Legislature(2007 - 2008)CAPITOL 17

02/06/2008 03:00 PM LABOR & COMMERCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 316 PRESCRIPTION DATABASE TELECONFERENCED
Moved CSHB 316(L&C) Out of Committee
Bills Previously Heard/Scheduled
= HB 320 SEARCH & RESCUE: CERTIFICATION/WORK.COMP
Moved CSHB 320(L&C) Out of Committee
HB 316-PRESCRIPTION DATABASE                                                                                                  
                                                                                                                                
3:24:54 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON  announced that the  next order of business  would be                                                               
HOUSE  BILL  NO.   316,  "An  Act  relating   to  establishing  a                                                               
controlled substance prescription database."                                                                                    
                                                                                                                                
3:25:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   NEUMAN  moved   to   adopt  proposed   committee                                                               
substitute  (CS)  for  HB  316  labeled  25-LS1283\M,  Luckhaupt,                                                               
2/4/08,  as the  working  document.   There  being no  objection,                                                               
Version M was before the committee.                                                                                             
                                                                                                                                
3:26:05 PM                                                                                                                    
                                                                                                                                
EMILY BEATLEY,  Staff to Representative Jay  Ramras, Alaska State                                                               
Legislature,  on  behalf   of  the  prime  sponsor   of  HB  316,                                                               
Representative  Jay Ramras,  offered to  present the  bill.   She                                                               
informed  committee  members  that   all  states  have  laws  and                                                               
regulations  that   govern  the  distribution  and   handling  of                                                               
controlled substances and other  pharmaceuticals.  As of December                                                               
2007,  35  other  states  have   enacted  programs  that  require                                                               
prescription  monitoring  programs  with  another  14  additional                                                               
states, including Alaska, that are  in the process of considering                                                               
such  legislation.   Goals for  prescription monitoring  programs                                                               
vary,  but   the  major  objectives  include   programs  such  as                                                               
education  and  information,  public  health  initiatives,  early                                                               
intervention and prevention,  investigations and enforcement, and                                                               
confidentiality.   States  with prescription  monitoring programs                                                               
reported  the programs  provide effective  tools to  identify and                                                               
prevent drug  diversion at the prescriber,  pharmacy, and patient                                                               
levels,  she  offered.    Prescription  monitoring  programs  are                                                               
designed  to be  the  least disruptive  to  medical and  pharmacy                                                               
practices,  she opined.   In  fact, some  states report  that the                                                               
time to use  the prescription monitoring program  takes less than                                                               
three to five minutes.                                                                                                          
                                                                                                                                
MS.  BEATLEY noted  that  under HB  316,  prescription drug  data                                                               
would  only be  available  to entities  that  currently have  the                                                               
right to  access and  obtain prescription  data under  state law.                                                               
The proposed database  for monitoring prescription drug  use is a                                                               
tool that  would assist prescribing  and dispensing  practices to                                                               
improve  health care  for  Alaska's citizens,  she  opined.   The                                                               
proposed program is not intended  to target possible subjects for                                                               
investigation,  but  is to  help  law  enforcement perform  their                                                               
investigations after an official complaint has been made.                                                                       
                                                                                                                                
MS. BEATLEY  offered that the Department  of Commerce, Community,                                                               
& Economic Development (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.   In 2006,  the National                                                               
Survey on  Drug Use  and Mental  Health reported  that nationally                                                               
over 7  million people ages  12 or older used  prescription drugs                                                               
non-medically over a one-month period,  she stated.  According to                                                               
the survey,  of those 55.7  percent said  that the source  of the                                                               
drug they  most recently used  was from  a friend.   Further, the                                                               
Drug Enforcement  Administration (DEA) reported in  a recent fact                                                               
sheet that  Alaska has the  highest rate of  controlled substance                                                               
use.  The misconception that  the misuse of prescription drugs is                                                               
safer than  using illicit  street drugs makes  this type  of drug                                                               
abuse particularly dangerous, she  opined.  Oftentimes, kids will                                                               
steal prescription  drugs from their home  medicine cabinet, take                                                               
the drugs  to parties,  and throw  them in a  bowl for  others to                                                               
use, she noted.                                                                                                                 
                                                                                                                                
MS.  BEATLEY  gave an  overview  of  the prescription  monitoring                                                               
program established  in HB 316.   Under  HB 316, the  DCCED 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.    Some  provisions in  the  bill                                                               
outline the  requirements for reporting information,  such as who                                                               
is  responsible  for  reporting information  to  the  board,  the                                                               
specific  uses of  the database,  and  who has  the authority  to                                                               
access  information   contained  in   the  database,   such  that                                                               
individuals could also request their own  data for a fee with the                                                               
maximum fee  set at  $10.   She outlined  the safeguards  to keep                                                               
information confidential and the  penalty provisions contained in                                                               
HB  316.   The prescription  monitoring  database is  for use  by                                                               
practitioners when considering or  dispensing prescriptions for a                                                               
current  patient in  their office,  by licensed  pharmacists when                                                               
dispensing drugs, and  by law enforcement officers  pursuant to a                                                               
search  warrant.     Failure  to  report  data   is  grounds  for                                                               
disciplinary action  by the  Board of Pharmacy,  she said.   This                                                               
bill  would also  authorize the  state to  enter into  agreements                                                               
with tribal and military dispensers and practitioners.                                                                          
                                                                                                                                
