
assessments  were based  on  the projected  cost  for the  annual                                                               
purchase of vaccines.  She  said that there were also assessments                                                               
and payments made throughout the  year that generated the revenue                                                               
over the course of the year to  keep pace.  She reported that the                                                               
program bought  vaccine every month, allowing  management for the                                                               
expiration  dates and  the  necessary volume  to  respond to  any                                                               
disease outbreaks  or demand  in the state.   She  explained that                                                               
the aforementioned  $4.5 million was enough  capitalization as 50                                                               
percent of  the children's vaccine  was purchased with  a federal                                                               
grant, which, as  it was not forwarded to the  state coffers, did                                                               
not reflect in the fiscal notes.   She pointed out that, as there                                                               
was already  vaccine on the  shelf to  use, this would  be enough                                                               
capital  to get  started.    She declared  that  this system  had                                                               
worked well in other states.                                                                                                    
CHAIR HIGGINS  offered his understanding that  the program worked                                                               
well  in other  states  as those  were  only pediatric  programs,                                                               
whereas the proposed  bill included adult vaccines.   He asked if                                                               
the assessment value to the insurers had been determined.                                                                       
MS. LEWIS  replied that the  amount of assessment per  dosage had                                                               
not yet  been determined, although it  was $50 - $200  per person                                                               
in other  states.   She explained  that there  were a  variety of                                                               
variables for determining the assessment.                                                                                       
CHAIR HIGGINS  returned attention  to the assessment  formula and                                                               
asked about letters of support from the insurance carriers.                                                                     
MS. LEWIS offered her belief that  there had only been the letter                                                               
of  support  from  Premera  Blue   Cross  [Included  in  members'                                                               
packets],   although   the   Medicaid  program   had   plans   to                                                               
participate, and  its program covered  "a significant  portion of                                                               
the population."                                                                                                                
CHAIR  HIGGINS  asked  if,  as  payment  of  the  assessment  was                                                               
important,  it would  be beneficial  to have  letters of  support                                                               
from the insurance industry.                                                                                                    
MS. LEWIS replied that there  had been discussions with the human                                                               
resource departments  and Dr. Hurlburt regarding  the willingness                                                               
to  participate in  the program.   She  pointed out  that Premera                                                               
Blue Cross  served almost 75  percent of the private  health care                                                               
market in Alaska.                                                                                                               
CHAIR HIGGINS  surmised that a  lot of confusion had  arisen from                                                               
the Fiscal Note.                                                                                                                
3:17:27 PM                                                                                                                    
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature,  referred to  the  sectional  analysis [Included  in                                                               
members' packets].   She directed  attention to the  two graphics                                                               
titled  SB  169  Statewide   Immunization  Program  [Included  in                                                               
members'  packets] which  offered  a pictorial  analysis of  each                                                               
step of the program.                                                                                                            
MS.  CONWAY  paraphrased  from   the  SB  Statewide  Immunization                                                               
Program Sectional Analysis (LS 1219\I), which read:                                                                             
     Sec. 18.09.200(a). Establishes a statewide                                                                                 
     immunization program in the Department for the purpose                                                                     
     of monitoring, purchasing, and distributing vaccines                                                                       
     to providers.                                                                                                              
     Sec. 18.09.200(b). The Department of Health and Social                                                                     
     Services shall maintain a list of recommended vaccines                                                                     
     for inclusion in the program; establish the 1st year's                                                                     
     & thereafter make annual assessments based on                                                                              
     commission determinations; notify insurers and other                                                                       
     program participants of the assessment amount; devise                                                                      
     a method for crediting overpayments; coordinate the                                                                        
     bulk purchase of vaccine; set procedures for                                                                               
     distributing vaccines; and review appeals for errors.                                                                      
     Sec.   18.09.210.   Establishes   the   State   Vaccine                                                                    
