HB 25-INSURANCE COVERAGE FOR CONTRACEPTIVES  3:05:35 CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 25, "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date." 3:05:44 PM REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, explained that Alaskan women living and working in rural areas, in the tourism industry, in the military, and on the North Slope did not always have ready access to women's health services, and faced additional barriers for obtaining access to family planning options. He stated that women who currently used hormonal contraceptives had to return to a pharmacy everyone to three months to refill their prescriptions. He reported that proposed HB 25 required health insurers to offer consumers the option to receive a 12-month supply of hormonal contraception. He declared that the women in his family supported the proposed bill as improved access to contraceptives meant huge reductions in unintended pregnancies. He added that unintended pregnancies had a profound effect on the overall well-being of Alaskan families, as it was associated with adverse maternal and child health outcomes. Along with health concerns, unintended pregnancy was a dramatic cost driver to public health programs. He pointed out that it was often time consuming and inconvenient to obtain a prescription for contraceptives every one to three months. He offered his belief that, with the financial challenges in the state, there should be discussion for ways to reduce costs in both the short and long term. He declared that proposed HB 25 offered these cost reductions, and that it made sense for Alaska women and families. 3:07:34 PM LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State Legislature, stated that proposed HB 25 mandated that health care insurers provide coverage for a 12-month supply of contraceptives. She pointed out that prescriptive contraceptives included self-administered hormonal contraceptives which did not require insertion or other administration by a medical professional, namely oral contraceptives, noting that this was discussed in Section 1 of the proposed bill. She moved on to discuss the Sectional Analysis of the bill [included in members' packets]. She said that Section 1 also included a religious exemption and defined a health care insurer as including a self-insured employer, such as the State of Alaska. She moved on to discuss Section 2 of the proposed bill, which directed the Department of Health and Social Services to pay for the 12-month supply of prescription contraceptives for eligible recipients of medical assistance. She relayed that Section 3 of the proposed bill required the Department of Health and Social Services to amend and submit for federal approval a state plan for medical assistance coverage consistent with Section 2. She explained that Section 4 provided a conditional effect of Section 2 and Sections 5 and 6 pertained to the effective dates. MS. KUBITZ stated that one major premise behind the proposed bill was that when women had greater access and availability to contraceptives, there was a reduction of unintended pregnancies. This resulted in a direct cost savings to the state, which was reflected in the fiscal notes from Department of Health and Social Services [included in members' packets]. She relayed that one 2010 study in Alaska [included in members' packets] found that 48 percent of all pregnancies in Alaska were unintended. She added that an estimated 94.3 percent of these unintended pregnancies were publicly funded. She reported that Alaska spent $113.7 million on unintended pregnancies, of which $70.8 million was paid for by the federal government and $42.9 million was paid for by the state. She pointed to an additional study [included in members' packets] which studied 84,000 women in California given 1 month, 3 month, or 12 month supplies of oral contraceptives. The researchers of this study observed a 30 percent reduction in the odds of conceiving an unintended pregnancy for those women given the 12 month supply of oral contraceptives. This study also reported that the California family planning program paid $99 more annually for women who received three cycles and $44 more for women who received one cycle than for women who received a year-long supply all at once. She stated that this cost "was mostly due to the costs of associated visits and the higher use of pregnancy tests among women who received fewer cycles." She relayed that women who received three cycles were almost twice as likely as women who received the 12 month supply to visit a clinic to get a pregnancy test. She noted that the proposed bill did not change who was eligible for coverage, or the types of prescriptions covered. The bill merely allowed women already receiving coverage for prescription contraceptives to receive, if they so choose, a 12 month prescription. She addressed concerns brought forward by the Alaska National Federation of Independent Business (NFIB) and by America's Health Insurance Plan (AHIP) [included in members' packets]. As NFIB had concerns for whether the proposed bill would include the state employee health care plan, a definition of health care insurer which included self-insured employers, such as the State of Alaska, had been included in the proposed bill. She relayed that an additional concern voiced by NFIB was for the cost burden of supplying a 12 month supply of contraception at one time. She pointed to multiple studies which had found that contraceptive coverage did not raise insurance premiums, and that the employers providing coverage could save money by avoiding the costs associated with unintended pregnancy. She relayed that the average commercial insurer payment for all maternal and newborn care ranged from $18,000 to $28,000, whereas the average hormonal birth control cost ranged from $100 to $600 per year. She stated that prevention of one unintended pregnancy could save an insurer at least $17,000, enough savings to pay for 29 additional years of contraception. She moved on to discuss the concerns from AHIP [included in members' packets] which concluded that the 12-month supply of contraceptives could compromise patient safety as a result of decreased patient visits to the prescribing physician. She pointed to research which showed that birth control pills were safe and could be safely prescribed based on a careful review of the patient's medical history and blood pressure measurement. For most women, no further examinations were necessary after the initial prescription, unless the patient asked for a follow up during the recommended yearly examination. She stated that