3:33:21 PM                                                                                                                    
                                                                                                                                
MS. BEATLEY said  that it is not the sponsor's  intent to pass on                                                               
costs   of   the   prescription  monitoring   database   to   the                                                               
professionals  who use  it.    Thus, the  board  must notify  the                                                               
legislature if federal funding ceases  to cover the program costs                                                               
for the  prescription monitoring database.   Funding from federal                                                               
grants and  state appropriations should cover  the program costs,                                                               
she  opined.    Practitioners  are   not  obligated  to  use  the                                                               
database,  she offered.   Instead,  the  database is  a tool  for                                                               
dispensers to use to identify  misuse of prescription drugs.  The                                                               
penalty provisions  of HB 316  make it  a class A  misdemeanor to                                                               
unlawfully disclose information and a  class C felony to alter or                                                               
destroy information  contained in  the database,  she said.   The                                                               
prime sponsor  considered testimony  given on the  companion bill                                                               
when  making changes  to HB  316 that  are contained  in proposed                                                               
Version M.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  RAMRAS  added that  another  genesis  for HB  316                                                               
stems  from  the methamphetamine  forum  he  attended in  October                                                               
2007,  which was  held at  the  Anchorage Loussac  Library.   The                                                               
group  that  met included  a  representative  from the  DEA,  who                                                               
expressed   interest  and   support   of   Alaska  initiating   a                                                               
prescription   monitoring   database.     The   legislature   has                                                               
previously  considered   programs  similar   to  this,   but  the                                                               
technology  and   federal  funding  now  make   the  prescription                                                               
monitoring database  feasible, he opined.   He also  stressed the                                                               
importance  of  controlling  substances that  people  ingest  and                                                               
noted the  risks of drug  addiction.   This bill could  help curb                                                               
what is coined  "doctor shopping" and the  resale of prescription                                                               
drugs  referred to  as "diversion,"  he said.   Further,  curbing                                                               
diversion  and   inappropriate  pharmaceuticals   could  actually                                                               
result in  a negative fiscal  note.   He characterized HB  316 as                                                               
"good for society."                                                                                                             
                                                                                                                                
3:36:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as  to whether HB  316 addresses                                                               
the Health Insurance Portability  and Accountability Act (HIPAA).                                                               
She  further  asked  whether  other   states  currently  using  a                                                               
prescription  monitoring database  have experienced  any problems                                                               
and  how  often  pharmacists, dispensers,  and  other  authorized                                                               
users  in   other  states  access  the   prescription  monitoring                                                               
database.   She  asked what  liability the  state would  incur if                                                               
data  was  lost or  stolen  since  the  DCCED  and the  Board  of                                                               
Pharmacy  are  responsible  for   security  of  the  prescription                                                               
monitoring database.  Lastly, she  inquired as to whether federal                                                               
grants would be ongoing or if funding will end.                                                                                 
                                                                                                                                
MS. BEATLEY answered that HIPAA  provides an exemption for states                                                               
with prescription monitoring programs so  long as the program and                                                               
provisions of state law are  necessary to prevent fraud and abuse                                                               
related  to  the  provision  of health  care  and  its  principal                                                               
purpose  is the  regulation of  the distribution,  dispensing, or                                                               
other control of  any controlled substance.   Since the voluntary                                                               
prescription monitoring database has proven  to be such a helpful                                                               
tool to those who use it,  some states would like to change their                                                               
programs   to  mandatory   programs  to   increase  the   overall                                                               
effectiveness.   She  offered to  provide committee  members with                                                               
additional statistics.  She recalled  conversations she held with                                                               
program  administrators   in  other  state,  during   which  they                                                               
characterized their  prescription monitoring database  program as                                                               
a valuable and successful tool to help curb drug abuse.                                                                         
                                                                                                                                
MS. BEATLEY  explained the  stages of  federal funding  such that                                                               
the first stage would fund  research, the second stage would fund                                                               
implementation  with a  limit of  $400,000, and  the third  stage                                                               
would  be  enhancement grants.    Some  states have  continuously                                                               
received enhancement  grants, she  noted.   However, there  is no                                                               
guarantee or certainty that federal  funding for the prescription                                                               
monitoring programs will continue.                                                                                              
                                                                                                                                
3:40:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE    GARDNER    expressed    concern    that    busy                                                               
pharmaceutical  dispensers  might  not  have time  to  query  the                                                               
prescription monitoring  database.  She requested  information on                                                               
the number of states with active voluntary programs.                                                                            
                                                                                                                                
REPRESENTATIVE NEUMAN  expressed concern for  government programs                                                               
that  obtain  and  store confidential  information  contained  in                                                               
records.   He referred  to page  4, lines  2-7, that  require the                                                               
Board of Pharmacy  to ensure the security  and confidentiality of                                                               
the database  and the information contained  within the database.                                                               
He  expressed  further  concern  for a  security  breach  of  the                                                               
prescription monitoring database.                                                                                               
                                                                                                                                
MS. BEATLEY  referred to  page 5, lines  18-22, and  outlined the                                                               
penalty  provisions   of  the  bill.     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.                                                                                           
                                                                                                                                
