Legislature(2001 - 2002)
04/12/2002 03:25 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 282-PRESCRIPTION DRUG INSURANCE BENEFITS [This is a verbatim transcript.] TAPE 02-55, SIDE B Number 2382 VICE CHAIR HALCRO: ... House Bill 282, "An Act relating to prescription drug benefits under a group health care insurance plan," sponsored by Representatives Coghill and Fate. Representative Coghill, welcome to the committee, sir. REPRESENTATIVE COGHILL: Thank you, Mr. Chairman. VICE CHAIR HALCRO: We do have a [proposed committee substitute for the] sponsor substitute in front of us, Version L, and the chair would accept a motion to adopt it as our working document. Oh, I'm sorry, excuse me, it's ... Version J. REPRESENTATIVE MEYER: Mr. Chairman. VICE CHAIR HALCRO: Representative Meyer. Number 2312 REPRESENTATIVE MEYER: I'd move CS for Sponsor Substitute for House Bill 282, J version [22-LS1066\J, Ford, 2/5/02], before the committee. VICE CHAIR HALCRO: Any objections? Seeing none, Representative Coghill, welcome to the committee, sir. REPRESENTATIVE COGHILL: Thank you, and thank you for adopting this version. This has been kind of an exercise in learning for me as well. So, I've gone through three different versions just to ... get where I'm at right now, before I even had a hearing. The way this whole thing started was, my wife takes a continued medication, on thyroid medicine. And throughout the course of the pharmaceutical journeys, we were paying a copay for prescriptions. Doctors had been prescribing 90 days at a time, and just about a year ago it began -- the practice started where we had to pay a copay for every month now, instead of for the 90-day prescription. They said that ... was the change in the insurance plan. I got to thinking about it - and I know that the insurance companies have a little different view than I do - but it's really cost shifting, is what it amounts to. And the contract kind of changed in midstream on our part. REPRESENTATIVE COGHILL: So, I thought, well, I should at least ask the question why. And it really led to the discussion here, which brings us to AS ... 21.54.155, which would be a new section saying that [a] health care insurance plan that is providing a group market plan may not impose a supply limit for a prescription if the supply limit is lower than the supply limit prescribed by the prescription. Really, what I'm asking is that if a doctor prescribes for a certain amount, then the doctor should know and it should be appropriate that, for example, if I get a 90-day prescription for a blood-thinning medicine, that I should be able to get that filled. I know that this is going to be open for debate, and I think we'll hear some of the debate. And I'm open to some amendment if it makes it better, quite frankly. REPRESENTATIVE COGHILL: In the discussion with some of my pharmacy buddies, part number one came into view, and that is that pharmacists would go through the process of filling a prescription ... and even be paid by the insurance company, and they would agree that it was properly paid, only to find out later, upon review of their books, they decided that they didn't want to pay at that level and go back and change it after they'd already paid it. Once again, that is not my battle, but I decided I'd put it. Certainly, you'll hear, probably, pros and cons on ... each one of that. REPRESENTATIVE COGHILL: To me, it's a matter of fairness, and so I ... folded in the best I could with language. I would certainly submit to your thinking on the matter. Even on ... Section 2, on the supply limit, really my intention is if a doctor prescribes for 90 days, that it should be 90 days. And if the ... wording is not as artful as it can be, I'm open to amendment. I know that there are those who ... will come to some amendments. In fact, I see one right in front of me. So, ... that's my whole intent, very simple. Insurance companies certainly are ... very powerful, and it's a consumer-protection item. And then it's a matter of, can they work with the doctors on the timeliness of prescriptions. So, with that, I think you'll hear some testimony, both pro and con. And if you'll take that testimony, I'll get a chance to peruse this amendment that was just put in front of us, which I've never seen -- this looks like a different bill. VICE CHAIR HALCRO: Any questions for Representative Coghill? Representative Crawford. Number 2151 REPRESENTATIVE CRAWFORD: Thank you, Mr. Chairman. ... As an ironworker, we're under the Iron Workers Health Trust and we get a month of coverage for each hundred hours that we work. If we were to ... get a prescription that says for 90 days or 180 days, but we only have a month of coverage actually coming to us, ... there's the possibility there that ... the insurance company would have to pay for more than they were liable for if this ... wording were to go ... through. And I don't know how to fix that. REPRESENTATIVE COGHILL: Well, and I understand that. First of all, at the time that you got the prescription, certainly, I would imagine that that would be the time of payment. Certainly, the insurance is picking up a portion of the prescription cost; so are you. And once again, that would be -- just from my estimation, and I would be open to further testimony, ... it would seem to me like you pay for it when you buy it. And if you buy within the month that you're insured, then so be it. I mean, that would be my guess. And I would ... defer to those ... who know that ... technicality better than I. REPRESENTATIVE CRAWFORD: I have the same condition myself, with the thyroid medicine. And I know that they ... can write it for 180 days, but they will only fill 30 days at a time because that's how the insurance prefers it, each month of eligibility. But if ... it were to be changed in this manner, it seems that the health care trust would be liable for the whole 180 days, if I understand this. REPRESENTATIVE COGHILL: And that would be the way I understand it. If you bought it at the time you were covered, then I think that would be a fair assessment. Number 2058 VICE CHAIR HALCRO: Any other questions? Representative Coghill, let me ask you, ... [paragraph] (1), where it talks about a penalty against pharmacists. Part of the concern ... is that -- as I read your sponsor statement, it gives the incident that occurred in Fairbanks where a local pharmacy was audited. What we've heard from some in the pharmaceutical industry is that when they go in and do these audits, sometimes either the pharmacy has either misunderstood or misrepresented to the health insurance company exactly what the doctor said, and these audits catch these. So, in the case where it's a misunderstanding, that's one thing, and ... it's a genuine mistake. In the instance where there is a ... miscommunication ... and it is the pharmacist's fault, do you have any heartburn -- I mean, I think it's only fair that we should put a condition in here that says if the audit reveals that the pharmacy, in fact, was responsible for the error, and not the ... health care company or the ... doctor, if it was the pharmacy's problem, then they should be held liable. I mean, to me that only seems fair. REPRESENTATIVE COGHILL: Sure. And ... I would go along with that, that sense of fairness. And ... I think, as it was portrayed to me, that that was certainly open for discussion. It was my understanding that there was further appeal processes, but if we need to make it emphatic in this, I would be open to that. Number 1991 VICE CHAIR HALCRO: And the second ... point, where it talks about a supply limit for a prescription if the supply limit is lower: like probably a lot of my colleagues, ..., I have a prescription. And when we come down here in January through May, ... my doctor writes the prescription for a year, but every 30 days I've got to call. Especially in this day and age with technology - where I can pick up the phone at any time of the