Legislature(2007 - 2008)BELTZ 211
01/29/2008 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB183 | |
| SB196 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 183 | TELECONFERENCED | |
| *+ | SB 196 | TELECONFERENCED | |
SB 196-PRESCRIPTION DATABASE
2:43:50 PM
CHAIR ELLIS announced SB 196 to be up for consideration.
GINGER BLAISDELL, staff to Senator Green, sponsor of SB 196,
presented an overview on Prescription Drug Monitoring Program
(PDMP). She said PDMP is referred to as the prescription
database in the bill.
She said that all states have laws and regulations that govern
the distribution of controlled substances, but Alaska doesn't
have a way to track it. Diversion of controlled substances and
other pharmaceuticals is generally recognized as a serious
problem throughout the US. The White House is starting a new
media campaign to start educating everyone about this problem.
Most states have found the prescription monitoring programs are
the most effective tools because they stop some of the abuse at
the front end at the prescriber or the pharmacy. The goals of
the programs vary from state to state - some are under the
Department of Law or a health and social service agency. Most
states have found, however, they get the best results by having
them located in their Board of Pharmacy because medical
professionals are reviewing the data for abnormal patterns of
use by doctors or patients.
2:45:02 PM
Slide 6 showed how prescription drug diversion accounts for 2
percent of private insurance and Medicaid claims. In Alaska that
would amount to a $1.4 million savings to insurance providers as
well as Medicaid. Diversion and inappropriate drug use
promulgates other criminal activity.
2:45:38 PM
MS. BLAISDELL said the national and state goals are education
and information about misuse of pharmaceuticals. Early
intervention is the key for prescribers and dispensers by
reducing the availability of prescriptions.
The goals of PDMPs are to promote pharmaceutical care while
deterring diversion through education and law enforcement. They
are aimed at upholding statutory mandates in a manner that is
most supportive of and least disruptive to medical and pharmacy
practice.
2:46:47 PM
She hoped the Board of Pharmacy would consider looking at some
of the national computer databases that have already been
designed. It seems to take most pharmacies two minutes at the
end of every day to provide data to the feds and they could
provide the state with the same data.
Statistics on 2005 data show that 9 - 12.6 percent of Alaskans
ages 12 and over use illicit drugs. The reason that
prescriptions are listed with illicit drugs show that nonmedical
pain relievers are starting to be used. The medications are
illicit because of the ways they are used.
2:49:01 PM
MS. BLAISDELL said the legislation supports practices that are
already being done. The Department of Commerce, Community &
Economic Development has already started to do some of the
planning and they already have an investigator who is conducting
research on drug diversion and use. A database would certainly
help him; law enforcement could also use this information. She
added that this bill streamlines current paper tracking
practices.
2:49:56 PM
She said that over the summer a number of doctors and
pharmacists contacted the sponsor's office on this issue. An
interesting quote said, "You don't want to be the low spot when
everyone else is draining their swamps." This means that people
who abuse prescription drugs are going to those states that do
not track and control how they are managed. She said that
federal funding is available for setting up these systems.
2:50:50 PM
On November 26 she said CNN reported that Alaska is one of 15
states without a prescription monitoring program. The 20/20
program had a show about a university study that contacted every
person returning from Iraq. It found that rather than the 10
percent of military personnel using prescription drugs, 50
percent were using them. Further she said that while President
Bush's five-year goal to reduce illicit drug use by 25 percent
was almost there at 24 percent, prescription abuse has increased
by about 52 - 53 percent.
She said a survey of teenagers by the Partnership for a Drug-
Free America found that 1 in 5 teens has tried Vicodin, a
powerful addictive narcotic pain reliever; 1 in 10 has tried
Oxycontin, another prescription narcotic; 1 in 10 has used the
stimulants Ritalin or Adderall for nonmedical purposes; and 1 in
11 teens has admitted to getting high on cough medicine.
2:51:44 PM
Slide 17 indicated that controlled substance abuse has increased
by 81 percent before 2003 and it has almost doubled that by now.
Over 15 million people in the US are abusing prescription drugs
and the rate of individuals using controlled substance
prescriptions has increased at a rate greater than all other
prescription medications; and pain reliever use is increasing in
Alaska at four times the national rate.
MS. BLAISDELL stated that over-the-counter medications are
becoming the new party drugs. An unfortunate college trend is
for kids to grab whatever pills they can find at a relative's
house and put them in a bowl for people to take. Prescription
drugs are perceived to be safer than illegal street drugs, but
that's rapidly changing.
2:53:26 PM
Another chart from Substance Abuse and Mental Health Services
Administration (SAMHSA) showed that for the first time in 2006
the number of first-time users of drugs is higher than first
time marijuana-use. Further, she said, numerous websites tell
anyone how to make these drugs more powerful. Forty percent of
all Myspace.com websites have a drug abuse link. Most commonly
used are pain medications, stimulants, sedatives and
tranquilizers and over-the-counter drugs. She found that
pharmacists are now prescribing fewer Vicodin and going with
Oxycontin because it is less euphoric, but Oxycontin seems to be
the illicit drug of choice right now.
