Legislature(2017 - 2018)CAPITOL 106

04/13/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 118 COMPENSATION FOR WRONGFUL CONVICTION TELECONFERENCED
Heard & Held
-- Public Testimony --
+= SB 32 PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS TELECONFERENCED
Moved SB 32 Out of Committee
-- Public Testimony --
*+ HB 176 GROUND EMER. MEDICAL TRANSPORT PAYMENTS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 196 OPIOID TAX TELECONFERENCED
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
          SB 32-PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS                                                                       
                                                                                                                                
3:12:06 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be SENATE BILL  NO. 32, "An Act relating  to biological products;                                                               
relating to  the practice of  pharmacy; relating to the  Board of                                                               
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
3:12:35 PM                                                                                                                    
                                                                                                                                
AIMEE  BUSHNELL,  Staff,  Senator Shelley  Hughes,  Alaska  State                                                               
Legislature,  briefly recapped  the main  points of  the proposed                                                               
bill, which  included:   only bio-similars  approved by  the U.S.                                                               
Food and  Drug Administration (FDA) as  interchangeables could be                                                               
substituted for  the original prescription; within  three days of                                                               
dispensation of the  product to the patient,  a notification must                                                               
be  sent to  the  original prescriber;  and,  the prescriber  can                                                               
write "dispense as  written" on the prescription, if  this is the                                                               
only product the prescriber wants for the patient.                                                                              
                                                                                                                                
SENATOR  SHELLEY  HUGHES,  Alaska State  Legislature,  reiterated                                                               
that access to these medications  was important to many Alaskans,                                                               
and  that  the  proposed  bill   described  the  arrangement  and                                                               
notifications between the doctor and the pharmacist.                                                                            
                                                                                                                                
3:15:13 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony on SB 32.                                                                               
                                                                                                                                
3:15:22 PM                                                                                                                    
                                                                                                                                
ROBERT THOMS stated that he was  also known as Cajun Bob and that                                                               
he was  a Vietnam combat  veteran and  a recipient of  the Silver                                                               
Star medal,  as well as six  Purple Hearts.  He  declared that he                                                               
had chronic  pain for more  than 45 years,  and that he  had been                                                               
diagnosed  with severe  rheumatoid arthritis.   He  reported that                                                               
his original  medication was not  a biologic, which  "after three                                                               
years,  it  almost  killed  me."    He  said  that  he  was  then                                                               
prescribed  a biologic,  Humera,  which allowed  him  to enjoy  a                                                               
functional life after being bed  ridden.  He noted that, although                                                               
he was  not yet 100  percent, this had  allowed him to  do chores                                                               
and  projects with  his wife.   He  declared that,  although this                                                               
biologic "was  a miracle,"  he did  not know  if it  would always                                                               
work.   He  emphasized  that  it was  necessary  to approve  this                                                               
proposed   legislation  immediately,   as  he   wanted  to   have                                                               
immediately  available  any   approved  substitute,  should  this                                                               
current biologic cease to work.                                                                                                 
                                                                                                                                
3:18:25 PM                                                                                                                    
                                                                                                                                
CINDY CASERTA shared  that she was also a  chronic pain sufferer,                                                               
and that she spoke as an  ambassador for the U.S. Pain Foundation                                                               
in  support of  the proposed  bill.   She  referenced a  Stanford                                                               
study  of  6200  rheumatoid   arthritis  patients  on  biologics,                                                               
pointing out that  33 percent of these patients  stopped taking a                                                               
biologic within  two years  because of  a loss  of effectiveness.                                                               
She surmised that bio-similars could be the answer for Alaskans.                                                                
                                                                                                                                