     Assessment  Council  within  HSS  for  the  purpose  of                                                                    
     determining the  assessment amount. The  commission has                                                                    
     8 members  appointed by  the Commissioner:  the state's                                                                    
     Chief  Medical Officer  (chair); Division  of Insurance                                                                    
     Director; 3 health  care insurers, one of  whom must be                                                                    
     a plan  administrator; 2 health  care providers;  and 1                                                                    
     representing a  tribal or public health  insurance plan                                                                    
     who  serve  without  compensation or  reimbursement  of                                                                    
     expenses. Terms are  3 years with a 2-  term limit. HSS                                                                    
     will  provide   staff  and  other  assistance   to  the                                                                    
     commission. The  commission establishes  and implements                                                                    
     a  plan  of  operation,  submits  an  annual  financial                                                                    
     report to  HSS each  July 1st, and  monitors compliance                                                                    
     with the program.                                                                                                          
CHAIR HIGGINS asked who would run the assessment council.                                                                       
MS.  CONWAY  directed  attention  to  page 2,  line  19,  of  the                                                               
proposed bill,  which discussed the  makeup of the council.   She                                                               
reported that the  council would be chaired by  the Chief Medical                                                               
Officer  for the  [Division] of  [Public] Health.   She  directed                                                               
attention to  page 2, line  24, which described that  the council                                                               
consisted  of eight  members appointed  by the  commissioner, and                                                               
included  the  "department's  chief medical  officer  for  public                                                               
health," two  health care  providers licensed  in the  state, and                                                               
three members  representing health care insurers  licensed in the                                                               
state,  one of  whom must  be a  health care  plan administrator.                                                               
She noted  that each  insurer member  must represent  a different                                                               
organization in the state.   She continued, and stated that there                                                               
would  also be  a representative  of  a tribal  or public  health                                                               
insurance plan, and the director  of the division of insurance or                                                               
the designee.                                                                                                                   
CHAIR  HIGGINS acknowledged  that, although  Vermont included  an                                                               
adult portion in their program,  the state was "still working out                                                               
the  nuts and  bolts even  though they've  been at  it for  a few                                                               
years."   He pointed out  that Vermont  was now having  a company                                                               
run  this  program,  and  he   asked  if  the  bill  sponsor  had                                                               
investigated this option.                                                                                                       
MS.  LEWIS directed  attention to  page  3, line  8, which  read:                                                               
"The department shall  provide staff and other  assistance to the                                                               
council."    She relayed  that  seven  of  the nine  states  with                                                               
similar  programs had  contracted with  a company  experienced in                                                               
administration of  these programs.   She  noted that  those costs                                                               
were  included  as a  surcharge  in  the assessment  and  program                                                               
receipts, so there  were no state general funds in  support.  She                                                               
estimated  that cost  to  be about  one  percent, $300,000,  each                                                               
CHAIR HIGGINS  reported that the  fee in Vermont for  the overall                                                               
cost of  vaccines was $50,000  annually, three percent  the first                                                               
year, two percent the second year,  and one percent for the third                                                               
3:23:06 PM                                                                                                                    
MS. CONWAY returned to her discussion of the sectional analysis,                                                                
and paraphrased the section, which read:                                                                                        
     Sec.  18.09.210(f)(1).  The  "plan of  operation"  must                                                                    
     include  the  method  for  calculating  the  assessment                                                                    
     amount  for each  covered  individual;  the method  for                                                                    
     determining    proportional    costs   to    assessable                                                                    
     entities/participants;  procedures  for the  collection                                                                    
     and   deposit  of   assessment  fees;   procedures  for                                                                    
     collecting data which includes at  a minimum the number                                                                    
     of covered individuals and vaccine  usage; and a system                                                                    
     for crediting overpayments.                                                                                                
     Sec. 18.09.220(a). Requires the assessable                                                                                 
     entities/participants to pay the assessment to the                                                                         
     department for each covered individual; provide                                                                            
