Legislature(2021 - 2022)DAVIS 106

04/26/2022 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 10 Minutes Following Session --
+= HB 382 INSULIN COVERAGE:INSURANCE;MEDICAID TELECONFERENCED
Moved CSHB 382(HSS) Out of Committee
-- Testimony <Invitation Only> --
+= SB 132 CONTROLLED SUB. DATA: EXEMPT VETERINARIAN TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 26, 2022                                                                                         
                           4:53 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Liz Snyder, Co-Chair                                                                                             
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Ivy Spohnholz                                                                                                    
Representative Zack Fields                                                                                                      
Representative Ken McCarty                                                                                                      
Representative Mike Prax                                                                                                        
Representative Christopher Kurka                                                                                                
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 382                                                                                                              
"An Act relating to insurance coverage for pharmacy services."                                                                  
                                                                                                                                
     - MOVED CSHB 382(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
SENATE BILL NO. 132                                                                                                             
"An Act exempting veterinarians from the requirements of the                                                                    
controlled substance prescription database."                                                                                    
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 382                                                                                                                  
SHORT TITLE: INSULIN COVERAGE:INSURANCE;MEDICAID                                                                                
SPONSOR(s): REPRESENTATIVE(s) SNYDER                                                                                            
                                                                                                                                
02/22/22       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/22       (H)       HSS, L&C                                                                                               
04/21/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
04/21/22       (H)       Heard & Held                                                                                           
04/21/22       (H)       MINUTE(HSS)                                                                                            
04/26/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
                                                                                                                                
BILL: SB 132                                                                                                                  
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT VETERINARIAN                                                                          
SPONSOR(s): SENATOR(s) HOLLAND                                                                                                  
                                                                                                                                
04/28/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/28/21       (S)       HSS, L&C                                                                                               
02/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/03/22       (S)       Heard & Held                                                                                           
02/03/22       (S)       MINUTE(HSS)                                                                                            
02/08/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/08/22       (S)       Moved SB 132 Out of Committee                                                                          
02/08/22       (S)       MINUTE(HSS)                                                                                            
02/09/22       (S)       HSS RPT  4DP                                                                                           
02/09/22       (S)       DP: WILSON, REINBOLD, BEGICH, HUGHES                                                                   
02/23/22       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/23/22       (S)       Heard & Held                                                                                           
02/23/22       (S)       MINUTE(L&C)                                                                                            
03/02/22       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/02/22       (S)       Moved SB 132 Out of Committee                                                                          
03/02/22       (S)       MINUTE(L&C)                                                                                            
03/04/22       (S)       L&C RPT  2NR 1DP                                                                                       
03/04/22       (S)       NR: COSTELLO, REVAK                                                                                    
03/04/22       (S)       DP: GRAY-JACKSON                                                                                       
03/04/22       (S)       FIN REFERRAL ADDED AFTER L&C                                                                           
03/17/22       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/17/22       (S)       Heard & Held                                                                                           
03/17/22       (S)       MINUTE(FIN)                                                                                            
03/22/22       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
03/22/22       (S)       Moved SB 132 Out of Committee                                                                          
03/22/22       (S)       MINUTE(FIN)                                                                                            
03/23/22       (S)       FIN RPT  7DP                                                                                           
03/23/22       (S)       DP: STEDMAN, BISHOP, HOFFMAN, WILSON,                                                                  
                         WIELECHOWSKI, OLSON, VON IMHOF                                                                         
03/28/22       (S)       TRANSMITTED TO (H)                                                                                     
03/28/22       (S)       VERSION: SB 132                                                                                        
04/04/22       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/04/22       (H)       HSS, L&C                                                                                               
04/14/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
04/14/22       (H)       Scheduled but Not Heard                                                                                
04/19/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
04/19/22       (H)       -- MEETING CANCELED --                                                                                 
04/26/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
COLEMAN CUTCHINS, PharmD, Clinical Pharmacist                                                                                   
Office of Substance Abuse & Addiction Prevention                                                                                
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions  during the hearing on HB
382.                                                                                                                            
                                                                                                                                
LORI WING-HEIER, Director                                                                                                       
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions  during the hearing on HB
382.                                                                                                                            
                                                                                                                                
LAURA KELLER, Managing Director of Advocacy                                                                                     
American Diabetes Association                                                                                                   
Phoenix, Arizona                                                                                                                
POSITION STATEMENT:  Answered questions  during the hearing on HB
382.                                                                                                                            
                                                                                                                                
SENATOR ROGER HOLLAND                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As prime sponsor, presented SB 132.                                                                      
                                                                                                                                