day or night and call Fred Meyer, Carrs, and fill a prescription over the phone through their automated system, and go in the next morning and pick it up, you know - it seems to me that there are certain cost-containment protections ... built into this, only giving somebody a 30-day supply. VICE CHAIR HALCRO: In addition, ... I've had the case where ... you've prescribed medicine and it works good for the first three ... [or] four weeks, and ... you start to show some side effects. And ... maybe the doctor comes back in, and you go back to your doctor, and the doctor says, "Well, we need to take you off of this; let's get you on something else." But I've already filled a 90-day prescription at my pharmacy. Then what I do with the remaining 60 days' worth of medication, ... I'm certainly not going to return those to ... the pharmacy; ... they, in good faith, can't resell those. So, it seems that to be -- that although from a consumer standpoint, it is a little bit of a burden to have to call every 30 days and get your prescription renewed, but from a cost containment and even ... as far as an overall health benefit, there does seem to be some justification for that 30-day limit. Comment on that and all. Number 1934 REPRESENTATIVE COGHILL: And I appreciate that. And I can see that scenario as a realistic scenario. I don't know, though, through experience, that doctors would prescribe, especially if they anticipated that type of .. an adjustment. But even if they did, I would think that they would ... certainly try to time that adjustment. One of the things that I'm concerned about is, certainly those of us who travel, those who have to go and live in different parts, ... where you can't go every month and show up or go in to do your copay -- so, you might want a 90-day supply. And I just can't imagine a doctor would use that indiscriminately. I can understand that there are costs involved. But I also understand that, for me, whereas we were paying $10 copay for a prescription, now I'm paying an extra $20 for that prescription, because I'm having to go back every month and pick that up, with ... an extra part of copay that my insurance plan has outlined. So, certainly there is a cost savings to somebody, but it's not to me. VICE CHAIR HALCRO: Any other questions for Representative Coghill? Seeing none, thank you very much, and stick real close. Let's go online first to Fairbanks, Mr. Gerald Brown. Mr. Brown, are you with us, sir? Number 1866 GERALD BROWN: Yes, I am, and thank you very much for allowing me to speak to you. VICE CHAIR HALCRO: Mr. Brown ..., if you could state your name and affiliation for the record, please. MR. BROWN: My name is Gerald Brown ...; I'm a pharmacist; I work in Fairbanks. I'm also on the ... Alaska Pharmaceutical Association Board. I am not representing the board today. I'm ... representing just the profession, as a pharmacist here today. I would like to speak to this bill. I ... have some problems with the new, amended version. ... As a pharmacist, we've been listed as the number-one trusted profession in the nation ... since the mid-'80s through the mid-'90s. And because of that, the public trusts pharmacists very much. This bill is not about reimbursement, per se. This bill is -- the intent is to help the public. MR. BROWN: We are concerned about the public being able to get medication on a timely basis in an easy method, and in convenient forms that they can get for travel or remote locations or inaccessibility to pharmacies, especially in the state of Alaska. What we were having problems with is that the insurance companies want to refuse the delivery to mail orders, and it's ... intending, through economic incentives, to drive the prescription filling not from [an] in-state and local basis but to out-of-state, offsite basis. We feel this is not right; this is not good health care. And to say that it is under the guise of saving health care costs is a misnomer. We feel that ... this bill, as it has been amended here, does not take into consideration those ... factors. Number 1783 MR. BROWN: We like the first version a little bit better, but there are some problems with that also. What we were trying to do is to match up to being able to fill, if there is a mail- order provision, to be able to fill the same quantities of the mail order and the same copay so that everything is on the same basis. There is an economic disincentive to be able to only get 30 days locally, while you can get 90 days via mail order. And then, for instance, like the North Star Borough here allows a 30-percent copay locally, but 20-percent copay Outside at a mail-order place. And we don't believe that that's fair, and it's usury to the ... public. We believe that ... on the original bill [SSHB 282] there was a provision (3) that said for a supply limit, that does not necessarily need to be there, but we want to have it so that there is an option for regress and allowance for review by the ... patient to the insurance company, to allow for special situations such as remote location and special situations where a supply limit may need to be more than 30 or 90 days. MR. BROWN: I have a lady who lives 90 miles outside of Tok off on a snowmobile trail, ... and she's only able to come in about every six months, and it's a long travel just to get to the post office in Tok. We would like to be able to let her get her medication once or twice a year, so that she could get that but she would have to apply to the insurance company for special waivers on that. We feel that that's a practical solution. We don't feel that you should be able to get ... necessarily a 90- or 180-day supply because you happen to go South for the winter or you happen to be Outside visiting your relatives, or whatever. That, to me, is not a consideration. But we feel that ... we need to have some convenience for those people who live in Eagle who have a road closed for six to nine months out of the year. We think that it is important that we can have those changes, and they have an option to do that. Number 1662 MR. BROWN: We want to be able to fill the cost, ease, and supplies of the mail orders ... without ... the economic disincentives that the insurance companies are putting on the clients here. We feel that the ... companies that are touting these mail-order services are actually our government. And what this is saying to me is that the government doesn't want to do business with businesses within the state; they want to shuffle business to the ... Outside mail-order places. We feel that that is extremely unfair, and that we have the University of Alaska, ... the Fairbanks Northstar Borough, and the school district - just for examples here locally - who are saying that we don't want you to have business here in the state, we want you to use the mail-order business. And we feel that that's bad health care policy because there's nobody there to help look for drug interactions, help to look for questions and problems with the prescription, or to answer questions if there is a problem with a particular medication. And I can give you numerous examples of how that has and can occur in filling prescriptions here in Alaska and in Fairbanks. MR. BROWN: Remember, the National Chamber of Commerce says for every dollar that you spend within the state, it multiplies four to seven times. If we send a dollar out to a mail-order place, that's a dollar lost to the economy. That mail-order business does not pay business taxes here in Alaska, yet the businesses within the state do pay taxes; we do contribute to local nonprofit groups, charity groups. We donate to the University of Alaska. We donate to the school district in ... monetary firms. We sponsor hockey and soccer teams within the community. We are good business partners within the community. VICE CHAIR HALCRO: Mr. Brown. MR. BROWN: Yes. VICE CHAIR HALCRO: Could you please summarize? MR. BROWN: Okay. We feel ... that we'd like