     information about number of covered individuals and                                                                        
     actual usage; and provide audited financial statements                                                                     
     upon request.                                                                                                              
     Sec. 18.09.220(b). Requires that the assessment                                                                            
     include reasonable costs for overhead. The provider's                                                                      
     fee for administration of the vaccine is excluded from                                                                     
     the assessment.                                                                                                            
     Sec. 18.09.220(c). States that an assessment is a                                                                          
     medical expense for the assessable entity/participant.                                                                     
     Sec. 18.09.220(d). Provides for a process to appeal                                                                        
     the assessment determination to the commissioner.                                                                          
     Sec. 18.09.225. Allows health care providers to opt                                                                        
     into the program to purchase vaccine.                                                                                      
     Sec. 18.09.230. Creates a special account in the                                                                           
     general fund for the purpose of purchasing vaccines.                                                                       
     The legislature may appropriate program receipts from                                                                      
     vaccine assessments, money from other sources, and                                                                         
     interest earned. Appropriations do not lapse.                                                                              
REPRESENTATIVE KELLER, referencing Sec. 18.09.225, asked why                                                                    
someone would not be approved.                                                                                                  
MS. LEWIS explained that she could only think of a very rare                                                                    
instance when a provider was not already enrolled with the                                                                      
immunization program,  and had not  yet completed  the paperwork.                                                               
She stated  that the department  would work with the  provider to                                                               
fulfill the requirements.                                                                                                       
3:26:27 PM                                                                                                                    
MS. CONWAY paraphrased the next section, which read:                                                                            
     Sec. 18.09.240. Allows the commissioner to determine a                                                                     
     monetary penalty for noncompliance.                                                                                        
MS. LEWIS,  in response to  Chair Higgins, explained  that should                                                               
an entity not pay, the commissioner  may assess a penalty "on top                                                               
of the assessment," although the penalty was not required.                                                                      
CHAIR HIGGINS  asked for  clarification that  assessment payments                                                               
would be quarterly.                                                                                                             
MS. LEWIS replied that this  was currently being discussed, as it                                                               
was  the most  common  payment  schedule in  other  states.   She                                                               
shared that there was also  the possibility for monthly payments,                                                               
and could  be determined by the  best cash flow scenario  for the                                                               
payers and providers.                                                                                                           
CHAIR  HIGGINS  suggested  that quarterly  payments  be  paid  up                                                               
front,   prior  to   the  start   of  the   quarter,  to   ensure                                                               
participation  in the  program and  to eliminate  any need  for a                                                               
MS. LEWIS expressed her agreement.                                                                                              
MS. CONWAY  moved on to  paraphrase Section  2, page 5,  line 16,                                                               
which read:                                                                                                                     
     Section 2. 18.09.900. Defines the terms assessable                                                                       
     entity, commissioner (Health & Social Services),                                                                         
     council, covered individual, other program                                                                               
     participant, program, provider, recommended vaccine,                                                                     
     and vaccine.                                                                                                             
     Sec. 18.09.900(3). An "assessable entity" means a                                                                          
     health care insurer, the state health care plan, a                                                                         
     public or private entity that offers a publicly funded                                                                     
     plan (to the extent allowed by law), and third-party                                                                       
MS. CONWAY paraphrased  Section 3, Section 4,  Section 5, Section                                                               
6, and Section 7, which read:                                                                                                   
     Section 3. Requires assessable entities to provide                                                                       
     information to the department under (AS 21.09.242)                                                                       
     Section 4. Adds the vaccine assessment account to the                                                                    
     list of special accounts for program receipts in (AS                                                                     
     Section 5. Repeals Ch. 24, SLA 2012 (HB310), a                                                                           
