Legislature(2017 - 2018)SENATE FINANCE 532

05/30/2017 03:30 PM FINANCE

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03:47:40 PM Start
03:48:19 PM HB159
04:35:40 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time --
*+ HB 159 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES TELECONFERENCED
Moved SCS CSHB 159(FIN) Out of Committee
Bills Previously Heard/Scheduled
                 SENATE FINANCE COMMITTEE                                                                                       
                   FIRST SPECIAL SESSION                                                                                        
                       May 30, 2017                                                                                             
                         3:47 p.m.                                                                                              
                                                                                                                                
3:47:40 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair  MacKinnon  called  the  Senate  Finance  Committee                                                                    
meeting to order at 3:47 p.m.                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Lyman Hoffman, Co-Chair                                                                                                 
Senator Anna MacKinnon, Co-Chair                                                                                                
Senator Click Bishop, Vice-Chair                                                                                                
Senator Shelley Hughes                                                                                                          
Senator Peter Micciche                                                                                                          
Senator Donny Olson                                                                                                             
Senator Natasha von Imhof                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Sara Chambers, Director,  Division of Corporations, Business                                                                    
and   Professional   Licensing,  Department   of   Commerce,                                                                    
Community  and Economic  Development;  Laura Cramer,  Staff,                                                                    
Senator Anna  MacKinnon; Jay Butler, Chief  Medical Officer,                                                                    
Department of Health and Social Services.                                                                                       
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Richard  Holt,   Vice  Chair,  Alaska  Board   of  Pharmacy,                                                                    
Department of Commerce,  Community and Economic Development;                                                                    
Paul  Barney, Chair,  Alaska Board  Examiners in  Optometry,                                                                    
Department of Commerce, Community and Economic Development.                                                                     
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 159    OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                               
                                                                                                                                
          SCS CSHB 159(FIN) was REPORTED out of committee                                                                       
          with a "do pass" recommendation and with two                                                                          
          previously published fiscal notes: FN2(DHS),                                                                          
          FN3(CED).                                                                                                             
                                                                                                                                
CS FOR HOUSE BILL NO. 159(FIN) am                                                                                             
                                                                                                                                
     "An  Act  relating  to  the  prescription  of  opioids;                                                                    
     relating  to voluntary  nonopioid directives;  relating                                                                    
     to  the  controlled  substance  prescription  database;                                                                    
     relating to the practice  of dentistry; relating to the                                                                    
     practice  of  pharmacy;  relating to  the  practice  of                                                                    
     medicine;  relating   to  the  practice   of  podiatry;                                                                    
     relating  to the  practice of  osteopathy; relating  to                                                                    
     the practice  of nursing; relating  to the  practice of                                                                    
     optometry;  relating  to  the  practice  of  veterinary                                                                    
     medicine;  relating  to  the duties  of  the  Board  of                                                                    
     Pharmacy;  relating to  pharmacists;  providing for  an                                                                    
     effective date by repealing the  effective date of sec.                                                                    
     73, ch.  25, SLA 2016;  and providing for  an effective                                                                    
     date."                                                                                                                     
                                                                                                                                
3:48:19 PM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon directed attention to CSHB 159(FIN)am.                                                                       
She asked for an overview of the bill.                                                                                          
                                                                                                                                
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS                                                                     
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,                                                                             
COMMUNITY AND ECONOMIC DEVELOPMENT, introduced herself.                                                                         
                                                                                                                                
JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH AND                                                                     
SOCIAL SERVICES, introduced himself.                                                                                            
                                                                                                                                
Ms. Chambers reviewed the sectional analysis (copy on                                                                           
file):                                                                                                                          
                                                                                                                                
     Note:   Sec.  1   adds   legislative  intent   language                                                                    
    regarding the seven-day initial prescription limit                                                                          
                                                                                                                                
     Sec.  1:  Adds  language  stating  the  intent  of  the                                                                    
     legislature is  for the seven-day  supply limit  not to                                                                    
     be  considered  the  minimum appropriate  time  for  an                                                                    
     initial  prescription. The  Center for  Disease Control                                                                    
     and   Prevention    suggests   a    three-day   initial                                                                    
     prescription   limit  and   practitioners  should   use                                                                    
     professional   judgment  in   determining  prescription                                                                    
     lengths.                                                                                                                   
                                                                                                                                
     Note:  Sec.  2 -  27  amend  individual board  statutes                                                                    
     regarding:    education   requirements    for   initial                                                                    
     licensure;   continuing   education  requirements   for                                                                    
     licensure  renewal; disciplinary  authority of  Board's                                                                    
     pertaining  to the  maximum opioid  prescription limit;                                                                    
     sets a maximum opioid prescription  limit of 7 days for                                                                    
     the   initial  prescription   (with  exceptions);   and                                                                    
     defines opioids.                                                                                                           
                                                                                                                                
     Sec. 2:  Amends the Board of  Dental Examiners statutes                                                                    
     by  requiring  the  Board   to  adopt  regulations  for                                                                    
     renewal of licensure to include  a minimum of two hours                                                                    
     of continuing  education in pain management  and opioid                                                                    
     misuse  and   addiction  in  the  previous   two  years                                                                    
     preceding    renewal,   unless    the   licensee    has                                                                    
     demonstrated to the satisfaction  of the Board that the                                                                    
     licensee does  not currently hold a  valid federal Drug                                                                    
     Enforcement Agency (DEA) registration number.                                                                              
                                                                                                                                
     Sec. 3:  Amends the Board of  Dental Examiners statutes                                                                    
     by  requiring  the  Board   to  adopt  regulations  for                                                                    
     licensure qualifications  to include  a minimum  of two                                                                    
     hours  of  education  in  pain  management  and  opioid                                                                    
     misuse  and addiction  in the  two years  preceding the                                                                    
     application  for a  license, unless  the applicant  has                                                                    
     demonstrated to the satisfaction  of the Board that the                                                                    
     applicant does  not currently hold a  valid federal DEA                                                                    
     registration number.                                                                                                       
                                                                                                                                