3:20:10 PM                                                                                                                    
                                                                                                                                
BECKY HULTBERG, President/CEO, Alaska  State Hospital and Nursing                                                               
Home  Association  (ASHNHA),  reported   that  the  Alaska  State                                                               
Hospital  and   Nursing  Home  Association  had   consulted  with                                                               
hospital-based  pharmacists and  physicians  to  ensure that  the                                                               
proposed bill would supply the  necessary guidance to ensure safe                                                               
and  effective  treatments  for  patients,  while  providing  the                                                               
potential  to lower  pharmaceutical  costs.   She reported  that,                                                               
following  this  consultation,  ASHNHA  decided  to  support  the                                                               
proposed  bill.   She declared  that critical  components of  the                                                               
bill  included   its  specific  communication   requirements  and                                                               
timelines for pharmacists  associated with dispensing bio-similar                                                               
medication.   She stated  that the proposed  bill would  meet the                                                               
needs  of pharmacists  in a  variety  of settings,  and that  the                                                               
proposed  bill strikes  the right  balance  for notification  and                                                               
communication.       She    reported   that    bio-similars   and                                                               
interchangeable  biological  products  offered  affordability  as                                                               
they would provide competition to  biologic drugs, similar to the                                                               
way generic  drugs did  for brand  name drugs.   She  offered her                                                               
belief  that proposed  SB  32 would  protect  patients and  would                                                               
benefit the state.                                                                                                              
                                                                                                                                
3:21:43 PM                                                                                                                    
                                                                                                                                
PHIL   SCHNEIDER,   Alliance   for   Safe   Biologic   Medicines,                                                               
paraphrased  from  a  letter of  support  [included  in  members'                                                               
packets], which read as follows [original punctuation provided]:                                                                
                                                                                                                                
     As  the  chairman  and  advisory  board  chair  of  the                                                                    
     Alliance  for Safe  Biologic Medicines  (ASBM), we  are                                                                    
     writing to urge  you to support Senate Bill  32 (SB 32)                                                                    
     regarding  the  pharmacy   substitution  of  biosimilar                                                                    
     medical products. ASBM is  an organization of patients,                                                                    
     physicians,   pharmacists,    manufacturers   of   both                                                                    
     innovative  and biosimilar  medicines, researchers  and                                                                    
     others  who  are  working together  to  ensure  patient                                                                    
     safety is  at the  forefront of the  biosimilars policy                                                                    
     discussion.                                                                                                                
                                                                                                                                
     As  a retired  pediatric  rheumatologist  and a  former                                                                    
     president  of  the  American Society  of  Health-system                                                                    
     Pharmacists,  we are  keenly aware  of the  benefits of                                                                    
     biologics in  treating serious conditions  like cancer,                                                                    
     rheumatoid  arthritis, diabetes,  and  MS. "Copies"  of                                                                    
     these   medicines,   called  "biosimilars"   have   the                                                                    
     potential to  provide these therapies at  reduced cost.                                                                    
     Yet   unlike  generic   versions   of  chemical   drugs                                                                    
     biosimilars   are  not   exact   duplicates  of   their                                                                    
     reference   products.   Indeed,   the   complexity   of                                                                    
     biologics    and   their    proprietary   manufacturing                                                                    
     processes  mean that  these "copies"  can only  ever be                                                                    
     similar, never  the same. Even the  smallest structural                                                                    
     difference between  a biologic  and its  attempted copy                                                                    
     can have  a significant impact on  a patient, including                                                                    
     reduced efficacy or unwanted immune responses.                                                                             
                                                                                                                                
     We   believe  that   when  interchangeable   biosimilar                                                                    
     products   are   substituted,   communication   between                                                                    
     patients,  pharmacists, and  health  care providers  is                                                                    
     essential  to patient  care. We  fully support  and are                                                                    
     concerned that  patient safety  will be  compromised if                                                                    
     this legislation is not enacted.                                                                                           
                                                                                                                                
     Since 2012,  ASBM has  conducted surveys  of physicians                                                                    
     in eleven  countries, to  gather their  perspectives on                                                                    
     biosimilars. The  results of  these surveys  have since                                                                    
     been  shared with  policymakers  in  the U.S.,  Canada,                                                                    
     Europe, and  the World  Health Organization  in Geneva,                                                                    
     Switzerland.                                                                                                               
                                                                                                                                
     Our survey  of 376  U.S. physicians  found that  80% of                                                                    
     those surveyed  called communication in the  event of a                                                                    
     biosimilar    substitution    "very    important"    or                                                                    
     "critical".                                                                                                                
                                                                                                                                
