Legislature(2021 - 2022)DAVIS 106
04/15/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB168 | |
| SB21 | |
| HB105 | |
| HB58 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 105 | TELECONFERENCED | |
| *+ | HB 58 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 168 | TELECONFERENCED | |
| += | SB 21 | TELECONFERENCED | |
HB 58-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
3:56:15 PM
CO-CHAIR SNYDER announced that the final order of business would
be HOUSE BILL NO. 58, "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."
3:57:05 PM
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, introduced
HB 58, as prime sponsor. He shared that, since the 1990s, 28
states have required health insurance plans regulated by the
state that provide coverage of prescription drugs and devices to
also cover prescription contraceptives. Under the Affordable
Care Act (ACA) of 2010, these policies were extended in several
ways, he continued, and the contraception coverage guarantee in
the ACA stems from Section 27.13 of the Public Health Service
Act (PHSA). He stated that the PHSA requires non-grandfathered
health insurance coverage and employer sponsored group health
plans to cover preventative services without cost sharing. He
added that section 27.13 of PHSA requires coverage of women's
preventative services as defined by the Health Resources and
Services Administration (HRSA). He continued that HRSA asked
the institute of medicine to recommend the women's preventative
services that should be covered, and based on this
recommendation, HRSA defined women's preventative services to
include all contraceptives approved by the Food and Drug
Administration (FDA). He said that sterilization procedures and
patient education and counseling of women of reproductive
capacity is prescribed by a health care provider, which is
collectively referred to as contraceptive services.
REPRESENTATIVE CLAMAN explained that the final preventative
services rules issued required insurers and group health plans
to cover all such contraceptive services. Recognizing that
some religions object to contraceptive coverage, he added, the
federal government issued rules that excluded religious
employers from the contraceptive coverage guarantee. More
recently, some states have amended and expanded its requirements
to match the federal guarantee. He shared that some of these
state provisions go beyond the federal guarantee, ensuring that
women may receive an extended supply of a contraception method
at one time, usually being a twelve-month supply rather than a
typical one- to- three-month supply.
REPRESENTATIVE CLAMAN shared that HB 58 would put into Alaska
statutes language that is consistent with the standard that is
set in the federal contraceptive care guarantee. He added that
it also would add language that would mandate coverage for
dispensing up to twelve months of prescription contraceptives at
a time.
3:59:20 PM
REPRESENTATIVE CLAMAN paraphrased paragraph one of the Sponsor
Statement [hard copies included in community packets], which
read as follows [original punctuation provided]:
Alaskan women often face numerous challenges when
trying to access reproductive health care and
prescription contraceptives. Women living in rural
Alaska have less access to healthcare services and
therefore less reliable access to prescriptive
contraceptives. Fisherwomen working on a boat for
months at a time need longer supplies of prescription
contraceptives. For women who are trying to balance
their personal health with busy work and family
schedules, making multiple trips to the clinic or
pharmacy is a significant barrier to accessing
consistent contraception.
REPRESENTATIVE CLAMAN stated that research featured in the
journal of Obstetrics and Gynecology [hard copies included in
committee packets] shows that women who are dispensed a twelve-
month supply of contraceptives have a 30 percent drop in
unplanned pregnancies, and a 46 percent drop in the likelihood
of abortion in women dispensed a one-to-three-month supply. He
added that HB 58 would also save money for the state. He noted
that his office sponsored a prior version of this legislation in
a previous legislature, the Department of Health and Social
Services (DHSS) fiscal note estimated a $1.35 million dollar
savings annually due to the reduction in unplanned pregnancies.
He commented that the women in his family support HB 58. He
shared his understanding that the women in his family support it
because it is not only often time-consuming and inconvenient to
obtain contraception every one to three months, but also because
improved access to contraceptives also means improved health for
women and families.
REPRESENTATIVE CLAMAN added that HB 58 would also help protect
victims of domestic violence. He said that there has been an
increased awareness of domestic violence and sexual assault in
both Alaska and on the national level. He relayed that
movements such as "Me Too" and "Time's Up" have shown that more
support needs to be given to those that have experienced and are
currently experiencing that type of violence. He noted the
issue of contraceptive coercion, where abusers dictate when and
how contraceptives can be accessed as a means of gaining power
and control over victims. He relayed that research from a 2011
National Intimate Partner and Sexual Violence Survey shows that
around 9 percent of U.S. women report having an intimate partner
who tried to get the woman pregnant or refused to use a condom.
