Legislature(2017 - 2018)CAPITOL 106

04/13/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 118 COMPENSATION FOR WRONGFUL CONVICTION TELECONFERENCED
Heard & Held
-- Public Testimony --
+= SB 32 PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS TELECONFERENCED
Moved SB 32 Out of Committee
-- Public Testimony --
*+ HB 176 GROUND EMER. MEDICAL TRANSPORT PAYMENTS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 196 OPIOID TAX TELECONFERENCED
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 13, 2017                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 118                                                                                                              
"An  Act relating  to compensation  for  wrongful conviction  and                                                               
imprisonment."                                                                                                                  
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 32                                                                                                              
"An  Act  relating  to  biological   products;  relating  to  the                                                               
practice  of pharmacy;  relating to  the Board  of Pharmacy;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
     - MOVED SB 32 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 176                                                                                                              
"An Act  relating to medical assistance  reimbursement for ground                                                               
emergency medical  transportation services; and providing  for an                                                               
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 196                                                                                                              
"An Act  relating to a  tax on  certain opioids; relating  to the                                                               
alcohol and other  drug abuse treatment and  prevention fund; and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 118                                                                                                                  
SHORT TITLE: COMPENSATION FOR WRONGFUL CONVICTION                                                                               
SPONSOR(s): REPRESENTATIVE(s) KAWASAKI                                                                                          
                                                                                                                                
02/13/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/13/17       (H)       HSS, JUD, FIN                                                                                          
04/11/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/11/17       (H)       Heard & Held                                                                                           
04/11/17       (H)       MINUTE(HSS)                                                                                            
04/13/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: SB 32                                                                                                                   
SHORT TITLE: PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS                                                                              
SPONSOR(s): SENATOR(s) HUGHES                                                                                                   
                                                                                                                                
01/23/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/23/17       (S)       HSS, L&C                                                                                               
02/10/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/10/17       (S)       Heard & Held                                                                                           
02/10/17       (S)       MINUTE(HSS)                                                                                            
02/15/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/15/17       (S)       Moved  SB 32 Out of Committee                                                                          
02/15/17       (S)       MINUTE(HSS)                                                                                            
02/17/17       (S)       HSS RPT 2DP 1NR 1AM                                                                                    
02/17/17       (S)       NR: WILSON                                                                                             
02/17/17       (S)       DP: VON IMHOF, BEGICH                                                                                  
02/17/17       (S)       AM: GIESSEL                                                                                            
03/07/17       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/07/17       (S)       Heard & Held                                                                                           
03/07/17       (S)       MINUTE(L&C)                                                                                            
03/14/17       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/14/17       (S)       Moved  SB 32 Out of Committee                                                                          
03/14/17       (S)       MINUTE(L&C)                                                                                            
03/15/17       (S)       L&C RPT  5DP                                                                                           
03/15/17       (S)       DP: COSTELLO, HUGHES, MEYER, STEVENS,                                                                  
                         GARDNER                                                                                                
03/15/17       (S)       FIN REFERRAL ADDED AFTER L&C                                                                           
03/29/17       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/29/17       (S)       Heard & Held                                                                                           
03/29/17       (S)       MINUTE(FIN)                                                                                            
03/30/17       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/30/17       (S)       Moved  SB 32 Out of Committee                                                                          
03/30/17       (S)       MINUTE(FIN)                                                                                            
03/31/17       (S)       FIN AT 1:30 PM SENATE FINANCE 532                                                                      
03/31/17       (S)       -- MEETING CANCELED --                                                                                 
04/03/17       (S)       FIN RPT  1DP 3NR 1AM                                                                                   
04/03/17       (S)       NR: MACKINNON, BISHOP, DUNLEAVY                                                                        
04/03/17       (S)       DP: VON IMHOF                                                                                          
04/03/17       (S)       AM: OLSON                                                                                              
04/04/17       (S)       TRANSMITTED TO (H)                                                                                     
04/04/17       (S)       VERSION: SB  32                                                                                        
04/05/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/05/17       (H)       HSS, FIN                                                                                               
04/11/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/11/17       (H)       Heard & Held                                                                                           
04/11/17       (H)       MINUTE(HSS)                                                                                            
04/13/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 176                                                                                                                  
SHORT TITLE: GROUND EMER. MEDICAL TRANSPORT PAYMENTS                                                                            
SPONSOR(s): REPRESENTATIVE(s) FANSLER                                                                                           
                                                                                                                                
03/14/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/14/17       (H)       HSS, FIN                                                                                               
04/13/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
OLIVIA GARRETT, Staff                                                                                                           
Representative Scott Kawasaki                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 118 on behalf of the bill                                                                   
sponsor, Representative Kawasaki.                                                                                               
                                                                                                                                
TIFFANY MERRITT, Graduate Student                                                                                               
University of North Carolina                                                                                                    
Greensboro, North Carolina                                                                                                      
POSITION STATEMENT:  Testified in support of HB 118.                                                                          
                                                                                                                                
WILLIAM HARRINGTON                                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 118.                                                                   
                                                                                                                                
AIMEE BUSHNELL, Staff                                                                                                           
Senator Shelley Hughes                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SB 32 on behalf of the bill                                                                    
sponsor, Senator Hughes.                                                                                                        
                                                                                                                                
SENATOR SHELLEY HUGHES                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Reviewed SB 32 as the sponsor of the bill.                                                               
                                                                                                                                
ROBERT THOMS                                                                                                                    
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
CINDY CASERTA                                                                                                                   
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
BECKY HULTBERG, President/CEO                                                                                                   
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
PHIL SCHNEIDER                                                                                                                  
Alliance for Safe Biologic Medicines                                                                                            
Phoenix, Arizona                                                                                                                
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
KERRY McCLELLAND                                                                                                                
Colon Cancer Alliance                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
MARK GUIMOND, Director                                                                                                          
Legislative Affairs                                                                                                             
Arthritis Foundation                                                                                                            
Washington, DC                                                                                                                  
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
THOMAS FELIX, MD                                                                                                                
Amgen                                                                                                                           
Washington, DC                                                                                                                  
POSITION STATEMENT:  Testified in support of SB 32.                                                                           
                                                                                                                                
CRYSTAL KOENEMAN                                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of SB 32.                                                                    
                                                                                                                                
REPRESENTATIVE ZACH FANSLER                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 176 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
MARGARET BRODIE, Director                                                                                                       
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
176.                                                                                                                            
                                                                                                                                
BILL HOWELL, Fire Chief                                                                                                         
City of Bethel                                                                                                                  
Bethel, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 176.                                                                          
                                                                                                                                
ALEX BOYD, Assistant Chief                                                                                                      
Anchorage Fire Department                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 176.                                                                          
                                                                                                                                
RICHARD ETHERIDGE, Fire Chief                                                                                                   
Juneau, Alaska                                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 176.                                                                          
                                                                                                                                
