03/14/2017 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB4 | |
| SB16 | |
| SB32 | |
| SB64 | |
| SB79 | |
| SB37 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 64 | TELECONFERENCED | |
| *+ | SB 79 | TELECONFERENCED | |
| *+ | SB 37 | TELECONFERENCED | |
| += | SB 4 | TELECONFERENCED | |
| += | SB 16 | TELECONFERENCED | |
| += | SB 32 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
March 14, 2017
1:39 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Shelley Hughes, Vice Chair
Senator Kevin Meyer
Senator Gary Stevens
Senator Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 4
"An Act relating to the Board of Barbers and Hairdressers;
relating to a limited license to practice non-chemical
barbering; relating to a license to practice hair braiding;
relating to the Department of Environmental Conservation; and
providing for an effective date."
- MOVED SSSB 4 OUT OF COMMITTEE
SENATE BILL NO. 16
"An Act adopting and relating to the Revised Uniform Fiduciary
Access to Digital Assets Act."
- MOVED SB 16 OUT OF COMMITTEE
SENATE BILL NO. 32
"An Act relating to biological products; relating to the
practice of pharmacy; relating to the Board of Pharmacy; and
providing for an effective date."
- MOVED SB 32 OUT OF COMMITTEE
SENATE BILL NO. 64
"An Act adopting the Uniform Environmental Covenants Act;
relating to environmental real property covenants and notices of
activity and use limitation at contaminated sites to ensure the
protection of human health, safety, and welfare, and the
environment; and providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 79
"An Act relating to the prescription of opioids; establishing
the Voluntary Nonopioid Directive Act; relating to the
controlled substance prescription database; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; relating to
the practice of optometry; relating to the practice of
veterinary medicine; related to the duties of the Board of
Pharmacy; and providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 37
"An Act relating to the Board of Pharmacy; relating to the
licensing and inspection of certain facilities located outside
the state; relating to drug supply chain security; and creating
a position of executive administrator for the Board of
Pharmacy."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 4
SHORT TITLE: NON-CHEMICAL BARBERING; HAIR BRAIDING
SPONSOR(s): SENATOR(s) MICCICHE
01/09/17 (S) PREFILE RELEASED 1/9/17
01/18/17 (S) READ THE FIRST TIME - REFERRALS
01/18/17 (S) L&C, FIN
02/17/17 (S) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS
02/17/17 (S) L&C, FIN
03/02/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/02/17 (S) Heard & Held
03/02/17 (S) MINUTE(L&C)
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 16
SHORT TITLE: FIDUCIARY ACCESS TO DIGITAL ASSETS
SPONSOR(s): SENATOR(s) HUGHES
01/13/17 (S) PREFILE RELEASED 1/13/17
01/18/17 (S) READ THE FIRST TIME - REFERRALS
01/18/17 (S) L&C, JUD
03/07/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/07/17 (S) Heard & Held
03/07/17 (S) MINUTE(L&C)
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 32
SHORT TITLE: PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS
SPONSOR(s): SENATOR(s) HUGHES
01/23/17 (S) READ THE FIRST TIME - REFERRALS
01/23/17 (S) HSS, L&C
02/10/17 (S) HSS AT 1:30 PM BUTROVICH 205
02/10/17 (S) Heard & Held
02/10/17 (S) MINUTE(HSS)
02/15/17 (S) HSS AT 1:30 PM BUTROVICH 205
02/15/17 (S) Moved SB 32 Out of Committee
02/15/17 (S) MINUTE(HSS)
02/17/17 (S) HSS RPT 2DP 1NR 1AM
02/17/17 (S) NR: WILSON
02/17/17 (S) DP: VON IMHOF, BEGICH
02/17/17 (S) AM: GIESSEL
03/07/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/07/17 (S) Heard & Held
03/07/17 (S) MINUTE(L&C)
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 64
SHORT TITLE: UNIFORM ENVIRONMENTAL COVENANTS ACT
SPONSOR(s): SENATOR(s) MICCICHE
02/17/17 (S) READ THE FIRST TIME - REFERRALS
02/17/17 (S) CRA, L&C
02/28/17 (S) CRA AT 3:30 PM BELTZ 105 (TSBldg)
02/28/17 (S) Heard & Held
02/28/17 (S) MINUTE(CRA)
03/07/17 (S) CRA AT 3:30 PM BELTZ 105 (TSBldg)
03/07/17 (S) Moved SB 64 Out of Committee
03/07/17 (S) MINUTE(CRA)
03/08/17 (S) CRA RPT 2DP 2NR
03/08/17 (S) DP: BISHOP, HOFFMAN
03/08/17 (S) NR: MACKINNON, STEDMAN
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 79
SHORT TITLE: OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/06/17 (S) READ THE FIRST TIME - REFERRALS
03/06/17 (S) L&C, HSS, FIN
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 37
SHORT TITLE: PHARMA BD & EMPLOYEES; DRUG DIST/MANUFAC
SPONSOR(s): GIESSEL BY REQUEST
01/25/17 (S) READ THE FIRST TIME - REFERRALS
01/25/17 (S) L&C, FIN
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
RACHEL HANKE, Staff
Senator Peter Micciche
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented an overview of SB 64.