NIKKI ROSE, Staff                                                                                                               
Senator Roger Holland                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Presented the sectional analysis  of SB 132                                                             
on behalf of Senator Holland, prime sponsor.                                                                                    
                                                                                                                                
SARA CHAMBERS, Director                                                                                                         
Division  of Corporations,  Business and  Professional Licensing,                                                               
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions  during the hearing on SB
132.                                                                                                                            
                                                                                                                                
MICHAELA DICK, DMV, Past President                                                                                              
Alaska Veterinary Association                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions  during the hearing on SB
132.                                                                                                                            
                                                                                                                                
LAURA CARRILLO, Administrator                                                                                                   
Board of Pharmacy                                                                                                               
Department of Commerce, Community, and Economic Development                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions  during the hearing on SB
132.                                                                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
4:53:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  TIFFANY ZULKOSKY  called  the House  Health and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  4:53  p.m.                                                               
Representatives  Zulkosky,  McCarty,   Spohnholz,  Snyder,  Prax,                                                               
Fields, and Kurka were present at the call to order.                                                                            
                                                                                                                                
           HB 382-INSULIN COVERAGE:INSURANCE;MEDICAID                                                                       
                                                                                                                                
4:55:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY announced  that  the first  order of  business                                                               
would  be HOUSE  BILL  NO.  382, "An  Act  relating to  insurance                                                               
coverage for pharmacy services."                                                                                                
                                                                                                                                
4:55:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER refreshed  the committee  on the  purpose of  HB
382,  stating  that  the  bill   focused  on  the  importance  of                                                               
preventative care and improving  access to affordable healthcare.                                                               
She explained that over the past  few decades, the growth rate of                                                               
insulin costs had  greatly outpaced that of  inflation and become                                                               
incredibly  expensive,  with  no   generic  versions  of  insulin                                                               
available.    She  reported  that   there  were  50,000  Alaskans                                                               
diagnosed with  diabetes, and that  number increases  every year.                                                               
In conclusion, she  explained that the legislation  would cap the                                                               
co-pay for insulin at $100 a month.                                                                                             
                                                                                                                                
4:57:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY, acknowledging  that  he  had missed  the                                                               
previous  hearing, asked  what the  price  of insulin  is to  the                                                               
pharmacies and  whether this bill  would cause a  negative impact                                                               
in  their ability  to procure  insulin.   He mentioned  that some                                                               
states  have had  to  "go out  of country"  to  buy medicine  and                                                               
questioned whether those states were doing the same for insulin.                                                                
                                                                                                                                
CO-CHAIR SNYDER  explained that insulin currently  costs $200 per                                                               
vial,  in comparison  to $20  a vial  in 1994.   She  shared that                                                               
while the  typical usage for  a diabetic  patient is two  vials a                                                               
month, this can go  up to as many as five a  month depending on a                                                               
variety of factors  including severity and the  ability to manage                                                               
the  condition through  diet and  other lifestyle  choices.   She                                                               
stated that the question of going  out of country for insulin was                                                               
not brought up in the previous hearing.                                                                                         
                                                                                                                                
5:00:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  voiced his  understanding that HB  382 would                                                               
alter the co-pay of existing  policies and questioned whether the                                                               
bill would also affect future policies.                                                                                         
                                                                                                                                
CO-CHAIR  SNYDER confirmed  that HB  382 would  cap the  price of                                                               
current and future policies.                                                                                                    
                                                                                                                                
5:00:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY  inquired about  utilizing the  ability of                                                               
the Department of  Health and Social Services  (DHSS) to purchase                                                               
large quantities of medication to  reduce the cost of insulin for                                                               
the state.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  FIELDS  suggested   that  Representative  McCarty                                                               
refer to  a letter from  DHSS [included in the  committee packet]                                                               
which addressed this topic and  then direct any further questions                                                               
to  Lori  Wing-Heier,  Director of  the  Division  of  Insurance,                                                               
within  the   Department  of   Commerce,  Community   &  Economic                                                               
Development.                                                                                                                    
                                                                                                                                
5:01:38 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
5:01:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY asked  Representative McCarty  to restate  his                                                               
question and directed it to Coleman Cutchins from DHSS.                                                                         
                                                                                                                                
REPRESENTATIVE   MCCARTY  noted   that  the   state  buys   large                                                               
quantities of  other medications,  such as  hepatitis treatments,                                                               
and asked whether the department could do the same with insulin.                                                                
                                                                                                                                
