Legislature(2007 - 2008)
02/05/2008 01:32 PM Senate L&C
| Audio | Topic |
|---|---|
| Start | |
| SB117 | |
| SB196 | |
| SB230 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 196-PRESCRIPTION DATABASE
CHAIR ELLIS announced SB 196 to be up for consideration [CSSB
196 (L&C), version K, was before the committee].
1:46:00 PM
GINGER BLAISDELL, staff to Senator Green, sponsor of SB 196
compared the original bill and the proposed CS. The first item
on page 2 was not a change, but she explained, revisiting the
requirement for Schedule 1 through V controlled substances to be
reported had been recommended. She found little differences
between the federal schedules and Alaska State statute schedules
- one being that Schedule I in Alaska includes OxyContin and
codeine; so Schedule I needed to be included in this statute.
Schedule V controlled substances remains because although they
are the low-dose drugs, it is known if they are taken with other
drugs they do create a harmful effect. In Alaska statute,
Schedule V includes certain cough syrups that contain codeines
and steroids, both narcotics, so those need to be tracked.
On page 3, line 12, subsection 4 was rewritten to include only
the name of the person the prescription was written for and not
who is actually picking up the prescription. This saves the
pharmacist data entry time and it's not a standard field to be
collected.
MS. BLAISDELL said subsection 7, in version C on page 3, line
17, was eliminated because it duplicated the same information
that was collected under subsection 6. The following subsections
were renumbered. On page 4, lines 3-5, a sentence was added:
"The board shall undertake to ensure the security and
confidentiality of the database and the information contained
within the database." She explained this means that specific
data requirements will be at the discretion of the Board of
Pharmacy through regulation or operating procedures. The board
will be more aware of data security issues with this type of
program and more restrictive language would not provide it the
flexibility it needs.
1:48:36 PM
The bill also recommends following the 2005 federal National
All-schedules Prescription Electronic Reporting (NASPER)
standards. These allow states to communicate with each other and
to have a similar standard of data. The Board of Pharmacy could
put specific security requirements in its vendor contract, she
added.
1:49:21 PM
On page 4, line 20, (line 21 of the new bill), subsection 5, was
changed slightly to better represent law enforcement's access to
the data. Last week, she said, they heard that Medicaid and
potentially other government agencies would like to have direct
access to the database, but legislative legal, dispensers and
practitioners around the state pointed out concerns with that
because the database could be used to for "fishing expenditions"
to look for any anomalies.
1:50:28 PM
On page 5, line 5, subsection (f), had been replaced with: "The
board may enter into agreements with tribal and military
dispensers and practitioners in this state to submit information
to and access information in the database subject to this
section and the regulations of the board." Currently tribal and
military health care entities do not have to report to a state
mandated program because they follow federal jurisdiction. More
and more states are volunteering to participate in prescription
drug monitoring programs because they find it is in their
clients' best interests.
1:51:10 PM
MS. BLAISDELL said subsection (g) on page 5, line 8, of version
C had been moved into (i); subsection (g) now reads: "The board
shall notify the president and speaker of the house of
representatives if, at any time after the effective date of the
act, the federal government fails to pay the costs of the
controlled substance prescription database."
MS. BLAISDELL noted that this change allows the legislature to
plan for other means of funding without assuming the board would
automatically increase license fees to database users. It is the
intent of the legislature that this database be implemented as a
tool for improving public service and that the cost should not
be assessed to prescribers and dispensers.
1:52:01 PM
Language on page 5, line 11, replaces subsection (f) with: "An
individual who has submitted information to the database in
accordance with this section may not be held civilly liable for
having submitted the information. Nothing in this section
requires or obligates a dispenser or practitioner to access or
check the database before dispensing, prescribing or
administering a medication or providing medical care to a
person. Dispensers or practitioners may not be held civilly
liable for damages for accessing or failing to access the
information in the database."
She explained that computers aren't always available, especially
in Alaska. One instance happened last year in the Iditarod when
someone broke his leg and the doctor had to phone for some pain
medication to be flown out. The person wasn't flown out until a
few days later.
1:53:18 PM
Last, Ms. Blaisdell said, they were asked to include drugs other
than those in the controlled drug list. In response to this,
Senator Therriault introduced SB 38 that asks to include another
drug to the controlled drug list; this is where other drugs
should be added, not in SB 196.