KRISTIN RYAN, Director
Division of Spill Prevention and Response
Department of Environmental Conservation
Anchorage, Alaska
POSITION STATEMENT: Answered questions related to SB 64.
DR. JAY BUTLER, Chief Medical Officer
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented information on SB 79.
DANIEL NELSON, Director of Pharmacy
Tanana Chiefs Conference
Fairbanks, Alaska
POSITION STATEMENT: Presented concerns about SB 79.
MICHAEL CARSON, Chair
Mat-Su Opiate Task Force
Mat-Su, Alaska
POSITION STATEMENT: Testified in support of SB 79.
LEIF HOLM, Chair
Board of Pharmacy
North Pole, Alaska
POSITION STATEMENT: Voiced concerns about SB 79 and testified in
support of SB 37.
BARRY CHRISTENSEN, Co-Chair
Legislative Committee
Alaska Pharmacists Association
Ketchikan, Alaska
POSITION STATEMENT: Voiced concerns about SB 79; testified in
support of SB 37.
GERALD BROWN, Pharmacist
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to parts of SB 79.
SCOTT WATTS, Pharmacist
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to parts of SB 79.
SENATOR CATHY GIESSEL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 37.
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis of SB 37 on
behalf of the sponsor.
ACTION NARRATIVE
1:39:19 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:39 p.m. Present at the call to
order were Senators Meyer, Stevens, Gardner, and Chair Costello.
Senator Hughes arrived shortly thereafter.
SB 4-NON-CHEMICAL BARBERING; HAIR BRAIDING
1:40:11 PM
CHAIR COSTELLO announced that the first order of business would
be SB 4. She noted it is the second hearing on the bill and the
intent is to take any remaining questions of committee members
and then look to the will of the committee. She welcomed the
sponsor and others available to answer questions.
1:40:54 PM
SENATOR HUGHES moved to report SSSB 4, labeled 30-LS0078\J, from
committee with individual recommendations and attached fiscal
notes.
CHAIR COSTELLO announced that without objection, SSSB 4 is
reported from the Senate Labor and Commerce Standing Committee.
1:41:07 PM
At ease
SB 16-FIDUCIARY ACCESS TO DIGITAL ASSETS
1:42:40 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 16. She noted it is the second hearing on
the bill and there would be public testimony. She listed those
available to answer questions.
CHAIR COSTELLO, after seeing no testifiers, closed public
testimony.
1:44:03 PM
SENATOR HUGHES thanked the committee for hearing the bill.
SENATOR HUGHES moved to report SB 16, labeled 30-LS0172\D, from
committee with individual recommendations and attached fiscal
notes.
CHAIR COSTELLO announced that without objection, SB 16 is
reported from the Senate Labor and Commerce Standing Committee.
1:44:33 PM
At ease
SB 32-PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS
1:46:16 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 32. She said it is the second hearing of the
bill. She listed those available to answer questions.
1:47:07 PM
CHAIR HUGHES expressed appreciation to the committee for hearing
the bill. She pointed out a letter of support from the Alaska
State Medical Association.
1:47:23 PM
SENATOR HUGHES moved to report SB 32, labeled 30-LS0188\J, from
committee with individual recommendations and attached fiscal
notes.
CHAIR COSTELLO announced that without objection, SB 32 is
reported from the Senate Labor and Commerce Standing Committee.
1:47:45 PM
At ease
SB 64-UNIFORM ENVIRONMENTAL COVENANTS ACT
1:49:09 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 64. She noted it is the first hearing of the
bill. The intent is to hear from the sponsor, take members'
questions, take public testimony, and hold the bill for further
consideration. She noted those available for questions.
1:49:48 PM
RACHEL HANKE, Staff, Senator Peter Micciche, Alaska State
Legislature, presented an overview of SB 64. She said the
primary goal of the bill is to return [contaminated] fields back
to commerce, resolve liability, and protect future owners. She
explained that an environmental covenant is a recordable
interest in real property with no financial interest. SB 64
allows manageable contamination to remain with certain use and
activity restrictions. It formalizes an existing practice -
Institutional Controls - and allows for covenants to be placed
on federal land. The database that is required already exists.
1:50:52 PM
MS. HANKE reviewed the following sectional analysis for SB 64:
Section 1 adds a new article to AS 46.04 that
establishes all necessary guidelines and procedures
for environmental covenants for holders who are bound
by the covenant, subordination, required documents,
common law protections, notice procedures, recording
rules, termination procedures, and creates a process
for placing use restrictions on federal property, and
a database. It also provides definitions used in the
Act.
Section 2 [provides] that DCCED and DNR [may] adopt
necessary regulations [necessary to implement this
Act.]