5:02:42 PM                                                                                                                    
                                                                                                                                
COLEMAN   CUTCHINS,  PharmD,   Clinical  Pharmacist,   Office  of                                                               
Substance Abuse & Addiction Prevention,  Department of Health and                                                               
Social  Services, explained  that insulin  is a  refrigerated and                                                               
sterile product,  meaning it  requires more  effort to  store and                                                               
transport  than other  drugs.   He noted  that it  requires extra                                                               
personnel  to   maintain  those   sorts  of  medicines   and  the                                                               
department  is  experiencing  staffing  issues that  could  be  a                                                               
barrier to proper maintenance.   He mentioned that there are some                                                               
generic versions of  insulin available to the state  at prices of                                                               
$25  a vial  when buying  in bulk  quantities of  at least  1,000                                                               
units.                                                                                                                          
                                                                                                                                
REPRESENTATIVE    MCCARTY   posited    that   because    COVID-19                                                               
vaccinations  have  storage  requirements similar  to  those  for                                                               
insulin,  mainly  refrigeration,  Alaska  had  provided  employee                                                               
training and built  up "a lot" of  refrigerated facilities, which                                                               
he  believes put  the state  in the  position to  be able  to buy                                                               
insulin in bulk to reduce costs.                                                                                                
                                                                                                                                
DR. CUTCHINS explained  that there are 12-13 types  of insulin on                                                               
the market which would present  the department with the challenge                                                               
of  deciding   which  types  to   carry.    He   emphasized  that                                                               
implementing a system to purchase insulin would be complex.                                                                     
                                                                                                                                
CO-CHAIR ZULKOSKY asked Lori Wing-Heier  to share her perspective                                                               
on Representative McCarty's question.                                                                                           
                                                                                                                                
5:05:37 PM                                                                                                                    
                                                                                                                                
LORI WING-HEIER,  Director, Division of Insurance,  Department of                                                               
Commerce, Community  & Economic  Development, explained  that the                                                               
state  had supplied  a letter  to the  committee to  look into  a                                                               
similar  question  brought  up in  the  last  hearing  concerning                                                               
Utah's   insulin   distribution   program,  and   that   multiple                                                               
departments  would  be looking  into  whether  or not  a  similar                                                               
program would  be viable for  Alaska.  She reported  that another                                                               
option  the  state  was investigating  was  whether  the  Vaccine                                                               
Assessment  Council could  be amended  to provide  insulin.   She                                                               
explained  that both  courses of  action would  require answering                                                               
the many logistic issues Dr.  Cutchins discussed and specifically                                                               
the challenge  of transporting a  refrigerated medication  from a                                                               
central distribution location to the  far reaches of Alaska.  She                                                               
acknowledged  that  the state  had  done  this for  the  COVID-19                                                               
vaccines;  however, those  vaccines  were frozen  at -80  degrees                                                               
Fahrenheit  while insulin  required  less intense  refrigeration.                                                               
She emphasized  that there  would need to  be statute  changes if                                                               
the state were  to amend the Vaccine Assessment  Council and that                                                               
the state would be looking  into the options for possible insulin                                                               
distribution.                                                                                                                   
                                                                                                                                
REPRESENTATIVE MCCARTY  asked whether any of  the amendments that                                                               
Ms. Wing-Heier  mentioned could  be added to  HB 382  to expedite                                                               
the overall process.                                                                                                            
                                                                                                                                
MS. WING-HEIER  explained that it  could be possible to  amend HB
382,  but stated  that  based on  previous  testimony, this  bill                                                               
would  affect  only the  15  percent  diabetic Alaskans  who  are                                                               
insured.  She  shared her understanding that  the committee would                                                               
want  to   include  the  uninsured  in   any  state-wide  insulin                                                               
distribution programs.                                                                                                          
                                                                                                                                
5:08:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA asked  whether HB  382 would  cause premium                                                               
increases  for  all  those  with health  insurance  or  would  be                                                               
localized to only those who have diabetes.                                                                                      
                                                                                                                                
MS. WING-HEIER explained  that any increase to  premiums would be                                                               
negligible  and  that there  had  been  no reports  of  increased                                                               
insulin  costs from  insurance companies  dealing with  this same                                                               
issue in other states.                                                                                                          
                                                                                                                                
CO-CHAIR  SNYDER   shared  findings   from  studies   on  similar                                                               
legislation  passed  in  other   states  that  showed  negligible                                                               
premium increases  of 7-24 cents  per person.   She noted  that a                                                               
study on  the Washington co-pay cap  saw a 2 percent  decrease in                                                               
premiums.  She  argued  that  the  initial  increase  across  all                                                               
beneficiaries would improve access  to insulin and allow diabetic                                                               
patients to better manage their health,  leading to a cut in cost                                                               
overall  as hospitalizations  and  complications associated  with                                                               
poorly managed diabetes decrease.                                                                                               
                                                                                                                                