2:55:06 PM
She said that stimulants like Ritalin that are used on ADHD kids
can be very addictive and can cause heart attacks when mixed
with over-the-counter decongestants. Tranquilizers, like Valium,
can be mixed with cold and allergy medications for an extreme
effect. Over the counter drugs like Alka-Seltzer and Coldease
can cause liver damage and coma. Just recently, health
professionals started saying small children should not take cold
medicines.
2:56:55 PM
MS. BLAISDELL explained that the prescription abuser type is
very different from the regular street drug abuser type. It
could be a child who needs a pain reliever that the parent has
left over from dental surgery. She said people who find
themselves in a financial crisis are filling their prescription
and maybe selling half to pay for their ongoing living costs.
Most drugs are being supplied by a friend or relative for free.
2:57:16 PM
Alaska's prescription drug problem is that more schedule I - V
drugs are prescribed here per capita than any other state. While
she was unable to find evidence of this, every pharmacist she
spoke to said that. Alaska is in the top 10 percent nationally
for prescription drug abuse; we have transient populations and
use a lot of mail order drugs and telemedicine.
2:58:23 PM
She explained this bill would establish a drug monitoring
database program with the responsibilities being governed by the
Board of Pharmacy. All data from every prescription that
dispensed schedule I-V drugs would be provided electronically
for drugs under both state and federal law. She said that all
data would be confidential and not subject to public disclosure.
3:00:07 PM
MS. BLAISDELL stated the data could be used by the Board of
Pharmacy for license inquiries, for operational and review
purposes, and it can be requested through the board by an
individual who is the recipient of a controlled substance. It
can be used by licensed practitioners when considering
prescribing, licensed or registered pharmacists who are
considering dispensing a controlled substance to an individual
and by law enforcement by request through the board by
affidavit, subpoena or court order. Possible data requesters
include Medicaid and Medicaid fraud units, Medicare, Workers'
Compensation, Department of Corrections, Medical Examiner and
others, but it is up to the Board to fulfill those requests.
3:00:53 PM
She said misuse of the database is a Class A misdemeanor; and
intentional access to alter or destroy data without authority is
a Class C felony. She concluded that this legislation is trying
to stop the problem at the front end.
3:02:10 PM
SENATOR BUNDE asked her how this would coincide with the Health
Insurance Portability and Accountability Act (HIPAA)
requirements.
MS. BLAISDELL replied she found that all states qualify to use
an exception to the HIPAA rule, which says basically if a state
implements a drug or prescription monitoring program in statute,
it is exempt from HIPAA rules - as long as there are controls -
which Alaska has.
3:03:18 PM
GINNY STRICKLER,, Chief Licenser,, Division of Corporations,
Business and Professional Licensing, in the Department of
Commerce, Community & Economic Development, turned testimony
over to her investigator, Brian Howes.
3:04:06 PM
BRIAN HOWES, Senior Investigator, Division of Corporations,
Business and Professional Licensing, Department of Commerce,
Community & Economic Development, said he was available to
answer questions on SB 196. He supported Ms. Blaisdell's
explanation of the programs features.
CHAIR ELLIS asked if this is a significant problem in Alaska and
if the bill was a good approach.
3:04:59 PM
MR. HOWES replied yes and yes. SB 196 is a solution for this
problem because it gets a handle on what prescriptions are going
out and the problems that might come from multiple prescribers
and individuals who don't always know what prescriptions they
are on. It provides cost savings in the division's process when
a case of overprescribing occurs - in which case he explained
the division sends out letters to each of the 400 pharmacies in
the state. Their information comes back in a paper format and in
one case they had 10,000 scripts come in and it took the
division three months to put the data into an excel program so
they could make some sense out of it. It would also save lot of
time in spelling of drugs. Having a database would make him a
more effective investigator.
3:07:03 PM
SENATOR BUNDE asked who actually provides the enforcement.
MR. HOWES replied that the board would develop an administrative
case. Something criminal would be referred out. He said his
division is in the same office as 35 different professional
boards.
3:08:07 PM
WILLIAM STREUR, Deputy Commissioner, Medicaid and Health Care
Policy, Department of Health and Social Services (DHSS),
supported SB 196. He said it will save money and create a better
society for us all. He estimated it would save $160,000 to
$200,000/year or more. He said that last year Medicaid
expenditures in Alaska came to $68 million and he thought
additional savings could be found in a monitoring program.
3:10:09 PM
DAVE CAMPANA, Pharmacist, HCS Health Purchasing Group,
Department of Health and Social Services (DHSS), supported SB
196. He said it brings a balance between safe use of drugs and
the need to prevent illegal activity associated with drug
diversion of controlled substances. He described drug diversion
as an activity where a person obtains a prescription for a
controlled substance such as Oxycontin for an intended pain
problem and illegally sells the contents of the prescription.
This unintended use adds to the cost of the Medicaid program
through improper use of drugs and medical visits to obtain them.
A program like this, he said, would also assist insurance
companies statewide by preventing drug diversion and
inappropriate expenditures for diverted drugs. It would also
help reduce fragmented care when people obtain care from several
health care centers or providers. The program promotes
coordination of care where health care providers work together
for the good of the patient.
