Legislature(2007 - 2008)CAPITOL 120

02/22/2008 01:00 PM JUDICIARY

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Moved Out of Committee
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SB 196 - PRESCRIPTION DATABASE                                                                                                
[Contains brief mention of HB 316, the House companion bill.]                                                                   
1:10:48 PM                                                                                                                    
CHAIR RAMRAS announced that the  final order of business would be                                                               
CS  FOR  SENATE  BILL  NO.  196(FIN)  am,  "An  Act  relating  to                                                               
establishing a controlled substance prescription database."                                                                     
CHAIR RAMRAS  noted that he  sponsored a companion bill,  HB 316,                                                               
which  is  substantially  similar   to  this  version,  with  the                                                               
exception  of  an  amendment  which  he intends  to  offer.    He                                                               
explained that he  has worked closely with Senator  Green and her                                                               
staff  on   establishing  a  controlled   substance  prescription                                                               
database.  He  stated that he has attended  annual conferences at                                                               
the  Loussac  Library,  for  the  statewide  Meth  Watch  program                                                               
consisting  of  two  members   from  Fairbanks,  Alaska,  Juneau,                                                               
Alaska,  the Matanuska-Susitna  Borough,  Anchorage, Alaska,  and                                                               
Kenai,  Alaska.     This  year  a  member  from   the  U.S.  Drug                                                               
Enforcement  Administration  (DEA) participated  from  Washington                                                               
1:14:45 PM                                                                                                                    
GINGER  BLAISDELL,  Staff to  Senator  Lyda  Green, Alaska  State                                                               
Legislature,  stated on  behalf  of the  sponsor, Senator  Green,                                                               
that she asked pharmacists to  identify any concerns regarding SB                                                               
196  prior  to presenting  the  bill  to  175 pharmacists.    She                                                               
indicated that  the medical community and  the Alaska Pharmacists                                                               
Association (APA) brought  this need to the  attention of Senator                                                               
Green.  Ms. Blaisdell described  the legislation as a compilation                                                               
of  existing statutes  from  forty  other states.    Many in  the                                                               
medical  community who  prescribe or  dispense prescriptions  and                                                               
the  Department of  Public Safety  (DPS) support  the bill.   She                                                               
offered that feedback from her  presentation included requests to                                                               
more  clearly  define  terms  in   the  bill.    She  stated  one                                                               
suggestion  was to  change the  term "inpatient"  to someone  who                                                               
administers  medications since  dentists and  other professionals                                                               
administer drugs to patients who do  not spend the night in their                                                               
facilities.   She characterized the support  from the pharmacists                                                               
as very positive.                                                                                                               
MS.  BLAISDELL referred  to the  PowerPoint  presentation of  the                                                               
Prescription Drug  Monitoring Program  and Database  contained in                                                               
SB 196  and HB 316.   All states  have laws and  regulations that                                                               
govern the  distribution and  handling of  controlled substances.                                                               
Diversion of  controlled substances and other  pharmaceuticals is                                                               
generally recognized  as a serious problem  throughout the United                                                               
States, she stated.                                                                                                             
MS. BLAISDELL,  in response to Representative  Samuels, explained                                                               
that  the   bill  does  not  change   any  existing  requirement.                                                               
Controlled  substances  are  generally recognized  as  a  serious                                                               
problem  throughout  the United  States.    She offered  that  53                                                               
prescription drug deaths  were documented in Alaska in  2000.  By                                                               
2003, 102  deaths were recorded,  which demonstrates the  rise in                                                               
deaths.   Homicides,  thefts, muggings,  and other  problems have                                                               
increased  due to  prescription drug  abuse.   States have  found                                                               
that  Prescription Drug  Monitoring Programs  (PDMPs) are  one of                                                               
the  most effective  tools for  curbing prescription  drug abuse.                                                               
Diversion is  taking a legal prescriptive  substance and altering                                                               
it to provide  a different effect or selling it  to someone other                                                               
than the  person to whom  it was intended.   The street  rate for                                                               
oxycodone hyrdrochloride  (OxyContin) is about $1  per milligram,                                                               
with one pill  yielding $80.  She opined that  in Bethel, Alaska,                                                               
a single tablet sells for about $250.                                                                                           
1:22:43 PM                                                                                                                    
MS. BLAISDELL,  in response to Representative  Samuels, explained                                                               
the levels of  drugs.  She noted that schedule  I drugs generally                                                               
include  illicit drugs  or illegal  drugs such  as OxyContin  and                                                               
codeine, schedule  II drugs include pain  relievers, schedule III                                                               
drugs include  drugs such as  Ritalin and stimulants,  and lastly                                                               
schedule V drugs  would include low-dose narcotics  such as cough                                                               
syrup containing codeine.                                                                                                       
MS.  BLAISDELL  offered that  it  takes  a pharmacist  about  two                                                               
minutes  to  download the  information  from  the PDMP  database.                                                               
From a  national standpoint,  there is a  new news  article every                                                               
week.   She described national  ads produced for the  $30 million                                                               
U.S. drug  awareness campaign.   She  stressed the  importance of                                                               
MS. BLAISDELL stated that the  national perception is that use of                                                               
prescription  drugs   is  safer   than  use  of   illicit  drugs.                                                               
Prescription and  over-the-counter medications are  fast becoming                                                               
the new  "party" drugs  for many teenagers  and adults.   Twenty-                                                               
five to  forty percent of  MySpace users include postings  on how                                                               
to get prescription medication on the Internet, she opined.                                                                     
MS. BLAISDELL revealed that the  most commonly abused medications                                                               
include pain  killers, stimulants, sedatives,  tranquilizers, and                                                               
over-the-counter  drugs,  which  are  not  considered  controlled                                                               
substances.   She explained that  12-13 year olds' first  drug of                                                               
choice is a  painkiller.  She opined that  painkillers are within                                                               
one  percent   of  surpassing  marijuana  use.     She  described                                                               
prescription  abuse to  include  children,  who sometimes  obtain                                                               
prescription drugs  from the elderly.   Some  elderly individuals                                                               
keep half  and sell half  of their  prescription use in  order to                                                               
pay  fuel  bills  and  other living  expenses.    Nearly  seventy                                                               
percent of prescription drugs are  obtained for free from friends                                                               
and family.  Pain killers are  the number one abused drug because                                                               
of the feeling of euphoria and their high resale value.                                                                         
MS.  BLAISDELL   explained  that  the  Department   of  Commerce,                                                               
Community,    &    Economic   Development    (DCCED)    currently                                                               
investigates,   but   must   use   paper.     Data   entry   from                                                               
investigations can  take months and the  only clues investigators                                                               
generally receive  are from external complaints.   Complaints are                                                               
not  prevalent since  other  pharmacies  don't see  prescriptions                                                               
filled by other pharmacies, she opined.                                                                                         
