Legislature(2011 - 2012)CAPITOL 106

02/28/2012 03:00 PM HEALTH & SOCIAL SERVICES


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03:06:26 PM Start
03:06:54 PM Confirmation Hearing(s): State Medical Board
03:42:28 PM HB310
03:57:39 PM HB218
04:55:05 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearing: TELECONFERENCED
State Medical Board
+= HB 310 STATE IMMUNIZATION PROGRAM TELECONFERENCED
Moved CSHB 310(HSS) Out of Committee
*+ HB 218 PRESCRIPTION DRUG SPECIALTY TIERS TELECONFERENCED
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 28, 2012                                                                                        
                           3:06 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Wes Keller, Chair                                                                                                
Representative Alan Dick, Vice Chair                                                                                            
Representative Bob Herron                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Beth Kerttula                                                                                                    
Representative Bob Miller                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Charisse Millett                                                                                                 
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
State Medical Board                                                                                                           
                                                                                                                                
       Camille Carlson - Fairbanks                                                                                              
       Dr. Elizabeth Kohnen - Fairbanks                                                                                         
       Dr. David Miller - Juneau                                                                                                
       Dr. David Powers - Dillingham                                                                                            
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
HOUSE BILL NO. 310                                                                                                              
"An Act temporarily reinstating the child and adult immunization                                                                
program in the Department of Health and Social Services; and                                                                    
providing for an effective date."                                                                                               
                                                                                                                                
     - MOVED CSHB 310(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 218                                                                                                              
"An Act prohibiting an insurer from using a drug formulary                                                                      
system of specialty tiers under certain circumstances."                                                                         
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 310                                                                                                                  
SHORT TITLE: STATE IMMUNIZATION PROGRAM                                                                                         
SPONSOR(s): REPRESENTATIVE(s) HERRON                                                                                            
                                                                                                                                
02/01/12       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/01/12       (H)       HSS, FIN                                                                                               
02/14/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
02/14/12       (H)       Heard & Held                                                                                           
02/14/12       (H)       MINUTE(HSS)                                                                                            
02/28/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 218                                                                                                                  
SHORT TITLE: PRESCRIPTION DRUG SPECIALTY TIERS                                                                                  
SPONSOR(s): HEALTH & SOCIAL SERVICES                                                                                            
                                                                                                                                
03/31/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/31/11       (H)       HSS, L&C                                                                                               
02/28/12       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
CAMILLE CARLSON, Appointee                                                                                                      
State Medical Board                                                                                                             
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  As appointee to the State Medical Board,                                                                 
answered questions during the confirmation hearings.                                                                            
                                                                                                                                
ELIZABETH KOHNEN, MD, Appointee                                                                                                 
State Medical Board                                                                                                             
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  As appointee to the State Medical Board,                                                                 
answered questions during the confirmation hearings.                                                                            
                                                                                                                                
DAVID MILLER, MD, Appointee                                                                                                     
State Medical Board                                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As appointee to the State Medical Board,                                                                 
answered questions during the confirmation hearings.                                                                            
                                                                                                                                
DAVID POWERS, MD, Appointee                                                                                                     
State Medical Board                                                                                                             
Dillingham, Alaska                                                                                                              
POSITION STATEMENT:  As appointee to the State Medical Board,                                                                 
answered questions during the confirmation hearings.                                                                            
                                                                                                                                
JILL LEWIS, Deputy Director-Juneau                                                                                              
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the discussion of                                                              
HB 310.                                                                                                                         
                                                                                                                                
WARD HURLBURT, MD, Chief Medical Officer/Director                                                                               
Division of Public Health                                                                                                       
Central Office                                                                                                                  
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the discussion of                                                              
HB 310.                                                                                                                         
                                                                                                                                
MARIE DARLIN, Coordinator                                                                                                       
AARP Capital City Task Force                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 310.                                                                          
                                                                                                                                
DENISE DANIELLO, Executive Director                                                                                             
Alaska Commission on Aging                                                                                                      
Division of Senior and Disabilities Services                                                                                    
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 310.                                                                          
                                                                                                                                
JANET OGAN, Staff                                                                                                               
Representative Wes Keller                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As committee aide, presented HB 218 on                                                                   
behalf of the House Health and Social Services Standing                                                                         
Committee.                                                                                                                      
                                                                                                                                
LEONARD SORRIN, Attorney                                                                                                        
Director of Congressional and Legislative Affairs                                                                               
Premera Blue Cross Blue Shield of Alaska                                                                                        
Seattle, Washington                                                                                                             
POSITION STATEMENT:  Testified in opposition to HB 218.                                                                       
                                                                                                                                
BRENDA ROBERTSON                                                                                                                
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified during discussion of HB 218.                                                                   
                                                                                                                                
ROBERT LADA, MD                                                                                                                 
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 218.                                                                   
                                                                                                                                
ANTONIA FIFLIS-FOWLER, Executive Director                                                                                       
Alaska Multiple Sclerosis Foundation                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 218.                                                                          
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:06:26 PM                                                                                                                    
                                                                                                                                
CHAIR  WES KELLER  called the  House Health  and Social  Services                                                             
Standing   Committee    meeting   to    order   at    3:06   p.m.                                                               
Representatives  Keller,  Miller,  Kerttula, Herron,  and  Seaton                                                               
were present at  the call to order.   Representative Dick arrived                                                               
as the meeting was in progress.                                                                                                 
                                                                                                                                
^CONFIRMATION HEARING(S): State Medical Board                                                                                 
          CONFIRMATION HEARING(S): State Medical Board                                                                      
                                                                                                                                
3:06:54 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  first order of business would be                                                               
the confirmation hearings for the State Medical Board.                                                                          
                                                                                                                                
3:09:05 PM                                                                                                                    
                                                                                                                                
CAMILLE  CARLSON,  Appointee,  State Medical  Board,  established                                                               
that she  had lived in Fairbanks  for 45 years, and  that she had                                                               
served   on  the   Board   of   Psychologist  and   Psychological                                                               
[Associate]  Examiners.   She expressed  her  desire to  continue                                                               
service on a state board.   She stated that she was conscientious                                                               
and did not rubber stamp decisions.                                                                                             
                                                                                                                                