3:43:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RAMRAS  noted  that  a  class  A  misdemeanor  is                                                               
punishable with  a fine  up to  $5,000 and 1  year in  prison and                                                               
that a class C  felony is punishable with a fine  up to a $10,000                                                               
fine and 5 years in prison.                                                                                                     
                                                                                                                                
REPRESENTATIVE NEUMAN pointed  out that there is  not a mandatory                                                               
penalty listed in HB 316.   He offered his understanding that the                                                               
district attorney  offices are busy offices  that must prioritize                                                               
which cases  to prosecute.   He expressed concern that  crimes of                                                               
this  nature would  not  be considered  high  priority crimes  to                                                               
pursue.   People routinely  hack into databases,  he opined.   He                                                               
maintained his  concern about security breaches  to the database.                                                               
He  further   inquired  as  to   whether  there  is  a   seal  of                                                               
confidentiality  in  circumstances  in   which  a  court  obtains                                                               
information contained in the  prescription monitoring database or                                                               
whether that information becomes public.                                                                                        
                                                                                                                                
MS.  BEATLEY offered  her belief  that the  information would  be                                                               
held confidential.                                                                                                              
                                                                                                                                
3:45:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  asked whether  it is the  sponsor's intent                                                               
that  information contained  within  the prescription  monitoring                                                               
database would be  kept under seal and not be  open to the public                                                               
except under the strictest regulations controlled by a judge.                                                                   
                                                                                                                                
MS. BEATLEY  offered that  the database would  be kept  under the                                                               
strictest confidentiality and the language  [on page 2, line 6 of                                                               
Version M] specifies  the six categories of persons  who can have                                                               
access.   She  noted that  law enforcement  access is  limited in                                                               
scope  and  officers  would  not  be  allowed  to  log  into  the                                                               
database,  but  could only  access  information  through a  court                                                               
order.                                                                                                                          
                                                                                                                                
3:46:28 PM                                                                                                                    
                                                                                                                                
MS. BEATLEY, in response to  Representative Neuman, said that she                                                               
could  not find  any evidence  in the  research that  spans 10-15                                                               
years  that   someone  hacked  into  a   prescription  monitoring                                                               
database.    Further,  all states  with  prescription  monitoring                                                               
databases contract with vendors  that use sufficient firewalls to                                                               
protect the data, she offered.                                                                                                  
                                                                                                                                
3:47:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  referred to Version  M, page 3,  lines 27-                                                               
30,  of proposed  AS 17.30.200(c)(3),  which read:  .."relates to                                                               
controlled substances from a drug  outlet in quantities or with a                                                               
frequency  inconsistent with  generally  recognized standards  of                                                               
dosage for  a controlled substance;".   He asked  whether doctors                                                               
might  be targeted  if they  were  to prescribe  medication to  a                                                               
patient that falls  outside the norm.  He  expressed concern that                                                               
HB  316 might  capture legitimate  uses of  controlled substances                                                               
prescribed by  reputable doctors.   He related  several instances                                                               
in which doctors  may routinely prescribe a  number of controlled                                                               
substances, for example, to cancer patients.                                                                                    
                                                                                                                                
MS. BEATLEY  acknowledged that pharmacists  would be  required to                                                               
check  with  the doctor  to  verify  the  drug and  dosage  being                                                               
prescribed.    She  offered  that  one  reason  for  housing  the                                                               
administration  of the  prescription  monitoring database  within                                                               
the Board  of Pharmacy  is to  allow the  board to  establish the                                                               
norms for  prescribing practices.   She offered that  doctors who                                                               
demonstrate a continual pattern  of overprescribing would trigger                                                               
flags in the database.                                                                                                          
                                                                                                                                
3:50:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN  referring to the sponsor's  memo outlining                                                               
the changes included in Version M,  inquired as to the reason for                                                               
removing  the language  from  the original  HB  316, proposed  AS                                                               
17.30.200(b)(4),  which  read:   "the  name  and address  of  the                                                               
person for  whom the  prescription was written  and the  name and                                                               
address of the person who picked up the prescription."                                                                          
                                                                                                                                
MS.  BEATLEY  explained that  the  language,  "and the  name  and                                                               
address  of  the  person  who picked  up  the  prescription"  was                                                               
removed  from  the  original  bill   because  the  Alaska  Nurses                                                               
Association expressed concern  about nurses' personal information                                                               
being  logged  since  health  care   workers  routinely  pick  up                                                               
medication    for   patients    in   licensed-care    facilities.                                                               
Additionally, the requirement would  also capture information not                                                               
currently reported by pharmacists.   Pharmacists said it would be                                                               
burdensome to  report it,  she related.   In further  response to                                                               
Representative  Neuman,  Ms.  Beatley explained  the  information                                                               
that would be  recorded in the database includes the  date of the                                                               
prescription, date  filled, method  of payment, name  and address                                                               
of  the  patient,  name  and  national  code  of  the  controlled                                                               
substance,  its  strength,  the  name of  the  drug  outlet,  the                                                               
pharmacist or practitioner  prescribing the controlled substance,                                                               
and  other   pertinent  information.    She   noted  that  "other                                                               
pertinent information"  was added to  give the Board  of Pharmacy                                                               
the flexibility to capture additional information by regulation.                                                                
                                                                                                                                