SCOTT CLOUGH                                                                                                                    
AP Triton                                                                                                                       
Retired Fire Chief                                                                                                              
Sacramento, California                                                                                                          
POSITION STATEMENT:  Testified during discussion of HB 176.                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:54 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives  Spohnholz,  Sullivan-Leonard, Edgmon,  Johnston,                                                               
and  Tarr were  present at  the call  to order.   Representatives                                                               
Kito and Eastman arrived as the meeting was in progress.                                                                        
                                                                                                                                
          HB 118-COMPENSATION FOR WRONGFUL CONVICTION                                                                       
                                                                                                                                
3:05:50 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the first order of business would                                                                
be HOUSE BILL NO. 118, "An Act relating to compensation for                                                                     
wrongful conviction and imprisonment."                                                                                          
                                                                                                                                
3:06:17 PM                                                                                                                    
                                                                                                                                
OLIVIA GARRETT, Staff, Representative Scott Kawasaki, Alaska                                                                    
State Legislature, summarized from the Sponsor Statement                                                                        
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     Our judicial system is meant  to incarcerate the guilty                                                                    
     and  protect   the  innocent.   If  the   system  fails                                                                    
     Alaskans,  then the  state is  responsible to  help the                                                                    
     innocent get back on their feet.                                                                                           
                                                                                                                                
     With increasing technology,  DNA exonerations have been                                                                    
     on  the rise.  There have  been 349  postconviction DNA                                                                    
     exonerations   since  1989   with  the   vast  majority                                                                    
     occurring  since  2000.   These  individuals  spent  an                                                                    
     average of 14 years behind  bars and were released into                                                                    
     a changed world. House Bill  118 gives these wrongfully                                                                    
     imprisoned victims  a chance  to start  a new  life and                                                                    
     integrate back into society.                                                                                               
                                                                                                                                
     Specifically, HB 118  creates an administrative process                                                                    
     whereby victims of  overturned criminal convictions can                                                                    
     request compensation  from the  state for  time served.                                                                    
     They can be  compensated up to $50,000 per  year with a                                                                    
     lifetime  cap  at  $2  million,  University  of  Alaska                                                                    
     tuition  for  themselves  and  their  children,  state-                                                                    
     funded  health care  including mental  health services,                                                                    
     up to  3 years  of state  funded job  training services                                                                    
     and economic damages including  lost wages and attorney                                                                    
     fees.  In order  to qualify  for the  compensation, the                                                                    
     claimant must have served time  in prison and then have                                                                    
     been  exonerated  via  retrial, dismissed  charges,  or                                                                    
     executive pardon because of innocence.                                                                                     
                                                                                                                                
     While there is  no price on the  emotional and personal                                                                    
     suffering of  those who were wrongfully  imprisoned, HB                                                                    
     118 would  bring Alaska up to  the federal compensation                                                                    
     standards to  help right  the state's  wrong. Financial                                                                    
     compensation   would    help   victims    of   wrongful                                                                    
     imprisonment repair  their lives  by covering  costs of                                                                    
     education, healthcare, housing and transportation.                                                                         
                                                                                                                                
     Thirty-two  states and  the District  of Columbia  have                                                                    
     some  sort  of  compensation  statute.  Every  innocent                                                                    
     person,  regardless of  how  they became  incarcerated,                                                                    
     deserves just  compensation for  the time  they wrongly                                                                    
     served. HB  118 is a  stepping stone in a  long process                                                                    
     towards ensuring justice for all Alaskans.                                                                                 
                                                                                                                                
3:07:10 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony on HB 118.                                                                              
                                                                                                                                
3:07:28 PM                                                                                                                    
                                                                                                                                
TIFFANY MERRITT, Graduate Student,  University of North Carolina,                                                               
noted that  she was born and  raised in Alaska and  was currently                                                               
attending graduate  school at the  University of  North Carolina.                                                               
She shared  that her master's  research was in Sociology,  with a                                                               
concentration  in  Criminology.   She  reported  that, for  three                                                               
years, she  had been doing  research on wrongful  convictions and                                                               
she had  created a database  for the amount of  financial redress                                                               
received  by  death row  exonerees.    She  stated that  only  40                                                               
percent of  death row exonerees  received redress, and  that only                                                               
31  states had  compensation statutes,  pointing out  that Alaska                                                               
did not  have this  statute, even as  former Senator  Ted Stevens                                                               
was "technically an  exoneree."  She reported  that exonerees had                                                               
had everything  taken from  them.   After years  of incarceration                                                               
and  the loss  of  many  workable years  with  the attendant  job                                                               
experience, they were  released with a host of  health and mental                                                               
health  problems.    She  relayed  that much  of  this  could  be                                                               
addressed  by   the  proposed   bill.     She  stated   that  the                                                               
compensation package  in the proposed  bill was "probably  one of                                                               
the best  I've seen in  my research."   She declared  her support                                                               
for  the  proposed  bill,  noting that  the  United  Nations  had                                                               
mandated  for countries  to provide  compensation  for those  who                                                               
were wrongfully convicted within their borders.                                                                                 
                                                                                                                                
3:09:42 PM                                                                                                                    
                                                                                                                                
WILLIAM HARRINGTON urged swift passage  of the proposed bill, and                                                               
he suggested  to amend the bill  to include past incidences.   He                                                               
stated  that the  current treatment  of  wrongfully convicted  in                                                               
Alaska showed "no dignity."  He  said that it was necessary for a                                                               
strong  message of  dignity  to  be sent  from  the Alaska  State                                                               
Legislature and the governor to its citizens.                                                                                   
                                                                                                                                
3:11:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:12:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 118 would be held over.                                                                       
                                                                                                                                
          SB 32-PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS                                                                       
                                                                                                                                
3:12:06 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be SENATE BILL  NO. 32, "An Act relating  to biological products;                                                               
relating to  the practice of  pharmacy; relating to the  Board of                                                               
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
3:12:35 PM                                                                                                                    
                                                                                                                                
AIMEE  BUSHNELL,  Staff,  Senator Shelley  Hughes,  Alaska  State                                                               
Legislature,  briefly recapped  the main  points of  the proposed                                                               
bill, which  included:   only bio-similars  approved by  the U.S.                                                               
Food and  Drug Administration (FDA) as  interchangeables could be                                                               
substituted for  the original prescription; within  three days of                                                               
dispensation of the  product to the patient,  a notification must                                                               
be  sent to  the  original prescriber;  and,  the prescriber  can                                                               
write "dispense as  written" on the prescription, if  this is the                                                               
only product the prescriber wants for the patient.                                                                              
                                                                                                                                
SENATOR  SHELLEY  HUGHES,  Alaska State  Legislature,  reiterated                                                               
that access to these medications  was important to many Alaskans,                                                               
and  that  the  proposed  bill   described  the  arrangement  and                                                               
notifications between the doctor and the pharmacist.                                                                            
                                                                                                                                
