Legislature(2019 - 2020)BUTROVICH 205

02/06/2019 01:30 PM HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

Audio Topic
01:29:45 PM Start
01:30:36 PM SB37
02:27:43 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 37 RENEWAL OF VACCINE ASSESSMENT PROGRAM TELECONFERENCED
Moved SB 37 Out of Committee
-Invited Testimony Followed by Public Testimony-
-- Teleconference <Invitation Only> --
           SB37 Renewal of Vaccine Assessment Program                                                                       
                                                                                                                                
                                                                                                                                
1:30:36 PM                                                                                                                    
CHAIR WILSON announced the consideration  of SB 37. He stated his                                                               
intention to  hear from the  sponsor, take public  testimony, and                                                               
move the bill from committee.                                                                                                   
                                                                                                                                
1:31:14 PM                                                                                                                    
SENATOR  CATHY  GIESSEL, speaking  as  prime  sponsor of  SB  37,                                                               
stated  that  she  has  no  ethical  conflict  in  preparing  and                                                               
promoting this bill.                                                                                                            
                                                                                                                                
SENATOR GIESSEL  explained that SB 37  reauthorizes the statewide                                                               
Alaska Vaccine Assessment Program  (AVAP). Since its inception in                                                               
2014   the  program   has   been   monitoring,  purchasing,   and                                                               
distributing all childhood vaccines and  a select number of adult                                                               
vaccines  to  health  care  providers.  This  has  made  vaccines                                                               
universally available to Alaskans. She  said it was an innovative                                                               
solution  in 2014  to  the  challenge of  low  vaccine rates  and                                                               
difficulties  providers  faced  with  having  vaccines  in  their                                                               
clinics and  paying for them. This  is private-public partnership                                                               
between the state  of Alaska and health  care payers (essentially                                                               
insurance  companies).  The program  is  fully  funded through  a                                                               
vaccine assessment  account. Insurers pay for  the vaccines ahead                                                               
of time  for their insured  populations. No  unrestricted general                                                               
funds are used.                                                                                                                 
                                                                                                                                
SENATOR GIESSEL said  the program has been  highly successful. It                                                               
leverages the  state's ability to  buy vaccines in bulk  and then                                                               
distributes them to  the health care providers.  This reduces the                                                               
cost  of  vaccines. Previously,  providers  had  to maintain  two                                                               
different supplies of  vaccines and could not  borrow between the                                                               
two.  Now  providers  have  just  one  supply  of  vaccines  that                                                               
insurers pay for in advance.                                                                                                    
                                                                                                                                
SENATOR GIESSEL said  AVAP lowered the cost of vaccines  by 20 to                                                               
30  percent.  Providers administer  the  vaccines  at no  charge,                                                               
except for the office charge.  She referenced the many letters of                                                               
support in  the committee  packets. She said  at first  there was                                                               
opposition   to    bill   from    PhRMA,   a    manufacturer   of                                                               
pharmaceuticals, because  they did not want  adults included, but                                                               
Alaskans,  particularly  seniors,  need   vaccines  such  as  the                                                               
pneumococcal and shingles vaccine. Alaska  was the first state to                                                               
include adults.                                                                                                                 
                                                                                                                                
SENATOR GIESSEL said  she expects to hear  from parents concerned                                                               
that  the bill  is  taking  away their  ability  to exempt  their                                                               
children  from vaccines  for  religious  reasons. She  emphasized                                                               
that parental rights are not changing at all.                                                                                   
                                                                                                                                
SENATOR  GIESSEL noted  that the  committee would  hear from  Dr.                                                               
Lily Lou, the new Chief  Medical Officer for Department of Health                                                               
and Social Services (DHSS).                                                                                                     
                                                                                                                                
1:36:26 PM                                                                                                                    
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature,  Juneau, Alaska,  presented  the sectional  analysis                                                               
for SB 37 (version A).                                                                                                          
                                                                                                                                