1:53:56 PM
SENATOR BUNDE asked if she had seen the January 21 letter from
the Pharmacy Association and if she felt the CS adequately
addressed its concerns.
MS. BLAISDELL replied yes.
CHAIR ELLIS asked if it was safe to say that version K addressed
all the labor and commerce issues brought up at the last
meeting.
MS. BLAISDELL replied yes.
1:55:29 PM
RON MILLER, Pharmacist and Regional Manager, Safeway, supported
the National Association of Drug Store Chain's revisions to use
a national standard so that multi-state companies could easily
deal with the database entries and reporting periods. He was
concerned with who will pay for the program when all the grants
are gone.
MS. BLAISDELL answered that the general intent of the bill is to
provide a tool to prescribers and dispensers so they can make a
better choice in allowing client access to prescription
narcotics. Prescription abuse is a national trend, and in Alaska
it is a genuine concern because it rolls into a lot of other
criminal activities. This is a positive approach to curbing some
illegal activities in this state.
CHAIR ELLIS asked what happens when the money runs out.
MS. BLAISDELL answered the fiscal note indicates $400,000 for
the first year of start-up costs. Other states have on-going
costs of about $100,000 - $125,000 per year. Savings will be
seen in insurance fraud and over-prescribing and these savings
will make up the difference in the cost of the ongoing program.
CHAIR ELLIS commented that those savings could show up in
different components of the budget, which would have to be
recognized in future budgets.
MS. BLAISDELL agreed.
1:59:24 PM
BARRY CHRISTENSEN, Anchorage Pharmacist, said he was still a
little concerned that the funding for this program would fall on
the backs of the pharmacists. He saw a potential for the need to
double the Board's current budget of $80,000 - $90,000.
SENATOR BUNDE suggested a letter of intent stating that the cost
of this program is not to be borne by private businesses or the
consumers.
MR. CHRISTENSEN said he agreed and added that this is the number
one concern he is hearing from pharmacists.
2:02:18 PM
CHAIR ELLIS commented that a letter of intent wouldn't hold the
bill up.
2:03:06 PM
PATRICIA SENNER, Alaska Nurses Association, had some specific
questions about language in version K. Subsection (b) is unclear
whether the data is to be entered by the prescribing health care
provider, the pharmacists or both. She suggested that using both
would provide quality control. The data collected should also
include whether the patient has a signed pain management
contract and if so, with whom that is.
Subsections (c)(2) and (3) state that the Board of Pharmacy is
collecting data on the health care providers prescribing
patterns and the patients acquiring practices, but doesn't state
what the board is supposed to do with the data. She suggested
adding a line saying the board should alert the appropriate
licensing board if abnormalities are suspected. She also agreed
with a letter of intent stating that the cost of this program is
not to be borne by the license fees.
MS. BLAISDELL responded about the language in subsection (b) on
page 2 is a little confusing because Alaska has a number of
prescribers who also dispense from their practice like
veterinarians and medical doctors. Regarding Ms. Senner's second
concern, she said other language already exists in statute on
the board alerting others of certain types of activities. The
language in SB 230 clarifies that the data this bill collects
looks at "practices or trends" that are determined by the Board
of Pharmacy, not a single event.
CHAIR ELLIS asked Ms. Blaisdell to work with Ms. Senner on
intent language.
2:07:17 PM
SENATOR STEVENS moved to adopt CSSB 117(L&C), version K. There
were no objections and it was so ordered.
SENATOR BUNDE commented that he would be more comfortable with
the letter of intent.
CHAIR ELLIS gave his word that acceptable language on the
financial commitment/impact would be written and that it would
follow the bill.
2:08:39 PM
SENATOR STEVENS moved to pass CSSB 196(L&C) from committee with
individual recommendations, attached fiscal notes and the future
letter of intent. There were no objections and it was so
ordered.
SB 196-PRESCRIPTION DATABASE
2:58:38 PM
CHAIR ELLIS said the letter of intent had been delivered on CSSB
196(L&C).
SENATOR BUNDE moved to adopt the letter of intent and to send it
on with the bill. There were no objections and it was so
ordered.
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