5:10:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  asked why the  price of insulin had  gone up                                                               
so much and posited  that for a drug that has  been around for so                                                               
long, a generic version should be available.                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER explained  that individuals  with diabetes  must                                                               
take  insulin  to  live  and,  with  no  alternatives  available,                                                               
companies "can  charge whatever  they want"  for insulin  to fill                                                               
that demand.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX referred  to  the various  forms of  insulin                                                               
previously mentioned  and sought confirmation that  there were no                                                               
alternatives to insulin on the market.                                                                                          
                                                                                                                                
CO-CHAIR SNYDER explained  that the varied types  of insulin were                                                               
due to  differences in how  patients administered it, as  well as                                                               
who  was producing  and supplying  it.   She deferred  to invited                                                               
expert Laura Keller for a more detailed explanation.                                                                            
                                                                                                                                
5:12:55 PM                                                                                                                    
                                                                                                                                
LAURA KELLER,  Managing Director  of Advocacy,  American Diabetes                                                               
Association,  stated that  there  are no  other replacements  for                                                               
taking  insulin  for Type  1  diabetics  such  as herself.    She                                                               
explained   that  the   "generic"  form   of  insulin   mentioned                                                               
previously is a separate type  called regular insulin that is not                                                               
used  by most  diabetic patients.    She reported  that the  most                                                               
common type of insulin is analog,  which had been out for decades                                                               
but has seen a  massive jump in cost from $21 to  over $300.  She                                                               
mentioned that  the current standard  of care  recommends insulin                                                               
pumps which require  analog insulin and are  covered by Medicare,                                                               
making  them the  most  common devices  in use  in  Alaska.   She                                                               
acknowledged that  regular insulin  is available to  patients but                                                               
has not  received Federal Drug Administration  (FDA) approval for                                                               
use in insulin pumps.                                                                                                           
                                                                                                                                
REPRESENTATIVE  PRAX   opined  that  the  problem   seems  to  be                                                               
regulatory and that it is "odd"  that the FDA is preventing other                                                               
companies from producing insulin.                                                                                               
                                                                                                                                
DR.  CUTCHINS said  that  before  working for  the  state he  had                                                               
worked as  a practitioner  in diabetes care.   He  explained that                                                               
regular insulin can be used in  a pump but newer drugs are longer                                                               
lasting and  protect against low  blood sugar, which is  why they                                                               
are preferred  for Type 1  diabetes patients.  He  explained that                                                               
insulin, especially  the analog  types, is  an expensive  drug to                                                               
manufacture and  that the lower  profits mean many  companies are                                                               
not  interested in  creating  generic  forms of  the  drugs.   He                                                               
posited that even  when a generic drug is made,  it is often "not                                                               
much cheaper" than the brand name version.                                                                                      
                                                                                                                                
5:17:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  moved to adopt  Amendment 1 to  HB 382,                                                               
labeled 32-LS1494\A.1, Marx, 4/22/22, which read as follows:                                                                    
                                                                                                                                
     Page 2, line 6:                                                                                                            
          Delete "$100"                                                                                                         
     Insert "$35"                                                                                                               
                                                                                                                                
CO-CHAIR ZULKOSKY objected for the purpose of discussion.                                                                       
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ reported  that diabetes  is one  of the                                                               
most expensive  health conditions in  the country, leading  to 27                                                               
percent of patients with diabetes  rationing their insulin, which                                                               
can result in various complications  that are even more expensive                                                               
in  terms of  health care.   She  explained that  regular use  of                                                               
insulin  prevents  issues  like  kidney  failure,  dialysis,  and                                                               
amputations, as  well as reducing  the number of  hospital visits                                                               
by  29   percent.    She   stated  that  the   American  Diabetes                                                               
Association (ADA)  recommends a  co-pay cap of  $35 per  month, a                                                               
figure  that  has been  successfully  adopted  in legislation  by                                                               
several  states  with  varying  "operating  environments."    She                                                               
opined  that amending  the cap  from  $100 to  $35 monthly  would                                                               
allow "average  working Alaskans"  better access to  their needed                                                               
medication.                                                                                                                     
                                                                                                                                
5:19:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA asked  how  much the  average premium  cost                                                               
would increase with a $35 cap  in comparison to the original $100                                                               
cap.                                                                                                                            
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  explained that  in other states  with a                                                               
cap of  $35 there are  increases as high  as a dollar,  but there                                                               
are also states, like Washington,  that had a decrease in overall                                                               
cost.  She explained that this  was because the cost of any acute                                                               
care, such  as a  surgery or  long term  care [associated  with a                                                               
diabetes complication], is  also borne by all  [policy holders on                                                               
the same plan].                                                                                                                 
                                                                                                                                