He opined that, by providing consumers a twelve-month supply of
birth control, HB 58 would critically support victims and
survivors by assisting those who are attempting to live as
safely as possible in the short term while working toward
longer-term safety. He shared that, supported by a long-
standing body of evidence, contraceptives services have long
been recognized by both government bodies and private-sector
experts as a vital and effective component of preventative and
public health care. He shared his understanding that
contraceptive use helps women avoid unintended pregnancy and
improve birth spacing, which have substantial consequences for
infants, women, families, and society. He added that cost can
be a barrier to contraception for individual women, but that the
evidence suggests that insurance coverage of contraceptive
services and supply without cost sharing is a low-cost and even
cost savings way to help women overcome the obstacle of personal
cost.
4:03:03 PM
LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State
Legislature, provided the Sectional Analysis of HB 58 on behalf
of Representative Matt Claman, prime sponsor. She paraphrased
Section 1 through Section 5 of the Sectional Analysis [hard
copies included in committee packets] 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; (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 12.10.200 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.
4:06:26 PM
MS. KUBITZ continued by paraphrasing Section 6 through Section 9
of the Sectional Analysis, which read as follows [original
punctuation provided]:
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 those products or
devices. Distributed by the Office of Representative
Matt Claman 3.30.2021 2
Section 7 Uncodified law - applicability Requires the
Department of Health and Social Services 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 If 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.
MS. KUBITZ explained the changes that have been made since this
legislation was originally introduced in 2017. She stated that
during the Thirtieth Alaska State Legislature, multiple changes
were made to the legislation. First, the House Health and
Social Services committee adopted a committee substitute that
made changes based on recommendations by the Department of
Administration and the Department of Commerce, Community, and
Economic Development. She shared that these changes would give
health care administrators the ability to enact reasonable cost
containment measures [as shown in Section 1 of the Sectional
Analysis] as well as make certain that the bill would apply to
active state employees [as reflected in Section 4 and Section 5
of the Sectional Analysis]. Second, she continued, the House
Finance Committee adopted an amendment that clarified that
municipalities that were self-insured were also captured under
the bill and must cover a twelve-month supply of contraceptives.
Third, she continued, two amendments were adopted on the House
floor: the first changed the effective date to update it, and
the second amended created a narrower religious exemption to
contraceptive coverage than is currently provided under federal
law.
MS. KUBITZ continued, explaining that during the Thirty-First
Alaska State Legislature, one significant change was made to the
legislation. In the re-drafting process, she said, the office
of Representative Claman amended the legislation after receiving
feedback about coverage for male sterilization; therefore, the
federal guarantee does not require similar coverage for a
vasectomy or male condoms, she said, but upon research, it was
discovered that some states required coverage of male
sterilization, therefore the bill was amended to add clarifying
language so that high deductive plans can apply the policy
deductible to adult male sterilization benefits so that
enrollees in these plans can maintain health savings account
eligibility.
4:10:18 PM
CARMEN LOWRY, Executive Director, Alaska Network on Domestic
Violence and Sexual Assault (ANDVSA), testified in support of HB
58. She shared that (ANDVSA) is a membership-based organization
that is governed by 23 community-based agencies providing
services to victims of domestic and sexual violence. She
explained that ANDVSA offers its enthusiastic and unqualified
support for HB 58, which is a bill that requires insurance
coverage of all FDA-approved contraceptive methods and requires
insurance plans to cover a one-year supply of birth control at a
time. She stated that ANDVSA supports the bill because
increased access to the full range of contraceptive methods
results in increased safety and well-being for all women in
Alaska. She noted that it is especially important in those
rural areas where supply chains, transportation options, and
access to telehealth via Internet are vulnerable, which she
expressed has been evident during the COVID-19 pandemic.
MS. LOWRY continued by sharing some reasons as to why increased
access to birth control is so important for those women who may
be experiencing domestic violence. First, a common and early
controlling behavior used by an abuser is to isolate the victim
from others in her network of support, she explained. This
means, then, that this specific victim-survivor will be unable
to connect with friends or family, unable to ask others to
assist with transportation or childcare and have restricted
freedom of movement that is required to gain access to birth
control methods. She expressed that the ability to have a
twelve-month supply means that, for a woman who experiences this
type of commonly exercised abusive behavior, the woman would
know that at least she still has the ability to have control
over whether she becomes pregnant or not.