3:10:08 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER asked  why she  was  interested in  serving on  the                                                               
board.                                                                                                                          
                                                                                                                                
MS. CARLSON  replied that  she liked  to be  a good  citizen, and                                                               
that, as she was retired, she had the time.                                                                                     
                                                                                                                                
3:10:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked about  the most difficult  aspect of                                                               
being a board member, and what had surprised her the most.                                                                      
                                                                                                                                
MS.  CARLSON  responded  that  she had  been  expected  to  grade                                                               
examinations, and,  as this was  not her profession, it  was more                                                               
difficult.                                                                                                                      
                                                                                                                                
MS.  CARLSON, in  response to  Representative  Herron, said  that                                                               
nothing had surprised her.  She  declared that, although it was a                                                               
small 5 member board, it was what she had expected.                                                                             
                                                                                                                                
3:12:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA asked what she had been grading.                                                                        
                                                                                                                                
MS. CARLSON  said that  it was a  subjective examination,  with a                                                               
key.   She affirmed that  she had stated  that she should  not be                                                               
grading an exam as a public member,  but that the key had made it                                                               
possible.   She  shared that  all  the board  members graded  the                                                               
exams.                                                                                                                          
                                                                                                                                
MS. CARLSON said that she was  willing and interested to serve on                                                               
the State Medical Board or the Alaska Judicial Council.                                                                         
                                                                                                                                
3:13:31 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked what she believed would be the main issues.                                                                  
                                                                                                                                
MS. CARLSON  replied that  she did not  have any  pre conceptions                                                               
for the problems.                                                                                                               
                                                                                                                                
3:13:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked if she  had direct participation with                                                               
anything  that  could  be  perceived  to  have  any  conflict  of                                                               
interest.                                                                                                                       
                                                                                                                                
MS. CARLSON offered her belief  that any direct financial benefit                                                               
should result in that member recusing themselves.                                                                               
                                                                                                                                
REPRESENTATIVE  SEATON, referencing  earlier debates  for medical                                                               
procedures, asked  if she had  affiliation with  any occupational                                                               
practice.                                                                                                                       
                                                                                                                                
MS. CARLSON stated  that she had no affiliation  with any medical                                                               
practices  in  Alaska,  but  that her  daughter  was  a  physical                                                               
therapist in the State of Washington.                                                                                           
                                                                                                                                
REPRESENTATIVE SEATON asked if she  viewed the medical board as a                                                               
regulator to  the practice  of medicine, or  as a  constraint for                                                               
other health care practitioners.                                                                                                
                                                                                                                                
MS.  CARLSON listed  the  professions that  were  covered by  the                                                               
State Medical Board.                                                                                                            
                                                                                                                                
REPRESENTATIVE SEATON  asked if alternative  practitioners should                                                               
be included under the purview of the State Medical Board.                                                                       
                                                                                                                                
MS. CARLSON responded that this was  a decision to be made by the                                                               
legislature.                                                                                                                    
                                                                                                                                
3:19:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  posed  that   if  the  law  required  a                                                               
physician to  offer certain treatment,  would she follow  the law                                                               
even if it differed from her personal feelings.                                                                                 
                                                                                                                                
MS. CARLSON replied that she would follow the law.                                                                              
                                                                                                                                
3:20:35 PM                                                                                                                    
                                                                                                                                
ELIZABETH  KOHNEN, MD,  Appointee,  State  Medical Board,  stated                                                               
that  she first  came  to Bethel,  Alaska in  1990,  as a  public                                                               
health service  employee.   She moved to  Fairbanks in  1992, and                                                               
began  a private  practice.    She declared  that  she had  since                                                               
earned her  Master's Degree in  Public Health.  She  likened this                                                               
degree  to working  on  the  State Medical  Board,  as they  both                                                               
allowed a greater overview of medicine.                                                                                         
                                                                                                                                
3:22:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER  disclosed that  Dr. Kohnen was  his family                                                               
physician.                                                                                                                      
                                                                                                                                
3:22:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked if she  had direct participation with                                                               
anything  that  could  be  perceived  to  have  any  conflict  of                                                               
interest.                                                                                                                       
                                                                                                                                
DR.  KOHNEN replied  that  she had  been  reading previous  board                                                               
meeting  minutes for  the issues.   She  offered her  belief that                                                               
when  you know  more  about  an area,  you  can  often vote  more                                                               
intelligently.   She opined that  she could vote against  her own                                                               
financial  interest, but  she would  recuse herself  if it  would                                                               
result in  her personal financial gain.   She gave an  example of                                                               
payment to  medical practitioners,  noting that she  felt doctors                                                               
were overpaid, and that she  would vote against her own financial                                                               
interest in this instance.                                                                                                      
                                                                                                                                
3:25:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if alternative  practitioners should                                                               
be included under the purview of the State Medical Board.                                                                       
                                                                                                                                
DR. KOHNEN, in  response, expressed her need  for more education,                                                               
as  she did  not know  the regulations  on alternative  medicine.                                                               
She declared that no group should  run amok without being held to                                                               
the same  higher ethical standards as  other medical professions.                                                               
She stated that she would follow the law.                                                                                       
                                                                                                                                
3:26:27 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER reiterated that the  committee would forward all the                                                               
appointee names on to the next  committee.  He commented that the                                                               
committee did not  have an expectation of  non-bias, pointing out                                                               
that legislators declared any potential  conflict when a vote was                                                               
called.  He  offered his belief that rarely  were legislators not                                                               
allowed to vote  because of a declared conflict of  interest.  He                                                               
said, "Alaska is a small town  and we expect you to represent who                                                               
you're there to represent."                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON clarified  that "a  board in  a regulatory                                                               
capacity  is different  than our  public vote  in forming  policy                                                               
statewide.   I would not want  to give the people  the impression                                                               
that  the  executive  ethics  act lets  them  vote  in  financial                                                               
conflict of interest, 'cause it  specifically excludes that."  He                                                               
pointed out  that his questions  were "related to times  in which                                                               
the [State]  Medical Board has  not followed the ethics  act, and                                                               
allowed people  to vote  with the  direct conflict  of interest."                                                               
He  declared  that regulatory  boards  did  not follow  the  same                                                               
[voting] requirements as the legislature.                                                                                       
                                                                                                                                
