Legislature(2023 - 2024)DAVIS 106
03/23/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Department of Health, Commissioner | |
| HB112 | |
| HB60 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 112 | TELECONFERENCED | |
| += | HB 60 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 23, 2023
3:04 p.m.
DRAFT
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
Representative CJ McCormick
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Commissioner, Department of Health
Heidi Hedberg Anchorage
- HEARD
DEPARTMENT OF HEALTH
HOUSE BILL NO. 112
"An Act relating to the Board of Pharmacy; relating to the
practice of pharmacy; relating to pharmacies; relating to
prescription drug manufacturers; relating to prescriptions for
epinephrine; relating to the administration of epinephrine; and
providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 60
"An Act relating to the licensing of runaway shelters; relating
to advisors to the board of trustees of the Alaska Mental Health
Trust Authority; relating to the sharing of confidential health
information between the Department of Health and the Department
of Family and Community Services; relating to the duties of the
Department of Health and the Department of Family and Community
Services; and providing for an effective date."
- MOVED CSHB 60(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 112
SHORT TITLE: PROFESSION OF PHARMACY
SPONSOR(s): REPRESENTATIVE(s) RUFFRIDGE
03/13/23 (H) READ THE FIRST TIME - REFERRALS
03/13/23 (H) HSS, L&C
03/23/23 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 60
SHORT TITLE: RUNAWAYS; DFCS/DOH: DUTIES/LICENSING/INFO
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/03/23 (H) READ THE FIRST TIME - REFERRALS
02/03/23 (H) HSS, FIN
02/28/23 (H) HSS AT 3:00 PM DAVIS 106
02/28/23 (H) Heard & Held
02/28/23 (H) MINUTE(HSS)
03/07/23 (H) HSS AT 3:00 PM DAVIS 106
03/07/23 (H) Heard & Held
03/07/23 (H) MINUTE(HSS)
03/14/23 (H) HSS AT 3:00 PM DAVIS 106
03/14/23 (H) <Bill Hearing Canceled>
03/23/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
HEIDI HEDBERG, Commissioner Designee
Department of Health
Juneau, Alaska
POSITION STATEMENT: Testified as commissioner designee of the
Department of Health.
JEANNIE MONK, MPH, Senior Vice President
Alaska Hospital and Healthcare Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of Commissioner
Designee Hedberg.
ELLEN HODGES, MD, Chief of Staff
Yukon Kuskokwim Health Corporation
Bethel, Alaska
POSITION STATEMENT: Testified in support of Commissioner
Designee Hedberg.
RON MEEHAN, Policy and Advocacy Manager
Food Bank of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of the commissioner
designee.
NANCY MERRIMEN, CEO
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of the commissioner
designee.
ELIZABETH RIPLEY, CEO
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified in support of the commissioner
designee.
VERNE BOERNER, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of the commissioner
designee.
BRAEDAN GARRET, staff
Representative Ruffridge
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Read the sectional analysis of HB 112 on
behalf of Representative Ruffridge, prime sponsor.
ASHLEY SCHABER, Chair
Board of Pharmacy
Anchorage, Alaska
POSITION STATEMENT: Provided a PowerPoint presentation on HB
112.
SYLVAN ROB, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community, and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
112.
RILEY NYE, Staff
Representative Mike Prax
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the explanation of changes for HB
60, on behalf of the bill sponsor, House Rules by request of the
governor.
HEATHER CARPENTER, Deputy Director
Department of Health
Juneau, Alaska
POSITION STATEMENT: Provided the explanation of changes in a
proposed committee substitute for HB 60.
STACIE KRALY, Director
Civil Division
Department of Law
Anchorage, Alaska
POSITION STATEMENT: Answered questions relating to HB 60.
ACTION NARRATIVE
3:04:08 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Ruffridge, Sumner, Fields, Mina and Prax were
present at the call to order. Representative Saddler arrived as
the meeting was in progress.
^CONFIRMATION HEARING(S): Department of Health, Commissioner
3:05:26 PM
CHAIR PRAX announced that the first order of business would be a
confirmation hearing for the governor's appointee for
commissioner of the Department of Health.
3:06:48 PM
HEIDI HEDBERG, Commissioner Designee, Department of Health,
stated that she was born in Utah and raised in Seattle. She
said she had moved to Alaska in 1995 to attended Alaska Pacific
University and graduated with an outdoor studies degree. She
shared that her husband is from Alaska, and that they have two
boys. She explained that, prior to her state service, she
worked 13 years in the non-profit sector, which provided the
opportunities to travel to rural communities in the state and
showed the different perspectives around the healthcare system.
She said that she has worked for the Division of Public Health
for the past 13 years and was the director for the last four
years. She explained that, during her time as director and
during the COVID-19 pandemic, she represented the department in
unified command along with the federal Division of Homeland
Security, Emergency Management and Alaska's Department of Public
Safety for the pandemic response. She shared that being
director and leading the pandemic response was one of the most
fulfilling jobs. She said that she is thankful for staff and
partners that positioned Alaska to fare better compared to other
rural states, with fewer hospitalizations and fewer deaths;
through partnerships with tribal health organizations, Alaska
was ranked number one for vaccinations per capita when the
COVID-19 vaccine became available in December 2020. She stated
that her vision for the next four years is to help the wellbeing
and self-sufficiency of Alaskans, which will be achieved through
leveraging public health. She said that, as the chief health
strategist, she will address insufficient systems in public
assistance, addressing the gaps in the behavioral health
continuum of care, caring for the ability to age in place, and
focusing on timely reimbursement of Medicaid; her vision is
that, through these outcomes, Alaskans will be healthier, the
economy more vibrant, and healthcare will be more accessible and
affordable.