the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) had presented a study in 2013 which recommended dispensing a yearly supply of contraception with an advisement to return at any time for discussion of side effects or other problems, or to change the method. The study had declared that no routine follow-up was required. She added that, although AHIP had concerns for the efficacy of oral contraceptives due to improper storage for a 12 month supply, CDC had declared that oral contraceptives had a shelf life of three to five years, dependent on the manufacturer, although temperature and moisture could diminish this time frame. CDC stated that most women who opted for a 12-month supply, and were regular users of hormonal contraception, would know how to properly store the medication. She addressed concerns for waste, fraud, and abuse, and pointed out that research had found that the average waste of a 12-month supply was for one cycle of prescription contraceptives, and this was insignificant in comparison to the other cost savings for fewer clinician and pharmacy visits, and the associated costs for pregnancy. Regarding fraud and abuse, although there were existing criminal statutes for sale of hormonal contraceptives, this was not anticipated as women would have greater access to the contraceptives. She concluded by stating that proposed HB 25 would offer "huge advantages for Alaskan women, from eliminating the inconvenience of refilling the prescription every one to three months at a time, to the real inability of some Alaskan women to make it to the clinic, hospital, or pharmacy to refill that prescription at all." She pointed out that fisherwomen sometimes spend three to four months out on a boat, women attending college often have busy schedules balancing school and a job, and women in Rural Alaska often had trouble making it to a clinic or hospital due to a lack of transportation and limited operating hours. She declared the HB 25 ensured that all Alaskan women had the freedom to make decisions about their futures. 3:16:28 PM REPRESENTATIVE JOHNSTON shared that a three month supply of birth control pills for her daughter was $800. She asked if there was a discount for a 12 month supply. MS. KUBITZ replied that her research had shown a cost savings for buying in bulk. REPRESENTATIVE JOHNSTON suggested more research for this. 3:17:40 PM REPRESENTATIVE EDGMON pointed to the zero fiscal note. MS. KUBITZ replied that there were two zero fiscal notes [included in members' packets] provided by the Department of Health and Social Services [OMB Component 242 and OMB Component 2007]. She relayed that one fiscal note projected anticipated costs due to implementation of the proposed bill and the second fiscal note detailed the cost savings. 3:18:35 PM MARGARET BRODIE, Director, Director's Office, Division of Health Care Services, Department of Health and Social Services, addressed the Department of Health and Social Services (DHSS) fiscal note labeled OMB Component 2007, and explained that this fiscal note analyzed 7,940 female Medicaid recipients using oral contraceptives. She estimated that 10 percent, 794 women, would require duplication of services because the medication was not effective, it was lost or stolen, or was not stored properly and could lose its efficacy. She based the replacement value at $45 per month which was the national average drug acquisition cost and the cost that the state used for its determination. She shared that DHSS assumed that 75 percent of the women planned to use oral contraceptives longer than 12 months, and that, as the CDC cited a standard failure rate of 9 percent, this would result in 540 unintended pregnancies. She reported that the failure rate would decrease about 30 percent with a 12-month supply of contraceptives, thereby lowering the failure rate to 7 percent. She pointed out that about 120 unintended pregnancies could be avoided by using the 12-month contraception. She stated that the estimated savings was based on the Medicaid data, which reported that 5.28 births of the 120 avoided pregnancies would have been complicated births, with the remainder of births being non-complicated. She reported that the cost factor for a complicated birth was $110,000, whereas the cost factor for a non-complicated birth was $8,000. This would result in a benefit cost savings to the Medicaid program estimated to be $1,498,000, of which $562,000 would be attributed to the Medicaid expansion population. She reported an annual projected savings of $1,355,600. She added that this was a conservative estimate, as some complicated births could cost hundreds of thousands of dollars. MS. BRODIE addressed the second fiscal note, OMB Component 242. She offered her belief that this fiscal note could be removed, as there was no state or federal statute that declared a need for the department to go back and collect from the recipients. 3:24:41 PM CHAIR SPOHNHOLZ expressed her agreement with saving the "money in this particular area." She suggested that the savings would be $1.2 - $1.3 million annually in overall Medicaid costs related to contraception and unintended pregnancies. MS. BRODIE expressed her agreement. 3:25:03 PM REPRESENTATIVE SULLIVAN-LEONARD asked whether the proposed bill would allow the state workers' health insurance program to offer this benefit. REPRESENTATIVE CLAMAN, in response, relayed that the intent of the proposed bill was for this benefit to be included in the state workers' health insurance plan. REPRESENTATIVE SULLIVAN-LEONARD asked if there were other medications that could be prescribed on a yearly basis, or was this the first proposal for a year-long prescription. MS. KUBITZ asked if Representative Sullivan-Leonard was asking specifically about contraceptives. She stated that she was not aware of any other medications that could have a year-long prescription, as often many of these medications were controlled substances. REPRESENTATIVE SULLIVAN-LEONARD asked if any other prescription drugs could be included in this format, pointing out that a 90- day prescription was because a physician wanted to oversee the interaction of the drug for the patient. REPRESENTATIVE CLAMAN said that his office had not researched this specific question. He recollected that certain mail-in drug programs allowed for longer prescriptions, although it depended on the medication. CHAIR SPOHNHOLZ offered her belief that some other medications, including some hormonal medications, were available on a yearly prescription. REPRESENTATIVE CLAMAN replied that he would look into this. 3:28:53 PM CHAIR SPOHNHOLZ said that HB 25 would be held over.