     Sec. 4:  Amends the Board of  Dental Examiners statutes                                                                    
     for  disciplinary authority.  It  allows  the Board  to                                                                    
     discipline,  revoke, suspend,  reprimand  or censure  a                                                                    
     license of  a dentist,  if the  Board finds  a licensee                                                                    
     has prescribed or dispensed an  opioid in excess of the                                                                    
     maximum  dosage  authorized   under  AS  08.36.355,  or                                                                    
     procured,  sold,  prescribed,  or  dispensed  drugs  in                                                                    
     violation  of a  law, regardless  of whether  there has                                                                    
     been a criminal action or patient harm.                                                                                    
                                                                                                                                
     Sec.  5: Adds  a new  section  to the  Board of  Dental                                                                    
     Examiners statutes  limiting the  dosage for  an opioid                                                                    
     prescription  to a  seven-day  supply for  an adult  or                                                                    
     minor.  The dentist  must discuss  with  the parent  or                                                                    
     guardian of  a minor why the  prescription is necessary                                                                    
     and  the  risks  associated  with  the  opioid  use.  A                                                                    
     dentist  may issue  a prescription  for greater  than a                                                                    
     seven-day supply  to an adult  or minor patient  if, in                                                                    
     the professional judgement of  the dentist, more than a                                                                    
     seven-day  supply is  necessary for;  the chronic  pain                                                                    
     management,  or a  patient who  is unable  to access  a                                                                    
     practitioner within the time  necessary for a refill of                                                                    
     the seven-day supply because of  a logistical or travel                                                                    
     barrier.  The dentist  must document  in the  patient's                                                                    
     medical record the condition requiring  the excess of a                                                                    
     seven-day   supply,    and   indicate    a   non-opioid                                                                    
     alternative   was   not   appropriate  to   treat   the                                                                    
    condition. The section defines "adult" and "minor."                                                                         
                                                                                                                                
     Sec. 6:  Amends the  Board of Dental  Examiner statutes                                                                    
     by adding a definition of an "opioid."                                                                                     
                                                                                                                                
Ms.  Chambers   highlighted  that  Sections  7   through  14                                                                    
pertained  to  the medical  board.  She  specified that  the                                                                    
sections dealt with education on  opioid use, addiction, and                                                                    
pain  management  for the  various  license  types that  had                                                                    
prescribing  authority  and  were  managed  by  the  medical                                                                    
board.                                                                                                                          
                                                                                                                                
Ms. Chambers continued discussing the Sectional Analysis:                                                                       
                                                                                                                                
     Sec. 15:  Amends Medical Board  disciplinary authority.                                                                    
     The  Board may  impose a  disciplinary sanction  if the                                                                    
     Board  finds   that  a   licensee  has   prescribed  or                                                                    
     dispensed an opioid in excess of the maximum dosage.                                                                       
                                                                                                                                
Ms. Chambers explained that Section  16 provided the Medical                                                                    
Board the  same limitation in prescribing  opioids as dental                                                                    
examiners (a seven-day supply).  There was an opportunity to                                                                    
exceed  seven days  using professional  judgement or  due to                                                                    
logistical or travel  barriers, which must be  codified in a                                                                    
patient's medical record.                                                                                                       
                                                                                                                                
Ms. Chambers  relayed that Section 17  amended Medical Board                                                                    
statute   for   prescription   drugs  without   a   physical                                                                    
examination. She continued that  the amendment harkened back                                                                    
to   legislation   from    the   previous   year   regarding                                                                    
telemedicine,  and conformed  the bill  to existing  session                                                                    
law put in place in the current year.                                                                                           
                                                                                                                                
Ms. Chambers continued discussing the sectional analysis:                                                                       
                                                                                                                                
     Sec.  18: Amends  Medical Board  statute by  adding and                                                                    
     defining  "opioid"  to  include the  opium  and  opiate                                                                    
     substances and opium and opiate derivatives listed in                                                                      
     AS 11.71.140.                                                                                                              
                                                                                                                                
Ms. Chambers  communicated that Sections  19 through  21 all                                                                    
pertained  to  education and  discipline  for  the Board  of                                                                    
Nursing. There were requirements  for two hours of education                                                                    
on  opioid use  and addiction,  as  well as  the ability  to                                                                    
discipline   for  overprescribing   by  an   advanced  nurse                                                                    
practitioner.                                                                                                                   
                                                                                                                                
3:53:01 PM                                                                                                                    
                                                                                                                                
Ms. Chambers  turned to Section 22,  which limited licensees                                                                    
of the  Board of Nursing  to prescribing a  seven-day supply                                                                    
of  an  opioid.   The  same  waiver  was  in   place  -  the                                                                    
professional  judgement  or  logistical or  travel  barriers                                                                    
must be documented.  Section 23 defined opioid  and Board of                                                                    
Nursing statutes. Sections 24  through 26 required education                                                                    
for licensees  of the Board  of Optometry on  opioid misuse,                                                                    
addiction,  and  pain   management.  Optometrists  would  be                                                                    
required to take  two hours within the  four years preceding                                                                    
renewal  as  opposed  to   the  previous  licensing  period.                                                                    
Section  27 amended  the Board  of Optometry's  disciplinary                                                                    
authority  (similar to  the other  license types  discussed)                                                                    
when there was overprescribing or illegal prescribing.                                                                          
                                                                                                                                
Ms. Chambers  relayed that Sections  28 and 29  pertained to                                                                    
the Board of  Pharmacy. Section 28 included  a technical fix                                                                    
to conform  to session law  taking effect in July  2017. She                                                                    
detailed that  pharmacists did  not obtain  DEA registration                                                                    
numbers,  so  it was  being  removed  from law.  Section  29                                                                    
amended the Board of Pharmacy  statutes to allow pharmacists                                                                    
to  partially  fill prescriptions  for  Schedule  II or  III                                                                    
controlled   substances.   She   elaborated  that   if   the                                                                    
individual did  not want to obtain  the entire prescription,                                                                    
they could obtain  part of the prescription and  go back for                                                                    
the remainder at a later date.                                                                                                  
                                                                                                                                