REPRESENTATIVE KURKA  asked whether  there are any  other factors                                                               
in the 1.8 percent decrease of premium costs in Washington.                                                                     
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ confirmed  that the  co-pay cap  is the                                                               
only factor.                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER added  that  the State  of  Washington passed  a                                                               
second bill  to lower  the cap  to $35 after  the success  of the                                                               
first cap.   She also  mentioned that  there are 20  other states                                                               
who have instituted a cap between $35-$100 a month.                                                                             
                                                                                                                                
5:21:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY  asked whether  there are any  states that                                                               
passed this  legislation that had similar  demographics to Alaska                                                               
in  terms  of  population  and   diabetic  residents.    He  also                                                               
questioned  whether   there  could  be  a   threat  of  insurance                                                               
companies deciding  not to provide  insulin in Alaska due  to the                                                               
cut in co-pay, therein cutting off Alaska's supply of insulin.                                                                  
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ explained  the demographic  information                                                               
available is  about states like  Kentucky, Washington,  and Utah,                                                               
which passed similar legislation.   She stated that she could not                                                               
make  a direct  comparison to  a "like  state," but  studies have                                                               
shown minimal increase  to premiums.  In regard  to the insurance                                                               
companies, she reported that the  loss of income from the reduced                                                               
premium is  offset by a  reduction of [expensive] high  acuity of                                                               
care  cases.   She opined  that  instituting a  cap is  a way  to                                                               
incentivize  the  companies  to  use  their  "significant  market                                                               
position"  to  negotiate  better manufacturing  and  distribution                                                               
costs.                                                                                                                          
                                                                                                                                
5:24:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX asked  whether the  committee had  heard any                                                               
testimony from insurance companies.                                                                                             
                                                                                                                                
CO-CHAIR SNYDER replied  that there is a letter  from one company                                                               
that had been delivered to committee members' offices.                                                                          
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ  referred   to  a   report  from   the                                                               
Healthcare  Cost  Institute (HCI)  on  Type  1 diabetes  and  the                                                               
increasing costs  of insulin.  She  explained that the HCI  is an                                                               
insurance  industry  funded  organization  with  the  purpose  of                                                               
examining health care costs in America.                                                                                         
                                                                                                                                
REPRESENTATIVE  PRAX shared  that  in his  experience working  in                                                               
insurance sales,  companies and employers invest  in preventative                                                               
care, such as  buying memberships to a gym,  because they believe                                                               
that  doing so  saves money  in  insurance payouts  overall.   He                                                               
posited that  if putting a  co-pay cap in place  decreases costs,                                                               
insurance  companies would  have  done  so before.    He said  he                                                               
wished  to  hear  directly  from  insurance  companies  for  that                                                               
reason.                                                                                                                         
                                                                                                                                
CO-CHAIR  SNYDER  voiced  her  opinion that  the  path  of  least                                                               
resistance  for insurance  companies  is going  with "the  status                                                               
quo," and she  explained that the legislation  would add positive                                                               
pressure  for those  companies to  address  the problem  directly                                                               
with insulin  manufacturers.   She referred  to a  statement from                                                               
America's  Health Insurance  Plans (AHIP),  a national  insurance                                                               
organization, that  suggested many other forms  of cost reduction                                                               
with  which  she  agreed.   However,  she  stated  that  [AHIP's]                                                               
argument that  insurance premiums would rise  substantially cited                                                               
an out-of-date  study from  Kentucky, which  gave her  pause when                                                               
considering how much stock to put into that testimony.                                                                          
                                                                                                                                
5:29:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS recapped  part  of  the conversation  held                                                               
during  the previous  hearing by  stating that  the cost  savings                                                               
from   reducing  hospital   visits  and   expensive,  long   term                                                               
complications through  the proper  use of  insulin are  harder to                                                               
quantify than  immediate premium  costs, which could  account for                                                               
why they have not been quantified yet.                                                                                          
                                                                                                                                
5:29:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA  asked  what  is currently  in  statute  to                                                               
regulate the  cost of co-pay and  how the split of  who would pay                                                               
for what portion of prescriptions is structured.                                                                                
                                                                                                                                
5:30:42 PM                                                                                                                    
                                                                                                                                
MS. WING-HEIER  explained that there  is not anything  in statute                                                               
other than  what was  directed by the  federal government  in the                                                               
Affordable Care  Act, and  that the amount  of co-pay  depends on                                                               
the specific plan.   She explained that the purpose  of this bill                                                               
is to rectify that.                                                                                                             
                                                                                                                                