to have this legislation so that we can fill those same quantities, so, at least to the customers, ... we are helping them, and ... to them we're the same as if we were the mail order, also, and we can provide those services the same. VICE CHAIR HALCRO: Thank you for your testimony, sir. Is there any questions? Seeing none, we will go to our offnet site, Nicole Salinas. NICOLE SALINAS: Yes, I'm here via teleconference. VICE CHAIR HALCRO: If you could state your name and affiliation for the record, and please keep your testimony to three minutes or less. Number 1545 MS. SALINAS: Sure, I'll do my best. Chairman Halcro and members of the House Labor and Commerce Committee, my name is Nicole Salinas. I am part of Aetna's national account team responsible for the state of Alaska. And, again, thank you for letting me testify on this bill via teleconference this afternoon. Aetna does oppose HB 282 because it is designed to take away any incentive for insured Alaskans to use mail order as a means of purchasing maintenance prescription drugs. The use of mail order does benefit consumers by providing prescription drugs at a lower cost than could be obtained at local pharmacies. While our covered ... members do have their choice of purchasing drugs locally or by mail order, prescription plans are often set up with a differentials in copayment and differentials in quantity limits. Without these differentials, there would be very little incentive for individuals to use mail order, except ... the convenience of receiving drugs at their home. The results of the bill would be more business and profits for local pharmacies, but at a substantially higher cost to the insurance plan and, therefore, the smaller employer groups. MS. SALINAS: Today, drugs represent a component of health care costs which is increasing at the highest rate both nationwide and in Alaska. Aetna and other insurers do their best to mitigate this cost increase by using their national purchasing power to negotiate favorable financial discount arrangements with large pharmaceutical vendors like Express Scripts, Walgreen's, or Wal-Mart to provide maintenance drugs at a lower cost than could be obtained by individual employer groups locally. Pharmacists in Alaska currently fill over 85 percent of drugs covered under insurance plans. We make special arrangements to allow pharmacists in rural communities to receive reasonable compensation from Aetna for the service they do provide our customers locally. To increase the pharmacist's business to 100 percent will result in significant cost increases to Alaskans for their prescription drug coverage. We urge the committee members to oppose the bill as currently drafted. VICE CHAIR HALCRO: Thank you very much. Any questions for Ms. Salinas? Seeing none, we'll go to Roger Mortemore. Number 1426 ROGER MORTEMORE: Yes. My name is Roger Mortemore and I'm a pharmacist in Fairbanks, and I'm also on the Board of Directors of the Alaska Pharmaceutical Association. But as Mr. Brown said, I'm also just addressing the profession. And basically, in the interest of time, I'll say pretty much I agree with everything that Mr. Brown has said. But you were discussing about if you have coverage for just one month at a time and you get [a prescription for] three months. That also applies if you mail it off; even if you have coverage for just one month, you are going to be able to get three months from the mail-order pharmacy, what would be an additional incentive such as in Section 1, part (1), of what Ms. Salinas said for Aetna. MR. MORTEMORE: Aetna is rather cooperative as insurance companies go; there are several others that are not as cooperative -- and if there could be some wording that could help say that exceptions could be made. And my other comment was in regard to the part (3) of the bill [SSHB 282]. I am in full agreement of changing that one completely, saying, like, a 90-day supply. And my opinion would be to rewrite the bill ... with changing some of the amendments in support of HB 282. VICE CHAIR HALCRO: Thank you for your testimony, Mr. Mortemore. Is there any questions? Seeing none, we'll go to Jack McRae. Number 1347 JACK McRAE: Hi, I'm Jack McRae with Premera, and we own Blue Cross Blue Shield of Alaska. And I'm at a major disadvantage because I don't have Version J in front of me, and I haven't had a chance to see it yet. And ... if the chair agrees, maybe I'll respond to some of the questions that were brought up, if that's acceptable. VICE CHAIR HALCRO: Absolutely. Go ahead, sir. MR. McRAE: We insure 80,000 lives in Alaska. And in relation to the 30-day and the 90-day issue, we do require [a] 30-day prescription limit if they go to a pharmacist. (Indisc.) in Alaska, we've been doing business there before statehood. We recognize the differences in Alaska, and ... through all of our group plans, a person can go in and get 90-day supply of a drug either through the pharmacist or through mail order - the 30-day period - but they can get 90 days, but they would pay three copays. For example, if it's on our formulary and you went into a pharmacist in Alaska and purchased the pharmaceutical product, you'd pay $30 for the three months. To do mail order on that same drug through our Merck-Medco [Managed-Care L.L.C.] system, you'd pay a $20 copay. So you'd still get a 90-day supply. MR. McRAE: So, our practice in our group plans in Alaska has been, for quite a while, to prescribe a 90-day supply. And if that's not happening, then it must be a misinformation, because we just checked this today. In relation to the issue of mail order versus pharmacy, our concern up there is to keep cost down. Drugs are the, on a percentage basis, ... fastest growing percentage of health care when you look at hospital fees and physician fees; it's just going up faster than anything else. And we believe ... that if we were not able to use the mail- order system on ... our multistate basis, it would be about a 30-40 percent increase in the cost of drugs because of the contracts we're able to ... have with Merck-Medco, our mail- order ... prescriber. Number 1238 MR. McRAE: In relation to ... going over a 90-day period, we do have a concern there, that was brought up earlier, that there's a situation where somebody either quits an employer or moves on for some reason, and they get billed more than 90-days. There can be a tendency to do that just before they know they're moving on. So, we do like the limit of 90 days, but in Alaska we do use 90 days. Again, going back to the one issue of mail order: we are very concerned that if mail order is eliminated or, with some of the language that was up there, it would be no advantage for mail order - that it would be a cost driver for our 80,000 subscribers up there. So, with that, if there's any questions, I'd be more than willing to respond. VICE CHAIR HALCRO: Any questions to Mr. McRae? Mr. McRae, let me ask you, with regards to this supply limit, ... did you say it's currently 90 days? MR. McRAE: It's currently 90 days both through a pharmacy in Alaska and through mail order in Alaska. VICE CHAIR HALCRO: Okay. And ... you said you do not have Version J in front of you? MR. McRAE: I do not have ... Version J, I'm sorry. VICE CHAIR HALCRO: Subsection (2) says, ... "a supply limit for a prescription if the supply limit is lower than the supply limit described in the prescription." Would it be possible or practical for us to identify or add on that there is a 90-day limit? MR. McRAE: Yeah, that would be acceptable from our standpoint. As you're aware, Mr. Chair, ... a lot of times a doctor will prescribe less than ... 