     Further, 82%  of U.S.  physicians called  the authority                                                                    
     to  block   a  substitution   by  indicating   "do  not                                                                    
     substitute" or "dispense as  written" on a prescription                                                                    
     "very important" or "critical".                                                                                            
                                                                                                                                
     These results  are consistent with those  of physicians                                                                    
     around the  world, including  those surveyed  in Canada                                                                    
     and   Europe,  where   biosimilars  are   currently  in                                                                    
     clinical  use. All  ASBM surveys  are available  on our                                                                    
     website at www.safebiologics.org/surveys.                                                                                  
                                                                                                                                
     It is  our view that  SB 32 appropriately  reflects the                                                                    
     importance  of  pharmacist-physician communication  and                                                                    
     keeping   treatment  decisions   the  purview   of  the                                                                    
     physician and patient, without  posing undue or onerous                                                                    
     burdens upon the pharmacist:                                                                                               
                                                                                                                                
     It  provides  that only  "interchangeable"  biosimilars                                                                    
     (those  determined  by  the FDA  to  produce  the  same                                                                    
     effects in  a patient as the  reference product without                                                                    
     additional risks) may ever be substituted.                                                                                 
                                                                                                                                
     It allows  a physician  to prevent a  substitution they                                                                    
     consider inappropriate for their  patient by writing on                                                                    
     the prescription "dispense as written".                                                                                    
                                                                                                                                
     It provides  that the pharmacist receive  the patient's                                                                    
     consent in  order to make a  substitution. The Alliance                                                                    
     for Safe  Biologic Medicines -  PO Box  3691 Arlington,                                                                    
     VA 22203  www.safebiologics.org - (703) 971-1700                                                                           
                                                                                                                                
     Finally,   SB   32   requires   that   the   pharmacist                                                                    
     communicate to  the physician within a  reasonable time                                                                    
     frame  (3 days)  which  biologic  the patient  actually                                                                    
     received    whether that  prescribed by  the physician,                                                                    
     or  a  substituted  biosimilar-  so  that  an  accurate                                                                    
     patient record can be kept by all parties.                                                                                 
                                                                                                                                
     SB  32  will  extend   these  valuable  protections  to                                                                    
     Alaska's  patients  while  increasing their  access  to                                                                    
     biologic therapies. For these  reasons, lawmakers in 26                                                                    
     states  and Puerto  Rico have  passed similar  bills in                                                                    
     the past few years.                                                                                                        
                                                                                                                                
3:24:49 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked about the  substantial differences for side                                                               
effects and efficacy for interchangeables.   She asked whether it                                                               
was safe  for pharmacists  to recommend  changes at  the pharmacy                                                               
point of sale, rather than from the prescriber.                                                                                 
                                                                                                                                
MR. SCHNEIDER  explained that  biologics were  medicines produced                                                               
by  living cells  and that  bio-similars were  biologics, similar                                                               
for the  therapeutic effect  and safety  profile, but  with minor                                                               
differences which  needed to  be considered.   He  clarified that                                                               
these were  not considered to  be interchangeable.  He  said that                                                               
the  third category  was interchangeable  bio-similar, which  had                                                               
been  categorized by  the FDA,  based on  studies which  involved                                                               
switching patients  back and forth between  the reference product                                                               
to the  bio-similar, and then back  again.  These studies  had to                                                               
demonstrate   that  the   interchangeable   bio-similar  had   no                                                               
differences  for  both its  effectiveness  and  its safety.    He                                                               
stated  that the  proposed bill  only related  to interchangeable                                                               
bio-similars  as considered  by the  FDA based  on the  switching                                                               
studies.   He added that the  FDA stated that a  pharmacist could                                                               
switch those  medicines.  The  purpose of  the state laws  was to                                                               
ensure  communication  with  the  prescriber,  even  though  that                                                               
happened after the fact.                                                                                                        
                                                                                                                                
3:28:09 PM                                                                                                                    
                                                                                                                                
KERRY  McCLELLAND, Colon  Cancer  Alliance, stating  that he  was                                                               
advocating  for  all cancer  patients,  shared  his history  with                                                               
cancer  and  various  treatments.     He  declared  that  it  was                                                               
important to  pass the proposed  bill so that Alaskans  would not                                                               
have to travel out of state.                                                                                                    
                                                                                                                                