     Section 1:                                                                                                               
     Amends  AS  18.09.200(b)  by removing  the  "phase  in"                                                                    
     language from statute as  the Alaska Vaccine Assessment                                                                    
     Program is now fully implemented.                                                                                          
     Section 2:                                                                                                               
     Amends  AS  18.09.220(a)  by removing  the  "phase  in"                                                                    
     language from statute as  the Alaska Vaccine Assessment                                                                    
     Program is now fully implemented.                                                                                          
     Section 3:                                                                                                               
     Repeals AS 18.09.220(e) by removing  the opt out option                                                                    
     for  assesses since  the program  is no  longer in  the                                                                    
     "phase-in" stage                                                                                                           
     Section 4:                                                                                                               
     Repeals the  sunset provisions  (to repeal  the program                                                                    
     in 2021) that  were in section 5 of  the original bill,                                                                    
     SB 169 in 2014.                                                                                                            
                                                                                                                                
SENATOR COGHILL  asked her  to explain the  opt out  provision in                                                               
section 3.                                                                                                                      
                                                                                                                                
MS. CONWAY  explained that during  the phase-in period  under the                                                               
original  bill,  insurers  had  the  ability  to  opt-in  to  the                                                               
program. Now  so many  plans are fully  accepting of  the program                                                               
that is no longer part of the phase-in.                                                                                         
                                                                                                                                
1:39:06 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:39:44 PM                                                                                                                    
Lily Lou, M.D.,  Chief Medical Officer, Department  of Health and                                                               
Social Services (DHSS),  Anchorage, Alaska, said she  had been on                                                               
the  Alaska  Vaccine  Assessment  Council for  three  years.  She                                                               
mentioned  that  the  committee packets  contained  a  letter  of                                                               
support she had written as  the president of the American Academy                                                               
of  Pediatrics-Alaska  Chapter,  before   she  became  the  Chief                                                               
Medical Officer.  She said SB  37 reauthorizes a program  that is                                                               
very important  to all Alaskans  because it makes  vaccine access                                                               
universal at  no cost to the  state. The payers are  happy to pay                                                               
for vaccines that they would pay for anyway, but at full price.                                                                 
                                                                                                                                
DR. LOU said  that in 2018, AVAP covered  366,000 Alaskans, which                                                               
is  50 percent  of the  population. As  a member  of the  Vaccine                                                               
Assessment Council and as a  provider, she worked collaboratively                                                               
with the payers toward a common goal.                                                                                           
                                                                                                                                
DR. LOU  said one of the  greatest benefits to providers  is that                                                               
it took a  multilayered program where some providers  had to have                                                               
two  sets of  locked refrigerators  and streamlined  that into  a                                                               
simpler, single  system. Efficiencies were gained  in bookkeeping                                                               
and ordering  of vaccines.  Payers benefitted from  the 20  to 30                                                               
percent savings in costs.                                                                                                       
                                                                                                                                
DR. LOU said  one unique aspect of the program  is the ability to                                                               
opt in  for uninsured adults.  This program covers  all children.                                                               
Vermont  and  Rhode Island  offer  adult  vaccines, but  only  to                                                               
insured  adults.  Some  of highest-risk  Alaskans  are  uninsured                                                               
adults. DHSS  won a Centers  for Disease Control (CDC)  award for                                                               
increasing pneumococcal  vaccines for  adults in the  over-65 age                                                               
range. She  noted that any  group of high-risk people  can spread                                                               
infectious diseases to others.                                                                                                  
                                                                                                                                
DR. LOU  added that  the ability  to opt  in for  uninsured adult                                                               
patients  benefits the  providers who  step  up to  take care  of                                                               
members of  the community  who have the  least in  resources. The                                                               
program also benefits smaller  providers. Some pediatricians said                                                               
they couldn't afford  to vaccinate patients because  of the cost.                                                               
This makes sure that all patients have access to vaccines.                                                                      
                                                                                                                                
Dr. Lou  reported that the vaccine  assessment program eliminated                                                               
the  need  to  have  a big  warehouse.  The  simple,  streamlined                                                               
process allows suppliers to get  vaccines to most places directly                                                               
in  a  time-efficient  manner.   The  downsized  depot  can  help                                                               
providers  who don't  want to  order  a full  box. Providers  can                                                               
order just  what they need  and the  extra can be  distributed to                                                               
another practice without any waste.                                                                                             
                                                                                                                                
