Legislature(2025 - 2026)BUTROVICH 205

04/01/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES

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03:34:42 PM Start
03:35:53 PM SB134
03:49:21 PM SJR15
03:55:42 PM Confirmation Hearing(s):
04:10:22 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Agenda Change --
*+ SB 134 PHARMACY BENEFITS MANAGER;3RD PARTY ADMIN TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+= SB 122 HEALTH INSURANCE NETWORK STANDARDS TELECONFERENCED
<Bill Hearing Rescheduled to 04/03/25>
-- Public Testimony <Time Limit May Be Set> --
+= SB 88 CHILD PLACEMENT; DILIGENT SEARCH TELECONFERENCED
<Bill Hearing Rescheduled to 04/03/25>
-- Testimony <Invitation Only> --
+= SJR 15 OPPOSE MEDICAID CUTS TELECONFERENCED
Moved CSSJR 15(HSS) Out of Committee
-- Testimony <Invitation Only> --
Consideration of Governor’s Appointees:
Brent Taylor, State Medical Board
-- Public Testimony --
Samantha Smith, State Medical Board
-- Public Testimony --
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 1, 2025                                                                                          
                           3:34 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Cathy Giessel, Vice Chair                                                                                               
Senator Matt Claman                                                                                                             
Senator Löki Tobin                                                                                                              
Senator Shelley Hughes                                                                                                          
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Forrest Dunbar, Chair                                                                                                   
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 134                                                                                                             
"An Act relating to pharmacy benefits managers; relating to                                                                     
third-party administrators; and providing for an effective                                                                      
date."                                                                                                                          
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE JOINT RESOLUTION NO. 15                                                                                                  
Calling on the state's congressional delegation to oppose cuts                                                                  
to federal spending on Medicaid.                                                                                                
                                                                                                                                
     - MOVED CSSJR 15(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
State Medical Board                                                                                                           
Brent Taylor - Anchorage                                                                                                        
                                                                                                                                
     - CONFIRMATION ADVANCED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 134                                                                                                                  
SHORT TITLE: PHARMACY BENEFITS MANAGER;3RD PARTY ADMIN                                                                          
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
03/18/25       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/25       (S)       HSS, L&C                                                                                               
04/01/25       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SJR 15                                                                                                                  
SHORT TITLE: OPPOSE MEDICAID CUTS                                                                                               
SPONSOR(s): HEALTH & SOCIAL SERVICES                                                                                            
                                                                                                                                
03/19/25       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/19/25       (S)       HSS                                                                                                    
03/20/25       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
03/20/25       (S)       <Bill Hearing Canceled>                                                                                
03/25/25       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
03/25/25       (S)       Heard & Held                                                                                           
03/25/25       (S)       MINUTE(HSS)                                                                                            
03/27/25       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
03/27/25       (S)       Heard & Held                                                                                           
03/27/25       (S)       MINUTE(HSS)                                                                                            
04/01/25       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JANE ROHR, Staff                                                                                                                
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided the sectional analysis for SB 134.                                                               
                                                                                                                                
HEATHER CARPENTER, Deputy Director                                                                                              
Division of Insurance                                                                                                           
Department of Commerce Community and                                                                                            
Economic Development (DCCED)                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided a review of SB 134.                                                                              
                                                                                                                                
ARIELLE WIGGIN, Staff                                                                                                           
Senator Forest Dunbar                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Offered a summary of changes for SJR 15,                                                                  
version N.                                                                                                                      
                                                                                                                                
BRENT TAYLOR, MD, Appointee                                                                                                     
State Medical Board                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified as the governor's appointee to the                                                              
State Medical Board.                                                                                                            
                                                                                                                                
RACHEL GOLDBERGER, representing self                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to  the appointment                                                             
of Ms. Smith to the State Medical Board.                                                                                        
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:34:42 PM                                                                                                                    
VICE-CHAIR GIESSEL  called the Senate Health  and Social Services                                                               
Standing Committee meeting  to order at 3:34 p.m.  Present at the                                                               
call  to  order were  Senators  Hughes,  Claman, and  Vice  Chair                                                               
Giessel. Senator Tobin arrived thereafter.                                                                                      
                                                                                                                                
        SB 134-PHARMACY BENEFITS MANAGER;3RD PARTY ADMIN                                                                    
                                                                                                                                
3:35:53 PM                                                                                                                    
VICE-CHAIR  GIESSEL announced  the consideration  of SENATE  BILL                                                               
NO. 134 "An Act relating  to pharmacy benefits managers; relating                                                               
to  third-party administrators;  and providing  for an  effective                                                               
date."                                                                                                                          
                                                                                                                                
3:36:15 PM                                                                                                                    
VICE-CHAIR  GIESSEL speaking  as sponsor  introduced SB  134. She                                                               
stated SB 134 relates to  Third Party Administrators (TPAs). TPAs                                                               
do business as part of a  network related to insurance. TPAs also                                                               
relate  to pharmacy  benefit  managers  often collecting  profits                                                               
from them  and then relocating them  to use outside of  the state                                                               
of Alaska and  sometimes overseas. TPAs are not  regulated by the                                                               
Division of  Insurance. SB 134  endeavors to have  TPAs regulated                                                               
for the purpose of transparency and accountability.                                                                             
                                                                                                                                
