04/21/2022 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB295 | |
| Confirmation Hearing(s): | |
| HB382 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 382 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 295 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 21, 2022
3:05 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
MEMBERS ABSENT
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
COMMITTEE CALENDAR
HOUSE BILL NO. 295
"An Act relating to the practice of dentistry; relating to
dental radiological equipment; and providing for an effective
date."
- MOVED HB 295 OUT OF COMMITTEE
CONFIRMATION HEARING(S):
Alaska Mental Health Trust Authority
Kevin Fimon - Anchorage
Agnes Moran - Ward Cove
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 382
"An Act relating to insurance coverage for pharmacy services."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 295
SHORT TITLE: DENTIST SPEC. LICENSE/RADIOLOGIC EQUIP
SPONSOR(s): REPRESENTATIVE(s) ORTIZ
01/31/22 (H) READ THE FIRST TIME - REFERRALS
01/31/22 (H) L&C, HSS, FIN
02/09/22 (H) L&C AT 4:30 PM BARNES 124
02/09/22 (H) Heard & Held
02/09/22 (H) MINUTE(L&C)
02/14/22 (H) L&C AT 3:15 PM BARNES 124
02/14/22 (H) Moved HB 295 Out of Committee
02/14/22 (H) MINUTE(L&C)
02/16/22 (H) L&C RPT 5DP 2NR
02/16/22 (H) DP: SCHRAGE, MCCARTY, SNYDER,
SPOHNHOLZ, FIELDS
02/16/22 (H) NR: KAUFMAN, NELSON
03/31/22 (H) HSS AT 3:00 PM DAVIS 106
03/31/22 (H) -- MEETING CANCELED --
04/12/22 (H) HSS AT 3:00 PM DAVIS 106
04/12/22 (H) Heard & Held
04/12/22 (H) MINUTE(HSS)
04/19/22 (H) HSS AT 3:00 PM DAVIS 106
04/19/22 (H) -- MEETING CANCELED --
04/21/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 382
SHORT TITLE: INSULIN COVERAGE:INSURANCE;MEDICAID
SPONSOR(s): REPRESENTATIVE(s) SNYDER
02/22/22 (H) READ THE FIRST TIME - REFERRALS
02/22/22 (H) HSS, L&C
04/21/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
REPRESENTATIVE DAN ORTIZ
Alaska State Legislature
Ketchikan, Alaska
POSITION STATEMENT: Offered final comment on HB 295, as the
prime sponsor.
KEVIN FIMON, Appointee
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority.
AGNES MORAN, Appointee
Alaska Mental Health Trust Authority
Ward Cove, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority.
BRENDA STANFILL
Alaska Network on Domestic Violence and Sexual Assault
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of Agnes Moran's
appointment to the Alaska Mental Health Trust Authority.
JAMES HOLZENBERG, Staff
Representative Liz Snyder
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB
382, on behalf of Representative Snyder, prime sponsor.
LAURA KELLER, Managing Director of Advocacy
American Diabetes Association
Phoenix, Arizona
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 382.
BRANDON OUSLEY, Chief Executive Officer
Anchorage Fracture & Orthopedic
Consultant
Capstone Endocrinology and Diabetes Center
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony on HB 382.
CALISTA OUSLEY
Palmer, Alaska
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 382.
ACTION NARRATIVE
3:05:37 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Spohnholz, Zulkosky, Fields, and Snyder were
present at the call to order.
The committee took an at-ease at 3:05 p.m.
HB 295-DENTIST SPEC. LICENSE/RADIOLOGIC EQUIP
3:06:34 PM
CO-CHAIR SNYDER announced that the first order of business would
be HOUSE BILL NO. 295, "An Act relating to the practice of
dentistry; relating to dental radiological equipment; and
providing for an effective date."
CO-CHAIR SNYDER sought final comment from the bill sponsor.
3:07:27 PM
REPRESENTATIVE DAN ORTIZ, Alaska State Legislature, as prime
sponsor of HB 295, thanked the committee for hearing the bill
and said he had nothing to add at this time.
3:07:57 PM
CO-CHAIR ZULKOSKY moved to report HB 295 out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, HB 295 was reported out of the House
Health and Social Services Standing Committee.
3:08:33 PM
The committee took an at-ease at 3:08 p.m.