DR. LOU  said providers who don't  opt in can still  get vaccines                                                               
but without  the discount. She  recounted that before  the Alaska                                                               
Vaccine Assessment Program, some  providers may not have invested                                                               
in more  expensive vaccines such  as the HPV vaccine.  (She noted                                                               
the second award the CDC gave  Alaska was for most improved among                                                               
adolescents for HPV.)                                                                                                           
                                                                                                                                
DR.  LOU said  the  Alaska Vaccine  Assessment Council  evaluates                                                               
evidence  to  determine  what  vaccines   to  provide,  so  small                                                               
providers can also  provide these vaccines. Last  year Alaska had                                                               
a mumps outbreak,  which was one of the first  major tests of the                                                               
vaccine  program. A  third dose  was recommended  for anyone  not                                                               
vaccinated  five  years  previously.   The  program  handled  the                                                               
additional doses  and was  able to get  adequate stock.  The AVAP                                                               
price per dose  was $45.65 compared to the full  price of $75.04,                                                               
about a 40 percent savings.                                                                                                     
                                                                                                                                
DR.  LOU explained  that measles  is  different from  mumps in  a                                                               
number of  ways. One, it  is much  more infectious. The  other is                                                               
that the  vaccine is very  effective. Someone who has  received a                                                               
complete measles  immunization is  97 percent protected  for life                                                               
whereas  the mumps  vaccine wanes  after  a few  years. She  said                                                               
measles was declared eradicated  around 2000, but with increasing                                                               
hesitation about vaccination across  the country, there have been                                                               
increasing  cases of  measles in  the past  few years.  Currently                                                               
measles  have been  reported in  Texas, Connecticut,  Washington,                                                               
Oregon, and New York.                                                                                                           
                                                                                                                                
DR. LOU  said AVAP  has clearly  been successful.  The three-year                                                               
phase-in  period is  over  and  all the  payers  now support  the                                                               
program. She described  it as being ready to  remove the training                                                               
wheels.                                                                                                                         
                                                                                                                                
1:51:25 PM                                                                                                                    
JILL  LEWIS,   Deputy  Director,   Division  of   Public  Health,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
said SB 37  removes the sunset provision, takes  out the obsolete                                                               
language about  the phase-in period,  and uses the  state vaccine                                                               
assessment account to fully fund the program.                                                                                   
                                                                                                                                
MS.  LEWIS said  AVAP targets  the privately  insured but  allows                                                               
providers who serve  the uninsured to opt in. Alaska  is the only                                                               
state that has figured out how to do that, she said.                                                                            
                                                                                                                                
MS. LEWIS  said payers pay  assessments, which pays for  the cost                                                               
of the  vaccines and  program operation.  By pooling  that money,                                                               
the  program  can  buy  vaccines with  bulk  contracts  from  the                                                               
Centers for  Disease Control at a  20 to 30 percent  savings. The                                                               
vaccine  is  distributed to  the  providers  at no  cost  because                                                               
payers  have  already  paid  for   the  vaccine.  The  healthcare                                                               
provider can  still charge for  the office visit, but  the actual                                                               
vaccine is  without charge. The  insurance company  has basically                                                               
paid  for  it. Without  this  program,  providers would  have  to                                                               
purchase the vaccines and wait to be reimbursed.                                                                                
                                                                                                                                
MS. LEWIS  reported that Alaska  is one of  11 states that  has a                                                               
universal  childhood vaccine  program  funded by  these types  of                                                               
assessments, one of  only three states that  includes adults, and                                                               
the only  state that serves uninsured  adults. Uninsured children                                                               
are covered under a federal program.                                                                                            
                                                                                                                                
MS. LEWIS reviewed a diagram that showed how the program works:                                                                 
                                                                                                                                
     Alaska   Vaccine   Assessment   Council  sets   the   annual                                                               
     assessment rate                                                                                                            
     Payers  pay into  the assessment  quarterly  based on  their                                                               
     reported covered lives                                                                                                     
     The  Division  of  Public Health  purchases  vaccine  off  a                                                               
     discounted bulk contract                                                                                                   
     The Division  of Public Health  ships vaccine at no  cost to                                                               
     providers or through the Vaccine Depot                                                                                     
     Providers  vaccinate covered  patients, only  billing payers                                                               
     for office visit                                                                                                           
     Providers report  administered vaccines  to the  Division of                                                               
     Public Health                                                                                                              
     The Division of  Public Health provides data  to the Council                                                               
     for rate setting                                                                                                           
                                                                                                                                