3:37:24 PM                                                                                                                    
JANE   ROHR,  Staff,   Senator   Cathy   Giessel,  Alaska   State                                                               
Legislature, Juneau, Alaska, provided  the sectional analysis for                                                               
SB 134:                                                                                                                         
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
                        Senate Bill 134                                                                                       
                   Sectional Analysis (vsn A)                                                                                 
        "An Act relating to pharmacy benefits managers;                                                                         
     relating to third-party administrators; and providing                                                                      
     for an effective date."                                                                                                    
                                                                                                                                
       Section 1. Amends AS 21.06.120(a): Examination of                                                                    
     insurers.                                                                                                                
     This  section adds  pharmacy benefits  managers to  the                                                                    
     list  of  licensed  and formerly  licensed  groups  the                                                                    
     affairs of which the director may examine.                                                                                 
                                                                                                                                
     Section  2.  Amends  AS  21.06.120(d):  Examination  of                                                                
     insurers.                                                                                                                
                                                                                                                                
     This  section   adds  third-party   administrators  and                                                                    
     pharmacy  benefits managers  to the  list of  groups in                                                                    
     which  the  director  may examine  through  multi-state                                                                    
     participation   with   the  National   Association   of                                                                    
     Insurance Commissioners.                                                                                                   
                                                                                                                                
     Section  3.  Adds a  new  subsection  to AS  21.06.120:                                                                
     Examination of insurers.                                                                                                 
                                                                                                                                
     This  section  adds  a   new  subsection  allowing  the                                                                    
     director  to  examine   third-party  administrators  or                                                                    
     pharmacy  benefits  managers  at   any  time  that  the                                                                    
     director deems necessary.                                                                                                  
                                                                                                                                
     Section   4.   Amends  AS   21.06.160(a):   Examination                                                                
     expense.                                                                                                                 
                                                                                                                                
     This  section  removes  an  exemption  for  third-party                                                                    
     administrators  and makes  them responsible  for paying                                                                    
     costs associated with a market conduct examination.                                                                        
                                                                                                                                
3:37:45 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section 5. Amends AS 21.27.010(a): License required.                                                                   
                                                                                                                                
     This  section   adds  Third-Party   Administrators  and                                                                    
     Pharmacy  Benefits  Managers  to  the  list  of  people                                                                    
     required  to  be  licensed under  this  chapter  to  do                                                                    
     business in this state.                                                                                                    
                                                                                                                                
     Section 6. Amends AS 21.27.010(c): License required.                                                                   
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registered" with "licensed" on line 22.                                                                              
                                                                                                                                
     This section also replaces the  statute number with the                                                                    
     verbiage "this  chapter" since TPA will  now be subject                                                                    
     to licensing requirements throughout the chapter                                                                           
                                                                                                                                
     Section  7.  Adds  a new  subsection  to  AS  21.27.010                                                                
     License required.                                                                                                        
                                                                                                                              
     This  section  adds  a new  subsection  (l)  clarifying                                                                    
     third-party   administrators   and  pharmacy   benefits                                                                    
     managers  are   also  subject  to   specific  licensing                                                                    
     requirements under  the AS 21.27.630    21.27.660 (TPA)                                                                    
     and AS 21.27.901  21.27.955 (PBM).                                                                                         
                                                                                                                                
3:37:58 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section  8.  Amends  AS  21.27.060(d):  Examination  of                                                                
     applicants  and  licensees.   This  section  exempts  a                                                                  
     compliance officer  for a third-party  administrator or                                                                    
     pharmacy benefits manager from  taking an exam from the                                                                    
     division before a license is issued.                                                                                       
                                                                                                                                
     Section  9. Amends  AS  21.27.380(b): License  renewal,                                                                
     expiration, and reinstatement.                                                                                           
                                                                                                                                
     This section  pertains to  license expiration  and adds                                                                    
     third-party   administrators   and  pharmacy   benefits                                                                    
     managers to  the list of  entities who may  not operate                                                                    
     in the state with an expired license.                                                                                      
                                                                                                                                
3:38:15 PM                                                                                                                    
MS.  ROHR  continued  with  the sectional  analysis  for  SB  134                                                               
stating  sections 10  through  24  require designated  compliance                                                               
officers  to  be licensed.  She  stated  that it's  required  for                                                               
exempt TPA's to file a  certification with a director annually on                                                               
or  before February  1st as  well as  make conforming  changes by                                                               
replacing registered with licensed.                                                                                             
                                                                                                                                
                                                                                                                                
     Section  10.   Amends  AS   21.27.630(a):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registered" with "licensed" on lines 24 and 27.                                                                      
                                                                                                                                
     Section  11.   Amends  AS   21.27.630(b):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registered" with "licensed" on line 30.                                                                              
                                                                                                                                
     Section  12.   Amends  AS   21.27.630(c):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registered" with "licensed" on line 2.                                                                               
                                                                                                                                
     This section also replaces the  statute number with the                                                                    
     verbiage "this  chapter" since TPA will  now be subject                                                                    
     to licensing requirements throughout the chapter.                                                                          
                                                                                                                                
     Section  13.   Amends  AS   21.27.630(d):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term  "registration" with  "license"  on  line 7.  This                                                                    
     section is about fraudulent use of a name.                                                                                 
                                                                                                                                
     Section  14.   Amends  AS   21.27.630(e):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term  "registered" with  "licensed"  on  line 12.  This                                                                    
     section  is about  entities must  be  licensed not  the                                                                    
     individual.                                                                                                                
                                                                                                                                
     This section also replaces  the verbiage "section" with                                                                    
     "chapter" since  TPA will now  be subject  to licensing                                                                    
     requirements throughout the chapter.                                                                                       
                                                                                                                                