^CONFIRMATION HEARING(S):
Alaska Mental Health Trust Authority
CONFIRMATION HEARING(S):
Alaska Mental Health Trust Authority
3:10:23 PM
CO-CHAIR SNYDER announced that the next order of business would
be confirmation hearings on the governor's appointees to the
Alaska Mental Health Trust Authority.
3:10:52 PM
KEVIN FIMON, Appointee, Alaska Mental Health Trust Authority
(AMHTA), summarized his 44-year history in Alaska, stating that
after several years in Nome he moved to Anchorage where he has
been running his tax preparation business for the last 31 years.
He shared that he and his wife were very active in many aspects
of their community, including charity. He described the AMHTA
as a unique organization that he was honored to serve on. He
shared that his ability to learn, question, and listen would
allow him to make informed decisions on behalf of all trust
beneficiaries whom he described as "our friends, neighbors, and
even family members." He concluded that he would work along the
chief executive officer (CEO), staff, and other trustees of the
AMHTA while drawing on his own experience to present possible
improvements for better outcomes for current and future
Alaskans.
3:13:31 PM
CO-CHAIR SNYDER asked whether Mr. Fimon was continuing service
or whether he was a new appointee.
MR. FIMON explained he was newly appointed to replace an
appointee who was not confirmed the previous year.
3:13:58 PM
REPRESENTATIVE FIELDS questioned what role the trust should take
in providing resources for crisis intervention care for
behavioral health across the state.
MR. FIMON explained that he sees the trust's main role in crisis
intervention to be as a partner to organizations that provide
those services by helping with funding and furthering education
of their staff.
REPRESENTATIVE FIELDS asked which funding streams the trust
could use to help municipalities, such as Anchorage, implement a
crisis intervention approach [to behavioral health].
MR. FIMON explained that the board has been approached for
funding by organizations that address many facets of crisis
intervention, and that he believes the role of the trust is to
work with the organizations to ensure the money is spent
properly and efficiently. He shared his hope that providing
funding to such organizations would take the pressure off of
other municipal services, specifically the police force and
emergency care services.
REPRESENTATIVE FIELDS referred to a bill addressing needs for
the behavioral health crisis intervention in the state and
opined that the success of the bill hinged on the development of
more physical space to provide these intervention services. He
asked Mr. Fimon where he thinks funding would build more
capacity for short-term care for people in a behavioral health
crisis.
MR. FIMON replied that he is still learning about the
complexities of expanding treatment capacity; nonetheless, he
thinks there would be a partnership of funding between the
AMHTA, the state government, and national government funding
sources.
3:19:11 PM
AGNES MORAN, Appointee, Alaska Mental Health Trust Authority,
provided a personal history, sharing that she was born and
raised in Ketchikan, Alaska, and spoke briefly about her career
in aerospace engineering, computer networking, and grant-making.
She spoke about her experience on the First Bank board as the
head of multiple committees. She shared that she had worked
with beneficiaries of the AMHTA in a volunteer or professional
capacity for the last ten years, mentioning her work with
populations experiencing chronic homelessness and substance
abuse. She related that she had volunteered with the community
meal program, co-founded an overnight warming center in
Ketchikan, and served on the First City Homeless Services Board.
In a professional capacity, she said that she served as the
Executive Director for Women in Safe Homes (WISH), an
organization that provides services for women and families
experiencing physical and sexual abuse. She reported that
before she started, WISH was on probation for funding and facing
permanent closure and lack of community support. However, she
stated that during her tenure she has been able to restore
funding, stabilize her staff and attract new talent, triple the
ground space, and expand the services they provide to the
community, all while improving community relations. She
clarified that WISH has not received any funding from AMHTA
during her tenure. She emphasized that WISH serves the full
spectrum of AMHTA beneficiaries and that her extensive
experience working within this population fuels her strong
connection to the mission of the AMHTA, which she described as
the fundamental quality of a board member. She stated that her
main goal for working as a trustee is to be an advocate for
rural areas and to establish collaborative relationships between
the trust and the people working directly with beneficiaries in
those communities.
3:22:42 PM
CO-CHAIR SNYDER asked whether Ms. Moran would be continuing
service or whether this would be an initial appointment.
MS. MORAN confirmed that this would be her initial appointment.
3:23:08 PM
REPRESENTATIVE FIELDS asked what Ms. Moran viewed as the trust's
roll in providing funding for behavioral health crisis
intervention and how that would extend to the building of new
facilities.