REPRESENTATIVE KURKA  asked whether there are  plans available on                                                               
the  market with  higher premiums  that would  cover more  of the                                                               
cost of prescriptions.                                                                                                          
                                                                                                                                
MS. WING-HEIER replied  that there are plans that  cost much more                                                               
that would have lower co-pays.                                                                                                  
                                                                                                                                
5:32:26 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  removed her objection  to the motion  to adopt                                                               
Amendment 1.                                                                                                                    
                                                                                                                                
REPRESENTATIVE KURKA objected.                                                                                                  
                                                                                                                                
5:32:32 PM                                                                                                                    
                                                                                                                                
A roll  call vote was  taken.  Representatives  Sponholz, Fields,                                                               
Zulkosky, and  Snyder voted in  favor of  Amendment 1 to  HB 382.                                                               
Representatives  Prax,  Kurka,  and  McCarty  voted  against  it.                                                               
Therefore, Amendment 1 was adopted by a vote of 4-3.                                                                            
                                                                                                                                
5:33:32 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER moved  to  report  HB 382,  as  amended, out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal notes.                                                                                                                   
                                                                                                                                
CO-CHAIR ZULKOSKY noted there was an [inaudible] objection.                                                                     
                                                                                                                                
A roll  call vote was  taken.  Representatives  Sponholz, Fields,                                                               
Snyder, and  Zulkosky voted in favor  of the motion to  report HB
382,   as    amended,   out   of   committee    with   individual                                                               
recommendations    and    the    accompanying    fiscal    notes.                                                               
Representatives  Prax,  Kurka,  and  McCarty  voted  against  it.                                                               
Therefore, CSHB  382(HSS) was  reported out  of the  House Health                                                               
and Social Services Standing Committee by a vote of 4-3.                                                                        
                                                                                                                                
5:34:35 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 5:34 p.m. to 5:36 p.m.                                                                       
                                                                                                                                
        SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN                                                                    
                                                                                                                                
5:36:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY announced  that  the final  order of  business                                                               
would  be SENATE  BILL NO.  132 "An  Act exempting  veterinarians                                                               
from the  requirements of  the controlled  substance prescription                                                               
database."                                                                                                                      
                                                                                                                                
5:38:09 PM                                                                                                                    
                                                                                                                                
SENATOR  ROGER  HOLLAND,  Alaska   State  Legislature,  as  prime                                                               
sponsor, read the  sponsor statement for SB 132  [included in the                                                               
committee packet],  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Alaska's  25th  legislature  created  the  Prescription                                                                    
     Drug   Monitoring   Program   (PDMP)   in   2008.   The                                                                    
     legislative  intent behind  the  PDMP was  to create  a                                                                    
     database of prescriptions for controlled substances in                                                                     
     the   state.  The   PDMP  may   create  obstacles   for                                                                    
     individuals   seeking   opioids  to   obtain   multiple                                                                    
     prescriptions from  registered providers  and may  be a                                                                    
     useful tool for human doctors in combating the                                                                             
     opioid crisis.  Under the current  statutory framework,                                                                    
     Alaska's veterinarians  are required to  participate in                                                                    
     the  PDMP,   despite  the   irreconcilable  differences                                                                    
     between  human and  veterinary medical  practice. PDMPs                                                                    
     have been implemented  in all 50 states,  but 34 states                                                                    
     have   recognized  the   unsuitability  of   veterinary                                                                    
     participation in  the PDMP and  exempted veterinarians.                                                                    
     SB 132 would add Alaska to that list.                                                                                      
                                                                                                                                
     The majority  of states exempt veterinarians  from PDMP                                                                    
     because they  have recognized  that PDMPs  are designed                                                                    
     for  use in  human medicine;  and veterinary  exclusion                                                                    
     from  PDMPs  does  not increase  risk  to  the  public.                                                                    
     Alaska's  inclusion of  veterinarians in  the PDMP  has                                                                    
     produced  no identifiable  benefit;  yet  the PDMP  has                                                                    
     created  a   multitude  of  verifiable  harms   to  the                                                                    
     veterinary profession and the  Alaskans they serve. The                                                                    
     PDMP is  inappropriate and not  effective for  use with                                                                    
     animal  patients, as  animals do  not have  identifiers                                                                    
     such  as a  social security  number, and  veterinarians                                                                    
     must  view human  owners'  private  health data  before                                                                    
     treating an animal.                                                                                                        
                                                                                                                                
