Legislature(2003 - 2004)
05/07/2003 03:38 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 32 - UNIFORM PRESCRIPTION DRUG CARD Number 1754 CHAIR ANDERSON announced that the final order of business would be HOUSE BILL NO. 32, "An Act relating to a health insurance uniform prescription drug information card; and providing for an effective date." The committee took an at-ease from 4:10 p.m. to 4:11. [Not on tape, but taken from the Gavel to Gavel recording on the Internet, was: REPRESENTATIVE JOHN COGHILL, Alaska State Legislature, sponsor, paraphrased from his sponsor statement, which, with original punctuation provided, read: The intent of HB32 is to have a uniform prescription card implemented to expedite the amount of time a pharmacy technician spends gathering necessary information from the insurance company in order to process the insurance claim. Pharmacists are spending a disproportionate amount of time trying to address reimbursement issues rather than serving the health care needs of their customers. HB 32 would allow form more face-to-face care between pharmacists and patients. It would also minimize confusion, eliminate unnecessary paperwork, decrease administrative burdens, and streamline the dispension of prescription products paid for by third party payors. REPRESENTATIVE COGHILL indicated that he'd originally attempted to outline in statute all the things that would be on a prescription card, but because there were many things he was reluctant to have on the card, he'd instead decided to have a bill that simply said the director shall adopt, by regulation, uniform prescription drug information cards.] Number 1790 REPRESENTATIVE ROKEBERG made a motion to adopt the proposed committee substitute (CS) for HB 32, Version 23-LS0203\D, Ford, 3/5/03, as the work draft. There being no objection, Version D was before the committee. Number 1814 BARRY CHRISTENSEN, R.Ph., Legislative Chair, Alaska Pharmacists Association (AkPhA), said that the AkPhA supports passage of HB 32. He added that although the AkPhA would be more comfortable if certain items were listed in statute, it realizes that such is not possible at this time, and so it is trusting that the director will adopt suitable regulations. REPRESENTATIVE ROKEBERG asked whether the original version of HB 32 is similar to legislation sponsored during the prior legislation. REPRESENTATIVE COGHILL said it is essentially the same. REPRESENTATIVE ROKEBERG recalled that that legislation was controversial. REPRESENTATIVE CRAWFORD concurred. REPRESENTATIVE COGHILL indicated that those controversial issues are resolved via Version D. In response to a question, he relayed that "Aetna" is amenable to Version D. REPRESENTATIVE ROKEBERG noted that one of the problems with listing in statute the specific things that a card must have on it is that it would be difficult to make it be both uniform and flexible. REPRESENTATIVE COGHILL concurred, and indicated that Version D resolves that issue as well. REPRESENTATIVE GUTTENBERG asked why all the interested parties had not simply sat down with each other and created something that resolved their concerns. REPRESENTATIVE COGHILL suggested that everyone's past attempts to list and define, in statute, all the necessary terms had met with failure. He opined that "lining up" all the information in statute is the wrong approach; thus Version D simply gives the division the authority to, by regulation, adopt uniform prescription drug cards, and mandates that it shall do so. REPRESENTATIVE GUTTENBERG noted that the legislature has heard a lot of complaints over the years about the problems associated with creating, adopting, and changing regulations. Number 2163 REPRESENTATIVE COGHILL pointed out that having something implemented via regulation instead of via statute is a policy call the legislature can make. He added that if they really wanted to wrestle with getting the necessary items listed in statute to everybody's satisfaction, he would be willing to undertake that project next year, but adopting Version D this year will enable [the division] to develop something in the meantime. He surmised that without the pressure of HB 32, the division might not even bother with the process of developing a prescription drug card. On the issue of whether there even ought to be such a card developed, he relayed that his constituency is in favor of it. REPRESENTATIVE GATTO asked whether the information that would be on a uniform prescription drug card would be his information, the insurance company's information, or the pharmacy's information. REPRESENTATIVE COGHILL replied: "It would have your name, insurance information, and prescription information. And that's actually what we were trying to describe in [the original version of the bill]." REPRESENTATIVE CRAWFORD opined that Version D of HB 32 is heading down the right track, and that the quicker a uniform prescription drug card is developed, the better. REPRESENTATIVE ROKEBERG asked Katie Campbell whether she would be the one writing the regulations proposed by Version D. Number 2290 KATIE CAMPBELL, Actuary L/H, Central Office, Division of Insurance, Department of Community & Economic Development (DCED), confirmed that she would be the one writing those proposed regulations. REPRESENTATIVE ROKEBERG asked Ms. Campbell whether she anticipates any problems doing so or requires any additional direction from the legislature. MS. CAMPBELL replied: I think that it's something the division can take on, and it is not going to be easy. I think ... the reason why it's been controversial is because the insurance companies think they have everything they need on there and the pharmacists are saying, "No, you don't have everything we need on there." And I think that the goal is really to