Section 3 provides for an immediate effective date for
Section 2.
1:51:59 PM
CHAIR COSTELLO asked what the Uniform Environmental Covenants
Act addresses.
MS. HANKE explained that it is uniform law that has been used
all over the U.S. to return contaminated properties back to the
market.
CHAIR COSTELLO asked if other states have passed similar
legislation.
MS. HANKE said yes. She deferred to Ms. Ryan to provide more
information.
CHAIR COSTELLO welcomed Ms. Ryan and asked her to respond to
both questions.
1:52:56 PM
KRISTIN RYAN, Director, Division of Spill Prevention and
Response, Department of Environmental Conservation (DEC),
explained that her job involves cleanup of contaminated sites in
Alaska.
MS. RYAN related that SB 64 is a transparency law to communicate
when DEC puts restrictions on properties. The problem is that
sometimes restrictions are not communicated to future buyers. It
allows DEC to place a covenant that would run with the property
so that future owners are aware of restricted uses placed on
their land. It is a legal mechanism to safely transfer
contaminated property, and it removes a lot of the stigma
associated with contaminated property. She provided examples of
restrictions.
1:54:46 PM
SENATOR MEYER asked if it includes federal lands.
MS. RYAN said yes, and the majority of contaminated sites in the
state are federal properties. DEC can't put a covenant on
federal property, but can impose a use restriction. She used
Colorado as an example.
1:55:40 PM
SENATOR HUGHES asked how many contaminated sites this impacts.
MS. RYAN said DEC is currently monitoring about 2,000
contaminated sites; over 1,000 are allowed to remain above
cleanup levels under institutional control. DEC intends to apply
covenants to about 1,000 sites going forward.
1:56:20 PM
SENATOR HUGHES observed that the bill is not retroactive. She
asked how the mechanism works going forward.
MS. RYAN explained the process of working with the responsible
party that has contaminated property. The department and
property owner would make a joint decision to leave the
contamination in place for a variety of reasons. Next, they
would establish a covenant on the title that includes a future
mechanism for removing the covenant and an appeal process.
SENATOR HUGHES asked how long it would take before all
contaminated sites would have covenants.
MS. RYAN said DEC does not project a timeframe. A large
percentage of the 1,000 contaminated sites will be cleaned up
and not need covenants. A covenant is a transparency tool for
future buyers.
1:58:53 PM
CHAIR COSTELLO asked if Alaska should take an approach that is
similar to the Colorado law.
MS. RYAN explained that SB 64 is a uniform law from the National
Conference of Commissioners on Uniform State Laws (NCCUSL) which
proposed model legislation ten years ago. Colorado has adapted
the law to fit its situation of having a large amount of
contaminated federal land. They created a mechanism for noting
restrictions on federal property.
She said DEC has worked closely with NCCUSL and their testimony
is included in members' packets. NCCUSL agreed that Alaska's
changes to their model law are improvements and they have
accepted Alaska's better version. Currently, Alaska is only one
of seven states that has not adopted a procedure for an
environmental covenant.
2:00:08 PM
CHAIR COSTELLO asked if the public access page is the
transparency aspect of the bill.
MS. RYAN said she envisions DEC working with the records office
to put the restrictions on the title, as well as having a
database of contaminated sites. The database is currently in
place.
CHAIR COSTELLO asked if other states have experienced opposition
to this type of legislation.
MS. RYAN said DEC has talked to many stakeholders and all are
supportive of the concept. She pointed out that there is one
letter from the Department of Defense (DOD) requesting an
amendment. DEC disagrees with that request related to concerns
about the state setting any standards on federal property, a
long-standing debate. No other states have encountered problems
doing what SB 64 proposes.
2:02:46 PM
CHAIR COSTELLO asked if the bill would apply to "Travesty Wells"
[in the National Petroleum Reserve-Alaska (NPR-A)] on federal
lands.
MS. RYAN said yes, and it would also apply to the legacy wells
on [Bureau of Land Management (BLM)] land [within and adjacent
to NPR-A], if BLM decides, with DEC's involvement, to lease
contaminated sites above cleanup levels so future owners are
aware of the contamination.
2:03:14 PM
CHAIR COSTELLO asked how DEC can have a zero fiscal note if they
plan to investigate properties and handle communication.
MS. RYAN responded they are already putting restrictions on
properties. The bill allows DEC to put restrictions on land
titles and this will not increase workloads. The database is in
place and they will absorb costs to write regulations.
2:04:13 PM
CHAIR HUGHES asked if Alaska is using the same mechanism as
other states. She voiced concern about DOD's opposition.
MS. RYAN said the federal property aspect of SB 64 is identical
to Colorado's legislation. It was implemented several years ago,
and DOD and the Air Force have been in compliance.
2:04:56 PM
SENATOR STEVENS asks if SB 64 exonerates a bad actor that
abandons the contaminated property.