30 days or 15 days, some much smaller amount to 90. But to limit to 90 would be an advantage just from our standpoint. VICE CHAIR HALCRO: Okay, great. Thank you. Any questions for Mr. McRae? Seeing none, we'll go to Angie LeBoeuf. Number 1139 ANGIE LeBOEUF: Hi, I'm Angie LeBoeuf from Anchorage, and I'm a pharmacist, and I'm also the President of the Alaska Pharmaceutical Association, speaking on behalf of myself as a pharmacist. And I want to support HB 282. In the world of retail pharmacy, we're frequently presented with the situation of trying to explain the insurance to the customers. They don't understand why their policy requires that they use mail order outside the state to get a better copay, and it's an inconvenience for the consumer, and they're angry with the situation. Many times, they'll get only a 30-day limit if they use a local pharmacy versus a 90-day if they go Outside. It's not only an inconvenience for them when they try to use the mail order; the medication often arrives late, so they've already run out of medicine. So, they come to the local pharmacy to try to get the medications, to get them through until their other prescription comes in. MS. LeBOEUF: In cases like this, often they have to pay cash for the small quantity because the insurance may not allow for them to get an early fill. It's an early fill to the insurance because the mail order already filled and mailed it, but it's late. And so, then, this presents the pharmacy with the task of trying to get a hold of the doctor to get a prescription because the prescription was mailed Outside, so that they can ... help the patient get through. Other times, they may have questions about their medication, and they can't get the information they need in a timely manner. And, again, [in] these situations, the patient will call the local pharmacy, who did not fill the prescription. And there is also a risk of medications not properly maintained at the correct temperature. So you have a stability question through mail order. I think that ... for these reasons, it's in the best interest of the consumer to allow equal access and equivalent copays and quantities from the insurance. MS. LeBOEUF: And addressing the cost-containment issue that was brought forward regarding a 30-day supply or a 90-day supply, many times in the ways prescriptions are paid there is a dispensing fee. And so if they get a 90-day supply, then there's one dispensing fee, whereas if they have to get [a] 30- day supply at the local pharmacy, and they do that ..., then the insurance is really paying more because they're having to pay three dispensing fees. And so, I think ... it's not a bill about money and ... the insurance can save so much money by using the Outside source, but rather that ... it's just better for the patient if they use the same pharmacy that can check for interactions and give personal care and consultation to the patient. Thank you. VICE CHAIR HALCRO: Thank you. Is there any questions? Thank you very much for your testimony. Is there anybody here in the room that wishes to give testimony on House Bill 282? Seeing none, is there anybody else online that remains, that would wish to give testimony on House Bill 282? Number 0945 MR. BROWN: May we add to our comments or to our testimony? VICE CHAIR HALCRO: Is this Mr. Brown? MR. BROWN: Yes, it is. VICE CHAIR HALCRO: Yes, Mr. Brown, very briefly, sir. MR. BROWN: The comment about whether the ... dispensing fee is more expensive to the insurance company: the fact that the dispensing fee is only between a $1.75 and $2.75, you can divide that for one 30-day supply or you divide it over ... 90 days; that dispensing fee doesn't change. And so it actually saves the insurance company money. ... The insurance company determines what the cost is. So, the cost should be the same or relatively the same basis ... as the mail order is basing their cost off. So, it should be the same cost. VICE CHAIR HALCRO: Thank you very much. Any questions? We do have one more person in the committee room here that wishes to give testimony. Why don't you come to the table. If you could state your name and affiliation for the record, please. Welcome to the committee, Dan. Number 0888 DAN HEINCY: Thank you. My name is Dan Heincy. I'm am also a pharmacist, but I happen to work for Merck & Company, which owns Merck-Medco mail-order pharmacy, and we also own PAID Prescriptions, which is the fiscal intermediary who pays the claims for many local pharmacies as well as for the claims for the state of Alaska. Without revealing terms of contracts, ... my colleagues who are out in retail pharmacy are not seeing something that is going on. There is a difference in the cost to insurance companies as to whether or not they use the local pharmacy or whether they use a mail-order pharmacy, whether it's Merck-Medco or it's any other mail-order pharmacy. MR. HEINCY: And typically what happens here is that when they go to the local pharmacy they've negotiated a rate that includes an average wholesale price, less a discount, plus a dispensing fee. When ... that insurance company negotiates a contract with a mail-order pharmacy, they typically get a better discount rate; they get the average wholesale price, plus an even deeper discount off of the cost of ingredients. So immediately there are savings to the insurance company or the employer or ... whoever has contracted for this service. So they immediately save on the differential in the ingredient cost, and ... frankly, my colleagues in the private sector complain about the dispensing fees that they get. MR. HEINCY: The pharmacists who work for Merck-Medco - and we are the largest pharmacist employer in the United States; more pharmacists work for us than any other group - bottom line for those guys is they even get a lower fee too. So, it's not only less ingredient cost, but it's also a lower dispensing fee. So, the bottom line is whoever is paying for the drug benefit saves money if it happens to go through mail order. And we feel that we deliver ... very good, quality pharmaceutical services. All of our pharmacists are members of professional societies and are licensed in multiple states - just as I am licensed in multiple states, too. VICE CHAIR HALCRO: Any questions for Mr. Heincy? Seeing none, thank you for your testimony. With that, we will close public testimony. ... Number 0739 VICE CHAIR HALCRO: The chair would like to propose a couple of amendments, which I think the first two to the existing bill, [paragraph] (1), where it talks about "a penalty against a pharmacist if the penalty results for the pharmacist's accurately filling a prescription", et cetera. I believe that there needs to, as we discussed in committee with ... the sponsor -- Representative Coghill, if you'd like to come to the table and join us, that'd be great. If we could put a provision in there, and I have some language I'd just like to read ..., you might actually -- I don't know if everybody has this here, but I can certainly make copies. Basically, what we're going to say is, we're going to say you can't penalize a pharmacist, ... provided the pharmacist did not provide inaccurate information to the health care insurance plan administrator when the claim was filed. So, if it is genuinely not his fault and these claims ... are uncovered -- or these discrepancies are uncovered through the audit procedure - if, in fact, ... it is not the pharmacist's fault - then they shouldn't be held liable. But in the case where inaccurate information was provided, then I think there certainly needs to be ... some accountability there. And I would just propose that to the committee. And we'll make copies of that. And we'll open that up for discussion. Actually, ... once we get that in writing, I will move that as an amendment. [Later labeled Amendment 1, the written amendment dated 04/02/02 was to SSHB 282, rather than Version J. An upper portion that just quoted the existing language in SSHB 282 is omitted here. The lower portion read as follows, with original punctuation: Amend as follows: Page 1, Section 1. Section 21.54.155,(1),(2),(3), Lines 4 through 14. Section 1. AS 21.54 is amended by adding a new section to read: Sec. 21.54.155. Prescription drug benefits. A health care