1:29:29 PM                                                                                                                    
MS.  BLAISDELL  stated  that  state  and  local  law  enforcement                                                               
personnel have experienced increases  in criminal activity.  With                                                               
legislation  in place  the  state will  be  eligible for  federal                                                               
funding.  Under  SB 196, the Board of Pharmacy  would establish a                                                               
controlled  substance prescription  database administered  by the                                                               
Board of Pharmacy and provide  the board with the necessary staff                                                               
to implement  the program.   The database would contain  data for                                                               
every prescription for  federally controlled substances contained                                                               
in schedule  I, II, III,  IV, or V  under state and  federal law.                                                               
Schedule I drugs  are considered most harmful for the  user.  She                                                               
noted that  schedule I drugs  generally include illicit  drugs or                                                               
illegal drugs  such as OxyContin  and codeine, schedule  II drugs                                                               
include pain relievers, schedule III  drugs include drugs such as                                                               
Ritalin  and  stimulants,  and  lastly  schedule  V  drugs  would                                                               
include  low-dose  narcotics  such   as  cough  syrup  containing                                                               
codeine.   The  prescription monitoring  database is  for use  by                                                               
licensed   practitioners    when   considering    or   dispensing                                                               
prescriptions for a current patient  in their office, by licensed                                                               
or  registered  dispenser  when  dispensing  drugs,  and  by  law                                                               
enforcement officers pursuant to a search warrant.                                                                              
1:31:26 PM                                                                                                                    
REPRESENTATIVE HOLMES asked what constitutes an inquiry.                                                                        
MS.  BLAISDELL  said  obtaining   a  license  renewal  would  not                                                               
constitute  an  inquiry.    Rather,   an  inquiry  means  someone                                                               
suspects that a  person is doing something out of  the norm.  She                                                               
said that  she did not have  a specific definition for  the term,                                                               
MS. BLAISDELL returning to her  PowerPoint presentation said that                                                               
data  can be  used  by the  personnel of  the  Board of  Pharmacy                                                               
regarding licensing inquiries and  for database management.  Data                                                               
can be  requested through the  board by law  enforcement entities                                                               
with  a  subpoena or  court  ordered  warrant.   Law  enforcement                                                               
personnel  will  not  have  direct  access  to  the  database  to                                                               
randomly review names.                                                                                                          
1:33:51 PM                                                                                                                    
MS. BLAISDELL said  that data can be used to  improve health care                                                               
for patients.   The data can be used to  identify prescribing and                                                               
dispensing  practices and  can identify  individuals  who show  a                                                               
pattern of  inappropriate use.  The  information is confidential.                                                               
The Health  Insurance Portability and Accountability  Act (HIPAA)                                                               
provides  an   exemption  for   states  with   Prescription  Drug                                                               
Monitoring   Programs.     The   bill   contains  many   security                                                               
provisions.    She pointed  out  that  intentional disclosure  of                                                               
information  or  access  to  the  database would  be  a  class  A                                                               
misdemeanor, while  someone who  intentionally obtains  access or                                                               
alters or destroys  information in the database  would be subject                                                               
to a class C felony.                                                                                                            
MS. BLAISDELL reviewed the fiscal  note and stated that the DCCED                                                               
has   already   received   some   federal   funding,   but   that                                                               
approximately $400,000  in additional federal funds  is available                                                               
to   states  that   adopt  legislation   for  prescription   drug                                                               
monitoring programs.   The typical  startup costs  cover computer                                                               
hardware and public education.   She noted that ongoing costs are                                                               
significantly less than  the initial startup costs.   In Wyoming,                                                               
which is  similar to our  state in population, the  ongoing costs                                                               
are only $90,000 per year.   The Medicaid Services, Department of                                                               
Health  and  Social  Services  (DHSS)  fiscal  note  reflects  an                                                               
initial savings of $86,000 in the  first year.  However, the DHSS                                                               
testified in  other committees that  the amount could be  as much                                                               
as three times that amount.                                                                                                     
MS. BLAISDELL,  in response to  Chair Ramras, explained  that the                                                               
cost  savings  are   due  to  the  decrease  in   the  number  of                                                               
prescriptions  that  are  filled  and then  illegally  resold,  a                                                               
practice known as  "diversion."  She surmised  that statewide the                                                               
cost  savings  could  be  $1.4  million  including  from  private                                                               
insurance and governmental agencies.                                                                                            
CHAIR RAMRAS pointed  out that the fiscal note is  unique in that                                                               
it saves  money and the  harm, which is amplified  through street                                                               
drugs is eliminated.                                                                                                            
REPRESENTATIVE GRUENBERG  referred to the letter  of intent dated                                                               
February 5, 2008, and read:                                                                                                     
     It is  the intent  of the  Legislature that  the Alaska                                                                    
     Prescription  Drug Monitoring  Program  be funded  with                                                                    
     federal  grants and  state appropriations.   It  is not                                                                    
     the  intent of  the legislature  that the  professional                                                                    
     users  of the  database  absorb the  costs of  managing                                                                    
     this  public  program  through their  license  fees  or                                                                    
     other fee structure.                                                                                                       
REPRESENTATIVE  GRUENBERG   inquired  as  to  whether   the  drug                                                               
companies or insurers would obtain cost savings.                                                                                
1:38:28 PM                                                                                                                    
MS.  BLAISDELL answered  the  insurers  would save  approximately                                                               
$1.4 million savings.                                                                                                           
REPRESENTATIVE  GRUENBERG inquired  as  to  whether the  insurers                                                               
should  share  part of  the  cost  since  they would  obtain  the                                                               
MS.  BLAISDELL surmised  that  the state  would  also benefit  by                                                               
reductions in insurance premiums.                                                                                               
REPRESENTATIVE  GRUENBERG argued  that in  the industry  premiums                                                               
have typically not  been reduced.  He inquired as  to whether the                                                               
sponsor would support the industry bearing part of the cost.                                                                    
CHAIR RAMRAS interjected  that as sponsor of  the companion bill,                                                               
he would not support that concept at this time.                                                                                 
MS. BLAISDELL answered  that the impetus of this  program is that                                                               
it is a public program.   It would seem appropriate for the state                                                               
to bear  the costs, she  opined.  Fortunately, states  have often                                                               
received  full federal  funding  for multiple  years, she  noted.                                                               
She  said she  anticipates  that federal  funding will  continue.                                                               
She offered  the reason  for the intent  language was  to appease                                                               
pharmacists, who  held concerns  that the  program would  be paid                                                               
