02/07/2023 03:00 PM House HEALTH & SOCIAL SERVICES

        HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST                                                                     
                                                                                                                                
3:03:40 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that the  first order of business  would be                                                               
HOUSE BILL  NO. 17,  "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."                                                                                               
                                                                                                                                
3:04:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ASHLEY CARRICK, Alaska  State Legislator, as prime                                                               
sponsor, presented  HB 17.   She stated that since  the mid-'90s,                                                               
28 states have  required health insurance plans  regulated by the                                                               
state  to provide  coverage of  prescription  drugs and  devices,                                                               
including contraceptives.   Under  a provision of  the Affordable                                                               
Care Act  of 2010  (ACA), these state  policies were  expanded in                                                               
several ways.   She said  ACA's contraceptive  coverage guarantee                                                               
extends from Section  13 of the Public Health  Service Act, which                                                               
requires   non-grandfathered   health  insurance   coverage   and                                                               
employer-sponsored  group   health  plans  to   cover  preventive                                                               
services without  cost-sharing.  She said  Section 27.13 required                                                               
coverage  of  women's  preventive  services, as  defined  by  the                                                               
Health  Resources and  Service Administration  (HRSA).   She said                                                               
HRSA  asked the  then  Institute of  Medicine  to recommend  that                                                               
women's  preventative  services be  covered,  and  based on  this                                                               
recommendation,  HRSA defined  women's  preventative services  to                                                               
include all  contraceptives approved  by the  U.S. Food  and Drug                                                               
Administration  (FDA) and  patient education  and counseling  for                                                               
"women of reproductive capacity," as  prescribed by a health care                                                               
provider, collectively  referred to as  "contraceptive services."                                                               
The  final  preventative  services rules  required  insurers  and                                                               
group health plans to cover all such contraceptive services.                                                                    
                                                                                                                                
REPRESENTATIVE  CARRICK  said  more  recently  some  states  have                                                               
amended and expanded their own  requirements to match the federal                                                               
guarantee.  She offered examples.   She said HB 17 would put into                                                               
statute  language  consistent with  the  federal  standards.   It                                                               
would also  mandate dispensing coverage  of contraceptives  up to                                                               
12  months  at a  time.    She  noted  that Alaskans  often  face                                                               
numerous  challenges   when  trying  to   access  contraceptives,                                                               
especially  in rural  areas where  it is  not feasible  to travel                                                               
multiple   times   to  a   pharmacy   in   a  larger   community.                                                               
Additionally, some women work in  high demand jobs that take them                                                               
away  from access  to pharmacies,  such as  working on  the North                                                               
Slope,  on fishing  vessels,  or  in the  mining  industry.   She                                                               
argued  that a  one-year  supply of  contraceptives could  assist                                                               
many women to balance their  health with their professional work.                                                               
She cited  research in the  Journal of Obstetrics  and Gynecology                                                               
[hard  copy included  in the  committee packet]  as showing  that                                                               
women who are dispensed a  12-month supply of contraceptives have                                                               
a 30  percent drop in unplanned  pregnancy and a 46  percent drop                                                               
in "the likelihood of abortion"  compared to women dispensed a 1-                                                               
to  3-month supply.   Representative  Carrick stated  that HB  17                                                               
would also  save money for  the state.   Based on  prior, similar                                                               
legislation, the former Department  of Health and Social Services                                                               
estimated a $1.35 million savings  annually due to a reduction in                                                               
unplanned  pregnancies.   She pointed  out  that HB  17 has  zero                                                               
fiscal impact.  She expressed  her knowledge that improved access                                                               
to contraceptives  means improved health for  women and families.                                                               
She  said  providers   are  still  able  to   make  decisions  in                                                               
consultation with their patients;  the proposed legislation would                                                               
take "insurance coverage away as a barrier to access."                                                                          
                                                                                                                                
3:08:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARRICK  stated  that   HB  17  would  offer  the                                                               
additional benefit  of protecting  victims of  domestic violence.                                                               
She noted that in the past  few years there has been an increased                                                               
awareness of  domestic violence and  sexual assault.   She talked                                                               
about  contraceptive coercion  as  being a  form  of domestic  or                                                               
interpersonal  violence by  which abusers  "dictate when  and how                                                               
contraceptives can or  cannot be accessed as a means  of being in                                                               
power  or control."   She  stated,  "Contraceptive services  have                                                               
long  been recognized  by both  government  and a  wide range  of                                                               
private  sector experts  as a  vital and  effective component  of                                                               
preventative  and public  health  care."   She  talked about  the                                                               
benefits of contraceptive use  in preventing unintended pregnancy                                                               
and improving  "birth spacing."   She noted  that there  had been                                                               
letters  of support  for previous  versions  of this  legislation                                                               
from  organizations  such  as  the  Alaska  Network  of  Domestic                                                               
Violence and  Sexual Assault (ANDVSA),  the Alaska  Public Health                                                               
Association,  and  the League  of  Women  Voters; and  there  are                                                               
updated letters  and resolutions from  entities in support  of HB
.   Representative  Carrick  concluded by  stating  that HB  17                                                               
makes sense  for Alaska women  and families.  She  introduced her                                                               
staff to provide the sectional analysis.                                                                                        
                                                                                                                                