3:30:11 PM                                                                                                                    
                                                                                                                                
MARK   GUIMOND,   Director,    Legislative   Affairs,   Arthritis                                                               
Foundation, stated  that the Foundation fully  supported proposed                                                               
SB 32.   He  pointed out  that arthritis  was a  lifelong chronic                                                               
disease, which could  be debilitating.  He  stated that biologics                                                               
offered a  benefit, as they  changed lives  to a good  quality of                                                               
life.    He  pointed  out that  these  were  complex  medications                                                               
because  they  were live  cells  and  were also  very  expensive.                                                               
These  represented   .01  percent  of  prescriptions   filled  at                                                               
pharmacies.  He expressed hope  that bio-similiars would have the                                                               
same effect  on the market as  generic drugs.  He  suggested that                                                               
it was  best to pass  this legislation immediately.   He declared                                                               
that  the   communication  aspect   of  the  proposed   bill  was                                                               
essential,  as  it created  a  complete  medical record  for  the                                                               
patients.  He declared support for the proposed bill.                                                                           
                                                                                                                                
3:33:24 PM                                                                                                                    
                                                                                                                                
THOMAS FELIX,  MD, Amgen, stated  support for the  proposed bill,                                                               
and he  discussed one of  the five  provisions, key to  the bill,                                                               
which was a  departure from existing generic  substitution law in                                                               
Alaska.   He  pointed  to  the requirement  for  a pharmacist  to                                                               
communicate  with a  physician following  the substitution  of an                                                               
interchangeable  bio-similar.   He  said that  this ensured  that                                                               
members of the health care team  were talking with each other, as                                                               
this   created   transparency   and   accessibility   to   needed                                                               
information.    He  allowed  that   some  had  advocated  for  no                                                               
communication as  it was  too burdensome.   He stated  that there                                                               
had  been work  with both  pharmacists and  stakeholders to  make                                                               
sure their perspectives were represented  in the proposed bill to                                                               
make it  less burdensome.   He said  that communication  prior to                                                               
the substitution  went against the  spirit of the  designation of                                                               
interchangeability.    He  shared  that  the  federal  law  which                                                               
allowed   the   bio-similar    pathway,   the   description   for                                                               
interchangeability  was  for  the pharmacist  to  exercise  their                                                               
discretion   for  substitution   without  the   consent  of   the                                                               
prescriber.  He relayed that  it was important to understand that                                                               
this  facilitated drug  safety surveillance,  which was  required                                                               
for all biologics, and that  bio-similars were also included.  He                                                               
reminded the  committee that there  were currently  four approved                                                               
bio-similars in the United States, of  which two had not yet been                                                               
distributed.     He  pointed   out  that,   as  two   were  self-                                                               
administered,  this legislation  provided clear  terms of  use to                                                               
both the health care team  and the patient. He directed attention                                                               
to  a recent  draft  guidance for  interchangeability, which  was                                                               
intended  to  provide  clarity  to the  community  for  what  was                                                               
required to receive an interchangeability  designation.  He added                                                               
that,  as the  FDA was  very busy  developing bio-similars  which                                                               
were trying  to mimic  23 reference  products coming  off patent,                                                               
there was  a need to  ensure that  the health care  community and                                                               
patients had  a clear  understanding for  use of  these products,                                                               
both when they  were interchangeable and when they  should not be                                                               
substituted.   He reminded  that the FDA  had set  an appropriate                                                               
scientific  bar for  approval of  these products  and that,  once                                                               
approved, they would  be highly similar to  an existing reference                                                               
product and the differences in  efficacy and safety should not be                                                               
a concern.   When  an interchangeable  was approved,  it signaled                                                               
that there was not a concern  for its use when switching with the                                                               
original product.  Patients suffering  from grievous illness will                                                               
be  comforted  by  knowing that  the  appropriate  measures  that                                                               
comport with new technologies were being passed.                                                                                
                                                                                                                                