MS. LOWRY added that another abusive strategy often used is
known as "Reproductive and Sexual Coercion." This refers to
these types of behaviors: explicit attempts to impregnate a
partner against her will by controlling her access to
contraceptives; controlling outcomes of a pregnancy by limiting
her abilities to access pre- and/or postnatal care; forcing a
partner to have unprotected sex; and interfering with
contraceptive methods, including tampering with her
contraceptive methods. She explained that isolation, restricted
freedom of movement, limited access to contraceptives, and
limited control over how and when to use those contraceptives
are examples of what it is like for some women who experience
domestic violence. She expressed that these women are denied
the right to make intentional choices about pregnancy.
MS. LOWRY shared that there are still more harmful impacts that
may occur as a result of a forced or coerced pregnancy. For
example, homicide is a leading cause of pregnancy-associated
mortality in the United States. She shared her understanding
that multiple studies show that domestic violence increases as
pregnancy progresses and in post-partum, and that research
conducted across multiple sites has found that women with
unintended pregnancies were four times more likely to experience
domestic violence than women whose pregnancies were intended.
She added that HB 58 would increase access to birth control for
all women and, specifically for women who experience domestic
violence, would reduce the likelihood that they will experience
new or continued violence as a result of an unintended
pregnancy. She said that HB 58 would ensure that every woman
across Alaska is able make intentional choices about her
reproductive health, and overall well-being, and it would ensure
access to a 12-month supply to contraceptives.
4:15:00 PM
REPRESENTATIVE FIELDS asked Ms. Kubitz how many states go
further than the language in HB 58 and require coverage for
contraception that may not need a prescription to obtain.
MS. KUBITZ responded by referring to a paper by the Guttmacher
Institute, entitled, "Insurance Cost of Contraceptives" [hard
copies included in the committee packet], which details topics
such as the federal guarantee and the actions taken by states to
expand upon the guarantee. She noted that there is a table in
the back of the paper that discusses the various ways states
have gone beyond the federal guarantee and have required
coverage for over-the-counter contraception without a
prescription. She shared her understanding that the table that
shows that twelve states and the District of Columbia require
coverage of methods received over the counter.
REPRESENTATIVE FIELDS asked Ms. Kubitz to explain the rationale
for the modest scope of proposed legislation rather than going
further, as the other twelve states have.
MS. KUBITZ answered that the bill was based off of the federal
guarantee and shared that her understanding was that per the
Affordable Care Act, over-the-counter medicine and drugs were
removed from the list of reimbursable medical items if purchased
without a description. She said that there may be opportunity
to go further and expand. She added that there are some states
that allow pharmacists to do the prescribing right on site for
some contraceptives.
REPRESENTATIVE FIELDS asked what the benefit would be for
allowing broader authority for pharmacists.
MS. KUBITZ replied that she would like to defer the question to
Dr. Tina Tomsen. She said that her understanding is that women
in Alaska currently have two options: women can call their
doctor and get a prescription for an over-the-counter method
such as emergency contraception, or women can go to the pharmacy
and purchase it themselves without coverage.
4:18:24 PM
TINA TOMSEN, MD, answered Representative Fields' question, and
shared that the only contraception over the counter in Alaska is
the "morning after" pill, also known as Plan B. All other
require a prescription, she said, and currently there is no
authority in the state for pharmacists to prescribe the
prescription. She relayed that there may be some states that
allow pharmacists to prescribe on site, but she is not familiar
with those numbers. She shared that Plan B has been determined
safe enough to be available over the counter, but there is a
better pill that is more effective over a longer period of time
called "Ella," or ulipristal acetate, that requires a
prescription. She noted that if a woman of any age needs a
morning after pill, she could pay a price of "about $50" to buy
the Plan B pill over the counter without a prescription or
insurance coverage, or she could get a prescription from a
physician for the improved Ella pill and have that covered by
insurance.
4:20:51 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development (DCCED), responded to
Representative Fields' question. She said that she is sure that
there are ways that contraceptive care could be expanded upon,
and opportunities to broaden the services the pharmacists are
able to perform in respect to contraception.
4:22:08 PM
REPRESENTATIVE KURKA asked Ms. Wing-Heier what the process would
look like for an institution to obtain a religious exception
[from providing contraceptive coverage].
MS. WING-HEIER replied that, if an insurer were to apply for a
religious exception, it would be written in to the insurer's
plan documents as such. The plan would specifically say that
that law [requiring contraceptive coverage] doesn't apply
because the state allowed the exclusion due to religious
concerns.