insurance plan sold in the group market that provides prescription drug benefits may not impose (1) a higher copayment amount or lower supply limit for a prescription drug purchased from a pharmacy in this state than the copayment amount or supply limit imposed for a prescription drug purchased by mail service pharmacy, as long as the in state pharmacy agrees to the same price, reimbursement, terms, conditions, and services as the mail service pharmacy; (2) a penalty against a pharmacist if the penalty results from the pharmacist's accurately filling a prescription for which the pharmacist received written or electronic approval from the health care insurance plan administrator provided the pharmacists did not provide inaccurate information to the health care insurance plan administrator when the claim was filed; or (3) a supply limit for a prescription if the supply limit is lower than the supply limit described in the prescription. [This would allow [a] pharmacist to fill any quantity at all as long as that's what the doctor writes on the prescription. So a patient could get 365 days supply or more in one fill. This does not make sense in light of everyone trying to contain prescription cost. What happens if the patient becomes ineligible two weeks [later]?] (end of Amendment 1; short note at bottom omitted)] VICE CHAIR HALCRO: Representative Coghill could you speak to that. Does the sponsor have any objections to that amendment? Number 0647 REPRESENTATIVE COGHILL: No, I was open to the language that was proposed. I think that what ... I was looking for was some degree of equity. And I think if there is a discussion on if it was properly filled out, properly reported, I think that's appropriate. I understood that; certainly, I would think that an insurance company would have a claim if they found anything that was out of the ordinary or fraudulent, but I think we're expressing it very emphatically. VICE CHAIR HALCRO: Sure. And I think ... you bring up a very good point in the bill: we certainly don't want pharmacists to be penalized if, in fact, it was not their mistake. But in the case where something was misrepresented, I think ... it certainly sounds like we need some kind of a fallback. REPRESENTATIVE COGHILL: One of the things that was brought to my attention over this was the paper trail sometimes is very difficult because sometimes doctors go by way of phone, by way of fax, by way of delivering an actual prescription. And it's the ... auditable ones that can create some problems. VICE CHAIR HALCRO: And I raised that question earlier today in a meeting, and it seems to me that -- because I do that quite a bit, call my doctor in Anchorage and ask him to call in a prescription locally here. And I asked about that: ... how do you get a paper trail from a phone conversation? And it's my understanding that most pharmacies either fax the doctor back or ask them to fax down a written prescription so they keep it on file. So, there is some kind of a paper trail. So, ... in that kind of a case, it would be covered. VICE CHAIR HALCRO: You will see the amendment language is actually towards the bottom of the page, the bold language under [paragraph] (2), where it's just very clear. It states: "provided ... the pharmacist did not provide inaccurate information to the health care insurance plan administrator when the claim was filed", and then end. Number 0511 VICE CHAIR HALCRO: So, with that, I would move Amendment Number 1. Is there any objection? Seeing none, Amendment 1 is adopted. Number 0499 VICE CHAIR HALCRO: The second amendment I would offer would be on ... page 1, line 11, after "prescription", you would insert "with a maximum limit of 90 days". And that goes to the testimony that we heard, that currently that is their limit. And I think there is a good ... reasoning for a ... 90-day limit. There's, certainly, as we discussed ... the case where your medication changes. If you filled a 90-day prescription and you need to ... change your medication, what do you do with that, not to mention the fact that if you get a year prescription and they fill it for a year, ... what happens in three months if you change jobs, have a different health care provider; therefore, ... your former health care coverage is not paying, you're no longer ... under that policy, and you would certainly benefit from the remaining prescription. I think 90 days is equitable, and a very good compromise. Number 0432 VICE CHAIR HALCRO: And with that, I would move Amendment Number 2. Is there any objection? And Representative Coghill, any...? REPRESENTATIVE COGHILL: I'm not going to object to it. I'm going to do some checking. It sounds to me like it's an industry standard, sounds like something we would be amenable to, and I will just follow through with those who have testified both pro and con to get a feel for it. But at this point, I'm not going to object to it. Number 0394 VICE CHAIR HALCRO: All right. Okay. So, Amendment Number 2, without objection, is adopted. VICE CHAIR HALCRO: Amendment Number 3 is before the committee in a more lengthy form. If we could mark this Amendment Number 3, and I would move Amendment Number 3. Is there objection? [Amendment 3, 22-LS1066\J.1, Ford, 4/12/02, read as follows: Page 1, line 1, following "Act": Insert "requiring that the cost of contraceptives be included in certain health care insurance coverage, and" Page 1, following line 3: Insert a new bill section to read: "* Section 1. AS 21.42 is amended by adding a new section to read: Sec. 21.42.410. Coverage for contraceptives. (a) Except with respect to limited benefit health care insurance or health care insurance purchased by a religious employer, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan that provides coverage for prescription drugs on an outpatient basis shall provide coverage for any prescribed drug or device approved by the United States Food and Drug Administration for use as a contraceptive. The coverage required under this section is subject to standard policy provisions applicable to other benefits, including deductible or copayment provisions, within the constraints of (b) of this section. (b) An insurer may not impose on a person receiving prescription contraceptive benefits a (1) copayment, coinsurance payment, or fee that is not equally imposed on all individuals in the same benefit category, class, coinsurance level, or copayment level receiving benefits for prescription drugs; or (2) reduction in allowable reimbursement for prescription drug benefits. (c) This section may not be construed to (1) require coverage for prescription coverage benefits in a contract, policy, or plan that does not otherwise provide coverage for prescription drugs; (2) preclude the use of closed formularies if the formularies include oral, implant, and injectable contraceptive drugs, intrauterine devices, and prescription barrier methods; (3) require an insurer to provide coverage for abortion. (d) A health care insurance plan that, under (a) of this section, is exempt from providing coverage for contraceptives must contain a written notice that prescription contraceptives are not included under the policy. (e) In this section, (1) "limited benefit health care insurance" means accident and sickness insurance designed, advertised, and marketed to supplement major medical insurance, including accident only, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement, dental, disability income, fixed indemnity, long-term care, Medicare supplement, specific disease, vision, and other accident and sickness insurance other than basic hospital expense, basic medical-surgical expense, or major medical insurance; (2) "religious employer" means an employer (A) with a primary purpose of instilling religious principles; (B) that primarily employs individuals who share the religious principles of the employer; (C) that primarily serves individuals who share the employer's religious principles; and (D) that does not receive public funding." Page 1, line 4: Delete "Section 1." Insert "Sec. 2." (end of Amendment 3)] Number 0380 REPRESENTATIVE HAYES: I'll object for discussion. VICE CHAIR HALCRO: Representative Hayes has objected for purposes of discussion. And I will tell the committee that one of the reasons why I have forwarded this, it actually struck me this morning when I was reading the sponsor statement for House Bill Number 282. And I will read a couple of sentences from the sponsor statement. The first sentence is, "This legislation addresses concerns over certain prescription drug coverage inequities". There is a second sentence in the sponsor statement that talks about the intent of House Bill 282 "is to promote fairness and balance in prescription drug benefits." In the state of Alaska, contraceptives, birth control pills for women, are not required to be covered by health insurance plans, while ... for men, Viagra is. VICE CHAIR HALCRO: And I think if there is any kind of inequity, that's certainly an inequity. And certainly, those of us will agree that ... the women of this state should certainly have the benefit of their birth control being covered under their health plans. I've talked to a number of insurance health care providers who begrudgingly will tell you that it's not that ... big of an expense. The traditional ... opposition to this is more of "it's another mandate." But I think for all of us who want to do our part in preventing unwanted pregnancies, I think this certainly is a very good step in helping the women of this state have equitable health care coverage with their contraceptives being covered. And with that, once again, the amendment has been moved. Is the objection maintained? Representative Meyer. REPRESENTATIVE MEYER: Obviously, this amendment is [a] little ... different than your other two - not that I'm opposed to it, but it ... changes the scope of the bill. And I'd like to hear from the sponsor as to whether or not he ... VICE CHAIR HALCRO: Certainly. Representative Coghill. Number 0234 REPRESENTATIVE COGHILL: Well, certainly this changes the whole scope of the bill. And it is a policy call, and I object to the policy call. I understand the concern. I have been unashamedly an opponent of abortion. I have been unashamedly proactive in teaching and preaching abstinence. This particular bill would require that abortions be covered by insurance. I object. That's on page 2, line 3 [of Amendment 3]. The whole concept of the contraception, I'm certainly not against that debate. I just ... would ask that you don't amend this bill so that have to deal with that issue; it's way beyond the scope of what I wanted to do in this bill. And I would ask that you please don't amend it into this bill. REPRESENTATIVE MEYER: Mr. Chairman. VICE CHAIR HALCRO: Representative Meyer. REPRESENTATIVE MEYER: As a follow-up. I appreciate the thrust of the bill, bringing in ... line 6 ... on page 2. Obviously, the whole issue of abortions is a very emotional and sensitive issue. And I don't believe it really should be part of this particular bill 0 maybe an issue or bill separate, so that we can discuss it ... on its own merits. But I think to piggyback that big of a issue on a fairly simple bill is ... too much, Mr. Chairman. Number 0111 VICE CHAIR HALCRO: Just a correction for the committee. If you will look at page 1, line 24, it says, "This section may not be construed to provide the following". So, in fact, there's no coverage for the things that were mentioned by the committee and the sponsor. So, it just is women's oral contraceptives. REPRESENTATIVE MEYER: Okay, that's much better. REPRESENTATIVE COGHILL: Thank you for that clarification. Obviously, the amendment was just dropped on me moments ago. So, I appreciate that. This would include what is ... RU486, I would take it. VICE CHAIR HALCRO: I believe it is for contraceptives. I'm not quite sure about emergency contraceptives, but it would be, traditionally, birth control pills. REPRESENTATIVE COGHILL: And I would ask, please, don't make me carry that type of language. REPRESENTATIVE MEYER: Mr. Chairman. VICE CHAIR HALCRO: Representative Meyer. Number 0038 REPRESENTATIVE MEYER: Do ... other states cover contraceptives? I mean, I agree with the analogy of the Viagra versus the contraceptives, and certainly there is an inequity there. And maybe we should drop Viagra; I don't know. But I was just wondering ... what other states do. VICE CHAIR HALCRO: There are two states -- this debate is underway in several state legislatures. ... TAPE 02-56, SIDE A VICE CHAIR HALCRO: ... The State of Texas covers contraceptives.... At this time, maybe what I might be able to do is invite Robin Phillips to the table. And she might be able to tell the committee a little bit more about it. Number 0040 ROBIN PHILLIPS: Thank you, Mr. Chairman. My name is Robin Phillips; I'm the staff person to Representative Lisa Murkowski. We are carrying a similar bill. And just to answer a few of the questions: currently, there are 24 states that offer contraceptive coverage. There are 17 states looking at it - similar to the State of Alaska - that are looking to include contraceptive coverage. The type of coverage ... that we're looking for, according to this amendment, is FDA-approved contraceptives; that, I believe, does include emergency contraceptives, but I would have to look at that further just to double check. I do believe that the emergency contraceptive is FDA-approved. VICE CHAIR HALCRO: Representative Meyer. REPRESENTATIVE MEYER: Just a follow-up. Ms. Phillips, you said that this is similar to another bill you're carrying? MS. PHILLIPS: There's ... currently a House bill and a Senate bill that are both ... being offered that includes the language similar to this amendment. REPRESENTATIVE MEYER: Thank you, and if I may follow up, Mr. Chairman. I thought there was, that had dealt with contraceptives, because I remember talking to my staff about that. So with that in mind, why do we need to include it in this bill? Number 0146 VICE CHAIR HALCRO: I will answer that question, Representative Meyer. The fact is that it's been very difficult for us to even get a hearing in any of these committees. And it is the chairman's position that this state legislature needs to start protecting the women in this state. And I feel that this is an opportunity to amend a bill that is completely germane in its title, in its scope. And it is an amendment that is completely in order and conducive to not only Title 21 but, as I said, the sponsor statement, where we talk about promoting fairness and balance in prescription drug benefits; this certainly achieves that for the women of this state. And I think it's time that we do that. REPRESENTATIVE MEYER: Mr. Chairman, if I may follow up? Certainly, you have the right to make that amendment. But as you said, the two bills on their own, both on the Senate and the House side, ... have been stalled. So what I'm afraid of is, by putting this amendment on ... Representative Coghill's bill, that we'll just simply be stalling his bill too. And I don't think ... that's fair or appropriate to do that to ... the sponsor. VICE CHAIR HALCRO: And Representative Meyer, I would respond by pointing out that this bill goes back to the HES committee. And, as is ... the legislative process, committees amend bills every day. And, certainly, when this bill goes to the HES committee, ... if the committee so chooses, they can take this out and replace it with language desired by the sponsor. But in this committee, we all sit and look at these bills, and this is an amendment that I feel, once again, is ... not only germane to the title and the scope of what the sponsor has proposed, but it is certainly just overall good health policy for the State of Alaska. REPRESENTATIVE MEYER: And if I may follow up, Mr. Chairman. And, again, it's -- certainly you have that right to make that