3:28:28 PM                                                                                                                    
                                                                                                                                
DAVID  MILLER, MD,  Appointee, State  Medical Board,  established                                                               
that he had  served on the State Medical Board  for the last four                                                               
years.  He pointed out that,  upon his appointment, there were no                                                               
other surgeons  on the  board.   He shared that  he had  lived in                                                               
Juneau for 10 years, and had  arrived in Alaska with the military                                                               
in 1995.                                                                                                                        
                                                                                                                                
3:30:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   HERRON  asked   what  had   surprised  him   and                                                               
disappointed him during his tenure as a board member.                                                                           
                                                                                                                                
DR. MILLER, in response, said  that he was "always surprised when                                                               
members of our profession fall  short with various issues such as                                                               
drug  and alcohol  dependence, patient  improprieties, and  worse                                                               
..."  He declared that,  although these were emotional issues for                                                               
every  physician,   responsibility  for  serving  on   the  board                                                               
included regulation  within the  profession.   He stated  that he                                                               
was surprised  how enjoyable board  service was,  especially when                                                               
he  observed physicians  on probation  "turn their  lives around,                                                               
and get  the help that  they need, and  come back before  us, and                                                               
once  again can  join  the physician's  community  in Alaska  and                                                               
serve what is certainly an  underserved state."  He declared that                                                               
it was a privilege to serve on the board.                                                                                       
                                                                                                                                
3:31:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if alternative  practitioners should                                                               
be included under the purview of the State Medical Board.                                                                       
                                                                                                                                
DR. MILLER  replied that the statute  was very clear, and  it was                                                               
necessary to follow this.  He  emphasized that it was a privilege                                                               
to practice  medicine, not a right.   He enumerated the  years of                                                               
education, peer review,  and nationally standardized examinations                                                               
necessary to  receive that  privilege.   He declared  the [State]                                                               
Medical  Board to  be  a "proper  avenue  within its  legislative                                                               
scope"  for restoration  of the  privilege to  practice medicine.                                                               
He endorsed  that it  was the  legislature which  would determine                                                               
whether alternative  medicine was placed under  the regulation of                                                               
the [State]  Medical Board.  He  confirmed that he was  not well-                                                               
versed  to  the  education, training  criteria,  and  supplements                                                               
provided by  alternative medicine, and  opined that it  would not                                                               
be within the scope of the  board for regulation of a group which                                                               
they did not understand.                                                                                                        
                                                                                                                                
3:33:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA asked  if Dr. Miller could  put aside his                                                               
personal beliefs and enforce the law.                                                                                           
                                                                                                                                
DR. MILLER replied,  "Absolutely.  Those are  the easy decisions.                                                               
If the  law requires a  particular action  that is a  pretty easy                                                               
action to take."                                                                                                                
                                                                                                                                
3:35:10 PM                                                                                                                    
                                                                                                                                
DAVID  POWERS, MD,  Appointee, State  Medical Board,  established                                                               
that this  would be his second  term on the State  Medical Board.                                                               
He  ascertained  that he  brought  a  rural perspective  and  its                                                               
unique issues  to the board.   He listed some of  these issues to                                                               
include  transporting patients  over wide  distances and  working                                                               
with mid-level health  aides.  He endorsed  his board experience,                                                               
and his ability to contribute.   He shared that he came to Alaska                                                               
in  1984, and  his  employment  in public  health  at the  Alaska                                                               
Native  Medical Center  resulted in  work  in many  of the  rural                                                               
communities.                                                                                                                    
                                                                                                                                
3:37:03 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  stated  appreciation  for  his  service  in  rural                                                               
communities.                                                                                                                    
                                                                                                                                
3:37:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   HERRON  asked   what  had   surprised  him   and                                                               
disappointed him during his tenure as a board member.                                                                           
                                                                                                                                
DR. POWERS  replied that he  was most surprised by  the numerous,                                                               
often dumb  things that providers  did to  get into trouble.   He                                                               
affirmed that a large part of  the board function was to maintain                                                               
high standards  for the  benefit and  safety of  the public.   He                                                               
relayed  his   disappointment  for  the  myriad   of  trivial  or                                                               
meritless complaints.                                                                                                           
                                                                                                                                
3:39:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA,  reflecting on her board  service, asked                                                               
about drug and alcohol abuse in the medical profession.                                                                         
                                                                                                                                
DR. POWERS, in response, said  that the abuse was not increasing,                                                               
and   expressed  his   support  for   the  thoroughness   of  the                                                               
evaluations,   tasks,  and   safeguards   necessary  to   restore                                                               
professional licenses.  He agreed  that, although the severity of                                                               
some sanctions could  seem harsh, it was a  privilege to practice                                                               
medicine.   He  affirmed that  the State  Medical Board  had done                                                               
well at policing its own.                                                                                                       
                                                                                                                                
REPRESENTATIVE KERTTULA asked if he  could put aside his personal                                                               
beliefs and enforce the law.                                                                                                    
                                                                                                                                
DR.  POWERS   replied,  "Absolutely."    He   agreed  that  these                                                               
decisions were in  black and white, and that it  was necessary to                                                               
follow the law.                                                                                                                 
                                                                                                                                
3:41:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK  moved to advance  the confirmations  for the                                                               
State Medical Board to the joint  session of the House and Senate                                                               
for consideration.  There being no objection, it was so ordered.                                                                
                                                                                                                                
               HB 310-STATE IMMUNIZATION PROGRAM                                                                            
                                                                                                                                
3:42:28 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 310,  "An Act  temporarily reinstating  the child                                                               
and adult  immunization program in  the Department of  Health and                                                               
Social Services; and providing for an effective date."                                                                          
                                                                                                                                