MS. MORAN explained that what drew her to want to serve as a
trustee was AMHTA's history of working directly with local
organizations to provide multiple types of funding for important
services. She stated that in her experience, an organization
must have funding from a variety of sources to be successful,
and that the crisis intervention initiative would also need
multiple funding sources to come to fruition.
3:25:15 PM
CO-CHAIR SNYDER opened public testimony on the confirmation
hearing of the governor's appointees to the Alaska Mental Health
Trust Authority.
3:25:33 PM
BRENDA STANFILL, Alaska Network on Domestic Violence and Sexual
Assault (ANDVSA), testified in support of Ms. Moran's
appointment. She stated that she works with Ms. Moran in her
capacity as Executive Director for WISH and said that Ms. Moran
is able to balance her strong budgetary finesse and ability to
run the business side of the organization with her deep
compassion for serving the population with which AMHTA works.
She said she believes that Ms. Moran would bring her extensive
experience to the board and be a strong representative for the
people being served by the trust. She concluded by emphasizing
her support for Ms. Moran as an appointee to AMHTA.
3:26:47 PM
CO-CHAIR SNYDER, after ascertaining that no one else wished to
testify, closed public testimony.
3:27:18 PM
CO-CHAIR ZULKOSKY stated that the House Labor and Commerce
Standing Committee has reviewed the qualifications of the
governor's appointees and recommends that the following names be
forwarded to a joint session for consideration: Kevin Fimon and
Agnes Moran, Alaska Mental Health Trust Authority. She said
that signing the report regarding appointments to boards and
commissions in no way reflects individual member's approval or
disapproval of the appointee, and the nomination is merely
forwarded to the full legislature for confirmation or rejection.
3:27:40 PM
The committee took an at-ease from 3:27 p.m. to 3:30 p.m.
HB 382-INSULIN COVERAGE:INSURANCE;MEDICAID
3:30:11 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 382, "An Act relating to insurance
coverage for pharmacy services."
3:30:58 PM
CO-CHAIR SNYDER, as prime sponsor, explained that HB 382 had two
main focuses: promoting prevention to produce better health
outcomes and improving health care access. She stated that the
bill was motivated by the "astronomically high" price of
insulin, citing that the current $300 cost of a single vial is
four times what it was in 1996, including inflation. She
reported that in Alaska, 50,000 people were diagnosed with
diabetes, with an average of 5,000 new diagnoses every year, and
an additional estimated 15,000 people have diabetes but are
unaware. She shared that there is also a large population of
pre-diabetic people in the state and mentioned that the high
cost of insulin can force patients to choose between their
medication and paying for rent or groceries or to "ration" their
prescriptions and not use them as prescribed. She stated that
the bill would put a monthly cap on insulin copay which is
similar to legislation that has been passed in other states.
She addressed the concern about increased premiums by reporting
findings from various studies that said the cost per insured
individual would increase by somewhere between 70 cents to $3 a
year. She shared that there were states that saw a decrease in
premium costs, and that even those where their costs did
increase to the highest end of the estimate described that
increase as "negligible." She went on share that the cap would
allow more people to have regular utilization of insulin at the
appropriate dosage, which would save additional money on
healthcare overall by reducing the number and length of
hospitalizations and the severity of disease.
3:36:24 PM
JAMES HOLZENBERG, Staff, Representative Liz Snyder, on behalf of
Representative Snyder, prime sponsor, read the sectional
analysis for HB 382 [included in the committee packet], which
read as follows [original punctuation provided]:
Sec. 1: Adds conforming language to AS 21.42.390 (a)
Coverage for treatment of diabetes
stating that coverage for other kinds of medicines
required by this section are still subject to
standard policy provisions, except as provided in a
new section, (d), which is in section 2 of the
bill.
Sec. 2: Adds a new section to AS 21.42.390 that states
that a private health care insurer that
operates within the State cannot charge more than $100
in copays for a 30-day supply of insulin.
There is an exception, if necessary, for some high
deductible health plans that are eligible for a
health savings account tax deduction under 26 U.S.C.
223.
Sec. 3: Adds conforming language to AS 21.42.420
Coverage for prescription drugs; specialty
drug tiers prohibited, ensuring that all other kinds
of medicine are still subject to standard policy
provisions defined in other statutes.
Sec. 4: Adds a new section stating that these
provisions apply to all insurance policies created on
or after the bill's effective date.