for by  pharmacists through license  fees if federal  funding was                                                               
1:41:03 PM                                                                                                                    
MS.  BLAISDELL  returned  to   her  PowerPoint  presentation  and                                                               
reviewed changes  that were made  to SB 196.   She referred  to a                                                               
document  in the  member's packet  labeled, "Summary  of Side-by-                                                               
Side  Bill  Comparison  in  Senate  Labor  and  Commerce,"  which                                                               
outlines changes that were made  in the Senate Labor and Commerce                                                               
Standing Committee.   This  bill originally  required pharmacists                                                               
to   collect   information  on   the   person   picking  up   the                                                               
prescription, but  pharmacists expressed concern  that collecting                                                               
third  party  information would  place  an  additional burden  on                                                               
pharmacists.    She noted  language  was  added to  improve  data                                                               
security,  and   memorandums  of   agreement  with   health  care                                                               
entities,  typically   tribal  and   military  entities.     More                                                               
specifically the language added  read, "The board shall undertake                                                               
to ensure  the security and  confidentiality of the  database and                                                               
the  information contained  within the  database."   The bill  is                                                               
asking the  board to follow  national standards  for prescription                                                               
data  collection.    Many  safeguards  could  be  placed  in  the                                                               
database,  but  in  order  to  keep  pace  with  technology,  the                                                               
legislature  may not  want to  place the  safeguards in  statute.                                                               
Thus, SB 196 contains one broad statement instead.                                                                              
1:43:39 PM                                                                                                                    
MS. BLAISDELL relayed  that the following statement  was added to                                                               
SB 196, and she read:                                                                                                           
     The board  shall promptly notify  the president  of the                                                                    
     senate and the speaker  of the house of representatives                                                                    
     if, at any  time after the effective date  of this Act,                                                                    
     the federal government fails to  pay all or part of the                                                                    
     costs   of   the  controlled   substance   prescription                                                                    
MS.  BLAISDELL   opined  that   the  notification   provides  the                                                               
strongest language that can be placed  in a bill to support state                                                               
funding.   She explained other  substantive changes  with respect                                                               
to civil  liability.   She noted that  a prescriber  or dispenser                                                               
can not be  held liable if they do or  don't use the information.                                                               
She  opined  the  changes  made  the  database  more  secure  and                                                               
attempted  to address  the concerns  of pharmacists.   She  noted                                                               
that  in  Senate Finance  Committee  an  amendment was  added  to                                                               
clarify the penalty provisions.                                                                                                 
1:45:47 PM                                                                                                                    
MS. BLAISDELL explained changes that  occurred in the Senate that                                                               
include  changing "inpatient"  to  "administered  to a  patient".                                                               
Several  amendments help  to ensure  privacy, including  that the                                                               
"method of  payment" helps ensure  that specific  account numbers                                                               
would not  be collected and  stored in the database;  a provision                                                               
was removed  that would  have allowed the  Board of  Pharmacy the                                                               
ability to  collect other information  as necessary; and  data is                                                               
required to  be destroyed after  it is  more than two  years old.                                                               
An amendment added  a requirement to collect  the patient's "date                                                               
of  birth"  at the  request  of  health care  professionals,  she                                                               
noted.   Prescriptions are sometimes  transferred to  a patient's                                                               
pharmacy of choice so the  database only will track prescriptions                                                               
that are actually filled in order  to avoid a false impression of                                                               
overprescribing  drugs.     An  amendment  changed   "tribal  and                                                               
military"  with "non-state  regulated  health care"  in order  to                                                               
ensure  that other  health care  entities are  captured, but  the                                                               
language  still  will  allow  tribal  and  military  entities  to                                                               
participate in the program.                                                                                                     
MS.  BLAISDELL explained  amendments that  failed in  the Senate,                                                               
including an amendment that would  have decreased the fee charged                                                               
for  requesting a  report leaving  it at  $10 since  most medical                                                               
providers can  provide information  to patients at  no cost.   An                                                               
amendment to  remove redundant language with  respect to checking                                                               
the database was removed at the request of Senator Therriault.                                                                  
BRIAN   HOWES,  Investigator   III,  Division   of  Corporations,                                                               
Business,   and   Professional   Licensing,   Anchorage   Office,                                                               
Department  of   Commerce,  Community,  &   Economic  Development                                                               
(DCCED),  stated  that he  is  the  senior investigator  for  the                                                               
1:52:11 PM                                                                                                                    
REPRESENTATIVE GRUENBERG referred page  2, lines 20, through page                                                               
3, lines 6, of proposed AS  17.30.200.  He asked whether the best                                                               
organization to administer the program is the Board of Pharmacy.                                                                
INVESTIGATOR  HOWES answered  that historically  in other  states                                                               
the data  capability to  provide the  information is  through the                                                               
pharmacy boards.                                                                                                                
REPRESENTATIVE  GRUENBERG  referred  to  page  2,  line  26,  and                                                               
inquired as to whether the DCCED  is the best department to serve                                                               
the board.                                                                                                                      
INVESTIGATOR  HOWES   answered  that   the  DCCED  is   the  best                                                               
department  to  oversee the  database  since  all of  the  health                                                               
professionals are licensed by the division.                                                                                     
REPRESENTATIVE  GRUENBERG  referred  to  page  2,  line  29,  and                                                               
inquired as to whether the  pharmacist-in-charge of each licensed                                                               
or registered pharmacy  refers to one in each  store, for example                                                               
the  grocery stores,  or one  that  oversees all  of its  stores'                                                               
INVESTIGATOR  HOWES  opined  that  there would  be  one  at  each                                                               
1:53:30 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG said  he is  assuming that  it is  each                                                               
branch,  but if  it  is  not, that  SB  196  should reflect  that                                                               
INVESTIGATOR  HOWES  related  that investigators  currently  send                                                               
requests  to  the  corporate  store and  not  to  the  individual                                                               
MS.  BLAISDELL  related  that  she  spoke  with  the  Fred  Meyer                                                               
pharmacists in order  to determine the dispensing  authority in a                                                               
chain  store.   She  stated that  typically licensed  pharmacists                                                               
must  be  assigned  to  a  specific store.    One  pharmacist  is                                                               
assigned to a  specific store although he/she may  not be present                                                               
during  the   entire  store  hours,  that   pharmacist  would  be                                                               
responsible for the activity.                                                                                                   
REPRESENTATIVE  GRUENBERG  referred  to  page  2,  line  31,  and                                                               