     Section  15.   Amends  AS   21.27.630(g):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term  "registered" with  "licensed"  on  line 18.  This                                                                    
     section  pertains  to  credit  unions  banks  or  other                                                                    
     financial institutions.                                                                                                    
                                                                                                                                
     Section  16.   Amends  AS   21.27.630(h):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term  "registered" with  "licensed"  on  line 24.  This                                                                    
     section pertains to credit card companies.                                                                                 
                                                                                                                                
     Section  17.   Amends  AS   21.27.630(i):  Registration                                                                
     required.  This  section  makes conforming  changes  by                                                                  
     replacing  the  term  "registered" with  "licensed"  on                                                                    
     line  29. This  section pertains  to ERISA  plans which                                                                    
     are exempted from licensure.                                                                                               
                                                                                                                                
     Section  18.   Amends  AS   21.27.630(j):  Registration                                                                
     required.  This  section  makes conforming  changes  by                                                                  
     replacing  the term  "registration"  with "license"  on                                                                    
     lines 8 and 9. It  also removes duplicative language no                                                                    
     longer  needed  since  TPA  will   be  required  to  be                                                                    
     licensed. This  section is relating to  suspensions and                                                                    
     revocations of license.                                                                                                    
                                                                                                                                
     Section  19.   Amends  AS   21.27.630(k):  Registration                                                                
     required.  This  section  makes conforming  changes  by                                                                  
     replacing  the  term  "registered" with  "licensed"  on                                                                    
     line  12. This  section is  regarding an  exemption for                                                                    
     insurers who  hold a certificate of  authority from the                                                                    
     director.                                                                                                                  
                                                                                                                                
     Section  20.   Amends  AS   21.27.630(l):  Registration                                                                
     required.  This  section  makes conforming  changes  by                                                                  
     replacing  the  term  "registered" with  "licensed"  on                                                                    
     lines 15.                                                                                                                  
                                                                                                                                
     Adds  the requirement  that any  entity that  meets the                                                                    
     qualifications of  an exempt  TPA file  a certification                                                                    
     with the  director annually on  or before  February 1st                                                                    
     of each year.                                                                                                              
                                                                                                                                
     Section  21.   Amends  AS   21.27.630(m):  Registration                                                                
     required.                                                                                                                
                                                                                                                                
     This section pertains to  exempting employees of third-                                                                    
     party  administrators from  licensing requirements  and                                                                    
     makes   conforming  changes   by  replacing   the  term                                                                    
     "registered" with "licensed" on line 22.                                                                                   
                                                                                                                                
     This  section also  adds language  requiring designated                                                                    
     compliance officers to be licensed.                                                                                        
                                                                                                                                
     Section   22.  Amends   AS  21.27.640(a):   Third-party                                                                
     administrator qualifications.                                                                                            
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registration" with "license"  on lines 27 and 28.                                                                    
     This section  relates to untrustworthy  and incompetent                                                                    
     licensees.                                                                                                                 
                                                                                                                                
     Section   23.  Amends   AS  21.27.640(b):   Third-party                                                                
     administrator qualifications.                                                                                            
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registration"  with "license"  on line 2  and the                                                                    
     term "registrant"  with "licensee" on lines  3, 23, and                                                                    
     26. This  section lists  criteria relating  to licensee                                                                    
     qualifications                                                                                                             
                                                                                                                              
     Section   24.  Amends   AS  21.27.640(d):   Third-party                                                                
     administrator   qualifications.   This  section   makes                                                                  
     conforming changes  by replacing the  term "registrant"                                                                    
     with   "licensee"  on   lines   1  and   2,  the   term                                                                    
     "registration" with  "license" on line 3.  This section                                                                    
     pertains to license approval by director.                                                                                  
                                                                                                                                
3:38:33 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section   25.   Amends   AS   21.27.650(a):   Operating                                                                
     requirements for third-party administrators.                                                                             
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term "registered"  with "licensed"  on line  9. Removes                                                                    
     an exemption for  a TPA registered in  their home state                                                                    
     applying   for  a   non-resident  Alaska   license.  By                                                                    
     eliminated the exemption, we are  now requiring all TPA                                                                    
     who are  operating in Alaska to  be licensed regardless                                                                    
     of their resident state status.                                                                                            
                                                                                                                                
     Section   26.   Amends   AS   21.27.650(q):   Operating                                                                
     requirements for third-party.                                                                                            
                                                                                                                                
     This section makes conforming  changes by replacing the                                                                    
     term  "registration" with  "license" on  line 17.  This                                                                    
     section  outlines  criteria  by which  a  director  may                                                                    
     revoke a license.                                                                                                          
                                                                                                                                
     Section  27.  Amends   AS  21.27.901:  Registration  of                                                                
     pharmacy   benefits   managers;   scope   of   business                                                                  
     practice.                                                                                                                
                                                                                                                                
     This section makes the following conforming changes:                                                                       
        • Replaces the term "registration" with "license"                                                                       
           in the statute title.                                                                                                
        • Replaces the term "registered" with "licensed" on                                                                     
           page 12, line 30 and page 13, lines 1 and 14.                                                                        
        • Replaces the term "registration" with "license"                                                                       
           on page 13, lines 8, 11, and 12.                                                                                     
                                                                                                                                
3:38:47 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section 28. Adds new sections  AS 21.27.903, 904.                                                                      
                                                                                                                                