3:12:48 PM
COMMISSIONER DESIGNEE HEDBERG explained that public health has
strategies to better the health of Alaskans, which is the
"Healthy Alaskans 2030" Department of Education and Early
Development (DEED) health improvement plan. She further
explained that prevention is cheaper than treatment and is a
cost containment tool over time. She stated that the Division
of Public Assistance is a low point - not a reflection of the
dedicated staff that are trying their hardest - but rather a
reflection of the inefficient systems. She said that she knows
information technology (IT) systems need to be implemented, and
that they have a workflow management tool that is being
leveraged so that it can be more efficient for staff; through
the department reorganization, things like this are affordable.
She said that, looking back at the state's behavioral health
continuum of care, there has been a lot of progress, but there's
still more to go as gaps are still present. She said that last
year's passage of House Bill 172 [passed during the Thirty-
Second Alaska State Legislature] addressed one of the gaps, and
now over the next four years, behavioral health services need to
be implemented across the state. She spoke on aging in place
for elders and the disabled using local resources, as it is
another key to healthy families. She shared that, in November,
she had heard from advocacy groups calling for an update to rate
setting methodologies, increasing the workforce and allowing
individuals with disabilities to choose their direct services.
She recognized healthcare services, which she said touch all
parts of the Medicaid program.
3:16:23 PM
COMMISSIONER DESIGNEE HEDBERG stated that she has a great team,
who has been able to save $370 million in general funds over
past six years through tribal reclaiming. She said that her
vision is to see the governor's initiative on healthy families
realized, and that strong families are the foundation for a
vibrant economy and community. She concluded that she brings
organizational leadership, stability, innovation, and a team
approach to the role.
3:18:31 PM
REPRESENTATIVE MINA said she appreciates her speaking on issues
relating to the department, and that with the department split,
there is much opportunity to examine workplace culture and
rebuild relationships. She asked her to speak about the
importance of transparency in the department.
COMMISSIONER DESIGNEE HEDBERG answered that transparency means
building relationships with staff, as they need to know what her
own vision and leadership style is. She said that department
has 1,500 employees, and that she has held town hall meetings
with the Division of Public Assistance, which she is working on
making a regular occurrence. In regard to department partners,
she explained that the department cannot reform healthcare on
its own, so it needs to partner with tribal health, tribes,
hospitals, health centers, and businesses.
3:21:04 PM
REPRESENTATIVE SADDLER commented that the former Department of
Health and Social Services was massive and had many
responsibilities. He asked, even with the department
organization, whether the new department's mission is still too
big.
COMMISSIONER HEDBERG answered that the mission is health,
wellbeing, and self-sufficiency, and in looking at the divisions
within the department, the mission is rightly matched. She
reiterated that the department cannot do this alone; like
healthcare providers licensed with the Department of Commerce,
Community, and Economic Development or partnering with the DEED
to ensure school age children wellness. She stated that
partnerships with the business sector are critical towards
making changes in the workforce environment. She added that the
mission is set for the department, and that other state agencies
and stakeholders need to be leveraged in order to move forward
in creating a healthy workforce, economy, and people.
3:23:20 PM
REPRESENTATIVE RUFFRIDGE said he can personally attest to
Commissioner Designee Hedberg's work during the pandemic, and
that he appreciates the long hours and weekends worked during an
ever-changing situation. He asked about reports regarding staff
morale and what plan there would be to help improve the working
environment.
COMMISSIONER HEDBERG commented that the pandemic showed that
many staff in the department are exhausted. She shared that she
met with staff, and that it'd be important to hear from them
since they may just want to share their concerns and know
leadership supports them. She said there are three areas she
thinks of when it comes to staff; culture, work environment, and
compensation all create an environment where one wants to work
and fulfill their duties. She said her focus on addressing
morale and retention is being done by having a connection with
staff, examining compensation, and providing tuition
reimbursement.
3:27:44 PM
REPRESENTATIVE FIELDS thanked Commissioner Designee Hedberg, the
department, and the governor for advancing the healthy family
initiative as an organizing principal, which should guide policy
and budget decisions because it will drive preparedness to read
and reduce adverse childhood experiences. He further thanked
her for engaging with stakeholders, in that, the department had
listened, responded, and worked on solutions with them. He
shared that he cares about early care learning, which is
something her staff has been proactive about. He stated that
she has his unequivocal support based on her record, and asked
that she be honest with the legislature when there is a crisis,
like Supplemental Nutrition Assistance Program (SNAP) benefits,
so that the legislature can fund the department adequately.
3:30:31 PM
REPRESENTATIVE MINA said she echoes Representative Field's
comments. She asked if Commissioner Designee Hedberg had
thoughts about how the department could partner with the Office
of Health Savings.
COMMISSIONER DESIGNEE HEDBERG responded that the Office of
Health Savings is an "ask" within department's budget. She said
there are a lot of ideas around healthcare reform and cost
savings; it ultimately boils down to bandwidth, in that, the
office request is for positions that can investigate ideas and
demonstrate how they work and how to expand them.