3:55:04 PM                                                                                                                    
                                                                                                                                
Vice-Chair Bishop  asked for verification that  if a patient                                                                    
chose  to only  receive four  days' worth  of the  seven-day                                                                    
prescription, they would only  receive the remaining balance                                                                    
of the prescription if they came back at a later date.                                                                          
                                                                                                                                
Ms. Chambers answered in the affirmative.                                                                                       
                                                                                                                                
Ms.  Chambers continued  discussing the  Sectional Analysis.                                                                    
Section 30  pertained to the Board  of Veterinary Examiners.                                                                    
She detailed  the section would  require board  licensees to                                                                    
take educational  courses that  would help them  to identify                                                                    
resources to  assist them with  identifying an  animal owner                                                                    
who may  be at risk for  abusing or misusing an  opioid. The                                                                    
section  would  also  require  the  board  to  identify  and                                                                    
develop  related educational  materials  to  provide to  its                                                                    
licensees. The education  requirement was slightly different                                                                    
from the  other license types who  were prescribing directly                                                                    
to  a human.  Section 31  provided the  Board of  Veterinary                                                                    
Examiners  the  opportunity  to discipline  a  licensee  who                                                                    
prescribed or dispensed  an opioid in excess  of the maximum                                                                    
dosage authorized  under a  previous section.  She continued                                                                    
with the sectional analysis:                                                                                                    
                                                                                                                                
     Sec. 32 - Establishes the Voluntary Nonopioid                                                                              
     Directive                                                                                                                  
     Sec. 32:  The section  allows an  individual who  is 18                                                                    
     years  of  age or  older,  an  emancipated minor  or  a                                                                    
     parent   or  legal   guardian  of   a   minor,  or   an                                                                    
     individual's guardian or other  person appointed by the                                                                    
     individual  or court  to manage  the individual  health                                                                    
     care to  execute a voluntary non-opioid  directive in a                                                                    
     format  prescribed  by  the Department  of  Health  and                                                                    
     Social Services.  The section  further provides  that a                                                                    
     licensed    healthcare   providers,    hospitals,   and                                                                    
     employees,  and pharmacists  are exempt  from licensing                                                                    
     board  discipline,  civil  and criminal  liability  for                                                                    
     failure  to  administer,   prescribe,  or  dispense  an                                                                    
     opioid to  an individual  who has executed  a voluntary                                                                    
     non-opioid directive.  The directive  does not  limit a                                                                    
     healthcare  provider  or pharmacist  from  prescribing,                                                                    
     dispensing,  or administering  an opioid  overdose drug                                                                    
     or an  opioid for the  treatment of substance  abuse or                                                                    
     opioid dependence.                                                                                                         
                                                                                                                                
     Note:   Sec.   33-42   -  Changes   relating   to   the                                                                    
     Prescription Drug  Monitoring Program  (PDMP); updating                                                                    
     the  definition  of   opioid;  and  prescriber  "report                                                                    
     cards."                                                                                                                    
                                                                                                                                
     Sec.  33: Amends  AS 17.300.200(a)  to exclude  certain                                                                    
     facilities  from  the  requirements of  the  controlled                                                                    
     substance  prescription  database  (also known  as  the                                                                    
     PDMP).  This section  references a  section "u"  of the                                                                    
     PDMP (see section 42)  where by correctional facilities                                                                    
     are  exempt  from  the  PDMP  except  when  prescribing                                                                    
     opioids  to  an inmate  at  the  time of  the  inmate's                                                                    
     release  as in-patient  pharmacies and  emergency rooms                                                                    
     are exempt  if they  are only  prescribing less  than a                                                                    
     24-hour supply of opioids (see also section 41).                                                                           
                                                                                                                                
     Sec.   34:   Amends   AS   17.300.200(b)   to   exclude                                                                    
     correctional  facilities from  the requirements  of the                                                                    
     controlled substance prescription  database except when                                                                    
     prescribing opioids  to an  inmate at  the time  of the                                                                    
     inmate's  release. Note:  This is  required due  to the                                                                    
     delayed effective dates from SB 74 and this bill.                                                                          
                                                                                                                                
     Sec. 35: Amends AS 17.30.200(b)  as amended by sec. 23,                                                                    
     ch.  25,   SLA  2016  by  substituting   "weekly"  with                                                                    
     "daily."  The change  will  require the  pharmacist-in-                                                                    
     charge  of  a  pharmacy,   and  each  practitioner  who                                                                    
     dispenses  a   schedule  II,  III,  or   IV  controlled                                                                    
     substance, to submit the  information to the controlled                                                                    
     substance  prescription   database  daily   instead  of                                                                    
     weekly.  (Note: This  is required  due  to the  delayed                                                                    
     effective dates from SB 74 and this bill).                                                                                 
                                                                                                                                
     Sec. 36: Amends AS 17.30.200(d)  as amended ch. 25, SLA                                                                    
     2016 to clarify that  information contained in the PDMP                                                                    
     can  be  shared  with  federal,  state  and  local  law                                                                    
     enforcement that  have a valid search  warrant or court                                                                    
     order.                                                                                                                     
                                                                                                                                
     Sec. 37: Amends  AS 17.30.200(e) as amended  by ch. 25,                                                                    
     SLA 2016  to clarify that a  pharmacist, the individual                                                                    
     filling   a  prescription,   is   required  to   submit                                                                    
     information    into   the    database.   It    is   the                                                                    
     responsibility  of  the  practitioner,  the  individual                                                                    
     writing the prescription, to review the database.                                                                          
                                                                                                                                
     Sec. 38: Amends  AS 17.30.200(p) as amended  by ch. 25,                                                                    
     SLA  2016  to  require  the  Board  of  Pharmacy  shall                                                                    
     promptly notify the Board  of Veterinary Examiners when                                                                    
     a practitioner  registers with  the database  under (o)                                                                    
     of the section.                                                                                                            
                                                                                                                                