     This section adds 21.27.903 Pharmacy benefits manager                                                                      
    qualifications    which    outlines    the    following                                                                     
     qualifications:                                                                                                            
                                                                                                                                
        ? Disclosures; including information concerning                                                                         
          owners, officers,  directors and  partners, action                                                                    
          taken  against   them  by  a   financial  industry                                                                    
          regulatory  authority (including  the government),                                                                    
          and criminal prosecution.                                                                                             
        ? Identified a designated compliance officer.                                                                           
        ? A complete application, which includes:                                                                               
            o Application fee                                                                                                   
            o Organizational documents, including regulatory                                                                    
              documents.                                                                                                        
            o Contact information for the people responsible                                                                    
              for the conduct of affairs for the pharmacy                                                                       
              benefit manager.                                                                                                  
            o Certified financial documents for the last two                                                                    
              years, or for the last year and partial year                                                                      
              if the applicant has been in business for less                                                                    
              than two years.                                                                                                   
                                                                                                                                
      This section adds 21.27.904 Pharmacy benefit manager                                                                      
     required notifications. Outlines that PBMs must notify                                                                     
     the director of the following:                                                                                             
           ? Change of information i.e. place of business,                                                                      
             email, address, telephone number.                                                                                  
           ? Change in compliance officer and contact                                                                           
             information.                                                                                                       
           ? Any administrative action taken against the                                                                        
             licensee.                                                                                                          
           ? Conviction of misdemeanor or felony.                                                                               
                                                                                                                                
     Failure to provide the above information may result in                                                                     
     denial, revocation or suspension or license.                                                                               
                                                                                                                                
3:39:02 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section   29.   Amends   AS   21.27.905:   Renewal   of                                                                
     registration.                                                                                                            
                                                                                                                              
     This section makes the following conforming changes:                                                                       
                                                                                                                                
        ? Replaces the term "registration" with "license"                                                                       
          in the statute title.                                                                                                 
        ? Replaces the term "registration" with "license"                                                                       
          on lines 24 and 26.                                                                                                   
                                                                                                                                
     Regarding procedures  for biennial renewal  of license,                                                                    
     and renewal  fees established by the  director that are                                                                    
     self-supporting for the division.                                                                                          
                                                                                                                                
     Section  30. Adds  a new  subsection  to AS  21.27.905:                                                                
     Renewal of registration.                                                                                                 
                                                                                                                                
     This  section  adds  a  new  subsection  requiring  the                                                                    
     licensing fees  of pharmacy  benefit managers  to cover                                                                    
     the cost of:                                                                                                               
                                                                                                                                
        ? Salaries and benefits paid to the personnel of                                                                        
          the division tasked with enforcement.                                                                                 
        ? Reasonable technology costs related to the                                                                            
          enforcement process  of pharmacy  benefits manager                                                                    
          licensing,  including cost  of software,  hardware                                                                    
          and related training for use  of said software and                                                                    
          hardware.                                                                                                             
        ? Reasonable education and training costs to the                                                                        
          division for the enforcing personnel.                                                                                 
                                                                                                                                
3:39:15 PM                                                                                                                    
MS. ROHR continued with the sectional analysis for SB 134:                                                                      
                                                                                                                                
     Section 31. Amends AS 21.27.975(15): Definitions.                                                                      
                                                                                                                                
     This  section  adds  "regardless of  ownership  of  the                                                                    
     pharmacy  benefits   manager"  to  the   definition  of                                                                    
     pharmacy benefits manager.                                                                                                 
                                                                                                                                
     Section 32. Repeals AS 21.27.630(f):                                                                                   
                                                                                                                              
     Sec. 21.27.630(f). Registration required.                                                                                
                                                                                                                                
      This provision is no longer needed because they now                                                                       
     must be licensed rather than registered.                                                                                   
                                                                                                                                
       Section 33. Sets an effective date for January 1,                                                                    
     2026.                                                                                                                    
                                                                                                                                
3:39:34 PM                                                                                                                    
VICE-CHAIR GIESSEL asked Ms. Carpenter to review the bill.                                                                      
                                                                                                                                
3:40:03 PM                                                                                                                    
HEATHER  CARPENTER,  Deputy   Director,  Division  of  Insurance,                                                               
Department  of   Commerce  Community  and   Economic  Development                                                               
(DCCED), Juneau, Alaska,  provided a review of SB  134 and stated                                                               
that after the last session,  the division closely reviewed House                                                               
Bill  226,   sponsored  by  Representative  Sumner   and  Senator                                                               
Giessel.  The  intent was  to  strengthen  oversight of  pharmacy                                                               
benefit  managers (PBMs)  and ensure  compliance. She  said after                                                               
consulting  legal counsel  and reviewing  statutes, the  division                                                               
determined  that a  registration  framework did  not provide  the                                                               
same  oversight authority  as  full licensure.  She  said SB  134                                                               
makes   conforming  changes   to  update   examination  statutes,                                                               
allowing  the  division to  conduct  market  exams of  PBMs  when                                                               
complaint  patterns  arise.  Previously,  PBMs  were  treated  as                                                               
third-party   administrators,  were   not  clearly   included  in                                                               
examination statutes, and were sometimes  exempt from exam costs,                                                               
which  were instead  borne  by insurers.  SB  134 corrects  these                                                               
issues. She concluded  that the legislation is  a cleanup measure                                                               
that aligns  Alaska with other  states by moving PBMs  and third-                                                               
party administrators  from registration  to full  licensure. This                                                               
addressed   concerns  about   vertical  integration,   regulatory                                                               
confusion,  and  attempts  to circumvent  licensure,  while  also                                                               
making  requirements clearer  and easier  for licensing  staff to                                                               
administer.                                                                                                                     
                                                                                                                                