3:37:51 PM
REPRESENTATIVE FIELDS asked whether the attorney general had
attempted to pursue legal action against the insurance companies
for unfair trade practices under the Alaska Consumer Protection
Act.
CO-CHAIR ZULKOSKY noted that there were no representatives from
the Department of Law (DOL) available for questions and asked
Co-Chair Snyder to follow up with the department and share her
findings with the committee later.
CO-CHAIR SNYDER confirmed that she would provide that
information to the committee and noted that HB 382 is the first
step in solving the problem of increasing medicine costs; it
focuses on the relationship between insurers and patients. She
acknowledged that there are many other factors centered around
the actions of pharmaceutical companies but said she does not
see those factors being altered by the presence or absence of a
cap. She stated that she would want to work with the
administration to create future legislation to combat those
other factors.
REPRESENTATIVE FIELDS commented that he wants to look at the
full range of options for tackling the "predatory pricing
practices" and would welcome the opportunity to work on
legislation complimentary to HB 382.
3:39:58 PM
CO-CHAIR ZULKOSKY proceeded with invited testimony.
3:40:26 PM
LAURA KELLER, Managing Director of Advocacy, American Diabetes
Association, referred to a non-partisan study on copay cap
legislation from California that projected a raise in premiums
by less than one percent and a decrease in emergency room visits
and hospitalization costs by ten percent. She referenced the
same State of Washington legislation Co-Chair Snyder had
mentioned and said that the initial cap of $100 had lowered
premiums, allowing the state to pass further legislation
dropping the copay to $35, matching the recently passed national
Medicaid cap. She highlighted that there is no generic form of
insulin on the market at more affordable costs unlike other
major pharmaceuticals, and this has forced families in Alaska to
choose between paying their rent or getting the needed insulin.
She suggested that the committee consider lowering the cap to
align with the $35 national cap but emphasized that "any cap
would be better than none" and would work towards increasing a
sense of security for people with diabetes and saving lives.
She reported that the State of Alaska spends an estimated $575
million on diabetes and associated complications every year due
to the cost-prohibitive nature of insulin for many Alaska
patients.
3:43:26 PM
REPRESENTATIVE FIELDS asked how many people have had to seek
more expensive care after not receiving their insulin due to
"price gouging by drug companies."
MS. KELLER responded that she would work to provide that
information to the committee.
3:44:06 PM
REPRESENTATIVE SPOHNHOLZ requested further details on some of
the complications of improperly managed insulin-dependent
diabetes that can send patients to emergency care.
MS. KELLER explained that insulin allows blood cells to take in
nutrients, and for people like herself with Type 1 diabetes that
do not produce any insulin on their own, they must take insulin
to survive. She described what happens within the bloodstream
when there is no insulin present to process nutrients as high
blood sugar levels creating a "sludge" within the blood. She
stated that being unable to process sugar through the
bloodstream can lead to many different complications, including
retinopathy, neuropathy, potential amputations, kidney failure
and dialysis, increased dental issues, the possibility of heart
disease, and even death. She concluded that being able to
manage blood sugar appropriately with insulin allows diabetics
to reduce their chances of these costly and sometimes deadly
complications.
3:46:33 PM
REPRESENTATIVE FIELDS posited that the core issue is the
monopolization of insulin production and asked whether any
states have sought other ways of producing and providing insulin
in a more cost-effective manner.
MS. KELLER replied that California had looked into making
generic medications available to the public, with insulin high
on the priority list, but the process was interrupted by the
COVID-19 pandemic. She mentioned that other states had
expressed interest in joining California's efforts in this, but
that putting that project into motion would require a large
investment of time and resources. She explained that creating
the facilities, producing the drugs, and getting them into
pharmacies would be a very long-term solution, and she
emphasized that a copay cap could be implemented quickly to
provide needed relief for Alaskans while more time-intensive
options are put into place.
REPRESENTATIVE FIELDS expressed his hope that Alaska would seek
to join the consortium to produce insulin at a lower cost. He
asked whether Ms. Keller is aware of attorneys general from
other states that have pursued legal action against the
"monopoly" that pharmaceutical companies have on insulin, and he
opined that Alaska would have to pursue criminal or civil action
due to those companies' violation of multiple Alaska Statutes.
MS. KELLER said she is not aware of any attorney general
currently in that process.