MS. RYAN said no. That person is still liable and would be
pursued for cleanup. The covenant is a mechanism to communicate
to future owners if the owner leaves contamination above cleanup
levels.
SENATOR STEVENS asked if the financial cost to the owner is
taken into consideration.
MS. RYAN said that is a factor DEC considers and one of the
reasons why contamination remains. DEC tries to minimize the
risks and can allow the contamination to remain in place by
imposing restrictions. Their goal is to limit exposure pathways.
2:06:30 PM
SENATOR MEYER asked how DEC determines whether land is
contaminated. He provided an example of buried batteries that no
one knew about.
2:06:54 PM
MS. RYAN said DEC needs to be notified to become involved in the
process. They often find out about those kinds of
contaminations. She gave an example of lead acid batteries
discovered in Wrangell after several iterations of ownership.
They use the Department of Law to help find the responsible
party.
SENATOR MEYER asked if realtors have a position on SB 64.
MS. RYAN said they agree with the concept, but don't want it to
be overly cumbersome. DEC has agreed to work with them during
the drafting of regulations.
2:08:09 PM
CHAIR HUGHES asked what types of things might be in a covenant.
MS. RYAN referred to a flyer in members' packets that describes
a covenant. She provided examples of restrictions: no digging,
no wells, and no day care, depending on the contamination.
SENATOR HUGHES added - no residential land use, no disturbance
of soil, construction worker notice, engineer-controlled for
soil, no drilling, and no use of groundwater.
MS. RYAN said those are some examples. She provided another
example of no allowed vapor intrusion.
2:10:13 PM
CHAIR COSTELLO closed public testimony on SB 64 and held the
bill in committee.
SB 79-OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES
2:11:23 PM
CHAIR COSTELLO announced the consideration of SB 79. She noted
that the bill was introduced on behalf of Governor Walker. SB 79
helps address a major issue facing Alaska, an opioid epidemic.
It is a national epidemic. She provided an example from the New
York Times about a farmer who lost two children to opioids. She
said this type of addiction can lead to heroin abuse and
staggering problems across the country. Deaths related to opioid
abuse have increased three-fold in the past seven years.
She said SB 79 looks at a strategy in Alaska to prevent
prescription pain killer abusers from becoming heroin users. In
2008 the legislature established a controlled substance database
known as the Alaska Prescription Drug Monitoring Program. Last
year the legislature identified ideas to help combat this issue
through managing patient data. She shared another example of a
parent in Juneau who lost a son in January. She maintained that
the state has a moral obligation to address this issue because
of the tremendous impact it is having on Alaska.
She said this is the first hearing of SB 79. The intent is to
hear from the sponsor, take members' questions, take public
testimony, and then hold the bill for further consideration.
2:13:20 PM
DR. JAY BUTLER, Chief Medical Officer, Department of Health and
Social Services, commented that Chair Costello has nicely
outlined the reason for hearing SB 79. He noted the increasing
number of deaths due to opioid overdose, which has mirrored the
increase in the rate of prescribing opioid pain relievers.
Alaska is at a point where many people are dependent on or
addicted to opioids and are more susceptible to heroin and
fentanyl abuse. About 80 percent of those using heroin started
their addiction by using prescription painkillers.
DR. BUTLER spoke of an increase in rates of hepatitis C
associated with drug use and more emergency room admissions. He
emphasized that "all statistics are people with tears wiped
away." He said that, today, most everyone has been touched by
the opioid epidemic.
2:15:13 PM
DR. BUTLER highlighted the need to address overdose, treatment
of addiction, addiction as a chronic health condition, and
prevention, including limiting legal and illegal opioids,
involving law enforcement, curbing overprescribing, and
addressing why people self-medicate. The bill is part of the
larger response and is designed to encourage more evidence-based
prescribing and limit the flood of opioid painkillers into
communities. It intends to increase access to treatment and de-
stigmatization by improving provider knowledge. SB 79 aligns
with guidelines in SB 74 by healthcare boards, as well as with
the Centers for Disease Control Pain Management Guidelines, the
Surgeon General's Report on Alcohol Drugs and Health, and recent
statements from the American Medical Association and the
American Dental Association.
2:16:50 PM
DR. BUTLER said SB 79 provides an option for patients who do not
wish to be prescribed opioids to communicate their preference to
their providers by way of a voluntary, revocable, opioid advance
directive. This was a suggestion from the recovery community. It
also allows patients to request from pharmacists, less than the
total prescribed amount.
He said SB 79 requires that five percent of providers'
continuing education credits be committed to pain management and
addiction. The bill sets limits on the initial opioid
prescription to a seven-day supply. Exceptions can be made by
providers in certain instances.
SB 79 includes changes to the Prescription Drug Monitoring
Program (PDMP), a centralized database where providers can go to
look at a patient's prescription history. The bill authorizes
the Pharmacy Board to issue routine, periodic, confidential
reports to prescribers to provide feedback on their prescribing
practices. He referred to a recent report in the New England
Journal of Medicine that, using the Medicare Part D database,
looked at prescribing habits of emergency room physicians.