3:31:44 PM
REPRESENTATIVE SADDLER asked whether, given the recent revenue
shortfall forecast, Commissioner Designee Hedberg had any
thoughts about how she might help the department run more
efficiently and at less cost.
COMMISSIONER DESIGNEE HEDBERG explained that it starts with
having a discussion with division directors regarding what stays
in the budget, operating efficiencies, and how to leverage
partnerships. She provided examples, like increased obesity and
hypertension, and said the cost of preventing those conditions
are cheaper than the treatment and can serve as a cost
containment tool over time. She shared that the fresh start
program is focused on treating adults with the aforementioned
conditions, as well as helping reduce smoking; there were over
1,000 people that registered with the program with a total
reduced weight of 5,000 pounds.
3:34:31 PM
REPRESENTATIVE SUMNER asked how much in federal funds is being
spent on the fresh start program.
COMMISSIONER DESIGNEE HEDBERG answered that she doesn't know.
3:34:50 PM
REPRESENTATIVE SADDLER asked, regarding commissioner
compensation, if Commissioner Designee Hedberg can work with the
current pay for the next four years.
COMMISSIONER HEDBERG answered yes. In response to another
question from Representative Saddler, she answered that the
healthy families initiative has three pillars: healthy
beginnings, improving access, and healthy communities. She
explained that the department needs to complete its studies
around childcare in order to make recommendations on how to
support and sustain childcare in the state, as having such care
will allow parents to enter the workforce.
3:36:51 PM
CHAIR PRAX recounted when the economy in Alaska was shut down
due to the COVID-19 pandemic, and stated that he was impressed
with the department's response. He asked her what she learned
from the experience.
COMMISSIONER DESIGNEE HEDBERG shared that she had received a
call regarding a repatriation flight from Wuhan in January, and
then later in March, the public health emergency continued to
escalate; from March to May, the science behind the virus's
transmission was unknown. She recounted that the governor and
others wanted to ensure the economy opened as quickly as
possible, so there was much effort in getting personal
protective equipment and pandemic guidance. She relayed that
many communities took the measures and did what was best for
them at the community level while the state focused on getting
the economy going. She said that Commissioner Adam Crum, Dr.
Anne Zink, and herself worked with the governor and their
partners to assess what is known so far about the virus.
CHAIR PRAX commented that there was, and still is, lingering
skepticism of public health and the health system in general.
He inquired as to how trust could be restored.
COMMISSIONER DESIGNEE HEDBERG responded that it is about meeting
people and communities where they are at and understanding what
their concerns are around public health. She explained that
many listening sessions were held during the pandemic where
updates were shared and questions were fielded, and that such
sessions might be needed over the coming months.
3:42:32 PM
CHAIR PRAX opened public testimony on the confirmation hearing.
3:43:03 PM
JEANNIE MONK, MPH, Senior Vice President, Alaska Hospital and
Healthcare Association, stated that she is testifying in support
of the appointment of the Commissioner Designee Hedberg. She
shared that she worked with her for the past 12 years and has
seen her commitment to the health of Alaskans. She said she
appreciates her willingness to step forward to the new role, and
that she has a strong team; further, although she is new to the
role, she is taking ownership of the problems and is focused on
solving them. She said her success is her willingness to build
relationships, and that she will be fair and inform
stakeholders.
3:45:01 PM
REPRESENTATIVE SADDLER asked what Ms. Monk thinks the department
could improve in.
MS. MONK answered that she supports the three pillars that Ms.
Hedberg discussed. She said the association is interested in
having a strong healthcare system, but also examining upstream,
in that, what needs to be done to ensure Alaskans can be as
healthy as possible. She added that the association is also
interested in innovation around the healthcare system so it
works better; this has been a challenge during the pandemic as
the focus was keeping the health system functional, but now
post-pandemic, the focus is finding ways to improve.
3:46:32 PM
ELLEN HODGES, MD, Chief of Staff, Yukon Kuskokwim Health
Corporation, shared that she has been a family medicine
physician in rural Western Alaska for 20 years, and that she is
speaking in support of the appointment of Commissioner Designee
Hedberg. She said the appointee was able to find ways to
promote development of community healthcare aide programs. She
stated that, during the pandemic, she had been a steadfast ally
and advocate for rural Alaska, and that her enthusiasm never
waivered. She said there is still crisis in the state, with a
large tuberculosis (TB) outbreak, substance misuse, and other
health conditions, all of which impact rural Alaska uniquely.
3:49:16 PM
RON MEEHAN, Policy and Advocacy Manager, Food Bank of Alaska,
testified in support of the Commissioner Designee Hedberg. He
said that she has kept constant communication with Food Bank of
Alaska and the Anti-Hunger network throughout the food security
crisis, playing an instrumental role in securing funds for the
bank's immediate relief efforts to those suffering from the
supplemental nutrition assistance program (SNAP) backlog. He
said that, under her purview, the Department of Health has taken
positive steps to reduce the backlog, reduce the Division of
Public Assistance workload, and streamline the process for
clients. He said that she and her team have been working around
the clock to address the backlog.
3:50:55 PM
NANCY MERRIMEN, CEO, Alaska Primary Care Association, testified
in support of Commissioner Designee Hedberg. She said the
appointee has a wealth of knowledge and experience that leads to
strong collaboration that is result oriented. She relayed that
primary care that meets patients where they are at is the sort
of health that federally qualified health centers (FQHC) are
committed to. She said that she has deep awareness and the
ability to improve health and wellness through affecting
economic status, housing, education, and food security. She
stated that she is a strong public health leader in Alaska.