     temporary statewide immunization program.                                                                                
     Section 6. Redirects the remaining HB310 funds to be                                                                     
     deposited to the vaccine account.                                                                                        
     Section 7. Makes the act effective July 1, 2014.                                                                         
3:30:05 PM                                                                                                                    
CHAIR HIGGINS opened public testimony.                                                                                          
3:30:34 PM                                                                                                                    
WARD HURLBURT,  MD, Chief  Medical Officer/Director,  Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services, declared that five years  earlier, Alaska had been 49th                                                               
nationally in immunization rates for  two year olds; however, the                                                               
vaccine  money for  the uninsured  and underinsured  had improved                                                               
the  immunization rates  for 2  year olds  in Alaska  to 37th  or                                                               
38th.    He stated  that  although  this  was  not good,  it  was                                                               
significantly better  than it had  been, and  further improvement                                                               
was  intended.     Directing  attention  to   the  aforementioned                                                               
comparable programs in  nine other states, he  offered his belief                                                               
that the proposed  program presented the best  of these programs.                                                               
He noted  that Premera Blue Cross  was the chair for  the vaccine                                                               
advisory commission  in the State  of Washington, and  had shared                                                               
its experiences.  He stated  that essentially all the insurers in                                                               
Alaska  had  participated  in that  Washington  vaccine  advisory                                                               
council.    He mentioned  that  New  Hampshire had  improved  its                                                               
immunization rates for  two year olds and was now  second only to                                                               
Hawaii.  He explained that the  approach by Alaska was to do "the                                                               
right  thing" and  provide all  Alaskans  with the  immunizations                                                               
recommended for  national standards  by the  [Advisory] Committee                                                               
on  Immunization Practices  (ACIP),  although  it was  understood                                                               
that the  state could not  be placed  in financial risk  for more                                                               
general funding to the program.   He stated that the insurers and                                                               
the vendors needed an assurance of  no risk for double payment or                                                               
a  higher   cost.    He   offered  examples  that   the  proposed                                                               
legislation  offered the  flexibility  to prioritize.   He  noted                                                               
that  if there  were  any  savings over  current  costs, and  the                                                               
surcharge  covered administrative  costs with  sufficient funding                                                               
for the uninsured and underinsured,  then the program would offer                                                               
all the recommendations  of vaccines for all  Alaskans.  However,                                                               
kids would have priority over  adults, and certain diseases would                                                               
have priority.   He  noted that  there would be  a review  of the                                                               
return  on  investment,  as  some vaccines  were  a  much  better                                                               
investment for  the benefits.   He declared that the  state would                                                               
continue to  purchase children vaccines on  the favorable federal                                                               
schedule, and there were  multi-state purchasing cooperatives for                                                               
adult  vaccines,  if  necessary.   He  shared  that  some  states                                                               
included  Employment  Retirement   Income  Security  Act  (ERISA)                                                               
employers.  He stated that  the administrative surcharge would be                                                               
kept  as low  as  possible,  with a  long  term  projection of  1                                                               
percent.    He   pointed  out  that  Alaska   could  not  mandate                                                               
participation by  federal programs  or the Tribal  Health system,                                                               
although there  had been discussion  with these entities  for the                                                               
level  of participation.   He  noted that  Tricare wanted  to pay                                                               
retail prices  to providers after  the fact, although  there were                                                               
discussions  for  the  advantages  to saving  money  and  getting                                                               
better immunization rates.   He relayed that  Idaho had allocated                                                               
some general funds to provide  immunizations for Tricare children                                                               
beneficiaries.   In the  other states  with similar  programs, it                                                               
was  about  60   percent  more  likely  for   protection  of  the                                                               
population  through immunizations.   He  declared that  there was                                                               
strong support in Alaska from  the Alaska chapter of the American                                                               
Academy  of  Pediatrics,  the Alaska  Primary  Care  Association,                                                               
Premera Blue Cross, and the  Alaska Nurses Association.  He noted                                                               
that  the  proposed bill  would  allow  medical professionals  to                                                               
provide  immunizations  more  easily.   He  reiterated  that  the                                                               