3:15:13 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony on SB 32.                                                                               
                                                                                                                                
3:15:22 PM                                                                                                                    
                                                                                                                                
ROBERT THOMS stated that he was  also known as Cajun Bob and that                                                               
he was  a Vietnam combat  veteran and  a recipient of  the Silver                                                               
Star medal,  as well as six  Purple Hearts.  He  declared that he                                                               
had chronic  pain for more  than 45 years,  and that he  had been                                                               
diagnosed  with severe  rheumatoid arthritis.   He  reported that                                                               
his original  medication was not  a biologic, which  "after three                                                               
years,  it  almost  killed  me."    He  said  that  he  was  then                                                               
prescribed  a biologic,  Humera,  which allowed  him  to enjoy  a                                                               
functional life after being bed  ridden.  He noted that, although                                                               
he was  not yet 100  percent, this had  allowed him to  do chores                                                               
and  projects with  his wife.   He  declared that,  although this                                                               
biologic "was  a miracle,"  he did  not know  if it  would always                                                               
work.   He  emphasized  that  it was  necessary  to approve  this                                                               
proposed   legislation  immediately,   as  he   wanted  to   have                                                               
immediately  available  any   approved  substitute,  should  this                                                               
current biologic cease to work.                                                                                                 
                                                                                                                                
3:18:25 PM                                                                                                                    
                                                                                                                                
CINDY CASERTA shared  that she was also a  chronic pain sufferer,                                                               
and that she spoke as an  ambassador for the U.S. Pain Foundation                                                               
in  support of  the proposed  bill.   She  referenced a  Stanford                                                               
study  of  6200  rheumatoid   arthritis  patients  on  biologics,                                                               
pointing out that  33 percent of these patients  stopped taking a                                                               
biologic within  two years  because of  a loss  of effectiveness.                                                               
She surmised that bio-similars could be the answer for Alaskans.                                                                
                                                                                                                                
3:20:10 PM                                                                                                                    
                                                                                                                                
BECKY HULTBERG, President/CEO, Alaska  State Hospital and Nursing                                                               
Home  Association  (ASHNHA),  reported   that  the  Alaska  State                                                               
Hospital  and   Nursing  Home  Association  had   consulted  with                                                               
hospital-based  pharmacists and  physicians  to  ensure that  the                                                               
proposed bill would supply the  necessary guidance to ensure safe                                                               
and  effective  treatments  for  patients,  while  providing  the                                                               
potential  to lower  pharmaceutical  costs.   She reported  that,                                                               
following  this  consultation,  ASHNHA  decided  to  support  the                                                               
proposed  bill.   She declared  that critical  components of  the                                                               
bill  included   its  specific  communication   requirements  and                                                               
timelines for pharmacists  associated with dispensing bio-similar                                                               
medication.   She stated  that the proposed  bill would  meet the                                                               
needs  of pharmacists  in a  variety  of settings,  and that  the                                                               
proposed  bill strikes  the right  balance  for notification  and                                                               
communication.       She    reported   that    bio-similars   and                                                               
interchangeable  biological  products  offered  affordability  as                                                               
they would provide competition to  biologic drugs, similar to the                                                               
way generic  drugs did  for brand  name drugs.   She  offered her                                                               
belief  that proposed  SB  32 would  protect  patients and  would                                                               
benefit the state.                                                                                                              
                                                                                                                                
3:21:43 PM                                                                                                                    
                                                                                                                                
PHIL   SCHNEIDER,   Alliance   for   Safe   Biologic   Medicines,                                                               
paraphrased  from  a  letter of  support  [included  in  members'                                                               
packets], which read as follows [original punctuation provided]:                                                                
                                                                                                                                
     As  the  chairman  and  advisory  board  chair  of  the                                                                    
     Alliance  for Safe  Biologic Medicines  (ASBM), we  are                                                                    
     writing to urge  you to support Senate Bill  32 (SB 32)                                                                    
     regarding  the  pharmacy   substitution  of  biosimilar                                                                    
     medical products. ASBM is  an organization of patients,                                                                    
     physicians,   pharmacists,    manufacturers   of   both                                                                    
     innovative  and biosimilar  medicines, researchers  and                                                                    
     others  who  are  working together  to  ensure  patient                                                                    
     safety is  at the  forefront of the  biosimilars policy                                                                    
     discussion.                                                                                                                
                                                                                                                                
     As  a retired  pediatric  rheumatologist  and a  former                                                                    
     president  of  the  American Society  of  Health-system                                                                    
     Pharmacists,  we are  keenly aware  of the  benefits of                                                                    
     biologics in  treating serious conditions  like cancer,                                                                    
     rheumatoid  arthritis, diabetes,  and  MS. "Copies"  of                                                                    
     these   medicines,   called  "biosimilars"   have   the                                                                    
     potential to  provide these therapies at  reduced cost.                                                                    
     Yet   unlike  generic   versions   of  chemical   drugs                                                                    
     biosimilars   are  not   exact   duplicates  of   their                                                                    
     reference   products.   Indeed,   the   complexity   of                                                                    
     biologics    and   their    proprietary   manufacturing                                                                    
     processes  mean that  these "copies"  can only  ever be                                                                    
     similar, never  the same. Even the  smallest structural                                                                    
     difference between  a biologic  and its  attempted copy                                                                    
     can have  a significant impact on  a patient, including                                                                    
     reduced efficacy or unwanted immune responses.                                                                             
                                                                                                                                
     We   believe  that   when  interchangeable   biosimilar                                                                    
     products   are   substituted,   communication   between                                                                    
     patients,  pharmacists, and  health  care providers  is                                                                    
     essential  to patient  care. We  fully support  and are                                                                    
     concerned that  patient safety  will be  compromised if                                                                    
     this legislation is not enacted.                                                                                           
                                                                                                                                
     Since 2012,  ASBM has  conducted surveys  of physicians                                                                    
     in eleven  countries, to  gather their  perspectives on                                                                    
     biosimilars. The  results of  these surveys  have since                                                                    
     been  shared with  policymakers  in  the U.S.,  Canada,                                                                    
     Europe, and  the World  Health Organization  in Geneva,                                                                    
     Switzerland.                                                                                                               
                                                                                                                                
     Our survey  of 376  U.S. physicians  found that  80% of                                                                    
     those surveyed  called communication in the  event of a                                                                    
     biosimilar    substitution    "very    important"    or                                                                    
     "critical".                                                                                                                
                                                                                                                                
     Further, 82%  of U.S.  physicians called  the authority                                                                    
     to  block   a  substitution   by  indicating   "do  not                                                                    
     substitute" or "dispense as  written" on a prescription                                                                    
     "very important" or "critical".                                                                                            
                                                                                                                                