3:53:19 PM
REPRESENTATIVE MINA noted that, when she was working at Alaska
Primary Care Association, she had worked on COVID-19 pandemic
communications and had interfaced a lot with Commissioner
Designee Hedberg. She thanked her for working with community
health centers during the pandemic.
3:53:54 PM
ELIZABETH RIPLEY, CEO, Mat-Su Health Foundation, stated that the
foundation worked with Ms. Hedberg before and supports her
confirmation. She explained that her work during the pandemic
showed she is a proven leader, and that she is a high-energy,
experienced, and dedicated public servant, who built a solid
team around her. She said that she is also an excellent
communicator, which is a key strength a commissioner needs in
order to work with the many constituencies. She pointed out
that, upon her taking up her role of commissioner designee, she
had walked into a difficult situation around SNAP and Medicaid
payments, recognized that those were priority areas, and brought
resources to improve the situation.
3:55:47 PM
VERNE BOERNER, PhD, representing self, stated that she is
honored to speak in support of Commissioner Designee Hedberg's
appointment to the Department of Health. She shared that she is
a second-year PhD student in epidemiology and had previously
worked with her during her time as president and CEO of the
Alaska Native Health Board, which was also during the COVID-19
pandemic. She stated that she had demonstrated exceptional
strategic thinking, honed collaborations, and effectively
deployed scarce resources. She said that, during a time of
great scarcity, Commissioners Designee Hedberg had acted quickly
and decisively and worked countless hours; the collective result
was putting Alaska at the top of the nation in protecting its
people.
3:58:29 PM
CHAIR PRAX, after ascertaining that no else one wished to
testify, closed public testimony.
3:59:53 PM
CHAIR PRAX stated that the House Health and Social Services
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: Heidi Hedberg,
Commissioner of the Department of Health. He said that signing
the report regarding appointments to boards and commissions in
no way reflects an individual member's approval or disapproval
of the appointee, and the nomination is merely forwarded to the
full legislature for confirmation or rejection.
4:00:19 PM
The committee took an at-ease from 4:00 p.m. to 4:03 p.m.
HB 112-PROFESSION OF PHARMACY
4:03:06 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 112, "An Act relating to the Board of Pharmacy;
relating to the practice of pharmacy; relating to pharmacies;
relating to prescription drug manufacturers; relating to
prescriptions for epinephrine; relating to the administration of
epinephrine; and providing for an effective date."
4:03:34 PM
REPRESENTATIVE RUFFRIDGE, as prime sponsor, paraphrased the
sponsor statement [included in committee packet], which read as
follows [original punctuation provided]:
Pharmacists and pharmacies are an integral part of
Alaska' healthcare system. It is important that the
Alaska statutes that guide them are updated and
reflect the services provided by modern-day
pharmacies.
House Bill 112 clarifies the Alaska Board of
Pharmacy's powers and duties to align with the federal
Drug Supply Chain and Security Act (DSCSA) related to
licensing and oversight of manufacturers, out-of-state
pharmacies, outsourcing facilities, and internet
pharmacies who conduct business in Alaska. In doing
so, these out-of-state entities will be held to the
same high standard as those operating in the state of
Alaska, helping to ensure Alaskans have access to
medications that are safe, no matter where they
originate.
HB 112 aligns Alaska's pharmacy board statutes with
similar boards in other states. It allows for it to
meaningfully recognize retired pharmacists and their
contributions. Stressing the importance of public
safety, HB 112 would allow the board to institute a
national criminal background check for Alaska
pharmacists and pharmacy technicians. This would align
the Alaska Board of Pharmacy with the National
Association of Boards and Pharmacy Model State
Pharmacy Act.
The Executive Administrator plays a critical role in
the smooth functioning of the board and requires a
high degree of competency and understanding of the
complexities of pharmacy-related regulations and
issues. This bill gives Alaska's Division of
Professional Licensing flexibility to hire a qualified
pharmacist for this administrative role should one
apply.
The changes proposed in House Bill 112 reflect a
dedicated collaboration between the Alaska Board of
Pharmacy and the Alaska Pharmacists Association
(AKPhA) to modernize pharmacy practice statutes.