People who received opioids in the emergency department were
more likely to have dependency a year later. There was a three-
fold variation in the rate of prescribing opioids, which clearly
demonstrated a lack of agreement among providers as to how to
manage acute pain.
He named states that have been effective in reducing the number
of excessive prescriptions due to the non-punitive reports
issued to providers.
2:20:20 PM
DR. BUTLER spoke of two controversial aspects of the bill. One
requires veterinarians who prescribe opioids to register and use
the PDMP. The second controversial aspect is requiring daily
updates of the PDMP to make it a more useful tool.
2:21:25 PM
CHAIR COSTELLO noted that Public Safety Commissioner Walt
Monegan is present and showing support for the bill.
DR. BUTLER continued to say that 25 states have the requirement
of daily updates of the PDMP.
He stressed that the bill does not place blame. The goal is for
everyone to be responsible for owning the problem and doing
their part to address it.
2:22:52 PM
CHAIR COSTELLO requested the sectional analysis.
2:23:13 PM
DR. BUTLER presented the following sectional analysis for SB 79:
Sec. 1 Adds a new Chapter 55, Voluntary Nonopioid
Directive Act, to AS 13, Decedents' estates,
guardianships, transfers, trusts, and health care
decisions, that provides an option for patients to
execute a Voluntary Nonopioid Directive that would
allow a person in recovery (or for other reasons) to
make clear the person's desire not to be administered
an opioid. A person, guardian, conservator or other
appointed person may revoke a directive at any time.
The person would provide this confidential information
to a health care provider or hospital on a form
provided by the Department of Health of Social
Services. The department would promulgate regulations
on procedures, confidentiality, and exemptions for
emergency or substance misuse treatment. Providers are
not liable for following a directive. Prescriptions
are assumed to be valid; pharmacists are not liable
for dispensing a controlled substance in contradiction
to a directive. The directive does not alter an
advance health care directive, limit opioid overdose
drugs, or limit treatment for substance abuse or
opioid dependence.
CHAIR COSTELLO asked if there are alternatives to opioids that
doctors can use.
DR. BUTLER said there are. He described the evolution over the
past 20 years where opioids have become the first line of
treatment for all pain. He noted the influence of market forces
and the four-fold increase in prescribing and abuse, with no
decrease in the level of pain. Physical dependency is also a
factor.
He shared that there are updated clinical guidelines for back
pain by the American College of Physicians. Now, opioids are
given as the third line of pain relief, starting with something
like Tylenol and physical therapy.
2:26:11 PM
CHAIR COSTELLO noted that the bill will be in committee again
for further discussion.
SENATOR HUGHES thanked Dr. Butler and expressed appreciation of
the Governor's concern about the opioid crisis. She discussed
liberal prescribing practices in the 90s and noted that today
most doctors use opioids as a last resort. She asked how
extensive overprescribing is today.
DR. BUTLER opined that all providers use more opioids today than
five years ago. He said overprescribing is spread across the
profession nationally, but primary care providers prescribe more
than half of all opioids. He pointed out that Oxycodone was
heavily marketed to primary care providers. Heroin users
switched to Oxycodone before 2010 because it was so prevalent
and cheap. In the 90s there was a trend to be "pain free."
He discussed the importance of pain and noted that it is
subjective. It also can be debilitating and needs to be managed.
SENATOR HUGHES asked Dr. Butler if he has access to the PDMP
data to see who may be overprescribing.
2:31:23 PM
DR. BUTLER said he does not. He explained that PDMP monitoring
falls to the Pharmacy Board under SB 74, however, Public Health
can access de-identified data for public health purposes.
SENATOR HUGHES asked if law enforcement has access to the PDMP
with a warrant from the DEA.
DR. BUTLER said yes.
2:32:17 PM
DR. BUTLER continued the sectional analysis of SB 79:
Sec. 2-25 Amend AS 08, Business and Professions, for
the Boards of Dentistry, Medicine, Nursing, and
Optometry to:
Require two (2) hours of pain management and opioid
misuse and addiction instruction;
Disciplinary actions for prescribing or dispensing an
opioid in excess of the maximum dosage allowed by law
or violated a law related to drugs, regardless of any
criminal action;
Set the maximum dosage for initial opioid
prescriptions at a seven-day supply unless, in the
practitioner's professional judgment, it is necessary
for chronic pain management or a patient is unable to
access a practitioner in time to refill the
prescription; and
Require, for a minor under 18 years of age, the
practitioner discuss with the parent or guardian why
the prescription is necessary, and the risks
associated with opioid use.
He provided an example of a 15-year-old who was prescribed
Vicodin.
He continued the sectional analysis of SB 79.