inquired as to  whether "dispensed" means that  the pharmacist is                                                               
the  only  one   who  could  dispense  prescriptions,   or  if  a                                                               
pharmacist's technician can also dispense prescription drugs.                                                                   
MS.  BLAISDELL   said  that  a  pharmacist's   technician  cannot                                                               
dispense    any    prescriptions   without    the    pharmacist's                                                               
authorization of the pharmacist.                                                                                                
REPRESENTATIVE  GRUENBERG  referred  to   page  3,  line  7,  and                                                               
inquired as  to whether "practitioner"  is defined as he  did not                                                               
find it on page 6 of SB 196.                                                                                                    
MS.  BLAISDELL  answered that  in  order  for a  practitioner  to                                                               
prescribe, he/she would have gone  through the same criteria as a                                                               
pharmacist.  She  offered that in some locations  in rural Alaska                                                               
a practitioner can also dispense.                                                                                               
REPRESENTATIVE GRUENBERG  inquired as to whether  practitioner is                                                               
defined in state law.                                                                                                           
INVESTIGATOR  HOWES surmised  that a  practitioner is  anyone who                                                               
has the ability to prescribe.                                                                                                   
REPRESENTATIVE GRUENBERG  asked that Ms. Blaisdell  research that                                                               
point further  because he said  that he thinks it's  essential to                                                               
have the term "practitioner" defined.                                                                                           
1:58:03 PM                                                                                                                    
GREG POLSTON, M.D., Anesthesiology,  Pain Management, stated that                                                               
he  has served  on  the Medicaid  and  Pharmacy and  Therapeutics                                                               
Committees  for the  past  six  years and  during  that time  has                                                               
observed  some  of the  problems  with  prescription abuse.    He                                                               
stated  that  he  has   observed  other  prescription  monitoring                                                               
programs.   He  said that  he is  concerned that  the bill  might                                                               
potentially  limit  the ability  to  provide  care to  legitimate                                                               
patients who need  the ability to manage their pain.   He said he                                                               
wants  to ensure  that the  database is  accurate.   He currently                                                               
reviews the Medicaid database and  finds errors when providers or                                                               
pharmacies are incorrectly listed.                                                                                              
DR.  POLSTON said  that  the  second concern  is  to ensure  that                                                               
health care  providers receive  training or  education in  how to                                                               
use  the database.    He hopes  safeguards will  be  in place  to                                                               
monitor its effectiveness.                                                                                                      
2:00:54 PM                                                                                                                    
REPRESENTATIVE GRUENBERG  related that he has  heard from another                                                               
physician, Dr.  Jasper, who has  expressed similar concerns.   He                                                               
asked whether Dr. Polston is recommending any amendments.                                                                       
DR.  POLSTON   answered  that  Ms.  Blaisdell   has  worked  with                                                               
pharmacists and physicians.   He offered that use  of morphine or                                                               
other drugs in  an emergency room is often necessary,  but is not                                                               
the  source  of  drug  diversion or  misuse.    However,  chronic                                                               
conditions that  require prescription  pain medication  pose more                                                               
of a  problem for drug diversion.   By delaying [the  data entry]                                                               
it helps to  limit the information and those  that have immediate                                                               
access.   One concern by  physicians who provide  pain management                                                               
is that  they may  become targets  of "fishing"  operations since                                                               
they write a lot of pain medication prescriptions.                                                                              
2:03:40 PM                                                                                                                    
REPRESENTATIVE GRUENBERG  referred to  page 3,  lines 4-5,  of AS                                                               
17.30.200.  He  stated that the practitioners,  " ...shall submit                                                               
the information to the  board ... ".  He inquired  as to when the                                                               
information should  be submitted, which  he thinks is as  soon as                                                               
it is prescribed, not at a later stage.                                                                                         
DR.  POLSTON  disagreed and  clarified  that  he would  like  the                                                               
information  collected immediately.    He said  that  what he  is                                                               
referring to is the extraction of  the data and use it clinically                                                               
to  benefit  patients  and  protect   citizens  of  Alaska.    He                                                               
expressed  concern  about  the  availability  of  access  to  the                                                               
database.  Therefore, he said  he thinks that the database should                                                               
have  limited  access,  with the  retrieval  sent  to  providers,                                                               
quickly, and through a secure means.                                                                                            
CHAIR  RAMRAS inquired  as  to  which drugs  are  covered by  the                                                               
proposed database.                                                                                                              
2:06:12 PM                                                                                                                    
MS.  BLAISDELL stated  that the  only prescription  drugs covered                                                               
are the schedule I-V drugs,  which typically consist of the drugs                                                               
that  are  considered   most  harmful  for  the   user,  if  used                                                               
inappropriately.   The scheduled narcotics equate  to about 10-15                                                               
percent of all  drugs prescribed or dispensed in the  state.  She                                                               
surmised  that this  is a  relatively small  group of  drugs that                                                               
would be tracked in the database.   With regard to data security,                                                               
she said that  she spoke with a nationwide gatherer  of this type                                                               
of  information for  other states.    A simple  scenario is  that                                                               
information  can be  sent modem-to-modem,  which  means "a  phone                                                               
call to a phone call" and  no opportunity for hackers, or through                                                               
the Internet  using the same  type of encryption program  used by                                                               
online bankers.   Information can  also be sent via  compact disc                                                               
(CD), photo  copy, or  fax for  data entry by  the company.   The                                                               
"output" is in the form of  reports and is not entered or edited,                                                               
she stated.   A prescriber would see an Internet  screen, type in                                                               
a person's  name, birthday,  and address,  and obtain  a history.                                                               
Most of the databases have a  seven second rule to keep the mouse                                                               
or  keyboard active  or the  system automatically  times out  the                                                               
user, she noted.                                                                                                                
2:09:10 PM                                                                                                                    
REPRESENTATIVE GRUENBERG  opined that  new language  is necessary                                                               
to accomplish what Dr. Polston suggests.   He referred to page 4,                                                               
lines 3-31,  as a  possible place to  consider for  an amendment,                                                               
but stated  that it  was difficult  to know  what change  to make                                                               
without consulting with the bill drafter.                                                                                       
DR.  POLSTON  stated that  he  also  did  not yet  have  specific                                                               
language  to offer.    He  suggested that  the  highest level  of                                                               
encryption is  necessary, but  that the system  would need  to be                                                               
continued and monitored.                                                                                                        
REPRESENTATIVE  GRUENBERG  referred  to  page 3,  lines  7-9,  of                                                               