REPRESENTATIVE KURKA asked whether the plans would be dependent
on the business' [decision to enact a religious exemption] or be
the default for all plans.
MS. WING-HEIR responded that it would not be the default for all
plans. She explained that a business would have to present with
its insurer that it is a religious organization, such as the
Catholic Church, does not believe in birth control.
REPRESENTATIVE KURKA noted that there was a lot of discussion
with "Obamacare" regarding privately held businesses that had
strong religious beliefs such as Hobby Lobby, and shared his
understanding that this bill would not protect these sorts of
businesses.
MS. WING-HEIER responded that she would have to research that
and shared that she is not aware of that being an issue in
Alaska. She said that she has worked with churches, but is not
aware of a private employer, such as Hobby Lobby, that has
requested that its plan not include birth control.
REPRESENTATIVE KURKA asked for clarification on whether this
exemption applies only to religious institutions and not
businesses.
MS. WING-HEIR responded that she would need to research this as
well, but that she would say that it's [only applicable to]
religious organizations.
4:25:27 PM
CO-CHAIR SNYDER opened public testimony on HB 58.
4:25:51 PM
MORGAN LIM, Alaska Government Affairs Manager, Planned
Parenthood Alliance Advocate, testified in support of HB 58. He
relayed that Planned Parenthood strongly supports HB 58 and that
it would improve access to the full range of contraceptive
methods by requiring insurance providers to cover a year's
supply of birth control at one time. He said that it would also
build upon the ACA's contraceptive coverage mandate to ensure
that all people have meaningful and timely access to
contraceptive care. He expressed that people in Alaska deserve
affordable and accessible birth control, regardless of insurance
care, income, or life circumstances. He shared his
understanding that most birth control users are forced to refill
contraceptive prescriptions every month, which is a burden for
many, especially during the COVID-19 pandemic, and it increases
the odds of experiencing an unintended pregnancy. He said that
even with ACA in place, insurance carriers are permitted to deny
or delay aspects of certain contraceptive methods by applying
medical management techniques such as prior authorization or
step therapy.
MR. LIM expressed that HB 58 would have a huge impact for
patients in rural areas of the state and also for people who
have limited access to transportation, as it can be burdensome
for these individuals to travel to a pharmacy and get a
prescription every month. He shared a statistic that one in
four women say that they have missed pills because they could
not get the next birth control pack in time. He opined that an
extended supply of contraception is especially important for
young people, survivors of intimate partner violence, people who
work multiple jobs or have low income. He explained that these
people are disproportionately indigenous, black, and people of
color, due to a history of racism that permeates the system. He
added that the pandemic has highlighted the need for extended
supply with one in three women reporting difficulty accessing
birth control as a consequence of COVID-19. He concluded that
HB 58 would ensure that patients have a consistent and
predictable supply of contraception.
4:28:38 PM
SARRA KHLIFI, Community Advocate, Alaska Children's Trust (ACT),
testified in support of HB 58. She shared that the ACT is a
statewide, lead organization focused on the prevention of child
abuse and neglect. She said that, when discussing the
improvement of overall family wellbeing, pregnancy planning,
spacing of pregnancies, and pregnancy prevention are often
overlooked. There is more of a focus on the services for
children and families after birth rather than thinking about the
economic and social services in which people become pregnant.
She said that family planning and access to contraception is
essential for families to achieve economic security by
preventing unwanted pregnancy, which can impede a family's
ability to achieve upward trajectory of economic mobility. She
shared that one of the biggest stressors to families is
financial instability, and this sort of stress and tension in
families can drive child abuse and neglect. She opined that if
the families that are most at-risk of falling into poverty
cannot access affordable birth control, the cycle of poverty and
abuse will continue for these children and families.
MS. KHLIFI shared her understanding that people are relatively
less likely to be prepared for parenthood and develop positive
parent-child relationships if a birth is unplanned or the
parents are teenagers at the time of pregnancy. This also can
lead to larger families, which can impede a parent's ability to
impact each child. She expressed that all of these factors can
influence children's mental and behavioral development and
influence educational achievement. She concluded by noting that
this legislation would make it possible to close accessibility
gaps for individuals living off the road system and working
seasonal jobs, or facing other barriers, by allowing access to a
twelve-month supply of contraceptives at a time. She opined
that HB 58 would supply necessary tools for all children and
families to thrive and would prevent child abuse and neglect by
giving people more control over their individual birth control
needs.