3:59:28 PM                                                                                                                    
                                                                                                                                
Ms. Chambers continued to discuss the sectional analysis:                                                                       
                                                                                                                                
     Sec. 39: Amends AS 17.30.200(q)  as amended by, ch. 25,                                                                    
     SLA 2016 is  amended by allowing the  Board of Pharmacy                                                                    
     to    provide   unsolicited    notification   to    the                                                                    
     practitioner's  licensing   board  if  a   patient  has                                                                    
     received  one  or  more  prescriptions  for  controlled                                                                    
     substances   in   quantities   or  with   a   frequency                                                                    
     inconsistent  with  generally recognized  standards  of                                                                    
     safe  practice.  The   unsolicited  notification  to  a                                                                    
     practitioner's licensing  board under the  section must                                                                    
     also  be provided  to the  practitioner, is  considered                                                                    
     confidential,    may    not    disclose    confidential                                                                    
     information under the section, and  may be in a summary                                                                    
     form sufficient to provide notice  of the basis for the                                                                    
     unsolicited notification.                                                                                                  
                                                                                                                                
     Sec. 40: Amends  AS 17.30.200(r) as amended  by ch. 25,                                                                    
     SLA 2016 to provide guidance  so to when the Board must                                                                    
     update   the    requirement   that    pharmacists   and                                                                    
     prescribers must  comply with  the database on  a daily                                                                    
     basis rather than a weekly basis.                                                                                          
                                                                                                                                
     Sec. 41:  Amends AS 17.30.200(n)  as amended by  ch 25,                                                                    
     SLA 2016 to update the  definition of opioid to include                                                                    
     the opium  and opiate  substances and opium  and opiate                                                                    
     derivatives listed in AS 11.71.140.                                                                                        
                                                                                                                                
     Sec.  42:  Adds a  new  section  (t) to  AS  17.30.200,                                                                    
     giving  the Board  of Pharmacy  the authority  to issue                                                                    
     periodic   unsolicited   "report   cards"   with   non-                                                                    
     identifiable  information comparing  the practitioner's                                                                    
     opioid prescribing  practices with  others in  the same                                                                    
     occupation. However,  this information  is confidential                                                                    
     and  cannot be  released  to others.  Also  adds a  new                                                                    
     section  (u)  to  AS 47.17.200,  giving  the  Board  of                                                                    
     Pharmacy  the ability  to exempt  in-patient pharmacies                                                                    
     and  emergency rooms  from  the  review and  submission                                                                    
     requirement  of the  PDMP when  they are  dispensing no                                                                    
     more than a 24-hour supply of opioids upon discharge.                                                                      
                                                                                                                                
4:01:14 PM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon asked for verification that Sections 33                                                                      
and 34 exempted correctional facilities from reporting                                                                          
requirements. Ms. Chambers answered in the affirmative.                                                                         
                                                                                                                                
Co-Chair  MacKinnon remarked  that  subsection (u)  [Section                                                                    
45, subsection  (u)] was broader  than language  in Sections                                                                    
33  and 34.  She noted  that subsection  (u) pertained  to a                                                                    
health  care  facility  or   a  correctional  facility.  She                                                                    
elaborated that the 24-hour threshold  was for an in-patient                                                                    
pharmacy  like  a  senior  home   (e.g.  Pioneer  Homes)  or                                                                    
emergency  departments. She  asked for  the accuracy  of her                                                                    
statements.                                                                                                                     
                                                                                                                                
Ms. Chambers responded that the statements were accurate.                                                                       
                                                                                                                                
Ms. Chambers continued to review the sectional analysis:                                                                        
                                                                                                                                
     Note:  Sec. 43-45  - Relate  to regulations  and repeal                                                                    
     PDMP effective dates                                                                                                       
                                                                                                                                
     Sec. 43: Amends AS 18.05.040  to give authority for the                                                                    
     Commissioner of  Health &  Social Services  shall adopt                                                                    
     regulations   consistent   with    existing   law   for                                                                    
     implementation   of  AS   13.55,  Voluntary   Nonopioid                                                                    
     Directive Act.                                                                                                             
                                                                                                                                
     Sec.  44: Repeals  various sections  from  ch. 25,  SLA                                                                    
     2016 related to  the July 2018 effective  dates for the                                                                    
     PDMP in SB 74.                                                                                                             
                                                                                                                                
     Sec.  45:  Provides   transitional  authority  for  the                                                                    
     Department  of Commerce  and  Economic Development  and                                                                    
     Department  of  Health  and Social  Services  to  draft                                                                    
     regulations to  implement changes to the  PDMP prior to                                                                    
     the  effective  date of  certain  sections.  This is  a                                                                    
     technical fix.                                                                                                             
                                                                                                                                
     Note: Sec. 46-55 - Refer to Effective Dates                                                                                
                                                                                                                                
     Sec. 46, 47, 48, 49, 50,  51, 52: Relate to the various                                                                    
     changes  to the  PDMP  related to  the effective  dates                                                                    
     under SB 74.  This is necessary because  the changes to                                                                    
     the PDMP under  SB 74 are not in effect  until July 18,                                                                    
     2017.                                                                                                                      
                                                                                                                                
     Sec. 53:  These are  the new  effective dates  from the                                                                    
     PDMP (July 1, 2018).                                                                                                       
                                                                                                                                
     Sec.  54: The  advance directive  sections of  the bill                                                                    
     (sections 32 and 43) take effect on July 1, 2019.                                                                          
                                                                                                                                
     Sec. 55: All  other provisions of the  bill take effect                                                                    
     immediately.                                                                                                               
                                                                                                                                
Co-Chair MacKinnon asked if the  weekly requirement would go                                                                    
into effect July 2017.                                                                                                          
                                                                                                                                
Ms. Chambers  agreed that the weekly  requirement would take                                                                    
place for  a period  of one year  and the  daily requirement                                                                    
would be implemented in July 2018.                                                                                              
                                                                                                                                
4:03:26 PM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon asked  Dr. Butler if he  had any comments                                                                    
regarding  the  work  draft. Dr.  Butler  responded  in  the                                                                    
negative.                                                                                                                       
                                                                                                                                