proposed  AS 17.30.200(b)  (1), which  requires the  name and  an                                                               
identifier of  the prescriber  be included in  the database.   He                                                               
acknowledged that prescriber's signatures are often illegible.                                                                  
DR. POLSTON agreed,  adding his hope that the  industry will move                                                               
more towards  electronic records  and e-prescribing so  that data                                                               
will  be accurately  entered  by the  prescriber,  to reduce  the                                                               
human  error of  keypunching the  information into  the database.                                                               
Thus,  since the  patient will  not  have access  to the  written                                                               
form, the patient  cannot alter the prescription,  which can curb                                                               
diversion.   Controlled  substances are  not allowed  to transmit                                                               
prescriptions  for  opiates  electronically transferred  to  curb                                                               
diversion.   He surmised  that the problem  of diversion  is much                                                               
larger than tampering with physicians  written prescriptions.  He                                                               
opined  that many  sources for  prescription drugs  are currently                                                               
available on the Internet.                                                                                                      
2:13:08 PM                                                                                                                    
REPRESENTATIVE HOLMES  referred to page  4, line 14,  of proposed                                                               
AS 17.30.200(d)(3), which relates to  access of the database by a                                                               
licensed  practitioner.   She gave  her  understanding that  many                                                               
doctors  have patients  waiting  and are  behind  schedule.   So,                                                               
while  the  language   states  the  access  is   limited  to  the                                                               
practitioner,  she inquired  as to  whether it  might be  someone                                                               
else  who  is checking  the  database,  such as  a  receptionist,                                                               
nurse, office manager, or an aide.                                                                                              
MS.  BLAISDELL said  she'd inquired  as  to whether  it would  be                                                               
appropriate  for  a  pharmacist  to  delegate  the  authority  to                                                               
someone else.   The pharmacists  were adamant that  the authority                                                               
not be  delegated to  someone else.   She offered  one suggestion                                                               
from medical  professionals, which  is that  if the  authority to                                                               
delegate  the access  to the  database is  considered, to  ensure                                                               
that  the  access   is  delegated  to  a   licensed  health  care                                                               
professional.  Thus, licensing action  could be taken against the                                                               
licensee for  any abuses.  She  added that the function  of using                                                               
the database  is not mandated  and if it  was used, that  only 10                                                               
percent of prescription drugs are entered into the database.                                                                    
REPRESENTATIVE  HOLMES surmised  that the  only person  who would                                                               
access  the database  is the  prescriber, such  as the  doctor or                                                               
nurse practitioner.                                                                                                             
MS. BLAISDELL  explained that a  prescriber could be a  doctor, a                                                               
dentist, a  veterinarian, or a  nurse practitioner and  cannot be                                                               
DR.  POLSTON speculated  that this  information would  be treated                                                               
just like  any other  form of healthcare  information.   It would                                                               
have to come  from the physician and it  would the responsibility                                                               
to ensure that it  is secure and not seen by others.   He said he                                                               
would  not  want  his  medical records  person  to  request  that                                                               
information without his knowledge.   He suggested maintaining the                                                               
limit to access the information to the provider.                                                                                
2:18:37 PM                                                                                                                    
REPRESENTATIVE  SAMUELS  inquired  as  to  how  the  process  for                                                               
obtaining a  prescription for restricted drugs  will change under                                                               
SB 196.                                                                                                                         
MS. BLAISDELL  answered that currently  a patient can  hand carry                                                               
the prescription, it is filled  at a pharmacy, and the pharmacist                                                               
maintains a  record.   At some point  the DEA may  wish to  see a                                                               
record,  either in  ledger  form, or  electronic  form for  their                                                               
review.  The prescriber would  have the information listed on the                                                               
patient's chart,  and the only  record the pharmacy  would retain                                                               
is  information that  a  drug  was dispensed.    In contrast,  by                                                               
entering  this information  into a  database, the  prescriber can                                                               
review the complete patient drug history.                                                                                       
REPRESENTATIVE  SAMUELS surmised  that currently  he could  visit                                                               
three different  doctors for injuries  and go to  three different                                                               
pharmacies to have the prescriptions filled.                                                                                    
MS. BLAISDELL stated  that what will change under SB  196 is that                                                               
the data base would show  frequency of prescriptions, doctors and                                                               
pharmacies  visited   by  patients,  which  could   indicate  and                                                               
identify a  potential drug diversion  problem since a  person who                                                               
"doctor shops" will do so frequently.                                                                                           
MS.  BLAISDELL, in  response  to  Representative Samuels,  stated                                                               
that only the pharmacist would  provide the data.  The prescriber                                                               
or pharmacist  would have access,  but not any  regulatory agency                                                               
such  as workers'  compensation,  the insurance  company, or  law                                                               
REPRESENTATIVE  SAMUELS surmised  that the  health care  provider                                                               
can choose whether or not to prescribe the drug to the patient.                                                                 
MS. BLAISDELL concurred.   She explained that  the database helps                                                               
to  confirm   what  the  health  care   professional  intuitively                                                               
MS. BLAISDELL,  in response to Representative  Samuels, explained                                                               
that a pharmacist  is not required to check each  time a schedule                                                               
of narcotics  is distributed.  She  referred to page 5,  line 12-                                                               
18,  of   proposed  AS  17.30.200(h),   which  states   that  the                                                               
pharmacist  may  not  be  held civilly  liable.    Further,  that                                                               
subsection  would remove  any mandate  that  the pharmacist  must                                                               
check the  database.  Instead,  she offered that the  database is                                                               
only an option for the pharmacist to use.                                                                                       
2:24:27 PM                                                                                                                    
REPRESENTATIVE SAMUELS  asked whether a prescriber  will take the                                                               
time to check if he/she is not required to do so.                                                                               
MS. BLAISDELL  related that Nevada  is the  only state of  the 40                                                               
states that  use a prescription monitoring  program that mandates                                                               
that a  prescriber access the  database.  Most states  have found                                                               
that  the  program  is  helpful and  prescribers  find  that  the                                                               
database helps  to resolve  questions they  may have  about their                                                               
2:26:07 PM                                                                                                                    
ALEX MALTER, M.D., Medicaid Medical  Director, Division of Health                                                               
Care Services,  Department of Health and  Social Services (DHSS),                                                               
stated that the DHSS has  previously testified in support of this                                                               
bill.    He  noted  the  DHSS  has  several  recommendations  for                                                               
changes.  He offered he is available for questions.                                                                             
DR.  MALTER noted  that he  also practices  internal medicine  in                                                               