sit down at the table with both of them and figure out what it is that really needs to be on the cards, and I guess that's what we would do through the regulatory process. REPRESENTATIVE GUTTENBERG asked whether any other states or jurisdictions have a standard. MS. CAMPBELL replied: As I understand it, there are a number of states that have adopted uniform prescription drug card legislation; I don't know how many, or what they ... look like. From what I've heard, they vary from state to state, and the goal of the pharmacy organizations has been that it be a national standard so that it doesn't vary across states. And that just simply hasn't happened, as I understand it. REPRESENTATIVE GUTTENBERG asked Ms. Campbell whether she envisions that the cards will have a magnetic strip or a bar code on the back so that the information can be read in that fashion as opposed to having everything printed on the card. MS. CAMPBELL replied: "I don't think that was part of the plan; it was more ... like the Aetna card that has the information printed on it, [but] it wouldn't preclude the use of a bar code." REPRESENTATIVE ROKEBERG again asked Ms. Campbell whether she needs any additional direction from the legislature. MS. CAMPBELL replied: I think one really critical piece that would be useful would be to get your direction on the use of the actual national standard that was referenced [in] the prior versions of the bill, and how close we need to be there. TAPE 03-48, SIDE B Number 2388 MS. CAMPBELL continued: I think ... some of the issue has been that a lot of the claim processing is done electronically. And so even if you don't have it on the card, ... [when] you go in and you get a prescription filled, ... you have a social security number ... [to] put [on] the screen and ... all the information comes up that you need to process to a claim - ... you don't need to have all kinds of information on the card. ... That's their one side. And I think the pharmacists are saying, "No, we really want to have a card that has more complete information; that's consistent with this national standard." That's my understanding of the issue. And so, to the extent that you would want the division to draft a regulation that references those national standards, that would be useful. REPRESENTATIVE GATTO, noting that he already has two cards from different insurance companies, asked whether it would be possible to create one card that could replace those he now carries in his wallet. Or would the uniform prescription drug card they've been discussing be in addition to the cards he now carries? Is there a standard that says it doesn't matter because the information is the same? But then the companies would be different, he remarked, and the pharmacist needs to know the company. MS. CAMPBELL replied, "I think if we move to a single-payor system, that might work, but each insurance company is going to have their own information." REPRESENTATIVE GUTTENBERG asked what the process would be when someone is traveling. He noted that it would be good if a pharmacist could also use the card to see what other prescriptions a person is using so as to be able to prevent conflicts in medication usage. Number 2289 REPRESENTATIVE COGHILL said he is not sure whether this vehicle can solve the problem of having numerous cards. He suggested, though, that perhaps the cards could be made similar to each other. He reiterated that the goal of HB 32 is to streamline the prescription process, and that he is reluctant to list specific things in statute. He again indicated that Version D offers a good way to go about the process of creating a uniform prescription drug card. REPRESENTATIVE ROKEBERG posited that the division might welcome more legislative direction. REPRESENTATIVE COGHILL said he would not mind adding some intent language to the bill or perhaps even attaching a letter of intent. REPRESENTATIVE ROKEBERG asked Ms. Campbell whether there is a "turf war" going on and, if so, wouldn't it be better to avoid it by perhaps making a legislative decision with regard to certain items. MS. CAMPBELL replied: I think there is somewhat of a turf war, but any direction you that can give [regarding] how you would [like] ... to handle that would be helpful when we sit down ... [at] the table to talk about the card. I think it's been a very controversial issue, no doubt about it, between the pharmacists and the insurance companies [regarding] what should be on that card and how it should be structured. So I think some of the insurance companies' concern has been with the reference to those national standards, and so to the extent that we can get some direction on where you want to go, whether it's in statute or just intent language, something so that we know where you want to go with that would be helpful. REPRESENTATIVE COGHILL surmised that he could probably get something drafted to that effect for the next committee of referral, adding that he favors the standard set forth by the National Council for Prescription Drug Programs (NCPDP). REPRESENTATIVE DAHLSTROM mentioned that it would probably also be helpful to get input from the drug companies that provide computerized information. REPRESENTATIVE COGHILL concurred. REPRESENTATIVE ROKEBERG relayed that having the legislature make the decision regarding standards gives him greater comfort than just leaving that burden with the department to decide via regulation. Number 2037 REPRESENTATIVE ROKEBERG moved to report the proposed CS for HB 32, Version 23-LS0203\D, Ford, 3/5/03, out of committee with individual recommendations and the forthcoming fiscal note. There being no objection, CSHB 32(L&C) was reported from the House Labor and Commerce Standing Committee.
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