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