     These results  are consistent with those  of physicians                                                                    
     around the  world, including  those surveyed  in Canada                                                                    
     and   Europe,  where   biosimilars  are   currently  in                                                                    
     clinical  use. All  ASBM surveys  are available  on our                                                                    
     website at www.safebiologics.org/surveys.                                                                                  
                                                                                                                                
     It is  our view that  SB 32 appropriately  reflects the                                                                    
     importance  of  pharmacist-physician communication  and                                                                    
     keeping   treatment  decisions   the  purview   of  the                                                                    
     physician and patient, without  posing undue or onerous                                                                    
     burdens upon the pharmacist:                                                                                               
                                                                                                                                
     It  provides  that only  "interchangeable"  biosimilars                                                                    
     (those  determined  by  the FDA  to  produce  the  same                                                                    
     effects in  a patient as the  reference product without                                                                    
     additional risks) may ever be substituted.                                                                                 
                                                                                                                                
     It allows  a physician  to prevent a  substitution they                                                                    
     consider inappropriate for their  patient by writing on                                                                    
     the prescription "dispense as written".                                                                                    
                                                                                                                                
     It provides  that the pharmacist receive  the patient's                                                                    
     consent in  order to make a  substitution. The Alliance                                                                    
     for Safe  Biologic Medicines -  PO Box  3691 Arlington,                                                                    
     VA 22203  www.safebiologics.org - (703) 971-1700                                                                           
                                                                                                                                
     Finally,   SB   32   requires   that   the   pharmacist                                                                    
     communicate to  the physician within a  reasonable time                                                                    
     frame  (3 days)  which  biologic  the patient  actually                                                                    
     received    whether that  prescribed by  the physician,                                                                    
     or  a  substituted  biosimilar-  so  that  an  accurate                                                                    
     patient record can be kept by all parties.                                                                                 
                                                                                                                                
     SB  32  will  extend   these  valuable  protections  to                                                                    
     Alaska's  patients  while  increasing their  access  to                                                                    
     biologic therapies. For these  reasons, lawmakers in 26                                                                    
     states  and Puerto  Rico have  passed similar  bills in                                                                    
     the past few years.                                                                                                        
                                                                                                                                
3:24:49 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked about the  substantial differences for side                                                               
effects and efficacy for interchangeables.   She asked whether it                                                               
was safe  for pharmacists  to recommend  changes at  the pharmacy                                                               
point of sale, rather than from the prescriber.                                                                                 
                                                                                                                                
MR. SCHNEIDER  explained that  biologics were  medicines produced                                                               
by  living cells  and that  bio-similars were  biologics, similar                                                               
for the  therapeutic effect  and safety  profile, but  with minor                                                               
differences which  needed to  be considered.   He  clarified that                                                               
these were  not considered to  be interchangeable.  He  said that                                                               
the  third category  was interchangeable  bio-similar, which  had                                                               
been  categorized by  the FDA,  based on  studies which  involved                                                               
switching patients  back and forth between  the reference product                                                               
to the  bio-similar, and then back  again.  These studies  had to                                                               
demonstrate   that  the   interchangeable   bio-similar  had   no                                                               
differences  for  both its  effectiveness  and  its safety.    He                                                               
stated  that the  proposed bill  only related  to interchangeable                                                               
bio-similars  as considered  by the  FDA based  on the  switching                                                               
studies.   He added that the  FDA stated that a  pharmacist could                                                               
switch those  medicines.  The  purpose of  the state laws  was to                                                               
ensure  communication  with  the  prescriber,  even  though  that                                                               
happened after the fact.                                                                                                        
                                                                                                                                
3:28:09 PM                                                                                                                    
                                                                                                                                
KERRY  McCLELLAND, Colon  Cancer  Alliance, stating  that he  was                                                               
advocating  for  all cancer  patients,  shared  his history  with                                                               
cancer  and  various  treatments.     He  declared  that  it  was                                                               
important to  pass the proposed  bill so that Alaskans  would not                                                               
have to travel out of state.                                                                                                    
                                                                                                                                
3:30:11 PM                                                                                                                    
                                                                                                                                
MARK   GUIMOND,   Director,    Legislative   Affairs,   Arthritis                                                               
Foundation, stated  that the Foundation fully  supported proposed                                                               
SB 32.   He  pointed out  that arthritis  was a  lifelong chronic                                                               
disease, which could  be debilitating.  He  stated that biologics                                                               
offered a  benefit, as they  changed lives  to a good  quality of                                                               
life.    He  pointed  out that  these  were  complex  medications                                                               
because  they  were live  cells  and  were also  very  expensive.                                                               
These  represented   .01  percent  of  prescriptions   filled  at                                                               
pharmacies.  He expressed hope  that bio-similiars would have the                                                               
same effect  on the market as  generic drugs.  He  suggested that                                                               
it was  best to pass  this legislation immediately.   He declared                                                               
that  the   communication  aspect   of  the  proposed   bill  was                                                               
essential,  as  it created  a  complete  medical record  for  the                                                               
patients.  He declared support for the proposed bill.                                                                           
                                                                                                                                
3:33:24 PM                                                                                                                    
                                                                                                                                
THOMAS FELIX,  MD, Amgen, stated  support for the  proposed bill,                                                               
and he  discussed one of  the five  provisions, key to  the bill,                                                               
which was a  departure from existing generic  substitution law in                                                               
Alaska.   He  pointed  to  the requirement  for  a pharmacist  to                                                               
communicate  with a  physician following  the substitution  of an                                                               
interchangeable  bio-similar.   He  said that  this ensured  that                                                               
members of the health care team  were talking with each other, as                                                               
this   created   transparency   and   accessibility   to   needed                                                               
information.    He  allowed  that   some  had  advocated  for  no                                                               
communication as  it was  too burdensome.   He stated  that there                                                               
had  been work  with both  pharmacists and  stakeholders to  make                                                               
sure their perspectives were represented  in the proposed bill to                                                               
make it  less burdensome.   He said  that communication  prior to                                                               
the substitution  went against the  spirit of the  designation of                                                               
interchangeability.    He  shared  that  the  federal  law  which                                                               
allowed   the   bio-similar    pathway,   the   description   for                                                               
interchangeability  was  for  the pharmacist  to  exercise  their                                                               
discretion   for  substitution   without  the   consent  of   the                                                               
prescriber.  He relayed that  it was important to understand that                                                               
this  facilitated drug  safety surveillance,  which was  required                                                               
for all biologics, and that  bio-similars were also included.  He                                                               
reminded the  committee that there  were currently  four approved                                                               
bio-similars in the United States, of  which two had not yet been                                                               
distributed.     He  pointed   out  that,   as  two   were  self-                                                               
administered,  this legislation  provided clear  terms of  use to                                                               
both the health care team  and the patient. He directed attention                                                               
to  a recent  draft  guidance for  interchangeability, which  was                                                               
intended  to  provide  clarity  to the  community  for  what  was                                                               
required to receive an interchangeability  designation.  He added                                                               
that,  as the  FDA was  very busy  developing bio-similars  which                                                               
were trying  to mimic  23 reference  products coming  off patent,                                                               
there was  a need to  ensure that  the health care  community and                                                               
patients had  a clear  understanding for  use of  these products,                                                               
both when they  were interchangeable and when they  should not be                                                               
substituted.   He reminded  that the FDA  had set  an appropriate                                                               
scientific  bar for  approval of  these products  and that,  once                                                               
approved, they would  be highly similar to  an existing reference                                                               
product and the differences in  efficacy and safety should not be                                                               
a concern.   When  an interchangeable  was approved,  it signaled                                                               
that there was not a concern  for its use when switching with the                                                               
original product.  Patients suffering  from grievous illness will                                                               
be  comforted  by  knowing that  the  appropriate  measures  that                                                               
comport with new technologies were being passed.                                                                                
                                                                                                                                