3:42:23 PM                                                                                                                    
SENATOR  CLAMAN asked  for clarification  of  the term  "vertical                                                               
integration," including  what it  means in this  context, whether                                                               
it  is  a  problem,  and  why, noting  that  the  term  can  have                                                               
different meanings for different audiences.                                                                                     
                                                                                                                                
3:42:41 PM                                                                                                                    
MS. CARPENTER  replied that the  issue with  vertical integration                                                               
is largely a  lack of transparency. Insurers  may own third-party                                                               
administrators,  pharmacy   benefit  managers,   and  pharmacies,                                                               
sometimes  under exemptions  that  avoid  registration. She  said                                                               
this   makes  it   difficult  for   the  division   to  determine                                                               
responsibility  when complaints  arise. Without  clear disclosure                                                               
of  ownership and  operations,  vertical  integration can  create                                                               
confusion and hinder effective oversight and accountability.                                                                    
                                                                                                                                
3:43:51 PM                                                                                                                    
SENATOR  CLAMAN   explained  that   in  this   context,  vertical                                                               
integration creates  challenges for the division's  oversight. An                                                               
insurer   may  own   multiple   third-party  administrators   and                                                               
pharmacies  that  are  not  licensed,   making  it  difficult  to                                                               
determine what  is happening within the  overall organization. He                                                               
said  as  a  result,  the  division  lacks  visibility  into  the                                                               
activities of related but  unlicensed entities when investigating                                                               
the insurer.                                                                                                                    
                                                                                                                                
3:44:20 PM                                                                                                                    
SENATOR TOBIN arrived at the meeting.                                                                                           
                                                                                                                                
3:44:33 PM                                                                                                                    
MS. CARPENTER  explained that this  is why the  division proposed                                                               
updating the  definition of pharmacy  benefit manager  to include                                                               
the phrase "regardless  of ownership.She   said  this ensures the                                                               
division  can carry  out legislative  intent  and anticipate  how                                                               
insurers,  TPAs, and  PBMs might  structure  themselves to  avoid                                                               
oversight.                                                                                                                      
                                                                                                                                
3:44:54 PM                                                                                                                    
SENATOR  CLAMAN asked  whether this  proposed change  expands the                                                               
division's regulatory  authority, or  does it simply  ensure that                                                               
entities providing services in Alaska  are clearly subject to the                                                               
division's existing oversight and regulatory authority.                                                                         
                                                                                                                                
3:45:15 PM                                                                                                                    
MS.  CARPENTER replied  that the  changes accomplish  both goals:                                                               
they  clarify  the  division's   authority  to  examine  pharmacy                                                               
benefit  managers  by  removing  statutory  ambiguity,  and  they                                                               
expand  oversight by  eliminating exemptions  and moving  to full                                                               
licensure,  resulting  in  more   licensed  entities  and  better                                                               
consumer protection.                                                                                                            
                                                                                                                                
3:45:50 PM                                                                                                                    
SENATOR HUGHES referenced  Marty Makary's book The  Price We Pay,                                                               
which discusses  pharmacy benefit managers, and  asked whether SB
134  aligns with  those recommendations.  She also  asked whether                                                               
the legislation  builds on  prior PBM reforms  and helps  rein in                                                               
the system to improve oversight and control costs.                                                                              
                                                                                                                                
MS. CARPENTER stated that she was  not familiar with the book but                                                               
agreed SB 134  meets that intent. She explained  that the statues                                                               
on  examinations and  the  information the  PDM  must supply  the                                                               
division, such  as the  designation of  a compliance  officer and                                                               
provisions that  ensure registration fees cover  oversight costs,                                                               
provide  the  division  the  necessary tools  to  carry  out  the                                                               
legislature's direction.                                                                                                        
                                                                                                                                
3:47:19 PM                                                                                                                    
SENATOR  HUGHES  asked  if  page  6, line  15  of  the  sectional                                                               
analysis,  is narrow  enough  or does  there need  to  be a  more                                                               
detailed explanation.                                                                                                           
                                                                                                                                
MS.  CARPENTER replied  that the  division has  previously worked                                                               
with  legal  counsel on  the  definition  of "person,"  which  is                                                               
broadly  defined  in  Alaska statute  to  include  companies  and                                                               
individuals, such as a compliance  officer, and offered to follow                                                               
up with additional clarification.                                                                                               
                                                                                                                                
3:48:20 PM                                                                                                                    
SENATOR  HUGHES  commented  that the  broad  definition  possibly                                                               
means every Alaskan.                                                                                                            
                                                                                                                                
MS. CARPENTER replied that this  provision is found in the third-                                                               
party  administrator statutes  AS 21.27.630  and applies  only to                                                               
third-party administrators within that chapter.                                                                                 
                                                                                                                                
3:49:06 PM                                                                                                                    
VICE-CHAIR GIESSEL held SB 134 in committee.                                                                                    
                                                                                                                                
                  SJR 15-OPPOSE MEDICAID CUTS                                                                               
                                                                                                                                
3:49:21 PM                                                                                                                    
VICE-CHAIR GIESSEL  announced the  consideration of  SENATE JOINT                                                               
RESOLUTION   NO.  15   Calling  on   the  state's   congressional                                                               
delegation to oppose cuts to federal spending on Medicaid.                                                                      
                                                                                                                                