MS.  LEWIS noted  the  importance  of the  data  reported to  the                                                               
council  for managing  inventory, rate  setting, and  forecasting                                                               
how much vaccine will be needed in the future.                                                                                  
                                                                                                                                
MS.  LEWIS  said  the  program  has  many  steps,  but  it  works                                                               
seamlessly.  The  private  sector  cost  to  vaccinate  a  person                                                               
through 18 years of age is  $3,319, compared to $2,379 with AVAP,                                                               
a savings of almost a $1,000.                                                                                                   
                                                                                                                                
MS. LEWIS said AVAP covers half  of the population, 44 percent of                                                               
all  children and  52 percent  of  all adults.  She reminded  the                                                               
committee that  a federal program covers  the remaining children.                                                               
She  referred   to  a  graph   in  the  committee   packets  that                                                               
demonstrates the growth in vaccination rates with AVAP.                                                                         
                                                                                                                                
SENATOR STEVENS asked what percentage  of children are covered in                                                               
Alaska between the two programs.                                                                                                
                                                                                                                                
MS. LEWIS answered  almost all. Children not covered  by AVAP are                                                               
covered by the CDC program,  Vaccines for Children. That includes                                                               
children  in  Medicaid,  in the  tribal  healthcare  system,  and                                                               
uninsured and underinsured children,  everyone who doesn't have a                                                               
payer.                                                                                                                          
                                                                                                                                
MS.  LEWIS   called  AVAP  a  win-win-win-win   program  for  the                                                               
following reasons:                                                                                                              
                                                                                                                                
     The Division of Public Health reduces vaccine preventable                                                                  
     diseases.                                                                                                                  
     Providers have improved health outcomes for vaccinated                                                                     
     individuals and easier vaccine stock management.                                                                           
     The health insurance industry pays less to vaccinate                                                                       
     individuals.                                                                                                               
     All Alaskans save more money in the long run due to fewer                                                                  
     medical costs from vaccine-preventable diseases.                                                                           
                                                                                                                                
SENATOR BEGICH  asked if  there has been  any effort  to quantify                                                               
the savings as a result of the program.                                                                                         
                                                                                                                                
MS.  LEWIS   responded  that  she   would  follow  up   with  the                                                               
information if it was available.                                                                                                
                                                                                                                                
DR.  LOU referenced  the  97 percent  effectiveness  rate of  the                                                               
measles vaccine,  and explained  that of  those who  get measles,                                                               
one in four will require  hospitalization, one in a thousand will                                                               
have serious complications  such as encephalitis, and  one to two                                                               
in a  thousand will  die. She  said that  provides a  ballpark of                                                               
what might be saved.                                                                                                            
                                                                                                                                
2:03:21 PM                                                                                                                    
SENATOR BEGICH said  he didn't want DHSS to do  extensive work on                                                               
the question. He was curious but knows there will be savings.                                                                   
                                                                                                                                
MS. LEWIS said AVAP has removed  barriers to costs and access. It                                                               
has shown it can be nimble  enough to respond to an emergency and                                                               
manage  inventory  to avoid  waste.  Vaccines  are expensive  and                                                               
require refrigeration in a narrow temperature range.                                                                            
                                                                                                                                
MS. LEWIS  displayed a slide that  shows how every vaccine  is an                                                               
investment.  With  routine  vaccination   the  U.S.  saves  $13.5                                                               
billion in direct costs and $68.8 billion in societal costs.                                                                    
                                                                                                                                
MS.  LEWIS  concluded  that  reauthorizing  ensures  a  healthier                                                               
future for all Alaskans at the lowest possible cost.                                                                            
                                                                                                                                
2:06:07 PM                                                                                                                    
CHAIR WILSON  asked if there  have been  complications associated                                                               
with storing the vaccines.                                                                                                      
                                                                                                                                