3:54:18 PM                                                                                                                    
                                                                                                                                
MS.  BEATLEY, in  response  to  Representative Neuman,  explained                                                               
that  Version  M removes  proposed  AS  17.30.200(b)(7) from  the                                                               
original bill, which read:   "the dosage, quantity, and frequency                                                               
as  prescribed;"   because  it  captured  essentially   the  same                                                               
information  as proposed  AS 17.30.200(b)(6),  which read:   "the                                                               
quantity and  strength of the controlled  substance prescribed or                                                               
dispensed;" so it was removed.                                                                                                  
                                                                                                                                
3:55:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX asked  for clarification  of the  process.                                                               
She  related her  understanding that  a  person would  go to  the                                                               
pharmacy to submit a prescription  and the pharmacist would query                                                               
the database  to retrieve the  person's medical  and prescription                                                               
history.                                                                                                                        
                                                                                                                                
MS.  BEATLEY offered  her  understanding  that several  different                                                               
databases  exist  and the  information  stored  in the  databases                                                               
varies.    The Board  of  Pharmacy  and  DCCED will  select  from                                                               
several different  databases since there is  not one standardized                                                               
format.    She  elaborated  that   one  type  of  database  under                                                               
consideration uses  web-based access.   Users would use  a unique                                                               
login code  and confidential password  to query patients,  view a                                                               
list  of  prescribed medications,  along  with  the name  of  the                                                               
doctor  or medical  professional  who  prescribed the  controlled                                                               
substance.  She offered that  this information is currently being                                                               
captured by medical staff, but  that the proposed Version M would                                                               
place the  information in one  location.  Thus,  pharmacists will                                                               
not  have  to  call  numerous doctors  to  obtain  the  patient's                                                               
prescription profile.                                                                                                           
                                                                                                                                
3:57:18 PM                                                                                                                    
                                                                                                                                
MS. BEATLEY, in response to  Representative LeDoux, answered that                                                               
it  is  the  sponsor's  intent to  allow  pharmacists  to  access                                                               
information  for a  current  patient only.    Thus, a  pharmacist                                                               
would  not be  able to  "fish" for  information regarding  random                                                               
persons.                                                                                                                        
                                                                                                                                
3:58:13 PM                                                                                                                    
                                                                                                                                
MS.  BEATLEY,  in  further  response  to  Representative  LeDoux,                                                               
answered  that pharmacists  or  other  medical professionals  who                                                               
misuse  the   prescription  monitoring   database  would   be  in                                                               
violation of the penalty provisions  in proposed AS 17.30.200(i).                                                               
She   offered  that   a   person   who  intentionally   discloses                                                               
information  in the  database or  allows  an unauthorized  person                                                               
access to the database is subject  to a class A misdemeanor.  The                                                               
prime  sponsor is  considering a  specific  amendment to  address                                                               
"fishing for  information".  However,  the legal  drafter assured                                                               
the prime  sponsor that the aforementioned  activity is currently                                                               
covered in this subsection, she offered.                                                                                        
                                                                                                                                
REPRESENTATIVE  LEDOUX  noted  her  agreement  that  the  penalty                                                               
provision  described  would  address  intentional  disclosure  of                                                               
information.   However,  she expressed  concern  that if  someone                                                               
used information  to satisfy his/her  own curiosity,  the penalty                                                               
provision would not apply.                                                                                                      
                                                                                                                                
3:59:48 PM                                                                                                                    
                                                                                                                                
GINGER  BLAISDELL,  Staff to  Senator  Lyda  Green, Alaska  State                                                               
Legislature,  speaking on  behalf  of the  prime  sponsor of  the                                                               
companion  bill,   SB  196,  clarified  that   under  both  bills                                                               
pharmacists  would  have  access  to  the  specific  prescription                                                               
number  being  filled  or  refilled.   Since  the  pharmacist  is                                                               
interested in determining whether or  not to fill a prescription,                                                               
the  pharmacist does  not need  to have  access to  the patient's                                                               
condition, she  offered.  She  explained the  process pharmacists                                                               
would use  to access the  prescription database.   The pharmacist                                                               
would enter the  specific drug code for  the federally controlled                                                               
drugs from  the prescription.  Information  contained in selected                                                               
records would  be compiled and  transmitted daily or weekly  to a                                                               
secure  data  warehouse for  access  by  the Board  of  Pharmacy,                                                               
pharmacists or other authorized users.   When a pharmacist enters                                                               
the  patient's name,  specific information  that pertains  to the                                                               
prescription for the federally  controlled substance will appear,                                                               
not  the  patient's  high  blood  pressure  medication  or  other                                                               
medication, she noted.                                                                                                          
                                                                                                                                
REPRESENTATIVE  LEDOUX inquired  as to  the specific  language in                                                               
the bill that would limit the information to the prescription.                                                                  
                                                                                                                                
MS.  BLAISDELL  referred  to  page  3, line  14,  of  Version  M,                                                               
proposed AS 17.30.200(b)(5)  which read:  "the  name and national                                                               
drug  code  of  the  controlled substance;"  and  explained  that                                                               
refers to  the specific  information that  would be  collected in                                                               
the  prescription monitoring  database.   In further  response to                                                               
Representative  LeDoux,   Ms.  Blaisdell  said   that  controlled                                                               
substances vary  slightly in  state and  federal schedules.   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.                                                                                                                        
                                                                                                                                