Vice-Chair   Bishop  MOVED   to  ADOPT   proposed  committee                                                                    
substitute (CS) for CSHB  159(FIN)am, Work Draft 30-GH1021\N                                                                    
(Mischel/Bruce, 5/30/17).                                                                                                       
                                                                                                                                
Co-Chair MacKinnon  OBJECTED for  discussion. She  asked her                                                                    
staff to review changes in the CS (version N).                                                                                  
                                                                                                                                
LAURA CRAMER,  STAFF, SENATOR  ANNA MACKINNON,  informed the                                                                    
committee that  the CS incorporated several  changes made in                                                                    
the Senate Health  and Social Services committee  as well as                                                                    
changes identified in conversations  with the various boards                                                                    
outlined in the legislation.                                                                                                    
                                                                                                                                
Ms. Cramer discussed a document  titled "Summary of Changes"                                                                    
(copy on file):                                                                                                                 
                                                                                                                                
     Page 2, lines 2-3  and lines 10-11: Conforming language                                                                    
     to  Section 28  relating to  the four-day  supply limit                                                                    
     for  an initial  opioid prescription  for the  Board of                                                                    
     Examiners in Optometry.                                                                                                    
                                                                                                                                
     Page  7, line  9: Amends  the definition  of opioid  to                                                                    
     include    Schedule    IIIA    controlled    substances                                                                    
     (11.71.160).                                                                                                               
                                                                                                                                
     Page 15,  line 20: Conforming change  for the inclusion                                                                    
     of Schedule  IIIA controlled substances  (11.71.160) to                                                                    
     the definition of opioid.                                                                                                  
                                                                                                                                
     Page 19,  line 28: Conforming change  for the inclusion                                                                    
     of Schedule  IIIA controlled substances  (11.71.160) to                                                                    
     the definition of opioid.                                                                                                  
                                                                                                                                
     Page 22,  line 2-10:  Amends statute  for the  Board of                                                                    
     Optometry  removing   the  hour  requirement   for  the                                                                    
     board's  education  in prescription  of  pharmaceutical                                                                    
     agents  and  injection  of  therapeutic  pharmaceutical                                                                    
     agents which will be handled through regulation.                                                                           
                                                                                                                                
Ms. Cramer elaborated on the change on page 22. She relayed                                                                     
the intent was to manage the number of hours through                                                                            
regulation, not statute.                                                                                                        
                                                                                                                                
Co-Chair MacKinnon asked the language was consistent with                                                                       
all or most other boards.                                                                                                       
                                                                                                                                
Ms. Cramer replied in the affirmative. She added that the                                                                       
educational requirement set by the Board of Optometry was                                                                       
already higher than the statutory requirement.                                                                                  
                                                                                                                                
4:07:02 PM                                                                                                                    
                                                                                                                                
Ms. Cramer continued to discuss the Summary of Changes:                                                                         
                                                                                                                                
     Page 23, lines 13-14: Amends  the Board of Examiners in                                                                    
     Optometry  -  Grounds  for imposition  of  disciplinary                                                                    
     sanctions  (08.72.240)  stating   that  the  Board  may                                                                    
     impose  disciplinary  sanctions  when the  board  finds                                                                    
     after a  hearing that the  licensee (10)  prescribed or                                                                    
     dispensed  an opioid  in excess  of the  maximum dosage                                                                    
     authorized    under   Maximum    dosage   for    opioid                                                                    
     prescriptions (Sec. 28).                                                                                                   
                                                                                                                                
     Page  23, line  18 -  Page 24,  line 12:  Section 28  -                                                                    
     Amends the Board of Examiners in Optometry                                                                                 
     (1) A  licensee may  not issue an  initial prescription                                                                    
     for  an opioid  that exceeds  a four-day  supply to  an                                                                    
     adult                                                                                                                      
     (2) For a  prescription that exceeds a  four day supply                                                                    
     to a minor,  requires the licensee to  discuss with the                                                                    
     parent  of  legal  guardian  why  the  prescription  is                                                                    
    necessary and the risks associated with opioid use                                                                          
     (b)  Allows  the  Optometrist to  exceed  the  four-day                                                                    
     supply if the Optometrist determines it is necessary                                                                       
          (1)  Requires  the  Optometrist  to  document  the                                                                    
          patient's  medical   condition  or   chronic  pain                                                                    
          triggering the  need for the  opioid in  excess of                                                                    
          four-days                                                                                                             
          (2) Allows the Optometrist to take into                                                                               
          consideration logistical of travel barriers when                                                                      
          writing an opioid prescription.                                                                                       
                                                                                                                                
     Page 27,  lines 20-21:  Amends the Board  of Veterinary                                                                    
     Examiners  -  Grounds  for imposition  of  disciplinary                                                                    
     sanctions  (08.98.235)  stating   that  the  Board  may                                                                    
     impose  disciplinary  sanctions  when the  board  finds                                                                    
     after  a  hearing that  the  person  (9) prescribed  or                                                                    
     dispensed  an opioid  in excess  of the  maximum dosage                                                                    
     authorized    under   Maximum    dosage   for    opioid                                                                    
     prescriptions (Sec. 33).                                                                                                   
                                                                                                                                
     Page  27, line  24  - Page  28 line  13:  Section 33  -                                                                    
     Amends the Board of Veterinary Examiners                                                                                   
     (a)   A  veterinarian   may   not   issue  an   initial                                                                    
     prescription  for an  opioid that  exceeds a  seven-day                                                                    
    supply to the owner of an animal for outpatient use                                                                         
     (b)  Allows the  veterinarian to  exceed the  seven-day                                                                    
     supply if the veterinarian determines it is necessary                                                                      
          (1) Requires the veterinarian to document the                                                                         
          animals condition or chronic pain triggering the                                                                      
          need for the opioid in excess of seven-days                                                                           
          (2) Allows the veterinarian to take into                                                                              
          consideration logistical or travel barriers when                                                                      
          writing a prescription.                                                                                               
                                                                                                                                