3:41:11 PM                                                                                                                    
                                                                                                                                
CRYSTAL  KOENEMAN shared  her personal  story  for the  use of  a                                                               
biologic, Humera.   She reported that, although  this allowed her                                                               
to play with her young child and  function on a day to day basis,                                                               
these were  "scary.   They change your  chemical make-up  and you                                                               
are no  longer the  same."   She reported  that she  had recently                                                               
developed three lesions  on her brain, which  appeared similar to                                                               
multiple sclerosis.  She was then  unable to take biologics for a                                                               
few months,  and now she relied  on a name brand.   She expressed                                                               
her concern that with bio-similars,  insurance companies would no                                                               
longer cover name  brands.  She expressed  her understanding that                                                               
others  could not  afford  the cost  and  that some  bio-similars                                                               
would work for  some when the name brand did  not.  She expressed                                                               
support for the  proposed bill as it allowed for  choice, but she                                                               
expressed concern for  her ability to choose to be  taken away as                                                               
an unintended  consequence.  She  reported that she was  not able                                                               
to  take any  other biologic  that would  in any  way affect  her                                                               
nervous system.  She asked that the committee be cautious.                                                                      
                                                                                                                                
3:47:10 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:47:20 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ   moved  to  adopt  Amendment   1,  labeled  30-                                                               
LS0188\J.3, Wallace/Bruce, 4/13/17, which read:                                                                                 
                                                                                                                                
     Page 4, following line 10:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec. 8.  AS 21.42  is amended  by  adding a  new                                                                
     section to read:                                                                                                           
          Sec. 21.42.435. Coverage for biological products.                                                                   
     (a)  A  health care  insurer  that  offers, issues  for                                                                    
     delivery, delivers,  or renews  in this state  a health                                                                    
     care   insurance  plan   that  provides   coverage  for                                                                    
     biological  products  shall   provide  coverage  for  a                                                                    
     biological   product   or  interchangeable   biological                                                                    
     product  without requiring  prior authorization  if the                                                                    
     biological   product   or  interchangeable   biological                                                                    
     product is to be dispensed as prescribed.                                                                                  
          (b) In this section, "biological product" and                                                                         
     "interchangeable biological product"  have the meanings                                                                    
     given AS 08.80.480."                                                                                                       
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 4, line 17:                                                                                                           
          Delete "Section 8"                                                                                                    
          Insert "Section 9"                                                                                                    
                                                                                                                                
     Page 4, line 18:                                                                                                           
          Delete "sec. 9"                                                                                                       
          Insert "sec. 10"                                                                                                      
                                                                                                                                
                                                                                                                                
CHAIR SPOHNHOLZ objected for discussion.                                                                                        
                                                                                                                                
CHAIR  SPOHNHOLZ explained  that a  "tsunami"  of as  many as  41                                                               
biologic interchangeables was coming  and working through the FDA                                                               
process.   She noted how  important biologics were for  those who                                                               
took them, as  well as the transformative nature  they could have                                                               
for individuals.   She shared the  story of a biologic  that cost                                                               
$2000 each day.  She  explained that her proposed amendment would                                                               
require  that   health  insurance  plans  provide   coverage  for                                                               
biological  products,  both   interchangeables  and  biologicals,                                                               
without prior  authorization if the  product was to  be dispensed                                                               
as prescribed.   She said that  this would require coverage  of a                                                               
medication  prescribed  by  a  doctor  and  not  necessarily  the                                                               
cheapest one,  as a small  difference in  a product could  have a                                                               
big impact  on the health and  well-being of an individual.   She                                                               
wanted to ensure  that people with serious health  care issues in                                                               
the state be  able to have health care coverage  by the insurance                                                               
providers, and that cost not be the only consideration.                                                                         
                                                                                                                                
3:50:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  reflected on  the history  of the  change to                                                               
generic drugs from  name brand drugs, noting that,  as there were                                                               
some changes, some individuals reacted  adversely.  He encouraged                                                               
that the insurance companies be  sensitive to provide medications                                                               
as needed for the patient as identified by the medical team.                                                                    
                                                                                                                                