REPRESENTATIVE HERRON  moved to adopt Amendment  A.1, labeled 27-                                                               
LS1273\A.1, Luckhaupt/Mischel, 2/28/12, which read:                                                                             
                                                                                                                                
     Page 1, line 12:                                                                                                           
          Delete "recommended"                                                                                                  
                                                                                                                                
     Page 1, line 13:                                                                                                           
          Delete "recommended"                                                                                                  
                                                                                                                                
     Page 3, line 1:                                                                                                            
          Delete "recommended"                                                                                                  
                                                                                                                                
     Page 3, lines 3 - 8:                                                                                                       
          Delete all material and insert:                                                                                       
          "(f)  The vaccines included in the program                                                                            
               (1)  for a child under 19 years of age are                                                                       
       all vaccines required for school attendance under                                                                        
     AS 14.30.125 and influenza and pneumococcal vaccines;"                                                                     
                                                                                                                                
     Page 3, line 13, following "standards":                                                                                    
          Insert ", the recommendations of the federal                                                                          
     advisory committee on immunization practices,"                                                                             
                                                                                                                                
CHAIR KELLER objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  HERRON  explained  that  proposed  Amendment  A.1                                                               
would  delete "recommended"  as it  was  a hard  word to  define.                                                               
Referring  to  page 3,  lines  3-8,  he  explained that  all  the                                                               
vaccines approved  by the commissioner [Department  of Health and                                                               
Social  Services] for  school attendance  would now  be included.                                                               
He listed the required immunizations  for school attendance to be                                                               
diphtheria, tetanus, polio,  pertussis, measles, mumps, Hepatitis                                                               
A and B, rubella, and varicella.                                                                                                
                                                                                                                                
3:44:48 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  asked  if  the Department  of  Health  and  Social                                                               
Services (DHSS)  had reviewed  the proposed  amendment and  if it                                                               
had any  impact to  the fiscal  note.   He clarified  that public                                                               
testimony was still open from  the previous meeting [February 14,                                                               
2012].                                                                                                                          
                                                                                                                                
3:45:18 PM                                                                                                                    
                                                                                                                                
JILL LEWIS,  Deputy Director-Juneau, Central Office,  Division of                                                               
Public  Health,   Department  of  Health  and   Social  Services,                                                               
acknowledged that  DHSS had reviewed the  proposed amendment, and                                                               
had not found there to be any impact on the fiscal note.                                                                        
                                                                                                                                
3:45:55 PM                                                                                                                    
                                                                                                                                
WARD HURLBURT,  MD, Chief  Medical Officer/Director,  Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services,  expressed his  agreement  with Ms.  Lewis, and  stated                                                               
that the  proposed amendment clarified  the use of the  most cost                                                               
effective vaccines, and offered flexibility to DHSS.                                                                            
                                                                                                                                
3:46:56 PM                                                                                                                    
                                                                                                                                
MARIE DARLIN,  Coordinator, AARP Capital City  Task Force, stated                                                               
that  AARP  supported  proposed  HB   310.    Speaking  from  the                                                               
standpoint of the  older citizens, she said  that AARP recognized                                                               
that providing  free vaccines  for adults  was "a  good effective                                                               
public  health  measure" and  a  good  preventative issue.    She                                                               
declared support for the immunization  of children, as well.  She                                                               
pointed  to   the  large   number  of   AARP  members,   who,  as                                                               
grandparents, were raising grandchildren.                                                                                       
                                                                                                                                
3:48:18 PM                                                                                                                    
                                                                                                                                
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
Division  of  Senior  and Disabilities  Services,  Department  of                                                               
Health  and  Social  Services (DHSS),  testified  in  support  of                                                               
proposed HB  310.   She stated  that prevention  and vaccinations                                                               
were good  health measures for every  one of every age,  and were                                                               
especially important for older people  as immune systems weakened                                                               
with  age.    These  programs  enhanced  a  person's  health  and                                                               
independence.   She reminded  the committee  that Alaska  was the                                                               
leader in the rate of  senior population growth, and declared the                                                               
importance for immunizations, vaccines,  and healthy behaviors to                                                               
maintain  good  health.    She pointed  out  that  many  seniors,                                                               
including  those who  had lived  a subsistence  life style,  were                                                               
uninsured  or ineligible  for Medicare,  and  would benefit  from                                                               
proposed  HB 310.   She  asked  that the  committee consider  the                                                               
addition  of  an  immunization   for  shingles.    She  described                                                               
shingles as  a painful rash  that, if  in contact with  the eyes,                                                               
could  lead to  blindness.   She  pointed out  that  the risk  of                                                               
shingles increased with  age.  She declared  support for proposed                                                               
HB 310.                                                                                                                         
                                                                                                                                
3:51:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA  asked if shingles fit  into a nationally                                                               
recognized public  health standard, so  that DHSS could  add this                                                               
to the list of vaccinations.                                                                                                    
                                                                                                                                
3:52:29 PM                                                                                                                    
                                                                                                                                
DR.  HURLBURT  said   that  proposed  HB  310   would  allow  the                                                               
flexibility to  add a vaccination  for shingles.  He  pointed out                                                               
that it  was an expensive vaccine,  but that an efficient  use of                                                               
funding would  allow the addition  of vaccinations  for rotavirus                                                               
and shingles as the next cost effective vaccines.                                                                               
                                                                                                                                
3:53:26 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER closed  public testimony and asked  the committee if                                                               
there were any more questions on the proposed amendment.                                                                        
                                                                                                                                
3:53:55 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER removed  his  objection to  Amendment  A.1.   There                                                               
being no further objection, Amendment A.1 was passed.                                                                           
                                                                                                                                
3:54:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER asked  if it was necessary  to add shingles                                                               
to the language in proposed HB 310.                                                                                             
                                                                                                                                
CHAIR  KELLER  replied that  he  was  satisfied that  DHSS  would                                                               
support the  inclusion of the  shingles vaccination, and  that it                                                               
did not need to be mandated in the proposed bill.                                                                               
                                                                                                                                
3:54:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK  moved to report  HB 310, as amended,  out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSHB  310(HSS)  was                                                               
reported  from  the House  Health  and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
            HB 218-PRESCRIPTION DRUG SPECIALTY TIERS                                                                        
                                                                                                                                