4:05:33 PM
BRAEDAN GARRET, Staff, Representative Justin Ruffridge, Alaska
State Legislature, on behalf of Representative Ruffridge, prime
sponsor, read the sectional analysis for HB 112, which read as
follows [original punctuation provided]:
Section 1. Amends AS 08.08.010(a) Creation and
membership of board; officers
Alters composition of the seven-member Board of
Pharmacy by designating one member to be a licensed
pharmacy technician, and one being an individual with
no financial interest in the healthcare industry
Section 2. Amends AS 08.80.030 Powers and Duties of
Board
(b)(10) Separates out the licensing/regulating
entities relating to manufacturing and distributing of
drugs and devices by use of the
word "or"
(b)(12) adds an epinephrine auto-injector training
program
(b)(14) Clarifies that only pharmacists who dispense
federally scheduled controlled substances be required
to register with the Prescription Drug Monitoring
Program (PDMP)
(b)(16) Adds pharmacies and manufacturers from out-of-
state to the list of entities to be licensed and
inspected
(b)(17) Adds internet-based pharmacies to the list of
entities to be licensed if they are servicing Alaskans
(b)(18) adds language adopting regulations pertaining
to retired pharmacist status
Section 3. Amends 08.80.145 Reciprocity; license
transfer
2
(3) removes character requirement - "of good moral
character"
(4) removes internship details this is a national
standard among schools of pharmacy
Renumbering of statute items
Section 4. Amends AS 08.80.157 Licensing of facilities
(k) this adds out-of-state pharmacies and
manufacturers to the list of entities that must be
licensed and inspected
Section 5. Amends AS 08.80.159 Licensing and
inspection of facilities outside the state
(a) Adds "distributor, pharmacy, manufacturer" to
those out-of-state entities that must be licensed and
inspected, under the Drug Supply Chain and Security
Act
Section 6. Amends AS 08.80.159 Licensing and
inspection of facilities outside the state
(c) adds "pharmacy and manufacturer" to list that may
be inspected if located outside the state
Section 7. Amends AS 08.80.160 Fees
(10) Removes the word "registration" since the bill
mandates licensure of a facility
Section 8. Amends 08.80.168 and adds a new subsection
Administration of vaccines and related emergencies
(e) Allows a pharmacist to administer epinephrine to a
person or prescribe epinephrine auto-injectors to
someone who has completed the epinephrine auto-
injector training program
Section 9. Amends AS 08.80.270 Executive administrator
of the board
(a) Adds an additional salary range option for the
executive administrator, allowing flexibility for the
Division to select a pharmacist for the role
Section 10. Amends AS 08.80.420 Certain advertising
prohibited
3
(a) adds the term "apothecary" to list of those that
cannot be used in media or advertising unless the
store employs a licensed pharmacist with regular hours
Section 11. Amends AS 12.62.400 National criminal
history record check
(a)(23) adds pharmacist and pharmacy technician to
list of professions where a background check is
required. Aligns with State of Alaska's nursing
requirements and pharmacy requirements typical in
other states. This adds a national level background
check
Section 12. Amends AS 17.22.010 Prescription,
purchase, administration of epinephrine by a trained
individual
Allows anyone over 18 to purchase or be prescribed an
epinephrine auto-injector, and to administer
epinephrine in an emergency to another person if they
have completed an epinephrine auto-injector training
program approved by the board. It removes very
outdated language from this section
Section 13. Amends AS 17.22.020(a) Approval of
training programs
(a) Allows the board, rather than the department, to
adopt standards for the epinephrine auto-injector
training program and deletes outdated language
Section 14. Amends AS 17.22.020(b) Approval of
training programs
(b) Allows the board, rather than the department, to
approve an epinephrine auto-injector training program
that meets the board's standards
Section 15. Amends AS 17.22.030 Applicability
States that this chapter does not apply to someone
currently authorized under another law to administer
epinephrine, such as a nurse or doctor, or some other
authorized professional
Section 16. Amends AS 17.22.040 Liability of certified
individual
Outlines that a person may not be sued who administers
epinephrine to another in an emergency, and in good
faith, if he or she has completed the epinephrine
auto-injector training program approved by the board
Section 17. Amends AS 17.22.090 Definitions
(3) defines the "board" as the Board of Pharmacy
4
Section 18. Repeals AS 08.80.110(2) Qualifications for
licensure by examination
• Repeals (2) furnish the board with at least two
affidavits from reputable citizens that the applicant
has known for at least one year attesting to the
applicant's good moral character. This is not required
in medical board, dental or nursing statutes.
• Repeals 08.80.158 Registration of pharmacies located
outside the state since this bill would now require
licensure
• Repeals AS 17.22.020(c) which is the Department's
epinephrine auto-injector training program
• Repeals AS 17.22.090(1) that defines the department
as the Dept of Health, since it will no longer be the
approving entity of the epinephrine auto-injector
training program
Section 19. TRANSITION LANGUAGE for currently
registered pharmacies
A new section that would allow pharmacies previously
registered to continue to ship, mail or deliver
prescription drugs to its customers in Alaska until
their registration expires. At that time, they will
then have to apply for licensure.
Section 20. TRANSITION: REGULATIONS
Allows the Board of Pharmacy and DCCED to adopt
regulations to carry out the changes laid out in this
legislation.
Section 21. Section 20 has an immediate effective date
under AS 01.10.070(c)
Section 22: Effective date is set to coincide with the
Drug Supply Chain and Security Act that will go into
effect on November 26, 2023.
4:13:37 PM
ASHLEY SCHABER, Chair, Board of Pharmacy, began the PowerPoint
presentation titled, "House bill 112: Profession of Pharmacy"
[hardcover included in committee packet] on slide. She
explained the mission of the Board of Pharmacy, and that HB 112
touches on goal 4.1 [shown under "strategies on slide 2]
relating to regulation and enforcement, which read as follows
[original punctuation provided]:
Routinely review effectiveness of regulations that
reduce barriers to licensure without compromising
patient health and safety.
MS. SCHABER also pointed to 4.4, which read as follows [original
punctuation provided]:
Advocate for legislation as the pharmacy profession
evolves and new opportunities for improvement patient
safety arise.
MS. SCHABER further referenced the goal list, pointing to
4.5, which read as follows [original punctuation provided]:
Anticipate changes to the Drug Supply Chain Security
Act and respond proactively.