amendment. But I don't agree with making an amendment in one committee just so that another committee can take it out. So, I will ... object also. VICE CHAIR HALCRO: Representative Crawford. Number 0293 REPRESENTATIVE CRAWFORD: Thank you, Mr. Chairman. I ... would very much like to see contraception covered as well as Viagra and all. But I ... do have some heartburn with ... what the sponsor of the bill has said in ... making this bill cover emergency contraception as well. I would ... like to go ahead and have this amendment go forward, but I don't want to do that against the will of the sponsor, with the emergency contraception. VICE CHAIR HALCRO: Would you like to propose an amendment to the amendment, Representative Crawford? REPRESENTATIVE CRAWFORD: I would. VICE CHAIR HALCRO: Please proceed. Number 0350 REPRESENTATIVE CRAWFORD: Conceptual amendment to ... remove ... emergency contraception coverage. (Indisc.) I guess ... in line 5 [of Amendment 3], after "barrier methods". VICE CHAIR HALCRO: ... We could slip that in ... page 2, line 5 [of Amendment 3], after "barrier methods", eliminate the semicolon, ",or emergency contraceptives". Is there any objections to the amendment to the amendment? Representative Meyer. Number 0418 REPRESENTATIVE MEYER: I'll object just for discussion and clarification. Emergency contraception, ... is that the "morning after pill"? ... VICE CHAIR HALCRO: Ms. Phillips. MS. PHILLIPS: ... To answer that question, through the chair, ... there's a few different varieties, I believe. And I apologize for not having the types in front of me, and I can get you those. But I believe that includes what is considered the "morning after pill," and ... there is also, I believe, another form that is prescribed by a doctor. But ... all contraceptives are prescribed by doctors, but ... I believe it is called the "morning after pill," is the one. And I'll get you those ... titles. I just, unfortunately, don't have them in front of me. VICE CHAIR HALCRO: Is there any continued objection to the amendment to the amendment? REPRESENTATIVE MEYER: Well, ... I guess I'd like to speak to the sponsor, if I may. VICE CHAIR HALCRO: Certainly, go right ahead. Representative Coghill. REPRESENTATIVE COGHILL: Certainly that makes me feel a little more comfortable, although I can commit to you that I will work vigorously to get this whole amendment out. It's not an issue that I want to carry, quite frankly. And certainly I understand what it's like to have bills heard. I've got one sitting in this committee that will probably never see the light of day. And it's very tempting to amend it into another bill, but protocol being as it may, I was reluctant to do that. So, certainly, this carries a different subject matter, and for the amendment to the amendment, I appreciate that. I will not speak against the amendment to the amendment. Number 0540 VICE CHAIR HALCRO: Thank you, Representative Coghill. And ... just for the committee's notice, actually, if we could -- we're adopting it conceptually because from what I understand from the Division of Insurance, that is not an appropriate place. A more appropriate place would be in ... Section 1, between lines 10 and 14, somewhere in there. So, we will adopt it conceptually, but the drafter will have to find the appropriate place for it because that, apparently, is not the appropriate place for it. REPRESENTATIVE MEYER: Mr. Chairman, I'll ... maintain my objection. I think it's -- we're at a point now where I think it's more of a principle. Obviously, the sponsor of this bill is not comfortable with contraceptives being part of this bill. We sprung this on him last-minute; I don't think that's fair or right. Certainly, that's your prerogative. But I know ... I'd hate to have that done to one of my bills, and since we do have two other bills, both in the Senate and the House side, that has that same subject that you're trying to get incorporated here, I frankly don't think it's necessary. So, I'll maintain my objection. VICE CHAIR HALCRO: Objection to the amendment to the amendment? REPRESENTATIVE MEYER: Correct. VICE CHAIR HALCRO: Any other further comment? Representative Kott. Number 0630 REPRESENTATIVE KOTT: And Mr. Chairman, I think I'm going to have to side with my partner in crime that sits across from me. I think we're going down a slippery slope here in trying to define a term of art that has no definition; at least I haven't seen any evidence produced that emergency contraceptives means this. Is this a general term of art that is used within the insurance industry? Is it used by physicians? I just haven't heard that term before. So, I think we're trying to come up with a broad term of art that has no definition, unless we define what ... I would believe would be the normal nonemergency contraceptives - define those and then, by exclusion, the rest are emergency. I don't see how you could head down this path. VICE CHAIR HALCRO: In speaking to that, Representative Kott, I would simply point out that emergency contraceptives clearly would be the "morning after pill" or RU486, whatever you want to call it. There's nothing else out there that I know of that's FDA-approved that is considered an emergency contraceptive. And so, I don't believe we're going down a slippery slope. I believe it's very clearly defined. We can certainly leave it to the drafter to encompass if there is more than one ... emergency contraceptive .... But the committee -- the amendment is very clear in its nature. Representative Hayes. Number 0720 REPRESENTATIVE HAYES: Thank you, Mr. ... Chair. You know, it's a shame that we have to look at this ... in an amendment in this committee when you have two bills out there to adjust this. And ... the thing I think about the most is, when I look at this discussion, is the fact that when we had a bill on prostrate cancer, it zoomed through this building. And when we had a bill on breast and cervical cancer, it took almost till day 121 to pass out of this building. REPRESENTATIVE HAYES: I just I think it's a shame, not to folks' motives, but it does seem a little strange to me that you have very few women legislators in here and you have a lot of male legislators. And something that affects men can go through this building really quickly, and something that affects women takes forever or is not heard. I think that is ultimately a shame. It's a shame that we're not hearing the bill in ... whatever committees that it's being held in. But the amendment, as much as I hate to admit it, it actually does fit into what you put out here. I didn't even realize that until the chairman mentioned it. The amendment actually does fit in your bill. I know you would vigorously fight to pull this out, and I understand that, because I understand where you're coming from. But it actually does make with this legislation. Number 0825 VICE CHAIR HALCRO: Is there any other comments on the amendment on the amendment? Let's take a roll call vote. COMMITTEE SECRETARY: Representative Meyer. REPRESENTATIVE MEYER: Nope. COMMITTEE SECRETARY: Representative Kott. REPRESENTATIVE KOTT: No. COMMITTEE SECRETARY: Representative Crawford. REPRESENTATIVE CRAWFORD: Yes. COMMITTEE SECRETARY: Representative Hayes. REPRESENTATIVE HAYES: Yes. COMMITTEE SECRETARY: Chairman Halcro. VICE CHAIR HALCRO: Yes. So, the amendment [to Amendment 3] passes 3 to 2. Back on the main amendment; is there further discussion? Could we get a roll call vote, please? COMMITTEE SECRETARY: Representative Kott. REPRESENTATIVE KOTT: No. COMMITTEE SECRETARY: Representative Crawford. REPRESENTATIVE CRAWFORD: Yes. COMMITTEE SECRETARY: Representative Hayes. REPRESENTATIVE HAYES: Yes. COMMITTEE SECRETARY: Representative Meyer. REPRESENTATIVE MEYER: Nope. COMMITTEE SECRETARY: Chairman Halcro. VICE CHAIR HALCRO: Yes. And so the amendment [Amendment 3 as amended] passes 3 to 2. It is adopted. That brings the bill before us. Is there any other amendments? Seeing