3:49:39 PM                                                                                                                    
VICE-CHAIR GIESSEL said the committee  would consider a committee                                                               
substitute (CS), version N, for SJR 15.                                                                                         
                                                                                                                                
3:49:49 PM                                                                                                                    
VICE-CHAIR GIESSEL solicited a motion.                                                                                          
                                                                                                                                
3:49:53 PM                                                                                                                    
SENATOR TOBIN  moved to adopt  the committee substitute  (CS) for                                                               
SJR 15, work order 34-LS0631\N, as the working document.                                                                        
                                                                                                                                
3:50:07 PM                                                                                                                    
VICE-CHAIR GIESSEL objected for purposes of discussion.                                                                         
                                                                                                                                
3:50:35 PM                                                                                                                    
ARIELLE WIGGIN, Staff, Senator Forest Dunbar, Alaska State                                                                      
Legislature, Juneau, Alaska, offered a summary of changes for                                                                   
SJR 15, version N:                                                                                                              
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                              
                       SUMMARY OF CHANGES                                                                                     
                 CSSJR 15: OPPOSE MEDICAID CUTS                                                                               
                32-LS0631 Version A to Version N                                                                              
                                                                                                                                
     Page  2,  Line  2:  Updates the  percentage  of  Alaska                                                                  
     births covered  by Medicaid in  2023 to 36  percent and                                                                    
     clarifies  that  nearly  40 percent  of  enrollees  are                                                                    
     under age 18.                                                                                                              
                                                                                                                                
     Page  2, Line  12: Updates  the percentage  of Medicaid                                                                  
     enrollees who are Alaska Native to 30 percent.                                                                             
                                                                                                                                
     Page 2,  after line 15:  Adds a clause  clarifying that                                                                  
     the federal  government covers 100 percent  of Medicaid                                                                    
     costs  for Alaska  Native enrollees  receiving services                                                                    
     through  Indian   Health  Service  (IHS)   or  tribally                                                                    
     operated  facilities,  whether   directly  operated  by                                                                    
     Indian  Health Service  or on  behalf of  a Tribe;  and                                                                    
     adds   a  clause   stating  that   states  implementing                                                                    
     Medicaid  expansion  under   the  Affordable  Care  Act                                                                    
     receive a  90 percent federal match  for adults covered                                                                    
     through the expansion.                                                                                                     
                                                                                                                                
     Page  3, Line  5:  Changes the  potential  cuts from  2                                                                  
     trillion dollars  to eight  hundred and  eighty billion                                                                    
     dollars  to reflect  the current  stage of  the federal                                                                    
     budget negotiation process more accurately                                                                                 
                                                                                                                                
3:51:50 PM                                                                                                                    
VICE-CHAIR GIESSEL asked if the committee had questions. She                                                                    
noted that the sponsor of SJR 15 had incorporated changes that                                                                  
members of the committee suggested.                                                                                             
                                                                                                                                
3:52:20 PM                                                                                                                    
VICE-CHAIR GIESSEL  removed her  objection. She found  no further                                                               
discussion and  [CSSJR 15 was  adopted as the  working document].                                                               
She solicited the will of the committee.                                                                                        
                                                                                                                                
3:52:25 PM                                                                                                                    
SENATOR  HUGHES expressed  disappointment that  "over ten  years"                                                               
was omitted  on page  3, line 5  of the CS,  noting that  a "cut"                                                               
usually refers  to a  one-year amount,  whereas this  totals $880                                                               
billion over  ten years  ($88 billion per  year), which  she felt                                                               
was misleading.                                                                                                                 
                                                                                                                                
3:52:58 PM                                                                                                                    
VICE-CHAIR GIESSEL asked if Senator  Hughes would like to offer a                                                               
conceptual amendment.                                                                                                           
                                                                                                                                
3:53:10 PM                                                                                                                    
SENATOR HUGHES moved Conceptual Amendment 1:                                                                                    
                                                                                                                                
                     CONCEPTUAL AMENDMENT 1                                                                                 
                                                                                                                              
     On page 3, line 5, following "$880,000,000,000"                                                                            
          Insert "over ten years"                                                                                               
                                                                                                                                
3:53:29 PM                                                                                                                    
VICE-CHAIR  GIESSEL suggested  the amendment  read, "Whereas  the                                                               
United   States   Congress   is  considering   cuts   of   nearly                                                               
[$880,000,000,000] to federal spending on  Medicaid over the next                                                               
ten years                                                                                                                       
                                                                                                                                
3:53:51 PM                                                                                                                    
SENATOR  HUGHES  withdrew  Conceptual Amendment  1.  She  offered                                                               
Conceptual Amendment 2:                                                                                                         
                                                                                                                                
                     CONCEPTUAL AMENDMENT 2                                                                                 
                                                                                                                              
     On page 3, line 5, following "$880,000,000,000 to                                                                          
     federal spending on Medicaid"                                                                                              
                                                                                                                                
          Insert "over ten years;"                                                                                              
                                                                                                                                
3:54:15 PM                                                                                                                    
SENATOR CLAMAN asked if the  ten-year range had received previous                                                               
discussion.                                                                                                                     
                                                                                                                                
VICE-CHAIR GIESSEL  replied yes,  it was brought  up at  the last                                                               
committee meeting by Senator Hughes.  Excluding 10 years from the                                                               
committee substitute was an oversight.                                                                                          
                                                                                                                                