3:57:39 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  final order of business would be                                                               
HOUSE BILL NO.  218, "An Act prohibiting an insurer  from using a                                                               
drug   formulary  system   of  specialty   tiers  under   certain                                                               
circumstances."                                                                                                                 
                                                                                                                                
3:58:08 PM                                                                                                                    
                                                                                                                                
JANET  OGAN,  Staff,  Representative  Wes  Keller,  Alaska  State                                                               
Legislature,  as aide  to the  House Health  and Social  Services                                                               
Standing Committee, introduced  proposed HB 218 on  behalf of the                                                               
committee.  She read the sponsor statement:                                                                                     
                                                                                                                                
     Specialty  medications used  to  treat complex  chronic                                                                    
     diseases continue  to be  the fastest  growing segments                                                                    
     of overall  drug spend.   While traditional  drug spend                                                                    
     slowed  to an  increase of  only 1.5  percent in  2008,                                                                    
     specialty  drug  spend   continued  its  steady  climb,                                                                    
     increasing 15.4 percent.                                                                                                   
                                                                                                                                
     House   Bill  218   protects  patients   with  critical                                                                    
     illnesses from  sudden changes in their  drug treatment                                                                    
     and therapy protocols  which may un-expectantly deprive                                                                    
     the  patient   from  critical  therapies  due   to  the                                                                    
     inability to  pay for  the drug  or sufficient  time to                                                                    
     plan alternative financial or therapeutic strategies.                                                                      
                                                                                                                                
     Currently,   insurance  companies   can  change   their                                                                    
     reimbursement  policies  with  only a  30  day  notice,                                                                    
     often  forcing  the  patient  to  absorb  thousands  of                                                                    
     dollars  of unexpected  costs  for expensive  specialty                                                                    
     drug  therapy.   By extending  the notification  period                                                                    
     the savings  for the patient  will be absorbed  by rest                                                                    
     of the policy  holders on the plan.  This  may give the                                                                    
     patient additional time to  explore other options which                                                                    
     may allow  for a transition  to a more  affordable plan                                                                    
     with similar therapeutic results.                                                                                          
                                                                                                                                
     Without   these  specialty   drugs   quality  of   life                                                                    
     deteriorates  and  long  term  health  care  costs  may                                                                    
     increase.   Additionally, cost savings may  be achieved                                                                    
     by exploring options  like management through specialty                                                                    
     pharmacies   that   use   drug-utilization   monitoring                                                                    
     specifically designed for hard to manage conditions.                                                                       
                                                                                                                                
4:00:35 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  clarified that proposed  HB 218 was a  House Health                                                               
and Social  Services Standing Committee  bill, and that  it would                                                               
behoove the committee to understand  the bill.  He declared that,                                                               
as  pharmaceuticals were  getting  more  expensive, Medicare  was                                                               
using  a tier  system  to adjust  the co-pays  in  an attempt  to                                                               
manage the  rising costs.  He  reported that the average  tier IV                                                               
specialty drugs now  cost $2500 each month, and  that these price                                                               
increases had  been accompanied with  only a  30 day notice.   He                                                               
pointed out that  the proposed bill had a zero  fiscal note, with                                                               
the additional cost passed to the insurers.                                                                                     
                                                                                                                                
4:03:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON asked why there  was a request for 90 days,                                                               
if 30 days was the status quo.                                                                                                  
                                                                                                                                
MS. OGAN replied that 90 days was  felt to be a fair and adequate                                                               
amount of time.                                                                                                                 
                                                                                                                                
4:03:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HERRON, referring  to a  letter from  Jack McRae,                                                               
Senior Vice President of Premera  [Included in members' packets],                                                               
read:   "This change will  inflate costs for specialty  drugs and                                                               
will  increase overall  healthcare  premiums for  Alaskans."   He                                                               
asked for this  to be "expanded in explanation,"  in writing, for                                                               
the committee.                                                                                                                  
                                                                                                                                
4:05:02 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  declared that  he had  no intent  to move  the bill                                                               
today, as he only wanted to hear a discussion.                                                                                  
                                                                                                                                
4:05:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA asked  if it  were different  drugs that                                                               
caused the prices to rise so quickly.                                                                                           
                                                                                                                                
MS. OGAN replied that these  were specialty drugs for auto immune                                                               
diseases and  chronic conditions.   She relayed that  some people                                                               
were  paying a  co-insurance of  30 percent  of the  retail cost.                                                               
She explained  the difference  between co-pay,  which was  a flat                                                               
payment, and co-insurance, which was a percentage of cost.                                                                      
                                                                                                                                
4:07:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA  stated that although she  liked the idea                                                               
of giving  notice, she had  concerns for the availability  of the                                                               
older drug.                                                                                                                     
                                                                                                                                
4:07:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON, referring  to  the aforementioned  letter                                                               
from  Mr. McRae,  directed  attention  to page  2,  "Less than  3                                                               
percent   of   private   health  plan   members   use   specialty                                                               
pharmaceuticals;  however,  these members  account  for  25 -  30                                                               
percent of total  private payer medical costs."   He acknowledged                                                               
that the medical  costs to the State of  Alaska retirement system                                                               
for Alaskan retirees  prior to 65 years of age,  accounted for 75                                                               
percent of the  unfunded liability.  He asked if  proposed HB 218                                                               
would  increase the  unfunded liability  to the  state retirement                                                               
plan, and if so, to what extent.                                                                                                
                                                                                                                                
MS. OGAN replied that she would research that information.                                                                      
                                                                                                                                
REPRESENTATIVE SEATON  pointed out that any  proposed legislation                                                               
which affected benefits to the  retirement system was required in                                                               
statute to have a fiscal note.   He asked if this tier system was                                                               
just for new drugs, and, opining that  this was on a drug by drug                                                               
basis, asked for clarification as to who this would impact.                                                                     
                                                                                                                                
MS. OGAN  relayed that discussion  with drug  manufacturers would                                                               
determine if  these drugs should  be tiered.  She  clarified that                                                               
some of  these were not new  drugs, but that the  expense was now                                                               
being passed on to the consumers.                                                                                               
                                                                                                                                