3:10:41 PM                                                                                                                    
                                                                                                                                
CHERIE  BOWMAN,  Staff,  Representative  Ashley  Carrick,  Alaska                                                               
State  Legislature, on  behalf of  Representative Carrick,  prime                                                               
sponsor of  HB 17, provided  the sectional analysis  [included in                                                               
the   committee  packet],   which  read   as  follows   [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Section 1                                                                                                                  
     AS 21.42.427. Coverage for contraceptives.                                                                                 
     Amends  AS 21.42  by  adding a  new  section which  (1)                                                                    
     requires a health care insurer  to provide coverage for                                                                    
     prescription   contraceptives   and  medical   services                                                                    
     necessary  for  those  products or  devices  (including                                                                    
     over-the-counter   emergency  contraception   that  was                                                                    
     obtained   without   a  prescription);   (2)   requires                                                                    
     reimbursement to  a health care provider  or dispensing                                                                    
     entity   for  dispensing   prescription  contraceptives                                                                    
     intended to  last for a 12-month  period for subsequent                                                                    
     dispensing;  (3) prevents  an  insurer from  offsetting                                                                    
     the costs  of compliance; (4) prevents  an insurer from                                                                    
     restricting  or delaying  coverage for  contraceptives;                                                                    
     (5) if the provider  recommends a particular service or                                                                    
     FDA-approved item  based on a determination  of medical                                                                    
     necessity, the  plan or issuer must  cover that service                                                                    
     or  item   without  cost   sharing;  and   (6)  exempts                                                                    
     religious employers if certain criteria are met.                                                                           
                                                                                                                                
     Section 2                                                                                                                  
     AS 29.10.200. Limitation of home rule powers.                                                                              
     Amends AS  29.10.200 by adding a  provision applying to                                                                    
     home rule municipalities.                                                                                                  
                                                                                                                                
     Section 3                                                                                                                  
     AS 29.20.420. Health insurance policies.                                                                                   
     Amends  AS 29.20  by adding  a  new section  clarifying                                                                    
     that  municipal health  care insurance  plans that  are                                                                    
     self-insured are  subject to  the requirements  of sec.                                                                    
     1.                                                                                                                         
     Section 4                                                                                                                  
     AS 39.30.090. Procurement of group insurance.                                                                              
     Clarifies   that  a   group  health   insurance  policy                                                                    
     covering  employees  of  a  participating  governmental                                                                    
     unit is subject to the requirements of sec. 1.                                                                             
                                                                                                                                
     Section 5                                                                                                                  
     AS  39.30.091.  Authorization  for  self-insurance  and                                                                    
     excess loss insurance.                                                                                                     
     Clarifies  that  a   self-insured  group  medical  plan                                                                    
     covering  active state  employees  provided under  this                                                                    
     section is subject to the requirements of sec. 1.                                                                          
                                                                                                                                
     Section 6                                                                                                                  
     AS 47.07.065. Payment for prescribed drugs.                                                                                
     Requires the  Department of Health and  Social Services                                                                    
     to  pay  for  prescription contraceptives  intended  to                                                                    
     last for  a 12-month  period for  subsequent dispensing                                                                    
     for  eligible  recipients  of  medical  assistance,  if                                                                    
     prescribed to  and requested by the  recipient, as well                                                                    
     as medical  services necessary  for Distributed  by the                                                                    
     Office  of Representative  Ashley  Carrick 1.25.2023  2                                                                    
     those  products or  devices. The  Department of  Health                                                                    
     and  Social Services  must  also  provide coverage  for                                                                    
     over-the-counter   emergency  contraception   that  was                                                                    
     obtained without a prescription.                                                                                           
                                                                                                                                
     Section 7                                                                                                                  
     Uncodified law  applicability                                                                                              
     Requires the Department of  Health to immediately amend                                                                    
     and  submit  for  federal approval  a  state  plan  for                                                                    
     medical assistance  coverage consistent with sec.  6 of                                                                    
     this Act.                                                                                                                  
                                                                                                                                