Juneau.   He offered his  support for the previous  testimony and                                                               
surmised  that most  physicians will  be very  supportive of  the                                                               
prescription monitoring program, and that  it will be most useful                                                               
to prescribing  physicians.  He  noted that when  doctors consult                                                               
with patients  not known to them,  who come in an  unusual injury                                                               
or ailment, the doctor will  use his/her intuition to assess that                                                               
something seems astray.   This bill would provide  an easy method                                                               
to observe  the patient's prescription  history and  to determine                                                               
whether the patient  has had numerous prescriptions  filled or if                                                               
this is the first prescription being  issued.  He said he did not                                                               
have  a  feeling  for  how  many  pharmacists  would  access  the                                                               
database, but he  surmised that they might  contact the physician                                                               
in  instances in  which the  pharmacist thought  the prescription                                                               
involved diversion or had been altered.                                                                                         
2:30:50 PM                                                                                                                    
DR. MALTER, in response to Chair  Ramras, agreed that most of the                                                               
patients obtain narcotics for good  reasons.  He stated that only                                                               
a small percentage of patients  cause concern for prescribers and                                                               
DR. MALTER,  in response to Representative  Gruenberg, noted that                                                               
he  is not  a pharmacologist.   He  sated that  the federal  drug                                                               
administration (FDA) certifies  drugs for one year so  he did not                                                               
think  shelf  life  is  something  that can  be  solved  in  this                                                               
2:32:48 PM                                                                                                                    
JULIE WOODWORTH Homer Chamber of  Commerce, stated that the Homer                                                               
Chamber of Commerce recognizes that  drug abuse adversely affects                                                               
the quality  of life and  increased crime.   She stated  that the                                                               
Chamber  of  Commerce  supports  SB  196.    She  said  that  she                                                               
personally  experienced issues  in her  family which  led to  her                                                               
involvement  in the  methamphetamine education  task force.   She                                                               
related that through  her involvement she has been  amazed at the                                                               
propensity to  abuse prescription  drugs.   She related  one drug                                                               
abuser was  quick to say  he only took  pills, which is  not drug                                                               
abuse.    This highlighted  the  misperception  that exists  with                                                               
prescription  diversion.   In  response to  a  question by  Chair                                                               
Ramras,  she  acknowledged that  she  attended  the "Meth  Watch"                                                               
conference at  the Anchorage  Loussac Library  last summer.   She                                                               
commended  the state  for developing  the  Alaska Meth  Education                                                               
Project (AME) and  in joining 40 other states in  working to curb                                                               
methamphetamine  use.   She stated  that  the project  emphasized                                                               
that  methamphetamine abuse  is  a national  epidemic, she  said.                                                               
She also stated that she is  grateful for the work that Alaska is                                                               
taking to combat methamphetamine use.                                                                                           
2:34:53 PM                                                                                                                    
JANET  MULLEN,  Home  Health  Nurse,  South  Peninsula  Hospital,                                                               
stated that the  South Peninsula Hospital supports SB 196.   On a                                                               
personal level,  she said that her  own son has been  involved in                                                               
meth and  prescription drug use.   She opined that it  is so easy                                                               
for teenagers  to obtain prescription  drugs.  She hopes  that SB                                                               
196 will  pass since she said  she believes it will  help prevent                                                               
the widespread use of drug diversion among teenagers.                                                                           
2:35:44 PM                                                                                                                    
LINDA  BAREFOOT,  Regional  Director, State  Government  Affairs,                                                               
Purdue  Pharmaceutical  Company  ("Purdue  Pharma")  stated  that                                                               
Purdue Pharma  manufactures and  distributes controlled  and non-                                                               
controlled  prescription medications.    She  offered support  of                                                               
appropriately designed  state monitoring programs.   She said she                                                               
believes that SB  196 is a good  example of such a  program.  She                                                               
asked to  have Purdue Pharma  shown on  the record in  support of                                                               
SB 196.  In  response to questions by Chair  Ramras, Ms. Barefoot                                                               
answered  that Purdue  Pharma  manufactures OxyContin  (oxycodone                                                               
hyrdrochloride), and that Purdue Pharma  wants its products to be                                                               
prescribed for legitimate pain patients.   Purdue Pharma believes                                                               
that  a state  monitored prescription  program would  be able  to                                                               
provide a  resource tool for  the prescriber and can  assist them                                                               
in assessing appropriate  pain patients.  Purdue  Pharma does not                                                               
want their products distributed to  the wrong people since it can                                                               
jeopardize  the  legitimate patient  access  to  the benefits  of                                                               
their products, she offered.                                                                                                    
2:37:25 PM                                                                                                                    
REPRESENTATIVE  HOLMES  inquired  as  to whether  there  are  any                                                               
procedures  or  laws that  address  how  to dispose  of  physical                                                               
evidence such as printouts of prescription drug information.                                                                    
DR. MALTER  answered that the  federal HIPPA regulation  is quite                                                               
stringent with regard  to medical office data.   He surmised that                                                               
most clinics  would shred information  prior to disposing  of it.                                                               
Although concerns of  drug use are highlighted in  the bill, most                                                               
medical  records  contain  sensitive  information  that  patients                                                               
trust their  physician to safeguard.   Currently, medical history                                                               
is private  and he did  not sense  a looming problem  to maintain                                                               
the narcotic prescription data.                                                                                                 
2:40:42 PM                                                                                                                    
REPRESENTATIVE  HOLMES offered  that she  would assume  that most                                                               
doctors  and  pharmacies  would maintain  confidentiality.    She                                                               
inquired as to whether any other law applies.                                                                                   
MS. BLAISDELL relayed that she  would research that issue further                                                               
and  if  necessary,  have  a   provision  prepared  to  highlight                                                               
disposal  of  medical  information.     In  further  response  to                                                               
Representative   Holmes,  Ms.   Blaisdell   explained  that   law                                                               
enforcement can  gain access to  information is through  a court-                                                               
ordered  warrant  or  subpoena.    Further,  the  information  is                                                               
provided  in a  report  format  and the  officer  would not  gain                                                               
access to the database.                                                                                                         
REPRESENTATIVE HOLMES  surmised that  an officer has  a subpoena;                                                               
the database  could help  provide evidence,  but would  not allow                                                               
him/her to "fish" for information.                                                                                              
2:43:10 PM                                                                                                                    
REPRESENTATIVE HOLMES inquired  as to whether a  method exists to                                                               
correct inaccuracies in one's own record.                                                                                       
MS. BLAISDELL answered  that there is not an  appeal process, but                                                               