4:11:38 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  affirmed that he  had also presumed that  this cost                                                               
increase was  for new drugs.   He expressed the need  for caution                                                               
in identifying any of the groups as "good guys" or "bad guys."                                                                  
                                                                                                                                
4:13:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER passed the gavel to Vice Chair Dick.                                                                               
                                                                                                                                
4:13:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLER  asked  for  the  definition  of  "a  drug                                                               
formulary system."                                                                                                              
                                                                                                                                
MS. OGAN replied that she would research that definition.                                                                       
                                                                                                                                
4:13:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON offered his belief  that drugs needed to go                                                               
through  a  public vetting  process  prior  to designation.    He                                                               
questioned the length  of time necessary for a drug  to be listed                                                               
on a formulary.                                                                                                                 
                                                                                                                                
4:15:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLER asked if the  proposed bill could include a                                                               
required notification to patients that a change was pending.                                                                    
                                                                                                                                
MS. OGAN replied that the suggestion should be explored.                                                                        
                                                                                                                                
4:17:08 PM                                                                                                                    
                                                                                                                                
LEONARD   SORRIN,  Attorney,   Director   Of  Congressional   and                                                               
Legislative Affairs,  Premera Blue  Cross Blue Shield  of Alaska,                                                               
stated that Premera  Blue Cross was in opposition to  HB 218.  He                                                               
stated that Premera understood the  financial burden of specialty                                                               
drugs on  health care  consumers and on  the health  care system.                                                               
He noted that this increase in drug  cost was a key driver to the                                                               
increase  in health  care  costs over  the next  few  years.   He                                                               
opined that  the health  care system would  be "struggling  for a                                                               
number of years to figure out  how best to finance these sorts of                                                               
drugs,  how  best  to  provide   them."    He  stated  that  this                                                               
discussion  would need  to include  the pharmaceutical  industry.                                                               
He  directed  attention to  the  aforementioned  letter from  Mr.                                                               
McRae, which outlined the Premera  concerns with proposed HB 218.                                                               
He  pointed  out  that  Premera   currently  supplied  a  written                                                               
notification regarding  any policy change  30 days in  advance of                                                               
the  change in  terms.   He said  that he  was not  aware of  any                                                               
complaints or  concerns from members.   He cited that  the market                                                               
standard for notification  was 30 days, and that the  shift to 90                                                               
days  for  notification would  inflate  the  costs for  specialty                                                               
drugs and  would increase  the overall  health care  premiums for                                                               
all Alaskans.   He detailed that the longer a  health plan needed                                                               
to wait  until a change  was instituted,  the higher the  cost to                                                               
the system, which would increase premiums for the entire system.                                                                
                                                                                                                                
4:19:57 PM                                                                                                                    
                                                                                                                                
VICE  CHAIR DICK  asked for  any suggestions  to proposed  HB 218                                                               
that would be workable for Premera.                                                                                             
                                                                                                                                
4:20:15 PM                                                                                                                    
                                                                                                                                
MR. SORRIN  replied that  this was a  complicated set  of issues.                                                               
He offered his belief that  this "requires a broader based effort                                                               
to consider  how the system  at large  ought to respond  to these                                                               
types of costs and ought to finance these types of costs."                                                                      
                                                                                                                                
4:21:02 PM                                                                                                                    
                                                                                                                                
VICE CHAIR DICK asked that  any suggestions for solutions be sent                                                               
to the committee.                                                                                                               
                                                                                                                                
MR. SORRIN agreed to respond.                                                                                                   
                                                                                                                                
4:22:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked  Mr.  Sorrin if  he  worked  with                                                               
Premera and the State of Alaska health plan.                                                                                    
                                                                                                                                
MR.  SORRIN replied  that he  was  with Premera  Blue Cross  Blue                                                               
Shield of Alaska, which, until  a few years ago, had administered                                                               
the Alaska  employee benefit  plan.  He  shared that  his company                                                               
was still very involved with health plans in the Alaska market.                                                                 
                                                                                                                                
4:23:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  said  that,  for the  record,  she  had                                                               
complained about this problem.  She  asked for the kinds of drugs                                                               
being referenced.                                                                                                               
                                                                                                                                
MR. SORRIN  said that he  could not  provide names of  drugs, but                                                               
that  the  legislative   intent  of  proposed  HB   218  was  for                                                               
biological drugs  which provided treatment for  acute and chronic                                                               
illnesses.    He pointed  out  that  these drugs  were  extremely                                                               
expensive, and were, generally, new  drugs.  He stated that there                                                               
was a  crisis for how  to finance and  spread the cost  for these                                                               
expensive drugs.                                                                                                                
                                                                                                                                
4:25:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA asked for a  breakdown to the cost of the                                                               
drugs, to include the cost of  research, the profit, and the cost                                                               
to the customer.                                                                                                                
                                                                                                                                
4:25:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  opined that Premera had  managed the State                                                               
of  Alaska health  care during  the establishment  of the  tiered                                                               
formulary.  He  asked if these current tiers were  the same tiers                                                               
which the State of Alaska had  used, or an in-house tier of drugs                                                               
which Premera had designated for its insured patients.                                                                          
                                                                                                                                
MR. SORRIN  replied that  these tiers  were developed  by Premera                                                               
for its insured and self-insured  accounts.  He declared that the                                                               
vast  majority  of the  self-insured  accounts  used the  Premera                                                               
formulary.  He reported that  Premera was presently transitioning                                                               
to a value  based formulary, which assessed value  to the overall                                                               
holistic  value  of  a  drug  compared with  another  drug.    He                                                               
explained  that  this  value  would  include  the  medical  costs                                                               
foregone by the use of one drug  over another.  He noted that the                                                               
prescription drug formulary process  was in a continual evolution                                                               
for adaptation to the pharmaceutical marketplace.                                                                               
                                                                                                                                
4:27:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if drugs designed  for specific body                                                               
chemistry or  genetics were categorically  specified for  a tier,                                                               
and  was  it  necessary  for  the drugs  to  be  released  before                                                               
entering the tier process.                                                                                                      
                                                                                                                                