3:54:40 PM                                                                                                                    
VICE-CHAIR  GIESSEL asked  if there  was objection  to Conceptual                                                               
Amendment  2; finding  no objection  Conceptual  Amendment 2  was                                                               
adopted.                                                                                                                        
                                                                                                                                
3:54:48 PM                                                                                                                    
VICE-CHAIR  GIESSEL  asked if  there  was  further discussion  or                                                               
concerns  related to  [CSSJR 15,  as amended];  finding none  she                                                               
solicited the will of the committee.                                                                                            
                                                                                                                                
3:55:02 PM                                                                                                                    
SENATOR TOBIN moved  to report CSSJR 15,  work order 34-LS0631\N,                                                               
as amended,  from committee  with individual  recommendations and                                                               
attached fiscal note(s).                                                                                                        
                                                                                                                                
3:55:19 PM                                                                                                                    
VICE-CHAIR  GIESSEL  found no  objection  and  CSSJR 15(HSS)  was                                                               
reported  from the  Senate Health  and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
^CONFIRMATION HEARING(S):                                                                                                       
                    CONFIRMATION HEARING(S):                                                                                
                                                                                                                              
3:55:42 PM                                                                                                                  
VICE-CHAIR GIESSEL announced the  consideration of the governor's                                                               
appointee Brent Taylor to the State Medical Board.                                                                              
                                                                                                                                
3:57:11 PM                                                                                                                    
BRENT  TAYLOR, MD,  Appointee,  State  Medical Board,  Anchorage,                                                               
Alaska,  testified  as  the governor's  appointee  to  the  State                                                               
Medical Board.  He said he  is a board-certified  general surgeon                                                               
from Anchorage,  completed his  undergraduate studies  at Montana                                                               
State  in Boseman,  and  medical training  at  the University  of                                                               
Washington. He  practiced in  Palmer until two  and a  half years                                                               
ago, mentoring  medical students  and residents.  Since retiring,                                                               
he has been  active in search and rescue  training across Alaska.                                                               
He joined the state medical  board to contribute his nearly three                                                               
decades  of  clinical  experience  to  improving  healthcare  for                                                               
Alaskans.                                                                                                                       
                                                                                                                                
3:58:58 PM                                                                                                                    
SENATOR CLAMAN asked  how the experience has been  serving on the                                                               
State Medical Board.                                                                                                            
                                                                                                                                
DR. TAYLOR  replied that with less  than a year on  the board the                                                               
experience has  been very  educational. He  noted that  he became                                                               
chair in January  after the acting chair had  a health emergency,                                                               
and has  learned a  great deal,  particularly about  statutes and                                                               
regulations.                                                                                                                    
                                                                                                                                
3:59:44 PM                                                                                                                    
SENATOR CLAMAN  asked whether the  commission is able  to operate                                                               
independently  by making  decisions  based on  evidence and  law,                                                               
free from political influence, and  how he views that approach to                                                               
fulfilling the commission's mission.                                                                                            
                                                                                                                                
4:00:11 PM                                                                                                                    
DR. TAYLOR replied  that the board operates  within statutory and                                                               
regulatory guidelines  to oversee healthcare providers,  which he                                                               
sees  as   its  primary  role.   He  noted  that  the   board  is                                                               
occasionally asked to comment on other issues.                                                                                  
                                                                                                                                
4:00:46 PM                                                                                                                    
SENATOR TOBIN noted  that Dr. Taylor is retired and  asked how he                                                               
stays  current on  developments in  the medical  field, including                                                               
emerging  research on  comorbidities  and  evolving standards  of                                                               
care for Alaskans.                                                                                                              
                                                                                                                                
4:01:25 PM                                                                                                                    
DR. TAYLOR  replied that he  maintains an active  medical license                                                               
and  board certification,  which requires  ongoing completion  of                                                               
continuing medical education.                                                                                                   
                                                                                                                                
4:01:46 PM                                                                                                                    
SENATOR  TOBIN  asked  where  he   personally  gets  his  medical                                                               
information, such  as journals,  conferences, or  colleagues, and                                                               
about his  approach to staying  current on emerging needs  in the                                                               
field.                                                                                                                          
                                                                                                                                
4:02:09 PM                                                                                                                    
DR.  TAYLOR  responded  that  most   of  his  continuing  medical                                                               
education  is completed  online and  supplemented by  discussions                                                               
with colleagues who attend conferences and other CME events.                                                                    
                                                                                                                                
4:02:33 PM                                                                                                                    
SENATOR  TOBIN asked  for his  interpretation of  the Hippocratic                                                               
Oath and how he applies  that understanding to protect the health                                                               
and safety  of Alaskans  when evaluating  cases before  the State                                                               
Medical Board.                                                                                                                  
                                                                                                                                
4:02:57 PM                                                                                                                    
DR.  TAYLOR  replied   that  the  board's  role   is  to  oversee                                                               
healthcare providers, protect  Alaskans, and do so in  a way that                                                               
ensures due process for all involved.                                                                                           
                                                                                                                                
4:03:29 PM                                                                                                                    
SENATOR  TOBIN  said  the response  addressed  her  question  and                                                               
emphasized  her interest  in ensuring  that  State Medical  Board                                                               
members  consider guidance  from  professional organizations  and                                                               
the  potential  mental  health  impacts  of  their  decisions  on                                                               
Alaskans.                                                                                                                       
                                                                                                                                
4:04:00 PM                                                                                                                    
SENATOR HUGHES  expressed appreciation for the  board's work with                                                               
Mat-Su Search and Rescue (Mat-Sar).                                                                                             
                                                                                                                                