administration of the  program would be contracted,  and that the                                                               
vaccine assessment council would  be comprised of representatives                                                               
of providers and  payers.  He declared that  involvement from the                                                               
private sector would be much stronger.                                                                                          
REPRESENTATIVE  REINBOLD  asked  which adult  vaccines  would  be                                                               
DR. HURLBURT replied that the  most cost effective adult vaccines                                                               
were  the  annual flu  vaccine  and  the once-given  pneumococcal                                                               
vaccine  to prevent  pneumonia.   He reported  that the  shingles                                                               
vaccine, which  was not  recommended until 60  years of  age, was                                                               
more expensive and was about 50 percent effective.                                                                              
REPRESENTATIVE REINBOLD offered her  belief that it was necessary                                                               
to have  vaccine plans for adults,  and asked whether it  was the                                                               
state,  the federal  government,  the insurance  company, or  the                                                               
patient who would save money with this program.                                                                                 
DR.  HURLBURT  replied  that  the  Affordable  Care  and  Patient                                                               
Protection Act  required the provision of  vaccines, although not                                                               
everyone would be  insured.  He noted that  those insured through                                                               
a private company or Medicaid  would purchase vaccines at retail,                                                               
while there  could be  significant increases  to premiums  in the                                                               
plans under  the Affordable  Care and  Patient Protection  Act in                                                               
the  next year.   Lower  cost for  vaccines could  mitigate these                                                               
premium increases, as  well as the costs to Medicaid.   He opined                                                               
that there would  be fewer people either  underinsured or without                                                               
REPRESENTATIVE REINBOLD asked who was going to save money.                                                                      
DR.  HURLBURT replied  that,  as the  costs  of the  immunization                                                               
services  were  divided  and  would  cost  less  for  those  with                                                               
coverage,  then the  premiums  would cost  less,  it would  lower                                                               
Medicaid costs, and it would save tax dollars.                                                                                  
3:45:42 PM                                                                                                                    
REPRESENTATIVE KELLER  expressed his approval that  the providers                                                               
were engaged  in the  program.   He opined that  the size  of the                                                               
fund defined  the number  of immunization  services offered.   He                                                               
asked if there  would be a higher assessment to  the providers if                                                               
the wholesale  price changed.   He opined that this  system would                                                               
fluctuate with  supply and  market demand,  and that  the council                                                               
would have to make these decisions.                                                                                             
DR. HURLBURT replied that vaccines  did become more expensive and                                                               
there were more  diseases that could be  prevented with vaccines.                                                               
He offered  his belief that the  cost of vaccines for  a two year                                                               
old was  now about  $1700, and  was continuing  to increase.   He                                                               
welcomed any constraints  for expenses, and opined  that, even if                                                               
the costs  go up,  the savings  would still  come to  the payers,                                                               
insurance companies,  and the employers.   This program  made the                                                               
vaccines  more  available  and  easier for  the  providers.    He                                                               
explained that providers that chose  not to participate would not                                                               
receive the vaccines.                                                                                                           
REPRESENTATIVE KELLER asked to confirm  that the priority for use                                                               
would be  set by  the council,  and would  be determined  by cost                                                               
DR. HURLBURT said that the upper  limit would be all the vaccines                                                               
recommended by  ACIP for all  the citizens.   He relayed  that 50                                                               
percent  of  children  were vaccinated  through  funding  by  the                                                               
federal program,  Vaccines for Children.   He said that  about 25                                                               
percent now had insurance coverage.   He stated that the goal was                                                               
to get  immunizations for all the  Alaskans who accepted it.   He                                                               
reminded the  committee that the priorities  would be implemented                                                               
if there was not enough money.                                                                                                  
CHAIR HIGGINS asked for clarification  regarding the vaccines for                                                               
tribal health.                                                                                                                  
DR.  HURLBURT  replied that  the  Vaccines  for Children  program                                                               
covered  all the  Alaskan Native  children, as  well as  those on                                                               
Medicaid.   He said that the  tribal entity was able  to purchase                                                               