Sec. 26-27 Amend AS 08.80 for the Board of Pharmacy to
Register with the Prescription Drug Monitoring
Database (PDMP) with or without a federal Drug
Enforcement Administration registration number; and
Allow pharmacists to dispense less than the prescribed
amount of a schedule II or III controlled substance at a
person's request; the pharmacists would inform the
prescribing practitioner and the Prescription Drug
Monitoring Database.
2:35:21 PM
Sec. 28 Amends AS 08.98 for the Board of Veterinary
Medicine to:
Register with the Prescription Drug Monitoring
Database if the veterinarian has a federal Drug
Enforcement Administration number; and
Identify resources and educational materials for
veterinarians to identify clients at risk for opioid misuse
or diversion of prescribed opioids.
Sec. 29-36 Amend AS 17.30, Controlled Substances, to
change the frequency pharmacists report to the
Prescription Drug Monitoring Database from weekly to
daily; remove the prohibition on sharing information
with the federal government. The pharmacy board may
provide a confidential unsolicited notification in
summary form to a practitioner's licensing board which
includes the basis for the notification. The
notification must be provided to the practitioner as
well.
Sec. 37 Directs the Department of Health and Social
Services to draft regulations to implement the
Voluntary Nonopioid Directive Act.
Sec. 38 Repeals sunset dates in sections 52 and 73 of
Ch. 25, SLA 2016 (SB 74).
Sec. 39-40 Set an immediate effective date and provide
an effective date for regulations.
2:37:29 PM
CHAIR COSTELLO thanked Dr. Butler and opened public testimony on
SB 79.
2:37:52 PM
DANIEL NELSON, Director of Pharmacy, Tanana Chiefs Conference,
presented concerns about SB 79. He agreed with the overall
intention of the bill and noted a consensus amongst the entire
medical community that opioid addiction is a huge problem.
He addressed specific concerns in the bill. He pointed out that
SB 74 from last year will not be implemented until July 17,
2017, and it contains several provisions that will significantly
positively impact the inappropriate prescribing of opioids. It
would make some things in SB 79 unnecessary. Also, there has
been a lack of participation in drafting the bill by medical and
pharmaceutical communities. Another concern is in Section 31
where there is a removal on the prohibition of sharing the PDMP
information with the federal government, which would undermine
public trust in PDMP. The requirement of daily updates to the
PDMP is unnecessary and onerous. Finally, the voluntary non-
opioid directive is unnecessary; no one is precluded from doing
that now, and the partial filling of controlled substance
prescriptions can be requested now.
MR. NELSON stated support for the mandatory continuing education
course.
CHAIR COSTELLO noted Department of Health and Social Services
Commissioner Davidson was present.
2:41:13 PM
SENATOR GARDNER requested Mr. Nelson repeat the last sentence.
MR. NELSON restated that the mandatory continuing education is
beneficial.
SENATOR STEVENS asked for clarification about partially filling
a prescription at the patient's request.
MR. NELSON explained that a pharmacist can fill a prescription
using a lower quantity drug, at the patient's request.
SENATOR STEVENS asked if pharmacists would be comfortable
overriding a physician.
MR. NELSON said only in that situation.
2:43:28 PM
MICHAEL CARSON, Chair, Mat-Su Opiate Task Force, stated that the
Task Force supports limiting opioid prescriptions to seven days
and imposing stricter rules tied to the PDMP. He thanked Chair
Costello for her introduction and confirmed that fatal overdoses
have tripled in the state due to the increase of heroin abuse;
fentanyl mixed with heroin is a factor. He said 80 percent of
heroin users started with opioids. He concluded that the goal is
to turn off the prescription spigot.
2:45:50 PM
LEIF HOLM, Chair, Board of Pharmacy, voiced concerns with SB 79.
He concurred with Mr. Nelson's testimony. He agreed it is
necessary to find ways to combat the opioid epidemic. He
maintained that the bill unfairly singles out pharmacists and
looks to correct SB 74, which has yet to take effect. He stated
that pharmacists have consistently spearheaded actions against
the opioid epidemic, especially in finding funding sources for
and using the PDMT. He questioned issues related to the partial-
fill provision. He concluded that he opposes the bill in its
current form.
SENATOR GARDNER asked if partial fill and voiding the balance of
a prescription is state law, and what needs to change to allow
retention of the remaining prescription.
MR. HOLM related that since July 2016 partial fills have been
allowed without voiding the balance of a prescription. He stated
support for that.
SENATOR GARDNER asked how the bill could be written to ensure
that a partial fill does not void the remaining amount.
MR. HOLM suggested eliminating the phrase, "the remainder of the
prescription is voided."
2:49:55 PM
BARRY CHRISTENSEN, Co-Chair, Legislative Committee, Alaska
Pharmacists Association, voiced concern with SB 79. He concurred
with the previous testifiers, Mr. Holm and Mr. Nelson. He spoke
of the poor timing, given the passage of SB 74. He shared the
many contributions pharmacists have made to this issue and said
many pharmacists feel that the Governor's press release put a
negative spin on them.