3:50:12 PM}
BRANDON OUSLEY, Chief Executive Officer, Anchorage Fracture &
Orthopedic; Consultant, Capstone Endocrinology and Diabetes
Center, began invited testimony on HB 382 by sharing that his
journey with advocating for affordable diabetes care started
with his daughter, who has Type 1 diabetes. He opined that it
can be easy for people to think diabetes is "no big deal" if
they do not have direct exposure to it. He underscored the
importance of proper health care access by mentioning the
100,000 prediabetic people in Alaska, and he applauded the cap
proposed under HB 382, commenting that he would love to see it
match the $35 in the Affordable Insulin Now Act. He explained
that in his personal and professional experience dealing with
access to diabetes care, a cap on copay is only one step of
controlling the "downstream" cost.
MR. OUSLEY shared that when his daughter was diagnosed, the
closest pediatric endocrinologist that would admit them was in
Utah, exemplifying that finding a practitioner to manage one's
condition and dosage of insulin is just as difficult as
affording the insulin. He reported that there is a shortage of
endocrinologists throughout the country and that it is
particularly hard to attract those specialists to practice in
Alaska, further stating that most of the small number of
existing endocrinologists in the state are several years beyond
retirement age. He pointed out that one of the biggest
financial burdens to both patients and the state is the cost of
dialysis, and he mentioned that dialysis centers get reimbursed
by Medicare for 2,500 to 7,000 percent. In comparison to the
numerous challenges and costs associated with diabetes care, he
opined that solving the cost of insulin with a copay cap is "an
easy piece" of this complicated issue.
3:54:24 PM
REPRESENTATIVE FIELDS asked what further measures in addition to
the proposed cap Mr. Ousley would suggest to decrease the price
of insulin.
MR. OUSLEY reported that every diabetes center he has worked
with in Alaska has a very high number of self-pay patients who
are constantly in search of cheaper insulin. He strongly
advocated that the state "go out of [its] way" to address the
need of the uninsured as well.
REPRESENTATIVE FIELDS asked whether Mr. Ousley is familiar with
ways other states have provided insulin to uninsured patients.
MR. OUSELY replied that he is not.
CO-CHAIR ZULKOSKY redirected the question to Ms. Keller.
MS. KELLER described a component of the passed Utah insulin
copay bill called the "insulin purchasing program" that allows
uninsured patients to buy insulin for the same price that the
state's employee plans pay. She explained that the system is
all digital, which kept the operation costs for the program
down, and once approved, uninsured applicants receive a card via
email that allows them to pay for the medication at a pharmacy,
but at the much lower rate that is granted to the state
insurance plan. She stated that it is a widely successful
program with most pharmacies in Utah accepting the cards, and
she offered her understanding that the executive and legislative
branches of Utah's government are pleased with how it has been
implemented so far.
REPRESENTATIVE FIELDS requested "the department" analyze the
viability of instituting a program similar to Utah's in Alaska.
3:58:22 PM
REPRESENTATIVE SPOHNHOLZ questioned the copay for insulin in
Utah.
MS. KELLER replied that the cost through the purchasing program
is $75 a vial.
3:59:20 PM
REPRESENTATIVE SNYDER explained that within the context of
inflation, $75 per vial is comparable to 1994's rate of $20 per
vial. She mentioned that typically patients use two vials per
month, which translates to a $150 monthly copay.
MS. KELLER responded that the Utah cap for copay is $30 per
month, which covers as many vials as are prescribed.
4:00:19 PM
CALISTA OUSLEY began invited testimony by sharing her personal
experience as a teenager with Type 1 diabetes. She explained
that although she has a strong support system between her family
and her medical team, she still struggles with the many
challenges of managing her health. In the 8 years since her
diagnosis, she reported, she has used 176 vials, which would
have cost $35,200 without insurance. She posited that without
any change, the costs of insulin will grow to an "unimaginable
number," and she asked the committee to consider amending the
bill to have a $35 cap to ensure insulin is available for all
Type 1 diabetics. She opined that if HB 382 were not passed,
lives would be put at risk as insulin remained inaccessible to
many Alaskans. She argued that access to insulin provides a
higher quality of life to diabetics that should be a right and
not a luxury.
4:02:58 PM
The committee took an at-ease from 4:03 p.m. to 4:09 p.m.
4:09:07 PM
CO-CHAIR ZULKOSKY opened public testimony on HB 382. After
ascertaining that no one wished to testify, she closed public
testimony.
[HB 382 was held over.]
4:10:11 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:10 p.m.