4:10:14 PM                                                                                                                    
                                                                                                                                
Ms. Cramer continued to discuss the Summary of Changes:                                                                         
                                                                                                                                
     Page  28, lines  16-17: Amends  statute to  add advance                                                                    
     practice  registered  nurse   and  optometrist  to  the                                                                    
     definition of practitioner.                                                                                                
                                                                                                                                
     Page 30,  line 22: Conforming change  for the inclusion                                                                    
     of Schedule  IIIA controlled substances  (11.71.160) to                                                                    
     the definition of opioid.                                                                                                  
                                                                                                                                
     Page 35,  line 13: Conforming change  for the inclusion                                                                    
     of Schedule  IIIA controlled substances  (11.71.160) to                                                                    
     the definition of opioid.                                                                                                  
                                                                                                                                
    Page 38 lines 1-5: Section 49 - Conditional effect                                                                          
     The intent is that  Optometrists would continue to have                                                                    
     a  four-day prescribing  limit  for  opioids and  other                                                                    
     controlled substances as they currently do.                                                                                
                                                                                                                                
     Page 38, lines 6-8: Section 50                                                                                             
     Immediate effective date for sections 27 and 28                                                                            
     relating to optometrists per Section 49 - conditional                                                                      
     effect.                                                                                                                    
                                                                                                                                
4:12:00 PM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  WITHDREW her  OBJECTION. There  being NO                                                                    
further OBJECTION, Work Draft 30-GH1021\N was ADOPTED.                                                                          
                                                                                                                                
4:12:41 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
4:13:29 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair MacKinnon  relayed that the public  hearing for the                                                                    
Senate version of the bill had  been opened and closed on an                                                                    
earlier date.  She relayed that  there were  several members                                                                    
of  different boards  online  to testify.  The  CS tried  to                                                                    
address issues  brought forward to the  committee. She noted                                                                    
there  were answers  to committee  member  questions by  the                                                                    
Department of Health and Social  Services dated May 26, 2016                                                                    
(copy on file).                                                                                                                 
                                                                                                                                
4:14:09 PM                                                                                                                    
                                                                                                                                
RICHARD  HOLT,   VICE  CHAIR,  ALASKA  BOARD   OF  PHARMACY,                                                                    
DEPARTMENT OF  COMMERCE, COMMUNITY AND  ECONOMIC DEVELOPMENT                                                                    
(via teleconference), introduced himself.                                                                                       
                                                                                                                                
Co-Chair  MacKinnon mentioned  a prior  inquiry by  Mr. Holt                                                                    
pertaining  to businesses  needing to  report. She  detailed                                                                    
Mr.  Holt had  asked whether  an  entity had  to report  its                                                                    
database  or to  the  Prescription  Drug Monitoring  Program                                                                    
(PDMP) if  its facility was  closed. She asked  Ms. Chambers                                                                    
to address the issue.                                                                                                           
                                                                                                                                
Ms. Chambers  affirmed that the  law required  PMDP database                                                                    
entry when  certain schedules of controlled  substances were                                                                    
dispensed. The  board already had  a system for a  waiver in                                                                    
the case  that a  pharmacy did  not ever  prescribe opioids.                                                                    
The next step, if the bill  became law, was for the board to                                                                    
consider the  exception in regulation mentioned  by Co-Chair                                                                    
MacKinnon.  She  furthered it  stood  to  reason that  if  a                                                                    
pharmacy was  closed, it would  not be  dispensing scheduled                                                                    
substances.  It  was not  the  goal  of the  legislation  to                                                                    
create any  illogical bureaucracy. She encouraged  the board                                                                    
to outline the issue in  regulation or policy. She concluded                                                                    
that if  a business was  closed it  would not need  to enter                                                                    
information into the database that day.                                                                                         
                                                                                                                                
Mr. Holt expressed appreciation for the follow up.                                                                              
                                                                                                                                
4:16:40 PM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  referred to  testimony by  Senator Cathy                                                                    
Giessel concerning  dosage versus the duration  of time. She                                                                    
believed the  committee had chosen to  follow best practices                                                                    
in  other  states.  She  asked Dr.  Butler  to  address  the                                                                    
duration versus  the dosage and  why the  administration had                                                                    
chosen a seven-day period.                                                                                                      
                                                                                                                                
Dr.  Butler stated  that the  administration  had based  its                                                                    
recommendations  on best  practices in  other states  and on                                                                    
determining  what was  pragmatic and  workable. He  believed                                                                    
the  duration  was the  easier  way  to  go than  trying  to                                                                    
convert  to the  BTU  equivalent of  the morphine  milligram                                                                    
equivalence. To his knowledge, only  one state had gone that                                                                    
route. He  elaborated that  the dosage would  be over  a set                                                                    
timeframe.   The   options   provided  different   ways   to                                                                    
accomplish  the same  goal. The  administration had  pursued                                                                    
what it believed to be the  more pragmatic and simple way to                                                                    
communicate the law.                                                                                                            
                                                                                                                                
4:18:04 PM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon  asked Ms.  Chambers  if  an issue  with                                                                    
software  had  been  addressed,  or  whether  the  Board  of                                                                    
Pharmacy  needed to  address the  issue  in regulation.  The                                                                    
committee had inquired whether  internet speed would prevent                                                                    
a  pharmacy from  uploading the  appropriate information  to                                                                    
the PDMP and whether it would be a violation.                                                                                   
                                                                                                                                
Ms.  Chambers  stated  that  the  Board  of  Pharmacy  would                                                                    
continue  deliberating  and  enumerating in  regulation  and                                                                    
policy   ways  to   assist  pharmacies   in  reporting   and                                                                    
circumventing some  of those elements beyond  their control.                                                                    
The goal  was to  be compliant  and not  penalize pharmacies                                                                    
for  spotty  internet  access.   The  board  already  had  a                                                                    
precedent in doing so.                                                                                                          
                                                                                                                                