3:12:32 PM
He explained the way it would work is that after prescriptions
are filled their information would be sent electronically to the
database through a secure file transfer protocol - on either a
daily or a weekly basis. The diversion prevention feature allows
prescribers and pharmacists to ask questions of the database to
determine who has been prescribing which controlled drugs for
their patients. One state's database found a Medicaid patient
who received prescriptions for controlled drugs from over 40
doctors over three months. A prescriber will be able to see his
name and the drugs associated with it; if he didn't write them
he could quickly notify the board or law enforcement.
3:13:53 PM
MR. CAMPANA said the department recommends two amendments; one
adding the Medicaid Agency as an entity that can query the
database. The second amendment would allow the pharmacy the
ability to add a non-controlled substance to the database when
necessary - like cough or cold drugs that can enhance the
effects of controlled substances. He also wanted to see
prescription data from Indian health and military facilities,
because it could be very beneficial to those entities.
CHAIR ELLIS agreed with him and stated his opinion that the more
Medicaid fraud squeezed out of the system, the more respect and
political support the program would get.
3:15:42 PM
JEFF JESSE, Chief Executive Officer, Alaska Mental Health Trust
Authority, supported SB 196. He related his personal experience
with a separated shoulder and how easily he could have obtained
a controlled substance. Also he believed that having an
electronic database would improve prescribing practices.
3:17:09 PM
CAPTAIN KEITH MALLARD, Commander, Alaska Bureau of Alcohol and
Drug Enforcement, Alaska State Troopers, Department of Public
Safety (DPS), supported SB 196 and said he would answer
questions.
CHAIR ELLIS asked if he sees this as a significant problem.
CAPTAIN MALLARD replied yes; the number of prescriptions that
are being diverted for illegal use is increasing and the
database would be useful in case investigation.
3:18:12 PM
PATRICIA SENNER, Chair, Legislative Committee, Alaska Nurses
Association, said over the last several years they had been
debating the pros and cons of establishing a controlled
substance prescription database. On the pro side it has a
preventive possibility; on the other side, safeguards have to be
in place so the patients' confidentiality is not lost. The
concern exists also that someone might access the database and
"go fishing" for information about individuals they are not
currently treating. She mentioned that licensed health care
professionals often delegate the job of collecting data for
their patients to unlicensed health care workers and she saw
that as a problem. Just using a DEA number is not enough
protection as some health care providers have it on their
prescription pad.
3:19:48 PM
Even more alarming is the prospect, she said, that someone
working in a health care provider's office could go fishing on
the database so they would know which homes to enter to obtain
controlled substances.
Another question she had about the criteria was what bar would
be used to determine who is abusing prescriptive privileges -
the concern being that health care providers will be afraid to
adequately treat pain experienced by their patients because of
fear of being accused of prescribing too much medication.
She was also concerned that the database would have information
about who picks up medications and maybe family members might be
reluctant to pick up pain medications for relatives for fear of
being labeled as drug seekers. The database should have some
place to indicate the relationship of the person picking up the
medication to the person it was prescribed for. She concluded if
the committee could address these concerns about privacy, the
Nurses Association would support the bill.
3:21:17 PM
BARRY CHRISTIANSON, Co-Chair, Alaska Pharmacists' Association,
emphasized that for this program to work it has to be
preventative. So any program that is implemented has to be user
friendly and must interface with pharmacy databases. He
explained that all pharmacies use different databases. For
example, his pharmacy could not comply right now with the log of
pickup persons.
Secondly, he was concerned that since the Alaska Pharmacists'
Association is funded only through license fees, that down the
road it wouldn't be able to fund this $400,000 program. He
wanted to see language saying the burden of funding this program
would not fall upon the board's license fees.
3:23:37 PM
CHAIR ELLIS said he and the sponsor would work together to
address these issues in a CS - they include adding the Medicare
Agency to the list of entities that can make queries, adding
non-controlled substances to the database, address privacy
issues, the interface concern, and the future costs issue after
federal grant funding goes away. He asked Ms. Blaisdell if she
had any reaction to these suggestions.
MS. BLAISDELL replied that she had already addressed some of
them. She said the concern with the additional information
gathering requirements is if you had to collect information on
the people actually picking up the prescription, most states
felt that was a very strong indicator of someone who might be an
abuser and that was very good information to have. However, it
doubles the workload for pharmacists who gather that information
and some people don't have an i.d. with them. So, some states
just keep a paper log for people who pick up a prescription
medication for another person.
She explained that one looks for trends in the database. They
look very different for someone using a substance for a true
medical purpose than someone who is abusing it personally. But
the sponsor was willing to take that provision out of the
statute and let the Board of Pharmacy add it where it would be
more acceptable.
On the continued funding, she said the first year of the program
would probably cost $400,000; but the second year those costs
are typically greatly reduced. New Mexico's annual cost is now
$13,000 a year. However, their investigator was already on the
payroll before the program started, though he did say that drug
diversion has increased so much that he now spends all his time
on drug monitoring issues.
CHAIR ELLIS asked her to work with the state Medicaid folks, the
nurses association and the pharmacists, and staff to address
those concerns in a CS.
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