     Section 8                                                                                                                  
     Uncodified law  applicability                                                                                              
     Makes sec.  6 of  the Act  conditional on  the approval                                                                    
     required under sec. 7 of the Act.                                                                                          
                                                                                                                                
     Section 9                                                                                                                  
     Uncodified law  applicability                                                                                              
     If, under sec. 8 of this  Act, sec. 6 of this Act takes                                                                    
     effect, it takes  effect on the day after  the date the                                                                    
     revisor   of   statutes   receives  notice   from   the                                                                    
     commissioner of  health and social services  under sec.                                                                    
     8 of this Act.                                                                                                             
                                                                                                                                
3:15:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA  expressed appreciation  to the  bill sponsor                                                               
and  asked  whether  "the  month-span   for  different  types  of                                                               
contraceptives" is found in statute or regulations.                                                                             
                                                                                                                                
3:15:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARRICK  offered  her understanding  that  it  is                                                               
typically within a one- to  three-month span depending on patient                                                               
needs, in consultation with the provider.                                                                                       
                                                                                                                                
3:16:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SADDLER,  seeking a baseline, asked  about current                                                               
limits to the duration of a prescription for any medication.                                                                    
                                                                                                                                
REPRESENTATIVE  CARRICK answered  she is  not sure  and suggested                                                               
Ms. Wing-Heier  from the Division  of Insurance could  provide an                                                               
answer.                                                                                                                         
                                                                                                                                
3:17:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE directed  attention to  language in  HB
, [Section 1, paragraph (2)], on  page 2, lines 5-9, which read                                                               
as follows:                                                                                                                     
                                                                                                                                
     (2)  reimburse a  health  care  provider or  dispensing                                                                    
     entity   for  dispensing   prescription  contraceptives                                                                    
     intended to  last for a 12-month  period for subsequent                                                                    
     dispensings of  the same prescription  contraceptive to                                                                    
     the  insured  regardless  of whether  the  insured  was                                                                    
     enrolled in the health care  insurance plan at the time                                                                    
     of the first dispensing.                                                                                                   
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE asked  for  more information  regarding                                                               
the part about enrollment.                                                                                                      
                                                                                                                                
REPRESENTATIVE  CARRICK  offered   her  understanding  that  that                                                               
potentially  may  allow  for  some  type  of  reimbursement,  but                                                               
deferred again to Ms. Wing-Heier.                                                                                               
                                                                                                                                
REPRESENTATIVE RUFFRIDGE then directed  attention to the repeated                                                               
use of  the term "emergency  contraception" in HB 17,  first seen                                                               
on  page  1, line  11,  and  he  offered his  understanding  that                                                               
emergency contraception is available over  the counter (OTC).  He                                                               
asked whether the  intent of the bill language was  that a person                                                               
would go  get emergency  contraception from  wherever it  is sold                                                               
and expect to obtain it at no charge upfront.                                                                                   
                                                                                                                                
REPRESENTATIVE  CARRICK answered  that  she  thinks the  language                                                               
means  that someone  who has  [insurance] coverage  for "Plan  B"                                                               
[emergency  contraception]  and  purchases it  could  submit  for                                                               
reimbursement.   This would allow  someone to get Plan  B without                                                               
having to  first make an  appointment with a medical  provider to                                                               
get a prescription,  which can be a burden.   She said she thinks                                                               
it does not mean the person could get it at no cost upfront.                                                                    
                                                                                                                                
REPRESENTATIVE   RUFFRIDGE  highlighted   language  on   page  2,                                                               
beginning  on  line  26:  "cost   containment  measure  does  not                                                               
unreasonably limit choice in access  to coverage".  He asked what                                                               
would be considered unreasonable.                                                                                               
                                                                                                                                
REPRESENTATIVE  CARRICK, in  response, offered  her understanding                                                               
that that  is not  defined in  statute, but  the reason  for this                                                               
language is  to ensure  that people are  incentivized "to  go for                                                               
generics  as much  as  possible."   In  response  to a  follow-up                                                               
question  regarding  restrictions  in  cost-containment  measures                                                               
related  to prescriptions,  and whether  that may  refer to  mail                                                               
order prescriptions,  she related  the key  goal of  HB 17  is to                                                               
provide access to contraceptives.                                                                                               
                                                                                                                                
3:24:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SADDLER  indicated concern that HB  17 may provide                                                               
"special    consideration   for    this   particular    kind   of                                                               
prescription."   He  also  questioned whether  there  was such  a                                                               
thing   as  reasonable   limitations  of   choice  in   terms  of                                                               
contraceptive prescriptions.                                                                                                    
                                                                                                                                