Co-Chair  MacKinnon asked  if Ms.  Chambers could  relay the                                                                    
administration's commitment  to work  with the  Alaska State                                                                    
Medical  Board for  concerns registered  about the  Board of                                                                    
Pharmacy's  potential adoption  and imposition  of standards                                                                    
of safe prescribing.                                                                                                            
                                                                                                                                
Ms. Chambers recounted that the  medical board had presented                                                                    
in its  letter some concerns about  pharmacies or individual                                                                    
pharmacists   red  flagging   prescribers  and   potentially                                                                    
setting their  own arbitrary standards. The  PDMP was housed                                                                    
within the  Board of Pharmacy  by law and the  board already                                                                    
set the  notification standards in  policy. The  board would                                                                    
continue  to set  notification  standards  through a  public                                                                    
process either in  policy or regulation; it would  not be up                                                                    
to  the  individual  pharmacist  or  pharmacy  to  make  the                                                                    
determination.  She  continued   that  as  safe  prescribing                                                                    
guidelines  were   developed  by  the  boards   it  was  the                                                                    
administration's  hope  and  encouragement that  the  boards                                                                    
that were  impacted and  had convened  the previous  year on                                                                    
the  Joint   Committee  on  Prescriptive   Guidelines  would                                                                    
continue to  work together on consensus  building. The group                                                                    
had  worked  together  quite easily  the  previous  year  in                                                                    
making sure  all prescribers were  at the table when  and if                                                                    
prescribing guidelines were put into regulation.                                                                                
                                                                                                                                
4:20:51 PM                                                                                                                    
                                                                                                                                
Senator Olson  asked if  the medical board  was in  favor of                                                                    
plan  that  had been  put  in  place  and was  currently  in                                                                    
writing.                                                                                                                        
                                                                                                                                
Ms. Chambers  answered that all  the members  (including the                                                                    
medical board)  were in consensus  that the  guidelines they                                                                    
wanted  to  recommend  would  be  the  State  of  Washington                                                                    
prescribing  guidelines   with  a  lower   maximum  morphine                                                                    
equivalent dosage than what Washington prescribed.                                                                              
                                                                                                                                
Senator Olson asked for verification  that the medical board                                                                    
had unanimously approved the guidelines.                                                                                        
                                                                                                                                
Ms. Chambers  stated that the  previous year each  board had                                                                    
elected  a  representative to  come  to  the table  for  the                                                                    
purpose of  making the recommendation to  the legislature as                                                                    
required  by law.  The committee  had not  gone further,  so                                                                    
there  was no  official guideline.  However, all  the boards                                                                    
with  prescribing authority  (except for  veterinarians) had                                                                    
agreed  with   the  thresholds.  She  reiterated   that  the                                                                    
agreement  was not  codified or  in regulation  and was  not                                                                    
disciplinable.    The   boards    understood   that    their                                                                    
representative  was   speaking  for   them  in   making  the                                                                    
recommendation to the legislature.                                                                                              
                                                                                                                                
Senator  Olson  asked  what  it  meant  that  the  guideline                                                                    
recommendation was not disciplinable.                                                                                           
                                                                                                                                
Ms.  Chambers   stated  that  the  boards   were  unable  to                                                                    
discipline  a  license if  there  were  standards that  were                                                                    
unwritten    or   uncodified.    She   continued    that   a                                                                    
recommendation had been made to  the legislature and none of                                                                    
the boards had adopted the guideline as its own practice.                                                                       
                                                                                                                                
Senator Olson asked if the  Alaska State Medical Association                                                                    
had weighed in on the issue.                                                                                                    
                                                                                                                                
Ms.  Chambers  responded  that the  meetings  were  publicly                                                                    
noticed  and  made available.  She  did  not recall  that  a                                                                    
member of the medical association had participated.                                                                             
                                                                                                                                
4:23:23 PM                                                                                                                    
                                                                                                                                
Senator  von  Imhof  highlighted  Section 16  of  the  bill,                                                                    
pertaining  to  a  physician's  flexibility  to  exceed  the                                                                    
seven-day limit  if it  was thought  to be  justified. Under                                                                    
the circumstance  the physician would be  required to notate                                                                    
the amount  prescribed in the  patient's file.  She remarked                                                                    
that a doctor  had been concerned about having  to write six                                                                    
separate  prescriptions if  they  wanted  a prescription  to                                                                    
exceed the  seven-day limit. She  surmised that  the section                                                                    
would allow a  physician to write one  prescription with the                                                                    
notation that a  patient may exceed the  seven-day limit for                                                                    
a specified reason.                                                                                                             
                                                                                                                                
Dr. Butler answered in the affirmative.                                                                                         
                                                                                                                                
Senator  Olson   referred  to   Section  9,   pertaining  to                                                                    
osteopaths. He  asked if there was  a significant difference                                                                    
between   osteopathic   doctors    versus   MDs   in   their                                                                    
requirements for prescriptions.                                                                                                 
                                                                                                                                
Dr. Butler replied that there  was no difference. Doctors of                                                                    
osteopathy  and  medical  doctors   were  under  the  Alaska                                                                    
Medical Board.                                                                                                                  
                                                                                                                                
Senator Olson  agreed that it  was much less  cumbersome and                                                                    
more acceptable to  write one prescription versus  six for a                                                                    
patient.                                                                                                                        
                                                                                                                                
4:25:47 PM                                                                                                                    
                                                                                                                                
Senator   Hughes   discussed   the  bill's   exemption   for                                                                    
correctional facilities from requiring  a prescriber to deal                                                                    
with  the  PDMP. She  referred  to  the problem  with  drugs                                                                    
circulating  in the  prison system.  She wondered  about the                                                                    
rationale behind  the exemption and asked  if the Department                                                                    
of Corrections (DOC) had weighed in on the issue.                                                                               
                                                                                                                                