MS. SCHABER read slide 3, which read as follows [original
punctuation provided]:
Background of HB 112
•Result of multi year, multi chair review of statutes
and regulations to ensure the Alaska Board of Pharmacy
can continue to meet its mission
•HB 112 addresses changes by:
•Streamlining licensure process while improving public
safety
•Compliance with the Drug Supply Chain and Security
Act
•Alignment with other professional boards in Alaska
and pharmacy boards in other states
•Clarification of pharmacists' roles in epinephrine
access
•Collaborative effort between the Alaska Board of
Pharmacy and the Alaska Pharmacists Association
4:15:53 PM
MS. SCHABER moved to slide 4, which read as follows [original
punctuation provided]:
Goal: Streamline licensure process while improving
public safety
•Eliminates unnecessary forms currently required in
statute
•Clarifies that only pharmacists who dispense
controlled substances are required to register with
the Prescription Drug Monitoring Program (PDMP)
•Adds national criminal background check
MS. SCHABER read slide 5, which read as follows [original
punctuation provided]:
Goal: Compliance with Drug Supply Chain and Security
Act
•The federal Drug Supply Chain and Security Act
(DSCSA) further secures the U.S. drug supply through a
system to prevent harmful drugs from entering the
supply chain, detect harmful drugs if they do enter,
and enable rapid response when such drugs are found
•Boards of Pharmacy play a key role in this process
through appropriate licensing of drug distributors and
pharmacies
•HB 112 ensures the AK Board of Pharmacy powers and
duties support the DSCSA related to manufacturers, out
of state pharmacies, and internet pharmacies to ensure
Alaskans receive safe medications
4:18:53 PM
MS. SCHABER directed attention to slide 6, which read as follows
[original punctuation provided]:
Goal: Alignment
•Replaces one of the two public member seats with a
pharmacy
technician seat
•Allows the board to adopt language for retired
pharmacist status
•Clarifies the board executive administrator's salary,
allowing flexibility for a pharmacist to serve in this
role in the future
MS. SCHABER showed slide 7, which read as follows [original
punctuation provided]:
Goal: Epinephrine Access
•Adds epinephrine training program under Board of
Pharmacy Oversight
•Clarifies that a pharmacist can administer
epinephrine to a person or prescribe epinephrine auto
injectors to someone who has completed the training
program
•Increases epinephrine access for Alaskans with
anaphylactic emergencies
4:22:18 PM
MS. SCHABER concluded the presentation on slide 8, which read as
follows [original punctuation provided]:
Support
•The Board of Pharmacy respectfully requests your
support of HB 112, allowing us to further promote ,
preserve, and protect the public health, safety, and
welfare of Alaskans by and through the effective
control and regulation of the practice of pharmacy.
•Thank you for your time!
4:22:34 PM
REPRESENTATIVE FIELDS inquired as to what type of person is
considered as someone that has a financial interest in the
healthcare industry.
MS. SCHABER answered that it is in statute, which is that it is
a person that is a public member that has no financial interest
in the healthcare industry. She said that such a person brings
a public consumer interest to the board.
REPRESENTATIVE FIELDS asked what the current board member
requirements are, other than just being a member of the public.
MS. SCHABER deferred the question to the division. She
mentioned statute and said that no financial interest is the
biggest change. She said that a willingness to attend quarterly
meetings and a commitment to the work involved is required.
4:24:14 PM
REPRESENTATIVE RUFFRIDGE added that there are currently two
public member positions on the board with only one recently
filled. He stated that it has been difficult to get public
members to serve due to the time commitment requirement, as well
as low willingness from a member of the public to serve on a
board for a profession they may not know much about; therefore,
HB 112 would change one of the public seats to a technician
position.
4:25:06 PM
REPRESENTATIVE FIELDS commented that he likes the idea. He
asked what Representative Ruffridge sees as the role of the
board in supporting training for pharmacy technicians.
REPRESENTATIVE RUFFRIDGE responded that, during his time serving
on the Board of Pharmacy, that was an item of interest, and that
regulations were passed to add a certified pharmacy technician
as a specific individual recognized in regulatory practice. He
explained that certified pharmacy technicians in Alaska
currently have the ability to do final checks on prescriptions,
if the prescription had a drug utilization review done by a
pharmacist, and administer vaccinations, as examples. He
stressed that there is an effort in the industry to promote
pharmacy technicians as being a "middle step."
4:26:54 PM
REPRESENTATIVE SADDLER observed that, if there are four
pharmacists on the board right now, it wouldn't seem necessary
to have the executive director be a pharmacist. He asked why
the executive director is required to be a pharmacist.
REPRESENTATIVE RUFFRIDGE responded that, in his time as previous
member of the Board of Pharmacy, as well as a pharmacist, there
is a lot of work to be an executive administrator of the Board
of Pharmacy, and members are expected to have a deep-level
understanding of what the department does for licensing. He
said that many licensing and professional questions are directed
to the executive administrator, and there would be a disconnect
if they had knowledge of the pharmacy profession since they
would have to go to the board to answer every question. He
added that a pharmacist serving in the role is current practice
in many states.
4:29:23 PM
MS. SCHABER added that the five pharmacists on the board are all
volunteers and work full time, so they don't have the time to
address the questions.
4:30:21 PM
REPRESENTATIVE MINA asked how out-of-state entities are being
regulated currently.
REPRESENTATIVE RUFFRIDGE answered that they are not. He
explained that they are required to register in the state, but
the Board of Pharmacy if the entity is dispensing or providing
services into the state has no option to protect or promote
the safety and wellbeing of Alaska patients because the entities
are not licensed.