4:04:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX inquired  as  to funding  sources for  the                                                               
prescription drug  monitoring program if the  federal funding for                                                               
the program "dries  up".  She related her  understanding that the                                                               
sponsor's  intent  is not  to  pass  on  the cost  of  monitoring                                                               
prescription drugs to the medical  professionals who would access                                                               
the prescription monitoring database.                                                                                           
                                                                                                                                
MS. BEATLEY answered that was the reason for adding                                                                             
proposed AS 17.30.200(g) to HB 316, which read:                                                                                 
                                                                                                                                
     The board shall 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 the costs of the controlled                                                                       
     substance prescription database.                                                                                           
                                                                                                                                
MS. BEATLEY noted  that the prime sponsor of  the companion bill,                                                               
authored a letter  of intent and the prime sponsor  of HB 316 has                                                               
drafted  a similar  letter.   She offered  to provide  a copy  to                                                               
Chair Olson or to the House  Finance Committee since the bill has                                                               
a further referral to that committee.                                                                                           
                                                                                                                                
4:05:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER,  in  response to  an  earlier  question,                                                               
offered her  understanding that evidence entered  into a criminal                                                               
record becomes  part of the record  and the public has  access to                                                               
the court record, with some exceptions.                                                                                         
                                                                                                                                
REPRESENTATIVE   LEDOUX  offered   her  understanding   that  the                                                               
information  becomes  public in  the  event  that the  person  is                                                               
convicted of  a crime, otherwise it  is not normally part  of the                                                               
public record.                                                                                                                  
                                                                                                                                
REPRESENTATIVE GARDNER  opined that the bill  could help identify                                                               
and  prevent "doctor  shopping"  by drug  addicts  or could  help                                                               
identify corrupt doctors who sell prescriptions.                                                                                
                                                                                                                                
4:09:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  NEUMAN  inquired  as  to  whether  the  Board  of                                                               
Pharmacy  would  have  access to  medical  records  of  federally                                                               
controlled prescription drugs that have been prescribed.                                                                        
                                                                                                                                
MS. BLAISDELL  answered that  the Board  of Pharmacy  would adopt                                                               
regulations to  more clearly define  how the program  would work,                                                               
its  reporting  functions,  and the  information  that  would  be                                                               
captured in the  database.  Thus, the structure  the board elects                                                               
to  use will  determine the  level  of direct  access users  will                                                               
have.  In  some states, the board does not  have direct access to                                                               
the database and  only its investigator and  technical staff have                                                               
access  to the  database.    Technical staff  has  access to  the                                                               
database since they  need to determine whether  the data captured                                                               
migrates  to the  correct field.   Other  boards have  elected to                                                               
receive data only  when specific flags appear, in the  form of an                                                               
automated report.   Such a report might list a  single person who                                                               
accessed 20  pharmacists and  30 doctors in  the past  12 months.                                                               
The board could assign its  investigator to review the matter for                                                               
potential criminal activity, she offered.                                                                                       
                                                                                                                                
4:11:51 PM                                                                                                                    
                                                                                                                                
BRIAN   HOWES,  Investigator   III,  Division   of  Corporations,                                                               
Business,   and   Professional   Licensing,   Anchorage   Office,                                                               
Department  of   Commerce,  Community,  &   Economic  Development                                                               
(DCCED),  said that  as senior  investigator he  supervises staff                                                               
that  provides investigative  services to  occupational licensing                                                               
boards  serving  35  professions.    The  Board  of  Pharmacy  is                                                               
currently authorized  to release confidential information  to the                                                               
division's investigators.                                                                                                       
                                                                                                                                
MR. HOWES explained that through  the current state, federal, and                                                               
HIPAA exemptions, the  data gathered by the  program is currently                                                               
available to the  division and to prescribers,  dispensers or law                                                               
enforcement  personnel.    However,  HB  316  would  help  reduce                                                               
prescription drug abuse such  as "prescription forgery", "blanket                                                               
prescribing",  and "doctor  shopping."   This bill  would provide                                                               
investigators  ready  access  to prescription  information  in  a                                                               
searchable,   electronic   form   which   makes   collection   of                                                               
information  easier  and less  intrusive,  and  reduces time  and                                                               
effort  to conduct  investigations.    Thus, investigators  could                                                               
access multiple pharmacy locations  without having to visit every                                                               
pharmacy,  mail  out  letters,  or  physically  review  countless                                                               
copies  of  pharmacy  prescriptions.   He  reviewed  the  current                                                               
investigative  procedures  and  noted  that  HB  316  would  help                                                               
investigators  identify  and  make  cases  on  prescription  drug                                                               
abusers in  cost effective ways.   He recalled one case  in which                                                               
pharmacists provided  copies of over 10,000  prescriptions, which                                                               
required  three  months of  data  entry  and analysis  to  enable                                                               
investigators to  document the case.   That same case  could have                                                               
been completed in  a few minutes using  the prescription database                                                               
authorized  by HB  316, he  opined.   He  has contacted  numerous                                                               
states    with   active    prescription   monitoring    programs.                                                               
Prescribers,  dispensers, professionals,  board licensing  staff,                                                               
and  law enforcement  all reported  positive feedback  on current                                                               
prescription monitoring  programs in other  states, he said.   He                                                               
pointed out that Nevada provides  patient prescription reports to                                                               
doctors  to alert  them when  their patients  are using  multiple                                                               
doctors and prescribers simultaneously.   Such reporting is often                                                               
the first  step in acquiring  drug abuse treatment  for patients,                                                               
he opined.                                                                                                                      
                                                                                                                                