3:41:11 PM                                                                                                                    
                                                                                                                                
CRYSTAL  KOENEMAN shared  her personal  story  for the  use of  a                                                               
biologic, Humera.   She reported that, although  this allowed her                                                               
to play with her young child and  function on a day to day basis,                                                               
these were  "scary.   They change your  chemical make-up  and you                                                               
are no  longer the  same."   She reported  that she  had recently                                                               
developed three lesions  on her brain, which  appeared similar to                                                               
multiple sclerosis.  She was then  unable to take biologics for a                                                               
few months,  and now she relied  on a name brand.   She expressed                                                               
her concern that with bio-similars,  insurance companies would no                                                               
longer cover name  brands.  She expressed  her understanding that                                                               
others  could not  afford  the cost  and  that some  bio-similars                                                               
would work for  some when the name brand did  not.  She expressed                                                               
support for the  proposed bill as it allowed for  choice, but she                                                               
expressed concern for  her ability to choose to be  taken away as                                                               
an unintended  consequence.  She  reported that she was  not able                                                               
to  take any  other biologic  that would  in any  way affect  her                                                               
nervous system.  She asked that the committee be cautious.                                                                      
                                                                                                                                
3:47:10 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
3:47:20 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ   moved  to  adopt  Amendment   1,  labeled  30-                                                               
LS0188\J.3, Wallace/Bruce, 4/13/17, which read:                                                                                 
                                                                                                                                
     Page 4, following line 10:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec. 8.  AS 21.42  is amended  by  adding a  new                                                                
     section to read:                                                                                                           
          Sec. 21.42.435. Coverage for biological products.                                                                   
     (a)  A  health care  insurer  that  offers, issues  for                                                                    
     delivery, delivers,  or renews  in this state  a health                                                                    
     care   insurance  plan   that  provides   coverage  for                                                                    
     biological  products  shall   provide  coverage  for  a                                                                    
     biological   product   or  interchangeable   biological                                                                    
     product  without requiring  prior authorization  if the                                                                    
     biological   product   or  interchangeable   biological                                                                    
     product is to be dispensed as prescribed.                                                                                  
          (b) In this section, "biological product" and                                                                         
     "interchangeable biological product"  have the meanings                                                                    
     given AS 08.80.480."                                                                                                       
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 4, line 17:                                                                                                           
          Delete "Section 8"                                                                                                    
          Insert "Section 9"                                                                                                    
                                                                                                                                
     Page 4, line 18:                                                                                                           
          Delete "sec. 9"                                                                                                       
          Insert "sec. 10"                                                                                                      
                                                                                                                                
                                                                                                                                
CHAIR SPOHNHOLZ objected for discussion.                                                                                        
                                                                                                                                
CHAIR  SPOHNHOLZ explained  that a  "tsunami"  of as  many as  41                                                               
biologic interchangeables was coming  and working through the FDA                                                               
process.   She noted how  important biologics were for  those who                                                               
took them, as  well as the transformative nature  they could have                                                               
for individuals.   She shared the  story of a biologic  that cost                                                               
$2000 each day.  She  explained that her proposed amendment would                                                               
require  that   health  insurance  plans  provide   coverage  for                                                               
biological  products,  both   interchangeables  and  biologicals,                                                               
without prior  authorization if the  product was to  be dispensed                                                               
as prescribed.   She said that  this would require coverage  of a                                                               
medication  prescribed  by  a  doctor  and  not  necessarily  the                                                               
cheapest one,  as a small  difference in  a product could  have a                                                               
big impact  on the health and  well-being of an individual.   She                                                               
wanted to ensure  that people with serious health  care issues in                                                               
the state be  able to have health care coverage  by the insurance                                                               
providers, and that cost not be the only consideration.                                                                         
                                                                                                                                
3:50:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  reflected on  the history  of the  change to                                                               
generic drugs from  name brand drugs, noting that,  as there were                                                               
some changes, some individuals reacted  adversely.  He encouraged                                                               
that the insurance companies be  sensitive to provide medications                                                               
as needed for the patient as identified by the medical team.                                                                    
                                                                                                                                
3:51:26 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ withdrew proposed Amendment 1.                                                                                  
                                                                                                                                
3:51:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN expressed  his  support  of the  proposed                                                               
bill.                                                                                                                           
                                                                                                                                
3:51:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON moved  to report  SB 32  out of  committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  SB 32 was moved from the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
3:52:03 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:52 p.m. to 3:54 p.m.                                                                       
                                                                                                                                
         HB 176-GROUND EMER. MEDICAL TRANSPORT PAYMENTS                                                                     
                                                                                                                              
3:54:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be HOUSE  BILL NO.  176, "An Act  relating to  medical assistance                                                               
reimbursement   for  ground   emergency  medical   transportation                                                               
services; and providing for an effective date."                                                                                 
                                                                                                                                
3:55:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved  to adopt  the  proposed  committee                                                               
substitute (CS) for HB 176,  labeled 30-LS0705\J, Glover, 4/7/17,                                                               
as the working draft.                                                                                                           
                                                                                                                                
3:56:08 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ objected for discussion.                                                                                        
                                                                                                                                
3:56:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   ZACH   FANSLER,    Alaska   State   Legislature,                                                               
paraphrased  from the  Sponsor  Statement  [Included in  members'                                                               
packets], which read:                                                                                                           
                                                                                                                                
     "An  Act relating  to medical  assistance reimbursement                                                                    
     for  emergency  medical  transportation  services;  and                                                                    
     providing for an effective date."                                                                                          
                                                                                                                                
     Emergency   Medical   Transportation  Services   (EMTS)                                                                    
     relates  to the  emergency transportation  of patients.                                                                    
     For  what  is  traditionally  considered  an  ambulance                                                                    
     ride,  EMTS   reflects  Alaska's   unique  geographical                                                                    
     challenges to  include air,  water, and  other approved                                                                    
     medical  transport services.  As  it currently  stands,                                                                    
     Alaska's  emergency  medical  service  providers  incur                                                                    
     additional uncompensated costs  when providing services                                                                    
     to  Medicaid   beneficiaries,  by  as  much   as  sixty                                                                    
     percent.                                                                                                                   
                                                                                                                                