He voiced concern about patients being scared, due to tightening
legislation, to refill medications for chronic pain management.
He shared the risks related to patients suddenly quitting their
pain meds.
GERALD BROWN, Pharmacist, testified in opposition to parts of SB
79. He said many items in SB 79 are similar to those in SB 74.
He suggested not holding the pharmacist in charge liable for
failing to check the database, as written in Section 32. He
pointed out the real control of abuse is when "the pen hits the
paper." He commented on revisiting page 2 of the bill.
CHAIR COSTELLO noted the people available to answer questions
and invited them back the next time the bill is heard. She said
she is keeping public testimony open.
2:55:25 PM
SCOTT WATTS, Pharmacist, testified in opposition to parts of SB
79. He voiced appreciation for what the bill is trying to
accomplish. He suggested that more input from pharmacy
associations would help correct some of the problems in the
bill. He said that daily monitoring of the database can be done
electronically at his pharmacy if the bill passes, however, it
may be more difficult for some pharmacies. He suggested having
some implementation time for that.
He pointed out that prescribers can check the PDMP database in
their offices in advance. He said pharmacists don't always have
the time to check the PDMP database, and they have better
avenues to see about prescribing data and usage. He did not want
to see daily checking of the database being a requirement. They
are willing to maintain and enter the data in PDMP. He said he
liked the ability to decrease the number of pills in the
prescription.
2:57:39 PM
SENATOR GARDNER asked if the database is confidential and
requires logging in every time.
MR. WATTS said correct. Pharmacists are waiting for SB 74, which
allows for an agent to monitor the database.
SENATOR HUGHES asked if there could be software to interface
with PDMP to flag problems.
MR. WATTS said there has been talk of that, but it is expensive.
SENATOR COSTELLO held SB 79 in committee with public testimony
open.
2:59:55 PM
At ease
SB 37-PHARMA BD & EMPLOYEES; DRUG DIST/MANUFAC
3:01:47 PM
CHAIR COSTELLO announced the consideration of SB 37. She noted
this is the first hearing. The intent is to hear from the
sponsor, take members' questions, take public testimony, and
hold the bill for further consideration.
3:02:40 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB
37, said she appreciates teaming SB 79 with SB 37. She noted the
bill is at the request of the Board of Pharmacy. It is not a new
issue; a similar bill was heard last session.
She stated that SB 37 ensures a more secure drug supply chain to
ensure that Alaskans receive safe, non-counterfeit,
unadulterated medications. In Alaska, when a pharmacy, doctor,
or hospital orders a supply of prescription medications, they
may order from one of the wholesale distributors in Alaska or
one in the Lower 48. Alaska is one of two states that does not
license out-of-state wholesale distributors. In 2012
contaminated medicines were distributed that resulted in the
death of many people in the Lower 48. To protect Alaska, SB 37
would ensure that out-of-state applicants seek licensure and
comply with the same regulations Alaska wholesale distributors
comply with.
She said that SB 37 also brings Alaska into compliance with a
federal law - the Drug Quality Security Act of 2013 - and will
create a new license category under the Board of Pharmacy for
out-of-state wholesale distributors. The Division of
Corporations, Business, and Professional Licensing estimates
that this will equal about 400 new licensees. Currently, the
Alaska Board of Pharmacy has no authority to regulate out-of-
state wholesale distributors and SB 37 would provide that. It
would require certain guidelines for the distributor: obtain a
license in Alaska, authorize inspection by a designee of the
Board, and give the Board the authority to appoint an agent to
examine the distributor's facility.
She highlighted the definition section of the bill, noting that
one definition - "outsourcing facility" - is a facility that
compounds sterile drugs. It is an example of an entity that
would fall under SB 37.
3:05:55 PM
SENATOR GIESSEL advised that the Board of Pharmacy is being
asked to take on more responsibilities. Last year under the
Medicaid reform bill the Prescription Drug Monitoring [Program]
(PDMP) was established, which puts more responsibilities on the
Board. SB 37 will allow the Board to create an executive
administrator position to implement statutes and regulations and
manage the Board's new responsibilities.
She noted a fiscal note for SB 37 and that the services provided
are all receipt services. Monies will be recovered through
wholesale license fees and the executive administrative position
will be funded by licensees of the Board of Pharmacy.
CHAIR COSTELLO noted that Sara Chambers from the Division of
Corporations, Business, and Professional Licensing, Department
of Commerce, Community and Economic Development was available to
answer questions.
3:07:45 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, presented the sectional analysis of SB 37 on behalf
of the sponsor. She read the following:
Section 1: Amends AS 08.80.030(b)
(14): Amends and allows licensing and inspection for
out-of-state drug distributors and outsourcing
facilities
(15): Establishes qualifications and duties of
executive administrator. Executive administrator is
delegated authority in order to conduct board business
Section 2: Amends AS 08.80.030 by adding a new
subsection:
AS 08.80.030(c): Specifications for facilities,
equipment, personnel, and procedures for control of
drugs in compliance with the federal Drug Supply Chain
Security Act.