Dr. Butler affirmed  that DOC had weighed in  on the matter.                                                                    
The  rationale  was  that someone  who  is  incarcerated  is                                                                    
similar to someone who is  hospitalized or in any other type                                                                    
of  institution. The  PDMP focus  was on  outpatient use  of                                                                    
controlled  substances. For  example, a  person who  was one                                                                    
year into  a 20-year term would  not be out on  the streets.                                                                    
The  administration  believed  it   would  be  an  excessive                                                                    
administrative  burden  and  it  would   be  up  to  DOC  to                                                                    
determine how  to avoid potential for  drug diversion within                                                                    
its   institutions.   The   statute   specified   that   the                                                                    
requirement  to use  the  PDMP would  be  maintained for  an                                                                    
individual  receiving a  prescription at  the time  of their                                                                    
release from incarceration.                                                                                                     
                                                                                                                                
4:27:35 PM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon  thought  it  might  appear  as  if  the                                                                    
committee  was  moving  quickly on  the  bill,  however  the                                                                    
administration  had access  to the  Senate's version  of the                                                                    
bill since  the previous Friday. She  asked for verification                                                                    
that the  administration had been  given time  to thoroughly                                                                    
review the CS.                                                                                                                  
                                                                                                                                
Ms. Chambers answered in the affirmative.                                                                                       
                                                                                                                                
Co-Chair  MacKinnon  relayed that  the  bill  used the  term                                                                    
palliative  care.  She  wanted to  ensure  that  individuals                                                                    
suffering life-limiting illnesses and qualifying for end-                                                                       
of-life  care through  different medical  programs would  be                                                                    
treated with  respect (as under  palliative care)  and would                                                                    
be allowed to access prescriptions for pain management.                                                                         
                                                                                                                                
Ms. Chambers  responded that  palliative care  included end-                                                                    
of-life care, but it did not exclusively deal with end-of-                                                                      
life  care. Palliative  care was  a broader  pain management                                                                    
specialty or type  of care, which end-of-life  care may fall                                                                    
under.                                                                                                                          
                                                                                                                                
4:29:06 PM                                                                                                                    
                                                                                                                                
Vice-Chair Bishop  reviewed the two fiscal  notes. The first                                                                    
zero  fiscal note  was  from the  Department  of Health  and                                                                    
Social Services  for Public Health  Administrative Services.                                                                    
The bill would require the  adoption of regulations, but the                                                                    
analysis stated  that no  additional appropriation  would be                                                                    
required.  The  second  note  was  from  the  Department  of                                                                    
Commerce,  Community   and  Economic  Development   for  the                                                                    
Division   of   Corporations,  Business   and   Professional                                                                    
Licensing (CBPL).  The cost for  FY 18 was  $27,500. Passage                                                                    
of the  bill meant the  division would require the  funds to                                                                    
cover  legal costs  to amend  regulations  and printing  and                                                                    
postage  in the  first year  to the  referenced professional                                                                    
licensing programs. There was  no anticipated cost to change                                                                    
the database  from weekly  to daily.  Professional licensing                                                                    
programs  within   the  division  were  funded   by  receipt                                                                    
supported  services. He  continued that  licensing fees  for                                                                    
each occupation were set in  AS 08.01.065. The total revenue                                                                    
collected  approximately  equaled  the  occupation's  actual                                                                    
regulatory cost.                                                                                                                
                                                                                                                                
Co-Chair  MacKinnon restated  that  the $27,500  was out  of                                                                    
designated receipts  covered by  the professions.  She added                                                                    
that the  administration had received  the R version  of the                                                                    
bill. The committee had made  a small amendment dealing with                                                                    
an  issue brought  forward by  the Board  of Optometry.  She                                                                    
detailed  the  issue  dealt   with  a  two-year  educational                                                                    
lookback.                                                                                                                       
                                                                                                                                
PAUL BARNEY, CHAIR, ALASKA BOARD  OF EXAMINERS IN OPTOMETRY,                                                                    
DEPARTMENT OF  COMMERCE, COMMUNITY AND  ECONOMIC DEVELOPMENT                                                                    
(via  teleconference),  stated  that  he  had  reviewed  the                                                                    
changes the committee had made  to the bill, which addressed                                                                    
the issue  he had  previously communicated to  Ms. Chambers.                                                                    
He was in support of the bill as written.                                                                                       
                                                                                                                                
Co-Chair  MacKinnon relayed  that  two  references in  prior                                                                    
versions  of the  bill to  specific years  had been  removed                                                                    
from  the  CS.  The  two-year lookback  had  created  clunky                                                                    
language for the Board of Examiners in Optometry.                                                                               
                                                                                                                                
4:32:29 PM                                                                                                                    
                                                                                                                                
Vice-Chair Bishop MOVED  to report SCS CSHB  159(FIN) out of                                                                    
Committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes. There  being NO OBJECTION, it was                                                                    
so ordered.                                                                                                                     
                                                                                                                                
SCS CSHB 159(FIN) was REPORTED out of committee with a "do                                                                      
pass" recommendation and with two previously published                                                                          
fiscal notes: FN2(DHS), FN3(CED).                                                                                               
                                                                                                                                
4:33:05 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
4:35:17 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair MacKinnon relayed that the committee had no other                                                                      
scheduled meetings at present.                                                                                                  
                                                                                                                                
ADJOURNMENT                                                                                                                   
4:35:40 PM                                                                                                                    
                                                                                                                                
The meeting was adjourned at 4:35 p.m.                                                                                          

Document Name Date/Time Subjects
HB 159 Sectional Analysis Version U.A 5.24.17.pdf SFIN 5/30/2017 3:30:00 PM
HB 159
HB 159 Comparison of HB 159 and SB 79 - 5.22.17.pdf SFIN 5/30/2017 3:30:00 PM
HB 159
SB 79
HB 159 Work Draft version N.pdf SFIN 5/30/2017 3:30:00 PM
HB 159
HB159 Changes to include from SB 79.pdf SFIN 5/30/2017 3:30:00 PM
HB 159
SB 79
HB159 Sponsor Statement - Governor Transmittal Letter 3.6.17.pdf SFIN 5/30/2017 3:30:00 PM
HB 159
HB 159 (FIN) v N Summary of Changes.pdf SFIN 5/30/2017 3:30:00 PM
HB 159