4:17:14 PM                                                                                                                    
                                                                                                                                
MR. HOWES, in response to  Chair Olson, advised that the proposed                                                               
database would  be able to  track user  access to provide  a tool                                                               
for   investigators   to   curtail  unauthorized   use   of   the                                                               
prescription monitoring database by  pharmacists.  In response to                                                               
Representative  LeDoux,  Mr.  Howes   explained  that  under  the                                                               
program  individual pharmacists  would  have  a login,  password,                                                               
access time, and  length of time.  He related  that cases of this                                                               
type  arise when  suspected leaks  are reported.   Under  HB 316,                                                               
investigators   would  have   the   necessary   tools  with   the                                                               
prescription   monitoring   database   that   could   result   in                                                               
apprehension of some criminals such as stalkers.                                                                                
                                                                                                                                
4:18:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  NEUMAN related  his understanding  that under  HB                                                               
316,  pharmacists  and  other  prescription  monitoring  database                                                               
users would  have limited  access to  information.   However, the                                                               
board  would  be  the  entity with  full  access  to  information                                                               
contained in the database.                                                                                                      
                                                                                                                                
MR. HOWES answered  that pharmacists would be able  to access all                                                               
of a  specific patient's prescriptions  in order to  identify any                                                               
contraindications to the prescription he/she was filling.                                                                       
                                                                                                                                
REPRESENTATIVE NEUMAN  expressed concern  that the  only patients                                                               
being  tracked   are  the  ones  requesting   reimbursement  from                                                               
insurance  companies, but  that patients  who purchase  with cash                                                               
would not be tracked in the proposed system.                                                                                    
                                                                                                                                
MS. BLAISDELL pointed out that  there are two separate databases.                                                               
She   clarified  that   the   prescription  monitoring   database                                                               
authorized by HB 316 is  separate from the pharmacist's database.                                                               
She  noted  that  only  prescriptions  for  federally  controlled                                                               
substances  listed  in  federal   drug  schedules  I-V  would  be                                                               
monitored in  the proposed  program.  She  explained that  when a                                                               
pharmacist is suspicious of drug  diversion, the pharmacist could                                                               
query  the controlled  substance  database  to determine  whether                                                               
there  is a  pattern of  multiple doctors  prescribing restricted                                                               
substances to  the patient.   She  offered that  some pharmacists                                                               
may examine  each patient's  record, but  others may  only access                                                               
the  database for  patients they  do  not personally  know.   She                                                               
posed a scenario  in which a pharmacist  might average dispensing                                                               
from one to  five federally restricted drugs per day.   The Board                                                               
of  Pharmacy could  establish security  guidelines to  trigger an                                                               
automatic  report  be  generated  when  a  red  flag  showed  the                                                               
pharmacist accesses  a certain  number of records,  such as  if a                                                               
pharmacist accessed 2,000 records during that same timeframe.                                                                   
                                                                                                                                
4:23:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  expressed concern that a  pharmacist might                                                               
review  the records  of a  specific individual,  such as  his/her                                                               
next door  neighbor and not  just randomly review records  in the                                                               
system.  She inquired as to  whether that type of access could be                                                               
detected in the proposed program.                                                                                               
                                                                                                                                
MS.  BLAISDELL answered  that HB  316  would allow  the Board  of                                                               
Pharmacy to  develop regulations to address  potential drug abuse                                                               
and database  access abuse.   The board  is the entity  that will                                                               
have  the   best  understanding  of  the   issues  and  potential                                                               
problems, she opined.                                                                                                           
                                                                                                                                
4:24:41 PM                                                                                                                    
                                                                                                                                
BARRY  CHRISTIANSON,  Pharmacist;  Co-Chair,  Alaska  Pharmacists                                                               
Association, offered  support for  the proposed Version  M, which                                                               
incorporates many  issues that were  worked out in  the companion                                                               
bill.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  NEUMAN expressed  concern about  unauthorized use                                                               
of the proposed prescription monitoring database.                                                                               
                                                                                                                                
MR. CHRISTIANSON offered his  understanding that the prescription                                                               
monitoring  program would  be administered  through the  Board of                                                               
Pharmacy,  but  pharmacists,  prescribing physicians,  and  other                                                               
medical    professionals   who    prescribe,   such    as   nurse                                                               
practitioners, would  have access to the  prescription monitoring                                                               
database.   He said  that the data  transmitted on  the federally                                                               
controlled substances would be limited to the Board of Pharmacy.                                                                
                                                                                                                                
4:26:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NEUMAN inquired as to  who will have access to the                                                               
individual's personal information.                                                                                              
                                                                                                                                
MR.  CHRISTIANSON  said he  believed  that  only pharmacists  and                                                               
prescribers currently  registered by the Board  of Pharmacy would                                                               
have access to the personal information.                                                                                        
                                                                                                                                
REPRESENTATIVE NEUMAN related his  understanding that the program                                                               
would  allow pharmacists,  pharmacy technicians,  physicians, and                                                               
the Board of Pharmacy access to the patient's information.                                                                      
                                                                                                                                