MS.  LEWIS  answered that  the  vaccine  depot predates  AVAP  by                                                               
decades and the  primary difference is that  all vaccines weren't                                                               
supplied before AVAP.  For more than 30 years,  thanks to Senator                                                               
Ted Stevens, Alaska  was a universal vaccine  state. When Senator                                                               
Stevens was  not re-elected, the funding  lapsed. Senator Giessel                                                               
facilitated  temporary funding  for a  few years  until AVAP  was                                                               
established.  What  was  in jeopardy  was  that  without  federal                                                               
funding there  was no way to  continue to be a  universal vaccine                                                               
state.  Providers were  going  to have  to pay  the  cost out  of                                                               
pocket to  make up  the difference.  That would  have been  a lot                                                               
considering that  DHSS spends  $10.5 million  just in  the Alaska                                                               
Vaccine  Assessment part  of  the program.  During  the H1N1  flu                                                               
outbreak  Alaska  was one  of  the  few  states able  to  rapidly                                                               
distribute a lot of vaccine because it is centralized.                                                                          
                                                                                                                                
CHAIR  WILSON recalled  working with  the depot  to get  the H1N1                                                               
vaccines  distributed across  Alaska.  He  said the  coordination                                                               
that the depot provided through DHSS was amazing.                                                                               
                                                                                                                                
DR.  LOU added  that  anyone who  touches  vaccines goes  through                                                               
repeated, detailed  training. This  program decreased  the number                                                               
of people who had to  be involved because the distribution system                                                               
was  simplified  and streamlined.  She  said  there has  been  no                                                               
increased  waste  because  product   handling  and  has  improved                                                               
significantly.                                                                                                                  
                                                                                                                                
SENATOR STEVENS asked where the homeless go for vaccinations.                                                                   
                                                                                                                                
DR. LOU  replied that  they are  taken care  of by  public health                                                               
nurses  in   the  public  healthcare  system.   In  2018,  14,000                                                               
immunizations were given to those  people who might need services                                                               
but don't seek care through insured, private provider routes.                                                                   
                                                                                                                                
2:11:20 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:11:45 PM                                                                                                                    
Fred Potter,  Managing Member,  KidsVax, Concord,  New Hampshire,                                                               
shared  that KidsVax  is under  contract  with DHSS  to serve  as                                                               
administrator  of the  Alaska  Vaccine  Assessment Program.  They                                                               
manage the collection process, the  remittances to the state, and                                                               
coordinate the advisory council  meetings. KidsVax also maintains                                                               
the  program website.  Such programs  waste.  This is  especially                                                               
true for Alaska  because of its geography.  Without this program,                                                               
vaccines must  be in two  separate silos under federal  law. That                                                               
makes it more difficult to efficiently use a vaccine supply.                                                                    
                                                                                                                                
MR. POTTER said  that in New Hampshire, sometimes  the wastage is                                                               
nearly  50  percent with  TRICARE  in  military clinics,  whereas                                                               
wastage in  the state  supply is two  to three  percent. Alaska's                                                               
numbers   are  remarkably   good   given   its  unique   physical                                                               
challenges. A  robust body  of literature  maintained by  the CDC                                                               
shows that $10  in direct medical cost is saved  for every dollar                                                               
spent on vaccines. Now it is  probably closer to $13 to $1. Since                                                               
AVAP  has  a budget  of  $10.5  million, the  expected  long-term                                                               
healthcare savings is more than $100 million each year.                                                                         
                                                                                                                                
MR.  POTTER concluded  with four  points. 1.  The Alaska  vaccine                                                               
association has implemented  nationally-recognized best practices                                                               
despite its relatively young age. 2.  All the opt outs for payers                                                               
were withdrawn before  the second year, which is a  sign of payer                                                               
satisfaction. 3.  The operating costs  have gone down  each year.                                                               
Remarkably, the assessment  rates have held steady  for this year                                                               
and  perhaps  for  next  year.   4  The  advisory  council  voted                                                               
unanimously to recommend continuation of the program.                                                                           
                                                                                                                                
2:17:58 PM                                                                                                                    
GARY  STRANNIGAN, Vice  President, Congressional  and Legislative                                                               
Affairs,  Premera  Blue Cross  Blue  Shield  of Alaska,  Seattle,                                                               
Washington,  called  attention  to   the  letter  of  support  he                                                               
submitted. He commended the program.                                                                                            
                                                                                                                                