the first  thing a  doctor would  examine is  the date  of birth.                                                               
The   computer  would   perform  some   presorting  and   similar                                                               
information, she advised.                                                                                                       
CHAIR RAMRAS  stated that  he would  research that  issue further                                                               
and provide information to members as the bill progresses.                                                                      
2:46:08 PM                                                                                                                    
REPRESENTATIVE HOLMES  referred to page  5, line 21,  of proposed                                                               
AS 17.30.200(h)(i).   She inquired as to  whether the information                                                               
is clear  as to  which date  to use when  purging files  since it                                                               
refers to both "issued or dispensed" dates.                                                                                     
MS. BLAISDELL surmised  that some language has  been deleted from                                                               
this proposed  section so it  might be appropriate to  remove the                                                               
words  "issued or"  since it  would refer  to prescriptions  that                                                               
were dispensed rather than prescriptions that are not picked up.                                                                
REPRESENTATIVE  HOLMES  referred  to  page  4,  lines  12-13,  of                                                               
proposed AS 17.30.200(d)(2),  which refers to who  can obtain the                                                               
information.   She asked whether  it would be appropriate  to add                                                               
the word, "database" to "tighten up" that provision.                                                                            
MS. BLAISDELL  pointed out  that subsection  (d) that  leads into                                                               
that paragraph refers to "access  to the database" so she thought                                                               
that it was not necessary  to identify database in paragraph (2).                                                               
She  further  added  that  she held  discussions  with  the  bill                                                               
drafter  about  "review" in  that  paragraph.   She  advised  the                                                               
members that  review refers  to the  information that  people can                                                               
access in  the database.   She opined that the  board's personnel                                                               
or  contractors  can not  conduct  any  review of  a  physician's                                                               
practice.   In  further  response to  Representative Holmes,  Ms.                                                               
Blaisdell answered that subsection (c)  refers to the purposes of                                                               
the database,  but does not  provide the authority to  access the                                                               
information.   She  further offered  that  subsection (d)  allows                                                               
access to the database.                                                                                                         
REPRESENTATIVE  HOLMES surmised  that  subsection  (d) would  not                                                               
allow people authorized to access  the database to conduct random                                                               
2:52:42 PM                                                                                                                    
CHAIR RAMRAS  inquired as to  how he  manages to work  in private                                                               
practice and for the DHSS.                                                                                                      
DR. MALTER explained  that he had a fulltime practice  up until a                                                               
year and  a half ago.   The  DHSS was seeking  a Medicaid/Medical                                                               
director,  which most  states employ.    However, it  is a  small                                                               
enough state  that the DHSS did  not need a fulltime  person.  He                                                               
stated  that  his practice  accepts  Medicaid.   He  opined  that                                                               
Medicare is  under fire  for low  reimbursement rates.   However,                                                               
the  state has  been  diligent  to provide  good  access for  its                                                               
Medicaid patients.   He opined  that Alaska provides  better care                                                               
for its Medicaid patients.  He  said that Alaskans are lucky that                                                               
the legislature has been willing to support Medicaid.                                                                           
REPRESENTATIVE  COGHILL  referred  to   page  5,  lines  1-5,  of                                                               
proposed subsection  (e), which outlines disciplinary  action for                                                               
failure  to submit  information.   He asked  how the  board would                                                               
know the pharmacist is not reporting the information.                                                                           
INVESTIGATOR HOWES offered that  licensees are required to report                                                               
and the board would have the ability to conduct an audit review.                                                                
REPRESENTATIVE  COGHILL inquired  as to  whether the  board would                                                               
review sales versus the data entry.                                                                                             
INVESTIGATOR HOWES concurred.                                                                                                   
2:57:14 PM                                                                                                                    
DR.  MALTER, in  response to  Representative Gruenberg,  answered                                                               
that  he could  not  speak  for the  department  with respect  to                                                               
Medicare problems.   However, he  offered his  understanding that                                                               
Medicare  access   is  a  tremendous  problem,   particularly  in                                                               
Anchorage, and  many are  not taking  any new  Medicare patients.                                                               
He  offered   his  understanding  that   a  few  years   ago  the                                                               
Congressional  delegation was  able to  obtain a  fix, but  since                                                               
then, the rates have fallen to  national rates.  He opined it may                                                               
pose a  problem due to the  scarcity of physicians in  the state.                                                               
The  past  few  years  the DHSS  and  medical  associations  have                                                               
examined these  issues.   Although he does  not have  the reports                                                               
with  him,  his  impression  is   that  the  problems  have  been                                                               
examined.  He offered to provide the information to members.                                                                    
2:59:17 PM                                                                                                                    
REPRESENTATIVE GRUENBERG referred to page  3 lines 4, of proposed                                                               
AS 17.30.200(b),  which in  part reads,  "federal law  other than                                                               
those administered to  a patient at a health  care facility", and                                                               
asked if people in a health care facility are exempt.                                                                           
MS. BLAISDELL answered that the  prior language read, "inpatient"                                                               
but that term was unclear  since some patients have day surgeries                                                               
and  are  not admitted  to  a  hospital  or  clinic.   Thus,  the                                                               
language in subsection (b) means that  the patient is in a health                                                               
care facility  when the  drug was dispensed  and the  health care                                                               
facility does not need to report.                                                                                               
REPRESENTATIVE GRUENBERG  inquired as  to whether  that exemption                                                               
would skew the database.                                                                                                        
MS.  BLAISDELL  explained  that  most  feel  that  in  "inpatient                                                               
facilities"  the patient  is managed  and  is under  supervision.                                                               
Thus, the level of concern is  reduced.  The people that would be                                                               
targeted by subsection  (b) are those who  must self-manage their                                                               
prescriptions.   She surmised  that once  the patient  leaves the                                                               
facility with  the drugs  that the  concern of  prescription drug                                                               
abuse is raised.                                                                                                                
REPRESENTATIVE  GRUENBERG  expressed   concern  that  not  having                                                               
access to  the initial prescription information  could impact the                                                               
subsequent  follow  up  care  and the  quantity  of  drugs  later                                                               
3:01:47 PM                                                                                                                    
DR. MALTER  offered that  the inpatient care  is a  less critical                                                               
issue.    If  the  person  is in  a  hospital,  he/she  might  be                                                               
prescribed morphine IV  for surgical pain.   However, some people                                                               
are  obtaining large  amounts of  narcotics and  using them  on a                                                               
day-to-day basis.   He noted that Medicaid  allows 120 milligrams                                                               