     Reimbursement    for     ground    emergency    medical                                                                    
     transportation  services  occurs   when  the  providers                                                                    
     submit  a billing  to the  department (specifically  to                                                                    
     the  Medicaid  fiscal   agent  Conduent)  for  eligible                                                                    
     services  provided;   the  department   reimburses  the                                                                    
     provider  using  the established  Medicaid  methodology                                                                    
     and   rate;   the  department   submits   documentation                                                                    
     supporting  the   payment  of  the   federal  financial                                                                    
     participation  (FFP)   to  Centers  for   Medicare  and                                                                    
     Medicaid Services  (CMS); and once it  is approved, the                                                                    
     department receives reimbursement for  the FFP from CMS                                                                    
     that  amounts  to  the appropriate  federal  assistance                                                                    
     percentage (FMAP).                                                                                                         
                                                                                                                                
     By enacting  this legislation  along with  an amendment                                                                    
     to the  state Medicaid  plan, public EMS  providers are                                                                    
     eligible  to   access  enhanced  federal   funding  for                                                                    
     emergency medical transportation  of Medicaid patients.                                                                    
     The use  of transfers is clearly  authorized in federal                                                                    
     statute  and is  both  legal and  useful. Further,  CMS                                                                    
     provides  reimbursement  for the  administrative  costs                                                                    
     associated  with  administrating  EMTS by  as  much  as                                                                    
     twenty percent.                                                                                                            
                                                                                                                                
     Anchorage,  Juneau,  Kenai,   and  Ketchikan,  combined                                                                    
     serve approximately forty-eight  percent of the state's                                                                    
     population.  In  2015  (for Kenai)  and  2016  for  the                                                                    
     others, these departments  provided 7,035 transports to                                                                    
     Medicaid  patients,   without  EMTS,   the  departments                                                                    
     received just  $2.1 million in reimbursements;  a total                                                                    
     collective under-compensation of  roughly $3.9 million.                                                                    
     Were they  EMTS eligible,  they could have  collected a                                                                    
     total of $6 million.                                                                                                       
                                                                                                                                
     HB 176  would allow EMS  providers around the  state to                                                                    
     collect  underfunded  costs  from the  effective  date,                                                                    
     providing a  financial boon to those  organizations and                                                                    
     communities.  Even smaller  communities such  as Bethel                                                                    
     can see  over a  quarter of a  million dollars  in EMTS                                                                    
     reimbursements per year.                                                                                                   
                                                                                                                                
     As you can see from  the attached bill packet, there is                                                                    
     widespread support  for HB 176 throughout  the state to                                                                    
     help   our  local   communities  receive   payments  to                                                                    
     actively cover the services they provide.                                                                                  
                                                                                                                                
                                                                                                                                
4:01:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO asked if the  entities that would be eligible                                                               
for  reimbursement  had to  meet  any  licensing or  registration                                                               
status.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  FANSLER  replied  that  they  did  have  to  meet                                                               
certain requirements.                                                                                                           
                                                                                                                                
REPRESENTATIVE  KITO   offered  his  belief  that   there  was  a                                                               
significance   difference  between   ground  and   air  ambulance                                                               
transportation for how  the services were provided and  paid.  He                                                               
asked to better understand these cost and payment structures.                                                                   
                                                                                                                                
REPRESENTATIVE FANSLER  deferred to the Department  of Health and                                                               
Social  Services and  directed attention  to the  different codes                                                               
for transportation [Included in members' packets].                                                                              
                                                                                                                                
4:03:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked how  many people  who used                                                               
the  ambulances paid  cash or  billed  insurance.   She asked  if                                                               
there  was  a large  number  of  patients  who used  Medicare  or                                                               
Medicaid, hence the need for this proposed bill.                                                                                
                                                                                                                                
REPRESENTATIVE  FANSLER  offered his  belief  that  there was  an                                                               
average of  15,000 transports  processed annually  throughout the                                                               
state.  He  opined that, in Bethel, there was  flexibility in the                                                               
municipal  code to  waive  the fee  for those  who  did not  have                                                               
insurance and  were not a  Medicaid recipient, rather  than leave                                                               
the patient behind.                                                                                                             
                                                                                                                                
4:06:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  how   the  transport  services  were                                                               
regulated  as  a  designated   carrier  for  emergency  services,                                                               
whether there  was any  licensing or  affiliation with  a medical                                                               
facility.                                                                                                                       
                                                                                                                                
4:07:14 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE, Director, Director's  Office, Division of Health                                                               
Care  Services,   Department  of  Health  and   Social  Services,                                                               
explained  that  the  proposed  bill  was  addressing  government                                                               
entities  which provide  these services.   These  providers would                                                               
have to be a government entity, as well as a Medicaid provider.                                                                 
                                                                                                                                
REPRESENTATIVE  KITO asked  how many  communities this  included,                                                               
noting  that  several communities  had  both  non-profit and  for                                                               
profit medical service providers.                                                                                               
                                                                                                                                
MS. BRODIE offered to research the exact number.                                                                                
                                                                                                                                
REPRESENTATIVE KITO asked about the air ambulances.                                                                             
                                                                                                                                
MS. BRODIE  said that she did  not know if any  rescue units were                                                               
run by municipalities or government entities.                                                                                   
                                                                                                                                
4:09:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  how  many  of the  15,000                                                               
annual  transports  were  eligible for  insurance  reimbursement,                                                               
Medicaid or Medicare reimbursement, or were self-payment.                                                                       
                                                                                                                                
MS.  BRODIE replied  that she  could  only report  on the  annual                                                               
amount of Medicaid paid for  ground transportation, $50,362.  She                                                               
said  she did  not  have  the figures  for  private insurance  or                                                               
Medicare.                                                                                                                       
                                                                                                                                
4:10:22 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  removed her objection.   There being  no further                                                               
objection,  the proposed  committee substitute  (CS) for  HB 176,                                                               
labeled 30-LS0705\J,  Glover, 4/7/17, was adopted  as the working                                                               
draft.                                                                                                                          
                                                                                                                                