2:18:50 PM                                                                                                                    
ROSALYN  SINGLETON, M.D.,  representing self,  Anchorage, Alaska,                                                               
said she  has seen firsthand  the dramatic impact of  vaccines on                                                               
the health of  Alaskans. Years ago, Alaska had up  to 4,000 cases                                                               
a year  of hepatitis  A with  huge impacts  on the  public health                                                               
system.  In the  last year  before vaccines,  two teenagers  died                                                               
from hepatitis  A. Now, because  of vaccines, there  is virtually                                                               
no transmission  of hepatitis A  in the state. Washington  has an                                                               
ongoing measles  outbreak. The Alaska Vaccine  Assessment Program                                                               
is critical  to respond if Alaska  did have a case  imported into                                                               
the state.  With AVAP the  state has more flexibility  to provide                                                               
vaccines to adults who may otherwise not have access.                                                                           
                                                                                                                                
2:20:51 PM                                                                                                                    
MATTHEW HIRSCHFELD,  M.D., representing self,  Anchorage, Alaska,                                                               
said  he is  a pediatrician  and board  chair of  the All  Alaska                                                               
Pediatrics Partnership. He  said vaccines are one  of true public                                                               
health successes in the history of  medicine and SB 37 makes them                                                               
accessible  to  almost everyone  in  Alaska.  He noted  that  the                                                               
partnership submitted a letter of support.                                                                                      
                                                                                                                                
2:22:30 PM                                                                                                                    
JODYNE BUTTO,  M.D., representing  self, Anchorage,  Alaska, said                                                               
she  is an  Anchorage  pediatrician and  AVAP  board member.  She                                                               
recounted  that  Alaska's  universal  vaccine  program  for  kids                                                               
lapsed a  few years ago  because of  funding cuts. She  said that                                                               
program  became  cumbersome  and   costly  for  pediatricians  to                                                               
maintain  and track  private and  public vaccines  and some  kids                                                               
slipped  through the  cracks. AVAP  streamlines that  process and                                                               
provides  access for  all  of Alaska's  children  to receive  the                                                               
necessary vaccines  to give  Alaskans a  healthy state.  She said                                                               
she is  speaking for her clinic  and colleagues in support  of SB                                                               
37.                                                                                                                             
                                                                                                                                
2:24:47 PM                                                                                                                    
CHAIR WILSON closed public testimony and solicited a motion.                                                                    
                                                                                                                                
2:25:20 PM                                                                                                                    
SENATOR COGHILL  moved to report  SB 37, work  order 31-LS0162\A,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal note.                                                                                                                    
                                                                                                                                
2:25:33 PM                                                                                                                    
There being no  objection, SB 37 was reported  from Senate Health                                                               
and Social Services Standing Committee.                                                                                         

Document Name Date/Time Subjects
SB37 AVAP Renewal vsn A 1-25-19.PDF HHSS 4/23/2019 3:00:00 PM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Sponsor Statement 1-28-19.cg.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Letter of Support AK Pediatric Grp 1-24-19.pdf HHSS 4/23/2019 3:00:00 PM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Letter of Support American Academy of Pediatrics - AK 1-24-19.pdf HHSS 4/23/2019 3:00:00 PM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document WA Post Anti Vaccine NC outbreak 11-18.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Alaska Public Health Advisory 1-29-19.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Annual Report 2018.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Status Update 2017.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Sectional Analysis 2-3-19.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document NPR 2-2-19.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document DHSS Vaccine Formulary 2019.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Letter of Support Premera 1-29-19.pdf SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Fiscal Note Div of Public Health Epidemiology 1.29.19.pdf SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Payers.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Providers.pdf HHSS 4/23/2019 3:00:00 PM
SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Status Update 2018.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Who Pays AVAP.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document PPt AVAP DPH 2-5-19.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB 37 Aetna Support 2.5.19.pdf SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Measles Info CDC.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Vaccination Rate Trends 2013-17.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Supporting Document Measles Info DHSS.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37
SB37 Letter of Support AK Ped Partnership 2-6-19.pdf SFIN 2/13/2019 9:00:00 AM
SHSS 2/6/2019 1:30:00 PM
SB 37