MR. SORRIN,  in response,  explained that  a drug,  subsequent to                                                               
its approval by the U.S.  Food and Drug Administration (FDA), was                                                               
reviewed  by a  health plan  to  determine its  placement on  the                                                               
formulary.  He stated that  disease specific drugs were generally                                                               
the biological drugs included in the specialty listing.                                                                         
                                                                                                                                
4:29:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   asked  about  the  time   necessary  for                                                               
placement of a drug in the formulary.                                                                                           
                                                                                                                                
MR.  SORRIN replied  that  he did  not know  how  long after  FDA                                                               
approval that the  process began, but deciding where  to place it                                                               
on the  formulary was  a relatively quick  process.   He reported                                                               
that Premera had a pharmacy  and therapeutic committee, comprised                                                               
of outside  pharmaceutical medical  experts and  ethical experts,                                                               
which met regularly for assessment and placement of drugs.                                                                      
                                                                                                                                
4:30:31 PM                                                                                                                    
                                                                                                                                
BRENDA ROBERTSON  shared a personal  experience for  the dramatic                                                               
increase in  the cost of  a drug.   She stated that  her husband,                                                               
Steven,  had been  taking copaxone  to  treat multiple  sclerosis                                                               
(MS)  for 10  years.   She reported  that, in  addition to  their                                                               
monthly  insurance  premium,  they  would  now  have  to  pay  an                                                               
additional $1000 each month for the copaxone.  She remarked:                                                                    
                                                                                                                                
     we  thought  that we  had  done  all the  right  things                                                                    
     because   we  were   paying   our  insurance   premiums                                                                    
     faithfully  every month,  so we  wouldn't have  to deal                                                                    
     with a surprising  financial burden.  And  yet, here we                                                                    
     were facing this unbelievable expense.                                                                                     
                                                                                                                                
MS. ROBERTSON  conveyed that  they had learned  to live  with the                                                               
challenges  of   MS,  never  asking  for   special  treatment  or                                                               
assistance, but had not expected  to be penalized for being sick.                                                               
She   commented:      "this   practice   of   specialty   tiering                                                               
discriminates against the  sickest among us and  puts their lives                                                               
in  danger."   She  pointed  out that  there  was  not a  generic                                                               
alternative  drug, all  MS  drugs were  included  in a  specialty                                                               
tier.  She stressed "that is  unfair and it is unconscionable" to                                                               
raise the cost  by several thousand percent, with  no notice, for                                                               
a lifesaving medication  with no generic options.   She expressed                                                               
her understanding  for the  need of  insurance companies  to save                                                               
money, but, she stated:                                                                                                         
                                                                                                                                
     this is  not the way.   Realizing their savings  on the                                                                    
     backs  of the  most vulnerable  Alaskans, the  sickest,                                                                    
     the  weakest,  and yet,  generally  the  ones that  are                                                                    
     still  getting  up  every day,  pushing  through  their                                                                    
     hardships,  going  to  work, and  contributing  to  the                                                                    
     state  economy,  there  cannot  be  anything  moral  or                                                                    
     ethical about it.                                                                                                          
                                                                                                                                
MS. ROBERTSON observed  that many states had  banned the practice                                                               
of  specialty  tiers,  with  an  additional  16  states  enacting                                                               
legislation  to either  ban  the specialty  tiers,  or limit  the                                                               
annual cost  increase to patients.   She opined that a  result of                                                               
drug   tiers  could   be  the   chronically   ill  becoming   the                                                               
responsibility of the state.  She  stated her support for HB 218,                                                               
but  she emphasized  that  the increased  costs  to patients  for                                                               
specialty drugs was  a bigger problem.  She urged  the passage of                                                               
legislation to  ban the  specialty tiers, or,  at the  least, cap                                                               
the annual  patient payments.   She affirmed  that many  of these                                                               
specialty tier drugs were not new drugs.                                                                                        
                                                                                                                                
4:36:48 PM                                                                                                                    
                                                                                                                                
MS.  ROBERTSON, in  response  to  Representative Miller,  replied                                                               
that the drug was copaxone, and  that it was manufactured by TEVA                                                               
pharmaceutical.                                                                                                                 
                                                                                                                                
4:37:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KERTTULA  expressed   that  she   was  outraged,                                                               
especially as this was not a new drug.                                                                                          
                                                                                                                                
MS. ROBERTSON, in response to  Representative Kerttula, said that                                                               
they  had been  informed of  the cost  increase by  the pharmacy.                                                               
She  offered her  belief that  having insurance  was supposed  to                                                               
protect  people from  this  type of  financial  crisis, and  that                                                               
people would  stop taking the  medication if prices  increased so                                                               
dramatically, because they had no choices.                                                                                      
                                                                                                                                
4:40:11 PM                                                                                                                    
                                                                                                                                
ROBERT LADA,  MD, Providence Alaska  Medical Center,  stated that                                                               
he was  a neurologist  and a  specialist in  sleep medicine.   He                                                               
expressed concern  with proposed HB  218.  He declared  that most                                                               
of the MS  medications had been released in the  early 1990s, and                                                               
allowed the  patient to have a  normal life span and  the ability                                                               
to work.   He pointed  out that  during the 1990s,  the insurance                                                               
companies  had labeled  the MS  medications as  experimental, and                                                               
therefore,  most patients  could not  afford the  treatment.   In                                                               
later years, as insurance coverage  was expanded by the insurance                                                               
companies,  the prices  to  patients were  more  affordable.   He                                                               
established  that this  tier system  would increase  the cost  to                                                               
patients so  dramatically that  they could  only afford  the less                                                               
effective  drugs  previously used  for  treatment  in the  1980s,                                                               
which would  not allow them "to  go through life in  the best way                                                               
possible, with the  less amount of the disability and  be able to                                                               
work."   He established that  options were limited no  matter the                                                               
lead time  for notification,  but that a  90 day  notification at                                                               
least allowed the opportunity to explore other options.                                                                         
                                                                                                                                