4:10:52 PM                                                                                                                    
                                                                                                                                
BILL HOWELL,  Fire Chief,  City of Bethel,  reported that  he had                                                               
been  with the  department for  25 years  and had  been the  fire                                                               
chief for the  past two years.  He shared  some of the challenges                                                               
for  providing  emergency  medical  care in  Bethel,  and  stated                                                               
support for  proposed HB 176.   He stated that the  proposed bill                                                               
would have  a positive, significant,  and long-lasting  impact on                                                               
the Emergency  Medical Service (EMS)  providers.  He  shared that                                                               
the Bethel  Fire Department EMS  call volume had increased  by 10                                                               
percent over the  past six years.  He reported  that the majority                                                               
of funding to  the City of Bethel was from  local sales, lodging,                                                               
and  alcohol  taxes,  with  the  balance  coming  from  community                                                               
support and fees  for services, including ambulance  service.  He                                                               
declared  that a  recent analysis  had shown  that the  ambulance                                                               
service was losing about $972,000  per year, noting that Medicaid                                                               
recipients were  the largest users  of the  service in 2016.   He                                                               
reported  that, as  Medicaid paid  an  average of  $455 per  call                                                               
toward an overall cost per transport  of $1287, there was a heavy                                                               
burden  on the  City of  Bethel.   He stated  that the  financial                                                               
needs of  the Bethel Fire  Department were  significant, pointing                                                               
out that additional  staff were necessary to  cover the increased                                                               
EMS  call volume  and that  about $1.5  million was  necessary to                                                               
replace  an aging  ambulance, a  1980 tanker,  and a  1980 ladder                                                               
truck.  He  added that the fleet would frequently  break down and                                                               
not  allow for  response, as  they did  not have  any back-up  or                                                               
mutual aid.   He shared that  there had been efforts  to increase                                                               
revenue, which included  an increase in ambulance  fees and close                                                               
work with  the third-party biller to  ensure proper documentation                                                               
for the services  and reception of the maximum allowed.   He said                                                               
that  funds were  raised  through the  volunteer  group and  from                                                               
grants for  staffing and equipment.   He  added that the  City of                                                               
Bethel  had  also  made  capital requests  to  the  Alaska  State                                                               
Legislature for  a new tanker and  ladder truck.  He  pointed out                                                               
that the  proposed bill would  reimburse local EMS  providers for                                                               
the   uncompensated  costs   of   providing   care  to   Medicaid                                                               
recipients.   He listed  support for the  proposed bill  from the                                                               
Bethel City Council, the Alaska  Fire Chiefs, and the Bethel Fire                                                               
Department.                                                                                                                     
                                                                                                                                
4:15:02 PM                                                                                                                    
                                                                                                                                
ALEX   BOYD,   Assistant   Chief,  Anchorage   Fire   Department,                                                               
emphasized that the scale of  the issue was growing exponentially                                                               
and  was impacting  the Anchorage  Fire Department  to an  almost                                                               
unmanageable  level.   He  reported  that  there  had been  a  74                                                               
percent increase in transport for  Medicaid recipients during the                                                               
past  year,  resulting  in  an  unrecovered  cost  of  nearly  $3                                                               
million.   He  stated  that  the proposed  bill  would provide  a                                                               
dramatic  impact on  the service  to the  municipality and  would                                                               
allow  the department  to  improve its  system  delivery and  its                                                               
impact  on the  city.   He noted  that this  current trend  would                                                               
result  in unrecovered  expenses of  $3.2 million  for more  than                                                               
7,000 transports  during the  calendar year 2017.   He  said that                                                               
Anchorage currently  collected about  $440 of the  $926 fee.   He                                                               
pointed out  that this significant  impact on the  budget brought                                                               
challenges for  the expansion of  staffing to meet  these growing                                                               
needs.                                                                                                                          
                                                                                                                                
4:18:12 PM                                                                                                                    
                                                                                                                                
RICHARD  ETHERIDGE,  Fire  Chief,  Juneau,  Alaska,  shared  that                                                               
Alaska had the  most complex, diverse EMS delivery  system in the                                                               
nation,  as  there  were  challenges  unlike  most  other  areas,                                                               
including the often high expenses  for even getting to a patient.                                                               
He reported  that there had  been an  increase in demand  for EMS                                                               
services,  which made  it  difficult for  fire  departments.   He                                                               
stated  that  the proposed  bill  provided  the authorization  to                                                               
develop  a program  where local  agencies could  recover some  of                                                               
their costs for  the provision of EMS.  He  acknowledged that the                                                               
Medicaid Expansion  had an impact  on emergency  services, noting                                                               
that in  Juneau the number  of Medicaid patients  transported had                                                               
more than  doubled.  He  added that  the call volumes  across the                                                               
state  were increasing,  in Juneau  there had  been a  13 percent                                                               
increase last year, an amount not  uncommon across the state.  He                                                               
pointed out  that Medicaid  did not  reimburse for  all expenses,                                                               
sharing that  the average  cost of  basic life  support transport                                                               
was $1,680, of  which Medicaid paid about $455.   The balance due                                                               
was absorbed  by the  fire department,  the local  community, and                                                               
the tax payers.  He reported  that the program utilized funds set                                                               
aside by the  federal Medicaid program just for  this purpose and                                                               
was not  tied to the  Patient Protection and Affordable  Care Act                                                               
or Medicaid  Expansion.   He reported that  the state  could also                                                               
collect administrative fees, up to  20 percent, an estimated $2.5                                                               
- $3  million back to  the state.   He estimated that  this could                                                               
put between $12  - $15 million into the local  economies for fire                                                               
departments.   He shared that  California was already  setting up                                                               
this program.   He stated that Alaska relied heavily  on the EMS,                                                               
and  that  the proposed  bill  provided  a foundation  for  first                                                               
responders  in   local  communities  to  recover   "some  of  the                                                               
desperately  needed financial  support and  stability across  the                                                               
state."                                                                                                                         
                                                                                                                                
4:22:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD   asked  if  the   borough  paid                                                               
reimbursement of transportation services  through local sales and                                                               
property tax.                                                                                                                   
                                                                                                                                
MR. ETHERIDGE  replied that fire  departments were funded  out of                                                               
general fund or fire service area funds.                                                                                        
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  if implementation  of the                                                               
proposed bill would free funds from local taxation.                                                                             
                                                                                                                                
MR.   ETHERIDGE  replied   that  this   would  be   up  to   each                                                               
municipality, although it  would provide money back  to the local                                                               
municipalities.                                                                                                                 
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked how much this would be.                                                                   
                                                                                                                                
MR.  ETHERIDGE said  that each  community was  different, stating                                                               
that  Anchorage could  receive up  to $4  million annually,  Nome                                                               
could receive  up to $16,000  annually, and Juneau  could receive                                                               
between $600,000 and $1 million.                                                                                                
                                                                                                                                
4:24:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO reflected on  the increase in calls statewide                                                               
and asked what was driving this increase.                                                                                       
                                                                                                                                
MR. ETHERIDGE said  that this was actively being  researched.  He                                                               
mused that more people were eligible  for health care and were no                                                               
longer self-payers, and that, as  it was more difficult to access                                                               
primary care providers,  more people came to  emergency rooms and                                                               
EMS for primary care.                                                                                                           
                                                                                                                                