4:04:26 PM                                                                                                                    
SENATOR  GIESSEL  asked whether  the  State  Medical Board  still                                                               
interviews every medical license  applicant or if initial license                                                               
approvals have been delegated to the executive director.                                                                        
                                                                                                                                
4:04:52 PM                                                                                                                    
DR. TAYLOR  responded that the  process has been  streamlined. He                                                               
said  individual interviews  are no  longer conducted,  but board                                                               
members still review applications,  and administrative staff have                                                               
improved efficiency and reduced applicant wait times.                                                                           
                                                                                                                                
VICE-CHAIR GIESSEL asked to know the average wait time.                                                                         
                                                                                                                                
DR. TAYLOR replied that he doesn't  know exactly but he looked at                                                               
an application today that was submitted in the middle of March.                                                                 
                                                                                                                                
VICE-CHAIR GIESSEL said the process seemed streamlined.                                                                         
                                                                                                                                
4:06:03 PM                                                                                                                    
VICE-CHAIR GIESSEL thanked Dr. Taylor for attending the hearing.                                                                
                                                                                                                                
4:06:18 PM                                                                                                                    
VICE-CHAIR  GIESSEL  announced  Ms.  Samantha  Smith  is  also  a                                                               
governor's appointee  to the State  Medical Board.  The committee                                                               
plans  to  hear  from  Ms. Smith  on  Thursday  However,  today's                                                               
meeting will hear public testimony for both appointees.                                                                         
                                                                                                                                
4:06:44 PM                                                                                                                    
VICE-CHAIR GIESSEL opened public  testimony on the appointment of                                                               
Dr. Taylor and Ms. Smith.                                                                                                       
                                                                                                                                
4:07:48 PM                                                                                                                    
RACHEL   GOLDBERGER,   representing  self,   Anchorage,   Alaska,                                                               
testified in  opposition to the  appointment of Ms. Smith  to the                                                               
State Medical  Board. She  felt she lacked  experience both  as a                                                               
physician  assistant  and  in practicing  in  rural  Alaska.  She                                                               
questioned her ability to represent  the PA profession, expressed                                                               
concern about her judgment based  on unprofessional remarks about                                                               
local  medical  establishments,  and   emphasized  the  need  for                                                               
someone with  a comprehensive understanding  of medicine  in both                                                               
urban and rural Alaskan settings.                                                                                               
                                                                                                                                
4:09:02 PM                                                                                                                    
VICE-CHAIR GIESSEL  closed public  testimony on  the confirmation                                                               
of Dr. Taylor and Ms. Smith. She solicited a motion.                                                                            
                                                                                                                                
4:014 PM                                                                                                                      
SENATOR TOBIN  stated that in  accordance with AS  39.05.080, the                                                               
Senate  Health and  Social Services  Standing Committee  reviewed                                                               
the following  and recommends the  appointment be forwarded  to a                                                               
joint session for consideration:                                                                                                
                                                                                                                                
State Medical Board                                                                                                         
Brent Taylor - Anchorage                                                                                                        
                                                                                                                                
She  reminded  members  that   signing  the  report(s)  regarding                                                               
appointments  to  boards  and  commissions  in  no  way  reflects                                                               
individual members'  approval or  disapproval of  the appointees;                                                               
the nominations are merely forwarded  to the full legislature for                                                               
confirmation or rejection.                                                                                                      
                                                                                                                                
4:09:36 PM                                                                                                                    
VICE-CHAIR GIESSEL stated Dr. Taylor's name would be forwarded.                                                                 
                                                                                                                                
4:10:22 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
VICE-CHAIR  GIESSEL  adjourned  the   Senate  Health  and  Social                                                               
Services Standing Committee meeting at 4:10 p.m.                                                                                
                                                                                                                                

Document Name Date/Time Subjects
SB 134 Sponsor Statement 03.18.25.pdf SHSS 4/1/2025 3:30:00 PM
SB 134
SB 134 Sectional Analysis 03.18.25.pdf SHSS 4/1/2025 3:30:00 PM
SB 134
SB 134 Fiscal Note DCCED DOI 3.28.25.pdf SHSS 4/1/2025 3:30:00 PM
SB 134
SJR 15 Fiscal Note LEG SESS 3.19.25.pdf SHSS 4/1/2025 3:30:00 PM
SJR 15
Samantha Smith Testimony Rec'd 03.28.25.pdf SHSS 4/1/2025 3:30:00 PM
State Medical Board - Samantha Smith
Samantha Smith Testimony Rec'd 03.31.25.pdf SHSS 4/1/2025 3:30:00 PM
State Medical board - Samantha Smith
Brent Taylor Medical Board Resume_Redacted.pdf SHSS 4/1/2025 3:30:00 PM
State Medical Board Appointee - Brent Taylor
Samantha Smith Medical Board Resume_Redacted.pdf SHSS 4/1/2025 3:30:00 PM
State Medical Board Appointee - Brent Taylor
State Medical Board Fact Sheet 2025 Final.pdf SHSS 4/1/2025 3:30:00 PM
CSSJR 15 Version N Summary of Changes 4.1.25.pdf SHSS 4/1/2025 3:30:00 PM
SJR 15
SJR 15 Version N 4.1.25.pdf SHSS 4/1/2025 3:30:00 PM
SJR 15
ASMB Fact Sheet 2025.pdf SHSS 4/1/2025 3:30:00 PM
Alaska State Medical Board