of methadone a day.  He noted  that the bill is trying to address                                                               
the problem  of non-malignant pain  and chronic back pain.   Many                                                               
need  their   medication  and  probably   most  are   using  them                                                               
appropriately.    However  when   large  numbers  of  pills,  for                                                               
example, 300 pills per month  or more are issued, prescribers are                                                               
concerned that the outpatient's tablets are being diverted.                                                                     
3:03:08 PM                                                                                                                    
REPRESENTATIVE  COGHILL  referred  to   page  5,  lines  6-8,  of                                                               
proposed  AS 17.30.200(f)  which  refers to  agreements that  the                                                               
board may  enter into with  dispensers that are not  regulated by                                                               
the state.  He inquired as to  how this would fit into the felony                                                               
MS. BLAISDELL  answered that this  subsection was amended  on the                                                               
Senate  floor, and  previously referred  to "tribal  or military"                                                               
entities.   She  said the  term relates  to "federally  regulated                                                               
entities."     Further,   she  noted   these  are   not  Internet                                                               
activities.    The  entities  would   have  to  follow  the  same                                                               
requirements set out in statute under a memorandum of agreement.                                                                
REPRESENTATIVE COGHILL  disagreed since some immunity  issues may                                                               
arise that would not require  the parties to be held accountable.                                                               
He suggested that this issue may need further review.                                                                           
3:05:47 PM                                                                                                                    
CHAIR  RAMRAS,  after determining  that  no  one else  wished  to                                                               
testify, closed public testimony on SB 196.                                                                                     
3:06:25 PM                                                                                                                    
CHAIR  RAMRAS made  a motion  to adopt  Amendment 1,  labeled 25-                                                               
LS1092\LA.1, Luckhaupt, 2/22/08, which read:                                                                                    
     Page 4, lines 10 - 11:                                                                                                     
          Delete "regarding license inquiries"                                                                                  
     Page 4, line 11, following "practitioner":                                                                                 
          Insert "pursuant to a search warrant, subpoena,                                                                       
      or order issued by an administrative law judge or a                                                                       
REPRESENTATIVE SAMUELS objected for the purposes of discussion.                                                                 
CHAIR RAMRAS  noted that Amendment  1 was requested by  Dr. James                                                               
Jordan,   Executive  Director   of  the   Alaska  State   Medical                                                               
Association.   He stated that the  intent of the amendment  is to                                                               
provide  due process  protection  for licensed  prescribers.   He                                                               
explained that the  additional language would require  a board or                                                               
other administrative  agency to obtain search  warrant, subpoena,                                                               
or order issued  by an administrative law judge or  a court.  The                                                               
new  language would  ensure  appropriate  protection while  still                                                               
allowing the  database to be used  as a tool to  assure that best                                                               
medicine is  practices in Alaska.   He  noted that a  letter from                                                               
the Alaska  State Medical  Association requesting  this amendment                                                               
is in member's packets.                                                                                                         
REPRESENTATIVE SAMUELS removed his objection.                                                                                   
CHAIR  RAMRAS,  noting that  there  were  no further  objections,                                                               
relayed that Amendment 1 was adopted.                                                                                           
3:08:32 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG  made  a  motion  to  adopt  Conceptual                                                               
Amendment 2, which read [original punctuation provided]:                                                                        
On page 6, line 10                                                                                                              
     Add a new definition:                                                                                                      
         (5) "practitioner" has the meaning given in AS                                                                         
REPRESENTATIVE COGHILL objected.                                                                                                
REPRESENTATIVE GRUENBERG explained  that the term "practitioner",                                                               
on page 3 of  SB 196, is not defined for  purposes of proposed AS                                                               
17.30.200; instead,  the term is  defined in AS  08.80.480, which                                                               
pertains to pharmacists.                                                                                                        
REPRESENTATIVE COGHILL removed his objection.                                                                                   
CHAIR RAMRAS announced that Conceptual Amendment 2 was adopted.                                                                 
3:09:48 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG  made  a  motion  to  adopt  Conceptual                                                               
Amendment 3, which read: [original punctuation provided]                                                                        
     page 5 line 9                                                                                                              
          after "shall" insert "promptly"                                                                                       
     page 5 line 11                                                                                                             
          after "pay" insert "all or part of"                                                                                   
REPRESENTATIVE COGHILL objected.                                                                                                
REPRESENTATIVE  GRUENBERG explained  that Conceptual  Amendment 3                                                               
is  a  technical amendment  to  proposed  AS 17.30.200(g),  which                                                               
would require the Board of  Pharmacy to notify the legislature as                                                               
soon as possible  if federal funding does not cover  the costs of                                                               
the database to initiate the budget process.                                                                                    
REPRESENTATIVE COGHILL removed his objection.                                                                                   
CHAIR RAMRAS announced that Conceptual Amendment 3 was adopted.                                                                 
3:10:59 PM                                                                                                                    
REPRESENTATIVE HOLMES  referred to page  5, line 21,  of proposed                                                               
subsection  AS  17.30.200(i),  and  inquired as  to  whether  the                                                               
terms, "issued or "dispensed" should be clarified.                                                                              
REPRESENTATIVE  GRUENBERG explained  that a  prescription can  be                                                               
issued even if  the drug is not dispensed.   Thus, both instances                                                               
would be covered in SB 196, he opined.                                                                                          
MS. BLAISDELL  offered that  there is not  any provision  for the                                                               
subscriber to enter any data  until the prescription is dispensed                                                               
to the patient.                                                                                                                 
3:12:34 PM                                                                                                                    
REPRESENTATIVE  HOLMES   made  a   motion  to   adopt  Conceptual                                                               
Amendment 4, to  delete the words, "issued or" from  page 5, line                                                               
21.    There  being  no objection,  Conceptual  Amendment  4  was                                                               
3:12:56 PM                                                                                                                    
REPRESENTATIVE COGHILL  again referred to  page 5, lines  6-8, of                                                               
proposed subsection  AS 17.30.200(f)  with respect to  tribal and                                                               
military agreements.                                                                                                            
CHAIR RAMRAS  asked to work with  the sponsor to address  the two                                                               
issues  with respect  to tribal  and military  agreements and  to                                                               
create a method to correct any inaccuracies in a medical record.                                                                
MS.  BLAISDELL  pointed out  another  issue  the committee  could                                                               
consider is to specify how the board shall dispose of records.                                                                  
CHAIR RAMRAS  announced that CSSB  196(FIN)am, as  amended, would                                                               
be held over.                                                                                                                   

Document Name Date/Time Subjects