REPRESENTATIVE CARRICK  emphasized that  emergency contraceptives                                                               
are not  the same thing as  an abortifacient drug.   She said she                                                               
would  like  to  find  out  more  about  the  issue  of  what  is                                                               
reasonable.  That said, she reiterated  that the goal of HB 17 is                                                               
"to  direct  toward generics  in  order  to  help with  the  cost                                                               
containment."     In  response  to  a   follow-up  question,  she                                                               
highlighted    the   medical    difference   between    emergency                                                               
contraception and an abortifacient drug.                                                                                        
                                                                                                                                
REPRESENTATIVE  SADDLER asked  about the  cost  of HB  17 to  the                                                               
State of Alaska.                                                                                                                
                                                                                                                                
3:28:42 PM                                                                                                                    
                                                                                                                                
LORI   WING-HEIER,  Director,   Anchorage  Office,   Division  of                                                               
Insurance Director, Department of  Commerce, Community & Economic                                                               
Development, addressed  the previously asked  questions regarding                                                               
cost  and  what is  reasonable.    She  confirmed that  based  on                                                               
previous iterations of this  legislation, insurance companies had                                                               
determined the  cost would be  negligible.   Contraceptives would                                                               
still be  covered; the difference  would be in  the cost-sharing,                                                               
which is the person's deductible  and co-pay, which she estimated                                                               
would be about $3.   She said HB 17 is asking  those be waived in                                                               
dispensing birth  control.  She  said she  could not think  of an                                                               
example of a  contraceptive pill on the market  today where there                                                               
would be  "an unreasonable expectation  or an  unreasonable limit                                                               
for  [the  generic version]  to  be  dispensed  in the  state  of                                                               
Alaska."  The only exception she  could think of, she said, would                                                               
be in a  case where an individual worked on  the North Slope, for                                                               
example, and had come to Fairbanks  to pick up a prescription for                                                               
a  contraceptive,  and the  pharmacy  was  currently out  of  the                                                               
generic  brand.   In  this  scenario,  she  opined, it  would  be                                                               
unreasonable to send  the person back to the  North Slope without                                                               
the prescription when a brand-name drug could be substituted.                                                                   
                                                                                                                                
3:31:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE  reiterated  his question  about  cost-                                                               
containment  measures.    He   offered  understanding  about  the                                                               
Medicaid system  using cost-management  techniques, and  he asked                                                               
if  "this bill  would override  those  for Medicaid."   He  asked                                                               
whether  HB 17  could  result in  a slight  increase  in cost  to                                                               
Medicaid.                                                                                                                       
                                                                                                                                
MS. WING-HEIER responded  that the division is  not involved with                                                               
Medicaid; therefore, she cannot speak to that issue.                                                                            
                                                                                                                                
3:32:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SUMNER asked if there  is any "strong reason" this                                                               
should not  be applied to  all medications  that do not  have "an                                                               
abuse potential."                                                                                                               
                                                                                                                                
MS. WING-HEIER responded that a  provider currently can prescribe                                                               
a 12-month dose  of whatever medication a patient  needs, but the                                                               
insurance plan  may be the limiting  factor by only paying  for 3                                                               
months  at a  time.   In response  to a  follow-up question,  she                                                               
confirmed that is what is trying to be addressed under HB 17.                                                                   
                                                                                                                                
3:33:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   CARRICK  added   that  HB   17  could   be  more                                                               
comprehensive  and include  other  types of  medication, but  the                                                               
reason she is  carrying the proposed legislation  is because many                                                               
women   have  specifically   asked  for   12-month  contraceptive                                                               
prescriptions to be allowed.                                                                                                    
                                                                                                                                
3:34:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SADDLER  asked what the justification  is to limit                                                               
any other  drug to a  three-month prescription and  whether there                                                               
is a therapeutic benefit to doing so.                                                                                           
                                                                                                                                
3:35:26 PM                                                                                                                    
                                                                                                                                
MS. WING-HEIER  noted that  often a physician  gives a  patient a                                                               
drug on  a trial  basis and  asked the patient  to come  back for                                                               
blood  work in  three months  to  determine the  efficacy of  the                                                               
drug.  In response to a  follow-up question, she said this may be                                                               
beyond her  expertise, but she  supposed birth control is  a drug                                                               
that is not  looked at as heavily as looking  at lab work; rather                                                               
it  is  a  matter  of  determining  effectiveness  in  preventing                                                               
[conception].                                                                                                                   
                                                                                                                                
3:36:34 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX announced that HB 17 was held over.