none, what is the will of the committee? Number 0850 REPRESENTATIVE CRAWFORD: I move the bill. REPRESENTATIVE KOTT: I'll object. VICE CHAIR HALCRO: There's objection to moving the bill. Discussion. REPRESENTATIVE MEYER: Mr. Chairman, ... I just think that you've changed the sponsor's bill dramatically with that amendment. And, again, I'm not opposed to adding contraceptives. I agree with Representative Kott: there's different kinds of contraceptives. You know, the ones I'm familiar with, that my wife [uses], are the ones that you take to prevent pregnancy, and ... now there's others that you take the morning after. The discussion for this is not in Labor & Commerce; I think the discussion for contraceptives is more appropriate in HES. And that's where the bills are, and that's where the bills should be discussed. I don't think this amendment or this discussion is appropriate in Labor & Commerce. VICE CHAIR HALCRO: Any other discussion? Well, ... I'll just say this: it's funny because, you know, it seems in this building when we address legislation, we tailor our arguments to whatever the topic is and whether we support a bill or we oppose a bill. About two weeks ago, I remember we had a Senate bill in here that was opposed not only by everybody that testified, but even the Federal Trade Commission. And when we amended that bill, ... the comment was made, with this amendment, the bill is moot. And the sponsor sat at the end of the table and said that he was going to do everything he could to put that language back in. This committee voted to move the bill forward with no objections. There [were] no concerns. There was no, "Hey, I don't think this is appropriate." We just did it. VICE CHAIR HALCRO: The ... idea that this is inappropriate is ... baseless. This is appropriate. We are talking about health care coverage for a specific part of health care. That's what we are talking about. This is the Labor & Commerce Committee. We've had bills in this committee in the last three years. We've talked about mental health coverage. We have talked about coverage for diabetes. We've talked about breast and cervical cancer. We talk about health care coverage on various items, every year in this committee, and this is no different. I know this discussion and this topic makes some uncomfortable, but you know what: it is time that this legislature start protecting the women of this state. VICE CHAIR HALCRO: This amendment derives out of frustration that for the last three years that I've been in this legislature, there has been a prescription-equity bill on file, every single year. And it has gone nowhere. And just because a few committee chairmen refuse to hear it - on the basis of ideology, completely overlooking not only the health benefits but the economic cost savings - is unbelievable. It is pure bad business. This amendment is germane. It is something that is well within the purview of this committee. And I think it's about time we start to recognize these issues and deal with them, rather than just sweep them under the rug and pretend they're not there until we sign out at the end of the session. Number 1045 REPRESENTATIVE MEYER: Mr. Chairman, if I may follow up. I don't disagree with what you're saying, and I don't disagree with your frustration for trying to get this issue heard. I think the better place would've been to go to those chairmans of the Senate and the House and say, "Hey, look, why aren't you hearing this bill? I think it's important." Maybe get up and do some special orders on the floor or whatever. But I think to ambush poor Representative Coghill here with this amendment to his small, simple bill, I frankly think was not right. But that's my opinion. VICE CHAIR HALCRO: I respect and appreciate your comments. But, once again, this is the legislative process, Representative Meyer. And in all my years in the business in this building, I can't tell you how many times I've had a bill go before the committee and it came out dramatically different than the way it came in. That's the process, and that's why we're all individually elected and sit on these committees. Is there any other discussion? Representative Kott. Number 1093 REPRESENTATIVE KOTT: Thank you, Mr. Chairman. You're ... correct in your assessment. This is the democratic process; this is how a bill becomes law. Oftentimes, we don't want to know how it gets to the end. But when we sit through these laborious hearings, you get a pretty good appreciation for what goes on. My only concern, Mr. Chairman, is I haven't sat on any of these committees in the last two or three years. This is a major policy call. We haven't heard the impact on insurance rates, haven't heard from industry. In general, when we've had these particular matters before us, whether it was cervical, breast cancer, prostrate, we had a full-blown hearing on that issue. So we knew the impact, knew what kind of drugs were out there. They're just so many things that ... I don't have the information and access to, I can't make a conscientious, good statement to support it. VICE CHAIR HALCRO: And ... once again, I would respect your comments too. But I would, once again, point to how many [times] we've sat in individual committees when pieces of legislation have been before us or amendments have been proposed, and those bills have been ushered out of committee with little or no discussion. And so, just because ... we are uncomfortable with this topic doesn't make the proposal of this amendment or the adoption of that amendment any different than any of the other uncomfortable or ... poorly discussed issues we've had before us. And this, on its merits, is a ... health issue. It is a Labor & Commerce issue. And it certainly is one, I believe, that is important to the health of the women in this state. Representative Crawford. Number 1179 REPRESENTATIVE CRAWFORD: Thank you, Mr. Chairman. We're five men sitting here deciding an issue that affects women. And each and every one of us sitting here, I'm sure, abhors abortion. This is a way to ... head off many unwanted pregnancies and the need for abortions. I think this is ... time that we should have this discussion and move this bill on further so that ... we can continue this discussion. I'm sorry for Representative Coghill being the ... recipient of ... it, but ... it's a policy call I'd like to have us discuss and move on. Thank you, Mr. Chairman. Number 1240 VICE CHAIR HALCRO: Any other committee discussion? Seeing none, we'll take a roll call vote for moving the bill [CSSSHB 282, version 22-LS1066\J, Ford, 2/5/02, as amended] from committee. COMMITTEE SECRETARY: Representative Crawford. REPRESENTATIVE CRAWFORD: Yes. COMMITTEE SECRETARY: Representative Hayes. REPRESENTATIVE HAYES: Yes. COMMITTEE SECRETARY: Representative Meyer. REPRESENTATIVE MEYER: Nope. COMMITTEE SECRETARY: Representative Kott. REPRESENTATIVE KOTT: Nope. COMMITTEE SECRETARY: Chairman Halcro. VICE CHAIR HALCRO: Yes. So, the bill [CSSSHB 282(L&C)] moves on a vote of 3 to 2 from committee. REPRESENTATIVE KOTT: Mr. Chairman. VICE CHAIR HALCRO: Representative Kott. REPRESENTATIVE KOTT: As a matter of policy, I believe to move the bill out of this committee you need four votes, the majority of the total membership. To move an amendment, you need a majority of the quorum, which would be four. So you can move an amendment on a 2-to-1 -- or a ... 3-to-1 vote. To move the bill out, you need four votes. Number 1259 VICE CHAIR HALCRO: I don't believe that's correct. I think we've had this discussion in the past. I think you need a majority of the quorum to move a bill from committee. With that, there's nothing further. We will meet again Monday, 3:15 [p.m.]; the chairman will be back at that time. And with that, we're adjourned at 5:20 [p.m.] [It was later decided that CSSSHB 282(L&C) failed to move out of the House Labor and Commerce Standing Committee.]
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