     Alaska  has the  highest veterinary  licensure cost  in                                                                    
     the  United  States.  Veterinary participation  in  the                                                                    
     PDMP contributes  to this unnecessary  financial burden                                                                    
     on a  profession already experiencing  extreme staffing                                                                    
     shortages,   decreasing   availability  of   veterinary                                                                    
     services  to Alaskans.  Moreso, a  recent survey  found                                                                    
     attempted veterinary doctor  shopping across the entire                                                                    
     United States is essentially non-existent.                                                                                 
                                                                                                                                
     Veterinarians  are   tightly  regulated  by   the  Drug                                                                    
     Enforcement  Agency, the  Know Your  Customer Act,  and                                                                    
     the State licensing  board. SB 132 seeks  to correct an                                                                    
     expensive overreach  so that  Alaskans can  have access                                                                    
     to  treatment  for   their  pets  without  compromising                                                                    
     public safety.                                                                                                             
                                                                                                                                
5:41:24 PM                                                                                                                    
                                                                                                                                
NIKKI   ROSE,  Staff,   Senator  Roger   Holland,  Alaska   State                                                               
Legislature, on  behalf of Senator  Holland, prime  sponsor, gave                                                               
the  sectional analysis  of  SB 132  [included  in the  committee                                                               
packet], which read as follows [original punctuation provided]:                                                                 
                                                                                                                                
     Sec.  1 AS  17.30.200(o),  relating  to the  controlled                                                                    
     substance   prescription   database,  is   amended   by                                                                    
     deleting  the Board  of Veterinary  Examiners from  the                                                                    
     list of required notification by  the Board of Pharmacy                                                                    
     when a practitioner registers with the database.                                                                           
                                                                                                                                
     Sec. 2 Adds veterinarians  to the list of practitioners                                                                    
     not required  to comply  with the  controlled substance                                                                    
     prescription database under AS 17.30.200(t).                                                                               
                                                                                                                                
     Sec.  3  Adds  a  definition of  "practitioner"  to  AS                                                                    
     17.30.200(u)                                                                                                               
                                                                                                                                
     Sec.  4 Repeals  AS  08.98.050(a)(10), which  obligates                                                                    
     the board of veterinary  examiners to require licensees                                                                    
     to register with  the controlled substance prescription                                                                    
     database.                                                                                                                  
                                                                                                                                
5:42:31 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked who manages the PDMP.                                                                                   
                                                                                                                                
SENATOR HOLLAND explained  that the expert who  could answer that                                                               
question was no longer available.                                                                                               
                                                                                                                                
CO-CHAIR  ZULKOSKY directed  the question  to Sara  Chambers from                                                               
the  Department of  Commerce,  Community  & Economic  Development                                                               
(DCCED).                                                                                                                        
                                                                                                                                
5:43:35 PM                                                                                                                    
                                                                                                                                
SARA CHAMBERS,  Director, Division of Corporations,  Business and                                                               
Professional  Licensing,  Department  of  Commerce,  Community  &                                                               
Economic Development (DCCED), replied  that the PDMP is monitored                                                               
by DCCED staff  through the Board of Pharmacy which  is in charge                                                               
of PDMP implementation.                                                                                                         
                                                                                                                                
5:44:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   MCCARTY   asked    for   confirmation   of   his                                                               
understanding that  when a pet  is owned by multiple  parties, as                                                               
in  a family  pet, whoever  brings  the pet  to the  veterinarian                                                               
would  have their  identification  (ID) number  entered into  the                                                               
PDMP.                                                                                                                           
                                                                                                                                
SENATOR HOLLAND explained that the  ID number could come from any                                                               
person who  drops off a pet  when the prescription of  opioids is                                                               
necessary; it does not have to be  the owner.  He stated that the                                                               
regulations simply require a number to be entered.                                                                              
                                                                                                                                
REPRESENTATIVE  MCCARTY   stated  that   this  seems   to  dilute                                                               
effectiveness  of the  PDMP since  multiple identifiers  could be                                                               
listed for the same animal.                                                                                                     
                                                                                                                                
SENATOR HOLLAND  explained that due  to time constraints,  he had                                                               
not  been  able  to  use   the  prepared  PowerPoint  during  his                                                               
presentation, and  he noted  that it is  a valuable  resource for                                                               
answering many of the basics about the bill.                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked what collaboration has  occurred between                                                               
DCCED and veterinarians to solve issues with PMDP.                                                                              
                                                                                                                                