MS. BEATLEY  referred to Version M,  page 4, line 2,  which would                                                               
limit  access to  the prescription  monitoring program  database.                                                               
She reviewed proposed AS 17.30.200(d)(3)-(6).   Under proposed AS                                                               
17.30.200  (d)(3),  a  licensed  practitioner  could  access  the                                                               
database specifically  to query  a patient that  the practitioner                                                               
is currently  treating.  Proposed AS  17.30.200(d)(4) would limit                                                               
a  licensed  pharmacist's  access  to  information  that  relates                                                               
specifically  to a  current  patient to  whom  the pharmacist  is                                                               
dispensing a  controlled substance.  Proposed  AS 17.30.200(d)(5)                                                               
would allow  enforcement authorities  to access printouts  of the                                                               
information pursuant  to a search  warrant, subpoena or  an order                                                               
issued by a court establishing  probable cause for the access and                                                               
use of the information.   Proposed AS 17.30.200(d)(6) would allow                                                               
individuals to access their own information for a fee.                                                                          
                                                                                                                                
4:29:14 PM                                                                                                                    
                                                                                                                                
MR. CHRISTIANSON, in response to  Chair Olson, offered that drugs                                                               
are  classified by  their  potential for  abuse,  and schedule  I                                                               
refers to  experimental drugs.   He noted that his  pharmacy does                                                               
not  stock any  schedule  I  drugs.   Schedule  II drugs  include                                                               
medications  such  as  OxyContin,   schedule  III  drugs  include                                                               
medications  such  as Vicodin  and  Percocet,  schedule IV  drugs                                                               
include medications such as Valium,  and schedule V drugs include                                                               
medications  such  as codeine-based  cough  syrups.   In  further                                                               
response to  Chair Olson,  Mr. Christianson  noted that  about 15                                                               
percent of all prescriptions fall  under the federally restricted                                                               
drugs.   Thus,  about 85  percent of  prescriptions would  not be                                                               
addressed by HB 316.                                                                                                            
                                                                                                                                
4:30:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as  to whether  Mr. Christianson                                                               
could predict how  often pharmacists will use the  database if it                                                               
is voluntary to do so.                                                                                                          
                                                                                                                                
MR.  CHRISTIANSON opined  that the  database would  frequently be                                                               
used.  Pharmacists  are intuitive so when  something seems amiss,                                                               
the pharmacist  will call the  prescriber's office to  be certain                                                               
that   the  patient   has  advised   their  physician   of  other                                                               
prescriptions  being filled,  he offered.   However,  if a  known                                                               
client submits a prescription for  a painkiller from her dentist,                                                               
the  pharmacist  would  probably  not query  the  database.    He                                                               
offered his  preference for a  program that allows  for voluntary                                                               
use.                                                                                                                            
                                                                                                                                
4:32:42 PM                                                                                                                    
                                                                                                                                
MR.   CHRISTIANSON,  in   response   to  Representative   Neuman,                                                               
explained that under HB 316,  pharmacists would voluntarily query                                                               
clients  who  submit  prescriptions  for  controlled  substances.                                                               
However, he  clarified that HB  316 would require  pharmacists to                                                               
report scheduled drug data to the Board of Pharmacy.                                                                            
                                                                                                                                
4:33:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  inquired as to  the cost for  a pharmacist                                                               
to report  and whether further  costs are covered by  the federal                                                               
grant.                                                                                                                          
                                                                                                                                
MR. CHRISTIANSON answered  that the major hurdle  for the program                                                               
will  be  whether  the   prescription  monitoring  database  will                                                               
interface with the portal to transfer  the data.  Since Alaska is                                                               
not  the  first state  to  initiate  the prescription  monitoring                                                               
program,  he anticipated  that sufficient  federal funds  will be                                                               
available  to  cover  the  state's   startup  costs.    Once  the                                                               
prescription  monitoring   database  is  online  the   costs  are                                                               
projected to be minimal, he said.                                                                                               
                                                                                                                                
4:34:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BUCH inquired as to  whether there are other means                                                               
for cost recovery of the program if federal funding is cut.                                                                     
                                                                                                                                
KEITH  MALLARD, Captain,  Commander, Alaska  Bureau of  Alcohol &                                                               
Drug  Enforcement,  Division  of  Alaska  State  Troopers  (AST),                                                               
Department of Public Safety (DPS),  said that setup costs are the                                                               
main expense  of prescription monitoring programs.   Other states                                                               
have reported that their costs  after setup have been rather low.                                                               
He  offered that  there are  a  number of  respected programs  in                                                               
other states and  the combined queries tally  about 5,000 queries                                                               
per month.  Thus, physicians  and pharmacists who are the primary                                                               
database  users  frequently  access  the system  in  states  that                                                               
currently have a prescription monitoring program.                                                                               
                                                                                                                                
4:36:54 PM                                                                                                                    
                                                                                                                                
MS. BLAISDELL reported that most  states initially spend close to                                                               
$400,000  in   federal  setup   grants  for   their  prescription                                                               
monitoring programs  for expenses  such as  establishing separate                                                               
servers and for hardware and  software purchases.  She noted that                                                               
New  Mexico reports  its  ongoing costs  at the  low  end in  the                                                               
amount  of $13,000  per  year.   However,  other  states such  as                                                               
Wyoming  hired additional  staff  and reported  ongoing costs  of                                                               
about $90,000 per  year.  She said she anticipates  that the cost                                                               
in Alaska will drop dramatically after the initial setup costs.                                                                 
                                                                                                                                