4:44:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked  if  the drug  prices  were  also                                                               
increasing for existing drugs, and not just new drugs.                                                                          
                                                                                                                                
DR. LADA replied  that all drug prices  were increasing, although                                                               
there were options for some of the drugs.                                                                                       
                                                                                                                                
4:45:37 PM                                                                                                                    
                                                                                                                                
VICE CHAIR  DICK asked  why the  cost would  increase for  a drug                                                               
that had no additional research to increase its expense.                                                                        
                                                                                                                                
DR. LADA  explained that it  was the insurance coverage  that was                                                               
being removed and that cost  was being transferred to the patient                                                               
responsibility.                                                                                                                 
                                                                                                                                
4:46:50 PM                                                                                                                    
                                                                                                                                
ANTONIA  FIFLIS-FOWLER,   Executive  Director,   Alaska  Multiple                                                               
Sclerosis  Foundation, stated  that the  foundation supported  HB
218.  She shared that there  had not many treatments when she was                                                               
diagnosed with  MS 30 years prior.   She touted the  results from                                                               
the new MS drugs, and expressed  her agreement with Dr. Lada that                                                               
removal  of  the  affordable  access for  these  drugs  would  be                                                               
regressive.   She  noted that  although  HB 218  only proposed  a                                                               
simple  notification  change,  it  brought an  awareness  of  the                                                               
unfair  burden  for drug  costs  to  the  chronically ill.    She                                                               
acknowledged that the  stress of not knowing  whether an increase                                                               
in  financial obligations  was looming  would  exacerbate the  MS                                                               
symptoms.   She expressed  agreement for a  ban to  the specialty                                                               
drug tiers as these tiers  were discriminatory toward people with                                                               
chronic  conditions.   She encouraged  support  for HB  218.   In                                                               
response  to an  earlier question  from Representative  Kerttula,                                                               
she listed the  other drugs for treatment of MS.   In response to                                                               
an  earlier  question  from Representative  Seaton,  she  defined                                                               
specialty tier  IV drugs as  "drugs made of proteins  from living                                                               
cells that are needed to be infused or injected."                                                                               
                                                                                                                                
4:51:44 PM                                                                                                                    
                                                                                                                                
VICE  CHAIR DICK  announced that  public  testimony would  remain                                                               
open.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  SEATON  suggested   assembling  information  from                                                               
other  states   addressing  this   issue,  in  order   to  better                                                               
understand the effects of various actions.                                                                                      
                                                                                                                                
4:52:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLER emphasized  the  need  for a  conversation                                                               
about:                                                                                                                          
                                                                                                                                
     the  sudden  increase in  cost  or  how its  formulated                                                                    
     because its  somewhere between  the manufacturers  of a                                                                    
     drug  claiming that  they have  high R&D  [research and                                                                    
     development] costs bringing that  product to market and                                                                    
     ... the  costs that insurance companies  decide need to                                                                    
     be  brought  forward. ...  It  seems  that this  entire                                                                    
     industry is always profitable,  several points ahead of                                                                    
     inflation, year after year after  year after year.  For                                                                    
     20 or  30 years this has  been going on.   I have never                                                                    
     been satisfied with knowing what  is the true causer of                                                                    
     all this  cost increase.   I find it constant  that the                                                                    
     insurance  coverages are  less  and  less, co-pays  are                                                                    
     higher or  impossible, and I  think it's time  we start                                                                    
     investigating this all the way  down to the very bottom                                                                    
     level.  Where  is the research starting?   Who's paying                                                                    
     for it?   What is it  really cost?  What  are the mark-                                                                    
     ups?   Where are these  people making all  the profits?                                                                    
     This has  got to be  discovered.  ... I  certainly want                                                                    
     to know these things.                                                                                                      
                                                                                                                                
VICE  CHAIR  DICK expressed  appreciation  for  the work  of  the                                                               
pharmaceutical companies, but affirmed  that "there certainly are                                                               
some mysteries going on."                                                                                                       
                                                                                                                                
4:54:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  directed  attention to  a  recent  report                                                               
about health  care costs.   He asked  for more  information about                                                               
the costs for infusion drugs in  Alaska, relative to the costs in                                                               
other western states.                                                                                                           
                                                                                                                                
[HB 218 was held over.]                                                                                                         
                                                                                                                                
4:55:05 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 4:55 p.m.                                                                                                          

Document Name Date/Time Subjects
State Medical Board Confirmations.docx HHSS 2/28/2012 3:00:00 PM
01 - HB 310 27-LS1273.A.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
02 - HB 310 sponsor statement 27-LS1273.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
2.5HB310-DHSS-EPI-2-10-12.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
03 - SB 144 Leg Legal Sectional Analysis (HB310 MODIFICATION HAS BEEN REQUESTED).pdf HHSS 2/28/2012 3:00:00 PM
HB 310
SB 144
04 - DHSSdph Epidemiology Bulletin 2010.10.06.pdf HHSS 2/28/2012 3:00:00 PM
4.5 - DHSSdph Epidemiology Bulletin 2010.10.19.pdf HHSS 2/28/2012 3:00:00 PM
05 - Alaska Health Care Commission 2011 Report exerpt.pdf HHSS 2/28/2012 3:00:00 PM
06 - HB 310 support letter Dr. Rosalyn Singleton.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
07 - HB 310 support letter PremeraBCBS.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
08 - HB 310 support letter Dr. Mary Ann Jacob.pdf HHSS 2/28/2012 3:00:00 PM
HB 310
test HHSS 2/28/2012 3:00:00 PM
HB 218
3 HB 218 Sectional summary.pdf HHSS 2/28/2012 3:00:00 PM
HB 218
4 Premera Letter HB 218.pdf HHSS 2/28/2012 3:00:00 PM
HB 218
2 HB 218.pdf HHSS 2/28/2012 3:00:00 PM
HB 218
2.5 HB 218-DCCED-INS-02-24-12 fiscal note.pdf HHSS 2/28/2012 3:00:00 PM
HB 218
1 HB 218 sponsor.docx HHSS 2/28/2012 3:00:00 PM
HB 218