4:31:17 PM
MS. SCHABER elaborated that the change in HB 112 gives the board
oversight. She explained that currently it is only a
registration that acknowledges that they are providing services.
She explained that if there was a safety concern regarding the
out of state pharmacy, the board has no oversight.
4:32:11 PM
REPRESENTATIVE MINA asked how prevalent out-of-state entities
are and what kinds of businesses they are.
MS. SCHABER pointed to mail-order pharmacies as an example, and
that some of the out-of-state pharmacies are considered
compounding pharmacies that provide either sterile or non-
sterile compounds, medications, eye drops, and injections to
patients in Alaska.
4:33:01 PM
REPRESENTATIVE FIELDS asked about fentanyl being present in
adulterated drugs, and how pharmacies are adapting to this.
REPRESENTATIVE RUFFRIDGE answered that it is a very large
concern and has always been a concern since fentanyl is one type
of the adulterated/counterfeit medications that's been seen. He
explained that getting a clearer picture of what the drug supply
chain looks like was one of the reasons why the Drug Supply
Chain Act is at the federal level, as adulterated medications
are being sent to Alaska often through Internet pharmacies. He
said the bill contains changes to comply with requirements
within federal regulation.
4:35:00 PM
MS. SCHABER added that the bill does address giving the board
oversight of Internet pharmacies, and that access to naloxone is
important.
4:35:33 PM
REPRESENTATIVE FIELDS shared that he is a parent, and that when
his kids get sick, it makes him think about how gaps in primary
care could lead to expensive care. He asked if there are
opportunities for the board to work with other primary
healthcare providers in an effort to reduce such gaps.
4:36:22 PM
REPRESENTATIVE RUFFRIDGE responded that there will be a more
detailed answer from him later; there is an extensive number of
opportunities for pharmacists to fill gaps in care. During the
pandemic, pharmacies across the state filled in roles that they
did not historically provide. He relayed that there is a
nationwide push for pharmacists to be given provider status,
something HB 112 does not do, but the state has taken steps to
promote the ability of pharmacists to take such steps. He said
there is a barrier in the fact that pharmacies are a difficult
business to be in, with many across the state and country
closing because there are many challenges.
4:38:53 PM
REPRESENTATIVE SADDLER asked for the number of licensed
pharmacists in Alaska.
MS. SCHABER deferred the question to the division. She shared
that there has been a challenge in ensuring that licenses are
processed quickly.
4:40:42 PM
SYLVAN ROB, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development, answered that, as of today, there are
1,049 licensed pharmacists and 1,206 licensed pharmacy
technicians.
4:41:10 PM
REPRESENTATIVE SUMNER asked how many registered pharmacies there
are.
4:41:33 PM
MS. ROB answered that she doesn't know how many but would get
that information to the committee.
4:42:18 PM
REPRESENTATIVE RUFFRIDGE thanked members for hearing the bill.
He said the hearing has been a good start in promoting changes
that have been worked on for a long time. He shared that the
chair before him would be proud that members are finally
bringing to bear a process they started a number of years ago.
4:43:26 PM
REPRESENTATIVE FIELDS shared that Representative Ruffridge had
previously shared that some regulatory reforms around staffing
could help address "pharmacy deserts" in the state. He asked if
there are other reforms to be thinking about to help bring more
pharmacies to places that are unserved.
REPRESENTATIVE RUFFRIDGE responded that pharmacies closing is
due to the high barrier entry, namely in payroll costs. He
pointed out that some corporate pharmacies are going through
staff reduction, even while the numbers of prescriptions being
dispensed go up. He elaborated that a lot of pharmacies operate
as a net loss to large corporations because there is a small
margin; a big component in altering that is the role of pharmacy
technicians becoming more of a manager while pharmacists act
more as clinical oversight for a pharmacy. He explained that
tele-pharmacies allow a pharmacy to operate in an urban setting;
downtown Anchorage, as an example, has three pharmacy
technicians with the pharmacists being more centrally located in
a larger facility and using technology to remotely access the
prescriptions that are being dispensed. He explained that this
is an option that already has statute to govern it, and a
barrier to it was changing regulations related to the pharmacy
technician's capacity, something the board has changed, which
opens the option now for pharmacy deserts.
4:46:35 PM
CHAIR PRAX announced HB 112 was held over.
4:46:51 PM
The committee took an at-ease from 4:46 p.m. to 4:49 p.m.
HB 60-RUNAWAYS; DFCS/DOH: DUTIES/LICENSING/INFO
4:49:07 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 60, "An Act relating to the licensing of runaway
shelters; relating to advisors to the board of trustees of the
Alaska Mental Health Trust Authority; relating to the sharing of
confidential health information between the Department of Health
and the Department of Family and Community Services; relating to
the duties of the Department of Health and the Department of
Family and Community Services; and providing for an effective
date."
4:49:54 PM
REPRESENTATIVE RUFFRIDGE moved to adopt the proposed committee
substitute (CS) for HB 60, 33-GH1343\S, Bergerud, 3/21/23, as
the working document.
4:50:14 PM
CHAIR PRAX objected for purpose of discussion.
4:50:37 PM
RILEY NYE, Staff, Representative Mike Prax, Alaska State
Legislature, on behalf of the bill sponsor, House Rules, by
request of the governor, explained that HB 60 was introduced to
support the reorganization of the Department of Health and
Social Services in to the Department of Family and Community
Services and the Department of Health under Executive Order 121.