REPRESENTATIVE  BUCH referred  to page  3  of an  article in  the                                                               
committee packet  labeled "The Goals of  Prescription Monitoring"                                                               
in the  section titled, Protection of  Confidentiality, and read:                                                               
"Over the  decades during which prescription  monitoring programs                                                               
have been operating,  there have been no  documented or anecdotal                                                               
causes of  breach of  confidentiality of  data."   That reference                                                               
should   help   members   with  questions   about   security   of                                                               
prescription monitoring systems, he opined.                                                                                     
                                                                                                                                
4:39:05 PM                                                                                                                    
                                                                                                                                
WILLIAM STREUR, Deputy Commissioner,  Office of the Commissioner,                                                               
Department of  Health and  Social Services  (DHSS), said  that he                                                               
oversees the Medicaid  and health care policy for the  DHSS.  The                                                               
DHSS  supports HB  316,  he  related.   He  offered that  similar                                                               
programs have  been successful in other  states.  It is  good for                                                               
legislators to strive to ensure  confidentiality because of risks                                                               
involved,   he  opined.     This   legislation  provides   for  a                                                               
prescription  monitoring  program  that   will  bring  a  balance                                                               
between safe  use of drugs  and the  need to prevent  the illegal                                                               
activity   associated   with   drug   diversion   of   controlled                                                               
substances.    He  reported  that  in  the  Medicaid  program  he                                                               
oversees  approximately  $68  million is  spent  on  prescription                                                               
drugs, of  which $8.6  million, or  approximately 15  percent, is                                                               
spent on schedule  I-V drugs controlled drugs.   "Drug diversion"                                                               
refers  to drugs  such as  OxyContin or  other prescription  pain                                                               
relievers that  are illegally sold to  other uses.  The  cost for                                                               
unintended use adds to the  overall cost of the Medicaid program,                                                               
he opined.  The proposed  prescription drug monitoring program in                                                               
HB 316  would help to ensure  the safe use of  medications beyond                                                               
what is currently  done such as checking  for contraindication of                                                               
prescribed drugs.   This bill  would help prevent  drug diversion                                                               
and reduces  "fragmented care",  which is  when a  person obtains                                                               
health care  from multiple  doctors and  pharmacists.   This bill                                                               
can  help health  care  professionals to  work  together for  the                                                               
benefit of  the patient.   This bill would allow  prescribers and                                                               
pharmacists  knowledge of  prescribed  controlled substances  for                                                               
specific  patients.   He related  an example  from another  state                                                               
drug  monitoring  program  that  identified  a  patient  who  had                                                               
received prescriptions  from over 40 doctors.   Additionally, the                                                               
proposed database would assist  in detecting forged prescriptions                                                               
when   physicians   report   their  name   is   associated   with                                                               
prescriptions that they did not write.                                                                                          
                                                                                                                                
4:43:36 PM                                                                                                                    
                                                                                                                                
CHAIR  OLSON,  after first  determining  no  one else  wished  to                                                               
testify, closed public testimony on HB 316.                                                                                     
                                                                                                                                
4:43:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER   made  a  motion  to   adopt  Conceptual                                                               
Amendment 1:                                                                                                                    
                                                                                                                                
     Page 3, line 20                                                                                                            
          Delete "(9) other relevant information as                                                                             
     required by the board."                                                                                                    
                                                                                                                                
REPRESENTATIVE   GARDNER   explained   that  HB   316   carefully                                                               
delineates  the data  to be  collected.   Conceptual Amendment  1                                                               
would  allow the  legislature direct  oversight over  information                                                               
that is collected in the drug  monitoring database.  The Board of                                                               
Pharmacy  may wish  to collect  information such  as a  patient's                                                               
social security number, she offered.   Since the legislature does                                                               
not have direct oversight over  the board, Conceptual Amendment 1                                                               
would  allow  the  legislature  the  opportunity  to  review  the                                                               
board's requests.                                                                                                               
                                                                                                                                
REPRESENTATIVE  RAMRAS   noted  his  agreement   with  Conceptual                                                               
Amendment 1, so long as it only deletes paragraph (9).                                                                          
                                                                                                                                
4:45:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX  objected for  the purposes  of discussion.                                                               
She  expressed  concern with  HB  316.    She then  withdrew  her                                                               
objection.                                                                                                                      
                                                                                                                                
4:45:43 PM                                                                                                                    
                                                                                                                                
CHAIR  OLSON  asked  if  there were  any  further  objections  to                                                               
adopting  Conceptual  Amendment  1.     There  being  no  further                                                               
objection, Conceptual Amendment 1 was adopted.                                                                                  
                                                                                                                                
REPRESENTATIVE NEUMAN noted his concern  with HB 316, but offered                                                               
that he does not  wish to keep the bill from  moving forward.  He                                                               
offered to work  with the sponsor to address his  concern with HB                                                               
316.                                                                                                                            
                                                                                                                                
4:46:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  NEUMAN moved  to report  the proposed  CS for  HB                                                               
316, Version  25-LS1283\M, Luckhaupt, 2/4/08, as  amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal notes.  There being no objection, CSHB 316(L&C) was                                                                      
reported from the House Labor and Commerce Standing Committee.                                                                  

Document Name Date/Time Subjects