Section 3: Amends AS 08.80.157 by adding a new
subsection:
(k): Applies to wholesale drug distributors and
outsourcing facilities outside the state under AS
08.80.159, regarding licensing.
Section 4: Amends AS 08.80 by adding a new section:
Sec. 08.80.159: Requires that a wholesale drug
distributor or outsourcing facility have a license in
Alaska before shipping, mailing, or delivering
prescription drugs to a licensee in the state or
before advertising in the state, that an agent must be
appointed in the state, and a designee of the board
must authorize inspection of the facility.
An outsourcing facility, in addition, must comply with
the federal Drug Quality and Security Act of 2013.
The board may require an inspection of facilities
located outside of the state, approve a designee to
inspect. The board shall adopt regulations to
implement this section.
3:09:53 PM
Section 5: Amends AS 08.80 by adding new section to
Article 2:
Sec. 08.80.270: Allows the Board to create an
executive administrator position. Defines the role of
the executive administrator.
Section 6: Amends AS 08.80.480 by adding a new
paragraph:
AS 08.80.480(37): Defines "outsourcing facility"
3:10:26 PM
SENATOR STEVENS asked if Alaska wholesalers receive federal
inspections and inspections by other states.
SENATOR GIESSEL said she did not know. She suggested asking
pharmacists.
3:11:00 PM
SENATOR GARDNER asked about reciprocity and why Alaska can't
rely on inspection standards of other states for wholesale drug
companies.
3:11:33 PM
SENATOR GIESSEL said she did not know. She suggested asking the
pharmacists. She said one provision in the bill is that the
Board could designate someone in another state to examine that
state's wholesaler.
SENATOR GARDNER asked how much medication is brought into Alaska
by wholesalers and how many wholesalers are in Alaska.
SENATOR GIESSEL said she believes there is one wholesale
distributor in Alaska.
3:13:23 PM
CHAIR COSTELLO opened public testimony on SB 37. She requested
that Mr. Christensen address members' questions.
BARRY CHRISTENSEN, Co-Chair, Alaska Pharmacists Association,
testified in support SB 37. He deferred to Mr. Holm to answer
members' questions. He said the bill is necessary to ensure that
Alaskans are receiving good medications. He agreed that the
Board of Pharmacy has been taxed with doing more with minimal
staffing. He supported having an executive administrator on the
Board.
3:15:00 PM
LEIF HOLM, Chair, Board of Pharmacy, testified in support of SB
37. He reiterated the purpose of the bill. He voiced support for
the executive assistant position due to the increased workload
of the Board. He repeated the funding mechanisms outlined in the
fiscal note.
SENATOR STEVENS asked, if the federal government inspects
wholesalers in Alaska, why there is a need for an extra
inspection. He also wondered whether other states inspect Alaska
wholesalers.
MR. HOLM clarified that the bill is written so that Alaska "may"
do an inspection. He did not have information on what other
states do. He added that there are 21 states that recognize the
National Association of the Boards of Pharmacy's Verified
Accredited Wholesale Distributor Program (VAWD), which is a
built-in inspection. The Alaska Board of Pharmacy accepts that
as part of the licensure process.
3:18:37 PM
CHAIR COSTELLO asked if the Board can direct an individual to
conduct the inspection. She asked whether the VAWD fulfills that
requirement.
MR. HOLM said he believes that would work.
3:19:14 PM
SENATOR GARDNER asked if it is customary in some places for
pharmaceutical wholesalers to be licensed to hold VAWD
accreditation.
MR. HOLM responded that four states require that accreditation
to do business in their state.
SENATOR GARDNER asked if it would make sense for Alaska to
require VAWD certification.
MR. HOLM said not at this point. Other states also have other
extensive pharmacy inspections that Alaska accepts. He did not
want to limit the drug supply, just insure its quality.
3:20:50 PM
SENATOR GARDNER asked if passing SB 37 means that if an Alaskan
pharmacist were to purchase drugs they would have to buy them
from an Alaskan wholesaler or an outside distributer with an
Alaskan license and certificate of inspection.
MR. HOLM said he believes they would have to have an Alaskan
wholesale license.
3:22:07 PM
SENATOR HUGHES asked Mr. Holms to explain the current makeup of
the Board. She wondered if the new executive position would be
covered by outside license fees and if pharmacist license fees
will increase. She also inquired whether pharmacists support SB
37.
3:23:08 PM
MR. HOLM related that the Board's licensing examiner is
backlogged with work. The wholesale license fee is anticipated
to be $1,000 to $5,000, which should be more than sufficient to
cover the cost of an executive administrator. He did not
anticipate that pharmacist license fees will increase.
CHAIR COSTELLO closed public testimony on SB 37 and held the
bill in committee for further consideration.
3:24:41 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor & Commerce Committee
at 3:24 p.m.