Version S amends the original version to reflect new fixes and
missions to support the reorganization, which include adding the
Department of Family and Community Services to the definition of
"department" in A.S. 18.65 Section 2, giving clarification of
the role of each department as it relates to shelters for
runaways. He requested the invited speakers to testify.
4:52:32 PM
HEATHER CARPENTER, Deputy Director, Office of the Commissioner,
Department of Health, paraphrased the explanation of changes to
HB 60 proposed in Version S [included in committee packet],
which read as follows [original punctuation provided]:
Section 1 This language is unchanged from section 1 of
version A.
Section 2 Version S includes the newly identified need
to include the Department of Family and Community
Services in the definition of department.
Section 3 This language is unchanged from section 2 of
version A.
Section 4 This language is unchanged from section 3 of
version A.
Sections 5-9 and 11-14 Version S updates these
sections to further clarify the duties of each
department related to programs for runaways.
Section 10 Version S updates the bill to include a
necessary clarification related to the confidentiality
of records related to shelters for runaways.
Section 15 This language is unchanged from section 10
of version A.
Section 16 Version S amends this section to replace
the term "authorizing" with "applicable" from section
11 of version A. This change reflects the removal of
the definition for the term "authorizing" in section
20 below.
Sections 17-18 This language is unchanged from
sections 12-13 of version A.
Section 19 This language is unchanged from section 14
of version A.
Section 20 Version S amends Section 15 from version A
to remove the new definition for "authorizing
department" to avoid potential confusion with the
duplicate definition of "applicable department."
Section 21 Version S moves the repeal of this language
related to the licensure of shelters for runaways from
Section 9 in version A. AS 47.32.010 was repealed and
reenacted under Executive Order 121, section 79.
Section 22 This language is unchanged from section 16
of version A.
4:55:50 PM
REPRESENTATIVE SADDLER pointed out that the date of the CS is
labeled March 21, and that there is a legal opinion by Margaret
Bergerud, Legislative Legal Counsel, about potential single
subject law violations, which is also dated March 21. He asked
if the legal opinion applies to the CS before the committee.
4:56:18 PM
STACIE KRALY, Director, Civil Division, Department of Law,
answered yes, in that, the memo relates to the CS and the
overall framework of HB 60.
REPRESENTATIVE SADDLER asked Ms. Kraly to comment on the
validity of the allegation that the bill may likely violate the
single subject provisions of the state constitution.
MS. KRALY answered that she disagrees with Legislative Legal
Service's assessment that there is a single subject issue with
the CS. She pointed to the title, which shows there are a
number of different issues being addressed, and looking at the
underlying theme, the bill deals with all of the powers and
duties for the Department of Health and the Department of Family
and Community Services. She relayed that a concern raised was
in regard to the mental health trust authority; the change in
the CS articulates that there was an issue with who was going to
be on the advisory council for the trust authority. She
explained that, at the advice of Legislative Legal Services last
year, the department had picked a particular commissioner
because it said a member cannot be added to the advisory board
because that would be a subject change in nature, which is not
allowed under executive order rule; further, the commissioner
was picked for that purpose, with an understanding that they
would need to come back this year and introduce a bill to
articulate how the two departments interact with the mental
health trust authority. She explained that there are no
substantive changes to trust statutes in the bill, rather, it
articulates that both departments need to be involved as
advisory members to the board. She elaborated that every
provision in the bill relates to the operations of the two
departments and how they meet their statutory duties. She
stressed that she does not see any problems with the bill as it
is drafted.
REPRESENTATIVE SADDLER advised that it'd be better to get these
issues resolved on the front-end, and that he hopes there will
be a meeting to hash out the legal issues.
5:00:20 PM
REPRESENTATIVE SUMNER read from Section 13 of the Alaska State
Constitution, which read as follows:
Every bill shall be confined to one subject unless it
is an appropriation bill or one codifying, revising,
or rearranging existing laws.
REPRESENTATIVE SUMNER offered his understanding that, through
the executive order, the two departments are separated and now
the legislature is codifying that.
5:01:18 PM
MS. KRALY stated that the power to split the department is
authorized by the constitution. She explained that it was
conveyed last year that there would some minor technical changes
this year because one cannot amend an executive order during the
process, and that HB 60 is a clean-up bill.
5:02:23 PM
CHAIR PRAX withdrew his objection. There being no further
objection, the CS, Version S, was before the committee as a
working document.
5:03:05 PM
REPRESENTATIVE RUFFRIDGE moved to report CSHB 60, Version 33-
GH1343\S, Bergerud, 3/21/23, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 60(HSS) was reported out of the House Health
and Social Services Standing Committee.
5:03:40 PM
The committee took an at-ease from 5:03 p.m. to 5:05 p.m.
5:05:56 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:06 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 112 Sectional Analysis .pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |
| HB 112 Sponsor Statement Version B.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |
| HB0112A.PDF |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |
| Heidi Hedberg Resume 2023.pdf |
HHSS 3/23/2023 3:00:00 PM |
|
| HB112 HSS Hearing slides 3.23.23.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |
| HB 60 CS Version S.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 60 |
| HB 60 Sectional Analysis (Version S) 3-23-23.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 60 |
| HB 60 Explanation of Changes Version A to Verson S (3-23-23).pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 60 |
| HB 112 Support as of 3_21 Redacted.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |
| HB 112 Fiscal Note DCCED.pdf |
HHSS 3/23/2023 3:00:00 PM |
HB 112 |