4:31:06 PM
VALORRAINE DATTAN testified in support of HB 58. She said that
when she went away to college out of state, her doctor
recommended that she take multiple of the birth control which
she took for medical reasons with her, but insurance wouldn't
cover it. She was fortunate enough that her parents were able
to purchase the birth control for her out of pocket, and for
this reason she didn't have to worry about finding a doctor in a
new state that she had never been to before or getting around a
new city without a car. She expressed that many other women are
not as fortunate as she is, especially in rural Alaska, where it
can be difficult to get to a pharmacy every month. If a woman
is in an abusive home, she continued, it can be dangerous or
outright impossible [to obtain birth control every month]. She
expressed that it's necessary for women to be able to plan their
lives and create healthy families and futures. She said that
both individual families and communities would benefit from
extended access to birth control and would provide cost savings
to the individual as well as insurance companies to prevent
additional costs associated with unintended pregnancies and
child welfare.
4:32:51 PM
LYNETTE PHAM testified in support of HB 58. She said that she
supports the bill because of the benefits it would provide to
rural women, seasonal workers, students, and others. She
expressed that accessible birth control can be life-changing in
many ways. She shared her understanding that HB 58 would
decrease the odds of women experiencing unintended pregnancy,
reduce the need for abortion care, and improve the lives of
Alaskans across the state. She added that during the pandemic,
many people lost their jobs, and getting a twelve-month supply
of birth control would've allowed for more security for these
individuals, and for less painful symptoms for those who use
birth control for medical reasons. She added that individuals
who live in rural areas and cannot travel to pick up birth
control, the bill would help these individuals overcome
accessibility barriers. She urged the committee to pass the
bill.
4:34:10 PM
KAREN BAKER testified in support of HB 58. She said that she
has been fortunate to have access to long-term birth control but
knows that that is not the case for everyone. She emphasized
the importance of twelve-month birth control particularly for
those who have seasonal employment, live off the road system,
are teachers and have lapses of coverage in the summer, have
been laid-off, or have unsafe home situations. She expressed
that birth control is a safe and necessary medicine and said
that Alaskans deserve reliable access to these prescriptions.
She said that "twenty-one states and Washington D.C." have laws
that require twelve-month supplies of birth control, and she
opined that Alaskans deserve to have the same level of care.
4:35:15PM
RUSSELL DENNIS testified in support of HB 58. He shared his
understanding that leading medical experts recommend access to a
full range of contraceptives, and he opined that it's time for
Alaska to join the other states [that allow for twelve-month
supplies] and increase access to birth control. He expressed
that the benefits include reduced abortion rates and savings to
the state, to the insurance companies, and to Alaskan families.
4:36:05 PM
SERENE OHARA JOLLEY testified in support of HB 58. She shared
that when she first moved to Alaska, she lived outside of
Cantwell, Alaska, and worked construction in the summer, where
there were no standard days off in remote construction. While
there, she said she started to experience symptoms that she
could not explain and was able to get a day off to drive to
Fairbanks, Alaska, to see a doctor. She learned that she was
experiencing Perimenopause. Ideally, she continued, she would
be able to see a compound pharmacist about this issue, but that
was not an option for her living in a rural area.
Alternatively, she said that her doctor recommended going on
oral birth control to replace the hormones her body was no
longer making. She went to Fred Meyer to fill her prescription
and, to her surprise, was only allowed a one-month supply. She
said that her prescription was for one year, and tried to
explain to the pharmacist that she lived hundreds of miles away
and would not be able to take off work and return each month,
but there was nothing the pharmacist could do. She explained
that, after a month of being on the medication, it was clearly
working, but she had no way to get back to Fairbanks to fulfill
her prescription. She said that she had to confide in her boss
as to why she needed a day off at the end of each month, and
that no one should have to tell their boss their medical
information, especially to obtain an already prescribed
medication. Each month, she explained, she missed a day of work
and spent hundreds of dollars in gas over the course of the
summer in order to drive to get a prescription that was deemed
safe and necessary. She shared her understanding that this is
simply because insurance companies and politicians have denied
her access. She noted that she was lucky as well because her
boss was compassionate, and she was on the road system. Many
others live off the road system, she said, or work on fishing
ships, or are firefighters in remote locations, and cannot
access a pharmacy. She urged the passage of HB 58.