4:24:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON shared that she  had read that the impact                                                               
of Medicaid  Expansion on  emergency rooms  had been  far greater                                                               
than  anticipated.   She acknowledged  that emergency  rooms were                                                               
now  being  reimbursed,  but  that the  desired  policy  was  not                                                               
happening.   She asked if  volunteer fire departments  could also                                                               
participate.                                                                                                                    
                                                                                                                                
MR. ETHERIDGE  said that any  fire department which  was eligible                                                               
to bill  and did bill for  EMS services could participate  in the                                                               
program.                                                                                                                        
                                                                                                                                
4:26:28 PM                                                                                                                    
                                                                                                                                
SCOTT CLOUGH,  AP Triton, Retired  Fire Chief, explained  that he                                                               
was a retired assistant fire chief  from Sacramento and was now a                                                               
consultant   with   fire   agencies  looking   to   pursue   this                                                               
legislation.   He  pointed  to his  initial  research in  Alaska,                                                               
which had identified  55 agencies eligible to  participate in the                                                               
program,  including  the  university  system and  a  health  care                                                               
district.    He clarified  that  some  public agencies  had  been                                                               
identified as  eligible to participate  in the  program, although                                                               
it did  not preclude  that private enterprise  also benefit.   He                                                               
said  that  municipalities  which  utilized  the  services  of  a                                                               
private provider,  as well as non-profit  and volunteer agencies,                                                               
could structure  to use  these revenues.   He  added that  it was                                                               
important  to  understand  that this  was  an  emergency  medical                                                               
transport bill  tied to  a federal  cost structure  for providing                                                               
these services.  He explained  that provider programs, if related                                                               
to the  EMS, could count  as a cost.   He offered an  example for                                                               
Juneau investing  in new extrication  equipment, and a  new squad                                                               
for  this  equipment.   Even  though  this  was not  a  transport                                                               
vehicle, it  was a  unit and equipment  utilized for  delivery of                                                               
emergency medical services and could  be rolled into the new cost                                                               
of service  for a draw  down of federal  funding.  He  said there                                                               
were  tremendous benefits  to the  communities  and the  Medicaid                                                               
beneficiaries  as it  allowed for  an opportunity  to expand  the                                                               
services and  recoup some of  that investment.  He  declared that                                                               
Alaska was unique, and it was  important to include both land and                                                               
air transport.                                                                                                                  
                                                                                                                                
4:32:25 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 176 would be held over.                                                                       
                                                                                                                                
4:32:38 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:33 p.m.                                                                                                          

Document Name Date/Time Subjects
SB 32 Legislation - Version J.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 32 Sponsor Statement - Biosimilars.pdf HHSS 4/13/2017 3:00:00 PM
SB 32
SB 32 - Sectional Analysis.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Fiscal Note DCCED CBPL.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
AK SB 32 Biosimilar Support Letter.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
ALF_AK SB 32__2 1 17 support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance of Specialty Medicine AK SB 32 020317.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
LADAAK support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
NORD AK_SB 32_ltr.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
2-6-17 biosimilar AK support.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
NFK BioSimilars State Letter - Alaska 2.1.17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance for Patient Access AfAP - SB32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alliance for Safe Biologic Medicines AK-SB 32 -FNL.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
American Liver Foundation ALF_AK SB 32__2 1 17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 AARDA support.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 AARDA support.docx HHSS 4/13/2017 3:00:00 PM
SB 32
Digestive Disease National Coalition Support for SB 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Global Healthy Living Foundation GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
International Cancer Advocacy Network (ICAN) letter of support SB32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
National Hispanic Medical Association (NHMA) _AK SB 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Pharmaceutical Research and Manufacturers of America (PhRMA) Support SB32.PDF HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Bios for Dr. Charles and Dr. Schneider.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - BIO Support Letter 2-2-17 Biotechnology Innovation Organization.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - BIO Support Letter 2-2-17.pdf HHSS 4/13/2017 3:00:00 PM
SB 32
RetireSafe support SB32 2-6-17 biosimilar AK.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
1-12-17 Group letter.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB 32 - 1 page handout explaining biosimilar legislation.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska ACS CAN Biosimilars Fact Sheet 2017.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SB032 Supporting Documents-Support Letters 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
Senate Bill 32 opposition AK Rheumatoloty Alliance.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska SB 32 - Merriman Comments 20170209.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
SupportLetter_Bio_SB32_psoriasis.docx HHSS 4/13/2017 3:00:00 PM
SHSS 2/10/2017 1:30:00 PM
SB 32
Alaska Biosimilars Arth Fdn oppose amendment sb 32.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32_ASMA.pdf HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB32 - Clarification on Questions Asked in the Committee (Sen Hughes).doc HHSS 4/13/2017 3:00:00 PM
SHSS 2/15/2017 1:30:00 PM
SB 32
SB 32 - Sectional Analysis.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Document - Potential Cost Savings of Biosimilar Drugs.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Document - H&SS Comm. Q&A.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Background Letter - State Medical Board.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Fiscal Note - DCCED.PDF HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Opposition Letter - Alaska State Medical Association.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Documents - Fact Sheet.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - Alliance of Specialty Medicine.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB032 Sponsor Statement 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB032 Opposing Document-Opposition Letters 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB032 Sectional Analysis ver J 04.04.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
SB 32
SB32 Letters of Opposition.pdf HHSS 4/13/2017 3:00:00 PM
SFIN 3/30/2017 9:00:00 AM
SB 32
SB32 Letters of Support.pdf HHSS 4/13/2017 3:00:00 PM
SFIN 3/30/2017 9:00:00 AM
SB 32
SB 32 Am No. 1.PDF HHSS 4/13/2017 3:00:00 PM
SB 32
SB 32 - Support Letter - U.S. Pain Foundation.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - State Advocacy & Alliance Development.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
SB 32 - Support Letter - Safe Biologics.pdf HHSS 4/13/2017 3:00:00 PM
SL&C 3/7/2017 1:30:00 PM
SB 32
HB 176 Sponsor Statement 4.12.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - City of Bethel resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB memo 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - Letter AK Fire Chiefs Assoc 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - letter AK Prof Firefighters Assoc 4.11.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - memo Bethel FD 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - North Pole resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 ver A.PDF HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document AK FD budget reimb process 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document DHSS review 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Draft Proposed CS ver J 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--HCMS 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--MAA 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 118 Sponsor Satement 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Doyon support letter 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Medical Compsensation by State 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - PBS Article 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - Support letters 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Document - TCC letter of support 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Supporting Documents 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 ver A 4.10.2017.PDF HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Fiscal Note DHSS--BHTRG 4.10.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Fiscal Note DOL--CJL 4.10.17.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118
HB 118 Sectional Analysis ver A 4.10.2017.pdf HHSS 4/11/2017 3:00:00 PM
HHSS 4/13/2017 3:00:00 PM
HB 118