3:51:26 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ withdrew proposed Amendment 1.                                                                                  
                                                                                                                                
3:51:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN expressed  his  support  of the  proposed                                                               
bill.                                                                                                                           
                                                                                                                                
3:51:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON moved  to report  SB 32  out of  committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  SB 32 was moved from the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
3:52:03 PM                                                                                                                    

Document Name Date/Time Subjects
SB 32 Legislation - Version J.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 32 Sponsor Statement - Biosimilars.pdf HHSS 4/13/2017 3:00:00 PM
SB 32
SB 32 - Sectional Analysis.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Fiscal Note DCCED CBPL.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
AK SB 32 Biosimilar Support Letter.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
ALF_AK SB 32__2 1 17 support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance of Specialty Medicine AK SB 32 020317.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
LADAAK support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
NORD AK_SB 32_ltr.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
2-6-17 biosimilar AK support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
NFK BioSimilars State Letter - Alaska 2.1.17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance for Patient Access AfAP - SB32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance for Safe Biologic Medicines AK-SB 32 -FNL.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
American Liver Foundation ALF_AK SB 32__2 1 17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 AARDA support.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 AARDA support.docx HHSS 4/13/2017 3:00:00 PM
SB 32
Digestive Disease National Coalition Support for SB 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Global Healthy Living Foundation GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
International Cancer Advocacy Network (ICAN) letter of support SB32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
National Hispanic Medical Association (NHMA) _AK SB 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Pharmaceutical Research and Manufacturers of America (PhRMA) Support SB32.PDF HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Bios for Dr. Charles and Dr. Schneider.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - BIO Support Letter 2-2-17 Biotechnology Innovation Organization.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - BIO Support Letter 2-2-17.pdf HHSS 4/13/2017 3:00:00 PM
SB 32
RetireSafe support SB32 2-6-17 biosimilar AK.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
1-12-17 Group letter.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - 1 page handout explaining biosimilar legislation.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska ACS CAN Biosimilars Fact Sheet 2017.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB032 Supporting Documents-Support Letters 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
Senate Bill 32 opposition AK Rheumatoloty Alliance.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska SB 32 - Merriman Comments 20170209.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SupportLetter_Bio_SB32_psoriasis.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska Biosimilars Arth Fdn oppose amendment sb 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32_ASMA.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32 - Clarification on Questions Asked in the Committee (Sen Hughes).doc HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 32 - Sectional Analysis.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Document - Potential Cost Savings of Biosimilar Drugs.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Document - H&SS Comm. Q&A.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Letter - State Medical Board.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Fiscal Note - DCCED.PDF HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Opposition Letter - Alaska State Medical Association.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Documents - Fact Sheet.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - Alliance of Specialty Medicine.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB032 Sponsor Statement 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB032 Opposing Document-Opposition Letters 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB032 Sectional Analysis ver J 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB32 Letters of Opposition.pdf HHSS 4/13/2017 3:00:00 PM
SFIN 3/30/2017 9:00:00 AM
SB 32
SB32 Letters of Support.pdf HHSS 4/13/2017 3:00:00 PM
SFIN 3/30/2017 9:00:00 AM
SB 32
SB 32 Am No. 1.PDF HHSS 4/13/2017 3:00:00 PM
SB 32
SB 32 - Support Letter - U.S. Pain Foundation.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - State Advocacy & Alliance Development.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - Safe Biologics.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
HB 176 Sponsor Statement 4.12.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - City of Bethel resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB memo 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - Letter AK Fire Chiefs Assoc 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - letter AK Prof Firefighters Assoc 4.11.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - memo Bethel FD 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - North Pole resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 ver A.PDF HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document AK FD budget reimb process 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document DHSS review 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Draft Proposed CS ver J 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--HCMS 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--MAA 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 118 Sponsor Satement 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Doyon support letter 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Medical Compsensation by State 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - PBS Article 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Support letters 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - TCC letter of support 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Documents 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 ver A 4.10.2017.PDF HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Fiscal Note DHSS--BHTRG 4.10.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Fiscal Note DOL--CJL 4.10.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Sectional Analysis ver A 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118