vaccines  through the  federal  authority, and  they  could be  a                                                               
community resource.                                                                                                             
CHAIR HIGGINS pointed out that the  tribal health was not part of                                                               
the  assessment value,  as they  did not  contribute to  it.   He                                                               
noted that the other providers  would have to "front that portion                                                               
out for that."  Reading from  the proposed bill, he asked whether                                                               
an individual  residing in  the state  was provided  coverage for                                                               
recommended vaccines if they did not have insurance coverage.                                                                   
DR. HURLBURT  said that the  intent of  the proposed bill  was to                                                               
cover  everybody,  whereas  a  portion  of  the  savings  by  the                                                               
insurers would  be paid as an  assessment to provide the  pool of                                                               
3:56:33 PM                                                                                                                    
PATRICIA  SENNER, Professional  Practice Director,  Alaska Nurses                                                               
Association, testified  in support of  SB 169.  She  relayed that                                                               
she  had  directed  a  clinic  serving  homeless  teenagers,  and                                                               
service had included immunizations for  youth and its staff.  She                                                               
explained  that current  Universal Coverage  legislation required                                                               
separation  when  purchasing  and  storing  the  vaccines.    She                                                               
pointed  out that  market  rates for  vaccines  not eligible  for                                                               
state vaccine  programs were much  more expensive.   She reminded                                                               
the committee  that young parents  also needed vaccines  in order                                                               
to protect  their children who  were too young to  be vaccinated.                                                               
She reported  that it  was not  possible to  buy single  doses of                                                               
vaccines, as  most were sold in  packages of ten, whether  or not                                                               
that  quantity  was necessary.    Reimbursement  only came  after                                                               
patient use, and the price to  her clinic had been much more than                                                               
either the government  or large providers paid.   She stated that                                                               
access to vaccines  sold through a state exchange  would afford a                                                               
great savings to  the providers.  She pointed  out that providers                                                               
were already familiar with the  state vaccine depot.  She offered                                                               
an  anecdote  about a  case  of  polio  in  her clinic,  and  the                                                               
rapidity for transmission of diseases  throughout the world.  She                                                               
offered  her  belief that  the  proposed  bill would  reduce  the                                                               
amount of reimbursement for  immunizations by insurance companies                                                               
to providers.                                                                                                                   
4:00:09 PM                                                                                                                    
JODYNE  BUTTO, Past  President, American  Academy of  Pediatrics,                                                               
stated her  agreement with the  earlier testimony  supporting the                                                               
proposed bill.   She pointed to the ease for  a universal system,                                                               
instead   of  a   separate  stash   of  vaccines,   and  separate                                                               
documentation for its use.                                                                                                      
4:02:08 PM                                                                                                                    
PAUL  RICHARDS,  introduced   another  PhRMA  representative  and                                                               
offered to answer questions.                                                                                                    
KURT STEMBRIDGE, Task Force Chair,  PhRMA, relayed that Idaho had                                                               
started a  pediatric [vaccine]  assessment program  in 2010.   He                                                               
shared that  PhRMA recommended three  amendments to  the proposed                                                               
bill.  He directed attention to  page 5, line 27, and recommended                                                               
that "an  adult" be  deleted, which would  make this  a pediatric                                                               
only  program,  similar   to  the  other  states.     The  second                                                               
recommendation was  on page 2, line  19, and he suggested  that a                                                               
member of each  body of the Alaska State Legislature  be added to                                                               
the State  Vaccine Assessment Council.   His final recommendation                                                               
was to  designate that  one of the  health care  provider council                                                               
members be a pediatrician.                                                                                                      
MR. STEMBRIDGE,  referencing his first suggestion  for making the                                                               
immunization  program pediatric  only, explained  that Idaho  had                                                               
struggled with ERISA  plans, which were governed  by federal, not                                                               
state, control  and allowed  an option to  either pay-in  or pay-                                                               
out.  He stated that Tricare  was one of the biggest ERISA plans,                                                               
and that Tricare had not paid in  in Idaho.  He reported that, as                                                               
Idaho  had to  keep  the  program solvent,  it  was necessary  to                                                               