5:46:59 PM                                                                                                                    
                                                                                                                                
MS.   CHAMBERS   responded   that  DCCED   has   conducted   many                                                               
conversations  with  the  Board  of Pharmacy  and  the  Board  of                                                               
Veterinary Examiners to address how  regulations should be set to                                                               
conform  with statute  and whether  or  not statute  needs to  be                                                               
changed.  She said that there  have been varying levels of follow                                                               
through among  the different entities that  have a responsibility                                                               
to  participate in  these  discussions.   She  reported that  the                                                               
department has  published instructions  on how  veterinarians can                                                               
use the  PDMP and  that she had  received positive  feedback from                                                               
veterinarians  that   the  instructions   made  using   the  PDMP                                                               
possible.   However, she mentioned that  many veterinarians still                                                               
have  concerns  about how  to  align  day-to-day operations  with                                                               
statute.                                                                                                                        
                                                                                                                                
5:49:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX  asked  how  long the  department  has  been                                                               
working with veterinarians to fix the issue.                                                                                    
                                                                                                                                
MS. CHAMBERS answered since the legislation passed in 2016.                                                                     
                                                                                                                                
5:49:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER shared her understanding  that many of the issues                                                               
veterinarians  have been  experiencing  with PMDP  relate to  the                                                               
navigability  of the  database itself.   She  asked what  kind of                                                               
changes have  been made  to the  database to  make it  more [user                                                               
friendly].                                                                                                                      
                                                                                                                                
MS.  CHAMBERS  voiced her  belief  that  there had  been  changes                                                               
implemented but directed the question  to Laura Carrillo for more                                                               
details on PMDP.                                                                                                                
                                                                                                                                
SENATOR HOLLAND  also referred the  question to Michaela  Dick, a                                                               
veterinarian who  has had a lot  of experience with the  PDMP and                                                               
has been advocating for change.                                                                                                 
                                                                                                                                
5:51:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER restated  her  question about  what changes,  if                                                               
any, have been made to the database since 2017.                                                                                 
                                                                                                                                
MICHAELA   DICK,   DMV,   Past   President,   Alaska   Veterinary                                                               
Association, replied that "we haven't  really been working on it"                                                               
and that  there has been  more of  a focus on  conversations with                                                               
the department  and the  boards due  to investigations  that have                                                               
been launched on veterinarians not  being able to use the system.                                                               
She  explained  that  because  veterinarians  work  with  animals                                                               
rather than  people, they are unable  to look up anything  in the                                                               
database  since   their  patients  do  not   have  identification                                                               
numbers.  She opined that any  fixes made to the database did not                                                               
solve the  core problem of  veterinarians being unable  to comply                                                               
with statute.                                                                                                                   
                                                                                                                                
5:53:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  asked what  changes to  regulation have                                                               
been  discussed   to  make  the   PDMP  more   user-friendly  for                                                               
veterinarians  while  still meeting  the  public  health need  of                                                               
tracking  opioids.    First,  she  posited  that  vets  could  be                                                               
required  to login  only  on days  that  they prescribe  opioids.                                                               
Second, she suggested  making the only ID  number associated with                                                               
the animal be connected to the responsible financial party.                                                                     
                                                                                                                                
5:55:16 PM                                                                                                                    
                                                                                                                                
LAURA CARRILLO,  Administrator, Board of Pharmacy,  Department of                                                               
Commerce,  Community, and  Economic  Development, explained  that                                                               
the  department  has had  "very  fruitful  discussions" with  the                                                               
Board of  Veterinary Examiners but  the discussions have  not yet                                                               
resulted  in  policy  suggestions.    She  voiced  concern  about                                                               
comingling of data  and explained that DCCED  has adjusted coding                                                               
within the  database to clarify species  and published guidelines                                                               
to help veterinarians know which codes  to use.  She deferred the                                                               
question  about regulations  around discerning  pet ownership  to                                                               
the veterinarians.                                                                                                              
                                                                                                                                
CO-CHAIR ZULKOSKY announced that SB 132 was held over.                                                                          
                                                                                                                                
5:57:48 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:57 p.m.                                                                                                          
                                                                                                                                

Document Name Date/Time Subjects
HB 382 Amendment #1.pdf HHSS 4/26/2022 3:00:00 PM
HB 382
SB 132 v.A.PDF HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Fiscal Notes DCCED 2.1.22.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 AKVMA White Paper.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Letters of Opposition as of 4.8.22.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
SB 132 Lincoln University Study PDMP Custom Tailoring is needed 2014.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Letters of Support as of 4.13.22.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
SB 132 Presentation 4-14-22.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Sectional Analysis.pdf HHSS 4/26/2022 3:00:00 PM
SB 132
SB 132 Sponsor Statement.pdf HHSS 4/26/2022 3:00:00 PM
HL&C 5/13/2022 9:00:00 AM
SB 132
HB382 DOI Response to Question from (H)HSS Committee 04.26.2022.pdf HHSS 4/26/2022 3:00:00 PM
HB 382