support  the program  with  state  money.   He  pointed out  that                                                               
Alaska  had  $4.6  million  to  cover the  cost  of  getting  the                                                               
pediatric program  "up and running,"  and that there was  time to                                                               
work through  any problems if  the ERISA  plans did not  pay into                                                               
the  assessment.   He declared  that the  problem with  the ERISA                                                               
plans would be compounded with an  adult program.  He stated that                                                               
the Tricare adult program would  not pay if the Tricare pediatric                                                               
program  did not  pay.    He reported  that  there  was also  the                                                               
possibility that Medicare would not  pay into the assessment.  He                                                               
opined that there  would be more time to get  the program running                                                               
if it  was pediatric only.   He pointed  out that there  was only                                                               
one other state with an  adult vaccination program, which limited                                                               
the  modeling  possibilities.    He declared  that  there  was  a                                                               
"vibrant,  growing  adult  market  out  there  right  now,  where                                                               
people,  because   of  the  ACA  [Affordable   Care  and  Patient                                                               
Protection  Act], requires  that  all  insurance companies  cover                                                               
preventative services."   He stated that the  adult portion would                                                               
only cover  people with insurance.   He offered his  belief that,                                                               
although the bill  declared that this was voluntary,  it was not,                                                               
and he offered an anecdote in  support.  He explained that, under                                                               
the ACA,  a person  could not  be charged for  any out  of pocket                                                               
expenses, and that  any reimbursement to the  pharmacist would be                                                               
denied  because   once  an  insurance   company  paid   into  the                                                               
assessment they  would sever the reimbursement  mechanism so they                                                               
would not  be billed twice.   He opined that there  were only two                                                               
choices:  join the program or don't give immunizations.                                                                         
MR. STEMBRIDGE  directed attention  to the  second recommendation                                                               
he had presented regarding the  appointment of legislators to the                                                               
assessment council.   He pointed out that,  otherwise, there were                                                               
no  elected officials  on  a  council which  had  been given  the                                                               
ability to tax  without any accountability to  the voting public.                                                               
He  noted that  Idaho  had  put two  legislators  on its  vaccine                                                               
assessment council.   Referring  to his  third suggestion  to add                                                               
two practicing  pediatricians to  the council, he  explained that                                                               
they would provide  expertise on vaccines.  He  declared that the                                                               
proposed adult  program would subsidize insurance  companies "off                                                               
the back of  the pharmaceutical industry."  He  reported that the                                                               
industry  spent billions  every  year to  invent medications  and                                                               
vaccines  to  prevent diseases,  and  that  the ACA  coverage  of                                                               
vaccines was built into the premiums.   He declared his pride for                                                               
working in an  industry that was "looking for the  next cure" and                                                               
preventing more diseases.                                                                                                       
CHAIR  HIGGINS  asked  for  clarification  whether  the  provider                                                               
submitted billing  for vaccinations  was denied by  the insurance                                                               
companies under the Idaho pediatric assessment program.                                                                         
MR.  STEMBRIDGE  replied  that   insurance  companies  would  not                                                               
reimburse  for vaccines  after the  pediatric assessment  program                                                               
was initiated,  as the  insurance companies  declared this  was a                                                               
double billing.   He said  that this  would happen with  an adult                                                               
assessment program, as well.                                                                                                    
MR.  STEMBRIDGE  said  that  PhRMA  wanted  to  provide  as  many                                                               
vaccines as possible  to the people of Alaska,  as vaccines saved                                                               
money and benefited the citizens.                                                                                               
CHAIR HIGGINS said  that Alaska worked toward taking  care of its                                                               
people.    He  offered  an   anecdote  about  enhanced  dentistry                                                               
treatment in rural Alaska for adults.                                                                                           
MR.  STEMBRIDGE added  that  the proposed  bill  did not  address                                                               
patients  without insurance.    He referred  to  the analysis  of                                                               
Fiscal Note  7, and read  "all except uninsured adults  and there                                                               
is  not payer."    He  suggested putting  effort  and money  into                                                               
support for  those with no  insurance, as opposed  to subsidizing                                                               
the insurance industry.                                                                                                         
4:14:03 PM                                                                                                                    
MR.  STEMBRIDGE, in  response  to  Representative Reinbold,  said                                                               
that,  as  insurance  companies  were  already  paying  into  the                                                               
assessment program,  they did not  want to also  reimburse claims                                                               
for vaccines.                                                                                                                   
REPRESENTATIVE REINBOLD asked who  were the potential winners and                                                               
MR.  STEMBRIDGE   replied  that,   without  the   proposed  PhRMA                                                               
amendments for this to become  a pediatric bill, the winners were                                                               
the  insurance companies,  as they  would receive  a benefit  for                                                               
covering  all the  immunizations.   He  declared  that the  adult                                                               
provision was merely a subsidy to the insurance companies.                                                                      
REPRESENTATIVE  KELLER  asked  for clarification  that  the  drug                                                               
industry controlled the prices.                                                                                                 
MR.  STEMBRIDGE replied  that  competition set  the  prices.   He                                                               
explained that multiple  pharmaceutical companies were soliciting                                                               
flu  vaccines  for the  upcoming  year.    He reported  that  the                                                               
contract  had  been  designed and  negotiated  with  Centers  for                                                               
Disease  Control  and  Prevention   (CDC)  for  a  very  specific                                                               
clientele, those  with no insurance,  or insurance that  does not                                                               
cover,  as   well  as  Native   Alaskans.    He   questioned  the                                                               
consequence  if  CDC  said  that   this  contract  could  not  be                                                               
4:19:06 PM                                                                                                                    
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
Division  of  Senior  and Disabilities  Services,  Department  of                                                               
Health  and Social  Services (DHSS),  explained  that the  Alaska                                                               
Commission  on Aging  was a  governor  appointed commission  that                                                               
planned  services for  seniors,  educated  Alaskans about  senior                                                               
issues,  and advocated  for the  needs  of older  Alaskans.   She                                                               
declared support  for the  proposed bill,  and reported  that the                                                               
commission had  been involved in  prior legislation  for ensuring                                                               
those un-insured and  under-insured for access to  vaccines.  She                                                               
explained that the  immune systems of seniors  weakened with age,                                                               
hence  the importance  for access  to vaccines.   She  listed the                                                               
recommended  vaccines, which  included  influenza, shingles,  and                                                               
pneumonia   vaccines.     She  allowed   that   there  was   some                                                               
underutilization for some of these  vaccines, noting that only 11                                                               
percent of seniors  took advantage of the shingles  vaccine.  She                                                               
reported that lack  of co-payment and deductible  funds was often                                                               
the  reason.   She  opined  that the  proposed  bill would  offer                                                               
improved  access to  the  vaccines.   She  pointed  out that  the                                                               
proposed bill would also benefit  grandparents who were living on                                                               
a fixed income and raising grandchildren.                                                                                       
4:22:24 PM                                                                                                                    
CHAIR HIGGINS said  that public testimony would be  kept open and                                                               
SB 169 was held over.                                                                                                           

Document Name Date/Time Subjects
HB347 ver A.PDF HHSS 3/27/2014 3:00:00 PM
HB 347
HB347 Sponsor Statement.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347-DHSS-ATAP-03-21-14.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347-LAW-CRIM-03-21-14.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347 Supporting Documents-Welfare Reform Insanity.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347 Supporting Documents-Food Stamp Bans Under Review.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347 Supporting Documents-Copy of FelonyDrugData01.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB347 Supporting Document-Leach Letter of Support.pdf HHSS 3/27/2014 3:00:00 PM
HB 347
HB355 ver A.PDF HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Sectional Analysis.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Sponsor Statement.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Document-Governments Discover Need for Mental Health First Aid.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-2011-12SSPCAnnualReport.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-AKSuicideStatistics.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-CSG Article.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-Intl J of Mental Health Systems on Youth MHFA.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-OtherStatesMHFAInitiatives2-15-13.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-The Million Dollar Homeless.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Dopcuments-NREPP Report & Effectiveness.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
HB355 Supporting Documents-SEARHC offers MHFA certification course.pdf HHSS 3/27/2014 3:00:00 PM
HB 355
CSHB 319 Ver P 3-21.pdf HHSS 3/27/2014 3:00:00 PM
HB 319
SB 169 Support Allergy Asthma.pdf HHSS 3/27/2014 3:00:00 PM
SB 169
SB169 WhoPaysFor VaccineInAK.pdf HHSS 3/27/2014 3:00:00 PM
SB 169
StateSupplyVaccinesDistributedByProviderType2013.pdf HHSS 3/27/2014 3:00:00 PM
AdultFluPneumoniaImmunizations2012.pdf HHSS 3/27/2014 3:00:00 PM
HB 347 Letter of support.pdf HHSS 3/27/2014 3:00:00 PM
HB 347