4:38:19 PM
DONOVAN CAMP testified in support of HB 58. He shared that,
when he was in college in Fairbanks, he and his partner were
cohabitating and had easy access to family planning during the
semester. During the summer, however, he and his partner were
working long hours and it became more inconvenient to get access
to birth control, and they had a pregnancy scare. He shared
that he and his partner were fortunate that it was only a scare,
and they didn't have to significantly alter their lives, such as
dropping out of college. He said this is an example of how just
a slight inconvenience could have life-long impacts. He
encouraged the passage of HB 58 to limit the barriers to
accessing the tools that are necessary for family planning.
4:40:19 PM
CHRISTINE ROBBINS testified in opposition to HB 58. She opined
that it is unconscionable to force employers to pay for
employee's contraceptives. She asserted that family planning is
an individual's responsibility and shared her understanding that
[the state] does not need to encourage sexual immorality or the
"murder of the unborn." She expressed her opinion that
contraceptives would allow a rapist or an abuser to hide their
behavior, and that abstinence is the solution.
4:41:49 PM
CO-CHAIR SNYDER, after ascertaining that there was no one else
who wished to testify, closed public testimony on HB 58.
4:42:10 PM
The committee took a brief at-ease at 4:42 p.m.
4:42:32 PM
REPRESENTATIVE MCCARTY asked Dr. Tomsen whether "forcing" a
twelve-month allowance of birth control would compromise the
physician's ability to verify the care of the patient.
DR. TOMSEN answered that there is nothing in the proposed
legislation that requires a twelve-month prescription. She
explained that some patients may warrant a shorter prescription
if, for example, a doctor was worried about the patient's blood
pressure, but that the vast majority of prescriptions make sense
to be for twelve months. She said that in her office, there was
a policy that if a patient called in, the nurses could refill
the prescription for a month or two if the patient had reached
the twelve-month limit. This ensured that the patient would
still have birth control until able to get in to the office.
She noted that women who have a birth control pill prescription
and are required by their insurance companies to come in every
one to three months are at a disadvantage, and that HB 58 would
overcome that disadvantage.
REPRESENTATIVE MCCARTY shared his understanding that this bill
is not related to mail-in prescriptions, and that it would not
resolve the issue of people having to travel great distances to
get prescriptions but is instead a pharmacy management decision.
He asked whether his understanding is correct.
DR. TOMSEN responded that HB 58 would allow a patient to ask for
as many packs of a prescription that the patient desires at a
time, up to a twelve-month supply. She said that a "hiccup"
between pharmacy benefit managers or insurance companies is a
different issue outside of her knowledge base but shared that
she is in favor of a patient being able to get up to twelve
months of a prescription at a time.
MS. KUBITZ cited her knowledge of a legislative research paper
that said that typically insurance carriers in Alaska will fund
medication from retail pharmacies for 30 days or 90 days.
According to this review, she relayed, which included
correspondence with the Division of Insurance, pharmacists, and
insurance representatives, these limits are not codified in
regulation or statute, but are standard operating procedure for
insurers. She said that it is the choice of the insurer to not
cover twelve months at a time. Patients can have a [twelve
month] prescription and know that it's possible to retrieve it
every one to three months, but it's up to the insurer whether to
cover the twelve-month supply at one time.
4:48:18 PM
REPRESENTATIVE MCCARTY asked Dr. Tomsen what would happen if a
patient were to lose medication included in a twelve-month
prescription.
DR. TOMSEN responded that a lost prescription is handled on a
case-by-case basis and the patient's chart would be reviewed.
She explained that a refill prescription may be called in,
depending on the circumstances. She said it would be handled in
a similar way as any lost prescription is handled.
4:50:16 PM
REPRESENTATIVE PRAX shared his understanding that the driver for
the one-month prescription limit is economic rather than
medical. He asked if this is correct.
MS. TOMSEN answered yes, the driver for requiring patients to
fulfill prescriptions every month or three months is financial.
She shared that when she had prescriptions when she was young,
the limit did not exist, but it developed over time as a way for
insurance companies to limit their outlay.
REPRESENTATIVE PRAX asked for more specific details about the
cost.
MS. TOMSEN answered that, for a brand name birth control pill, a
one-month prescription can cost from $60 to $80, or as little as
$10. She said that it likely costs the drug company "about a
dollar" to produce a month's supply of birth control. She said
that there are also problems with generic brands, but this is
why the bill would allow for generic substitutions for identical
products. However, she said, there is an occasional patient
that will have a dysphoric reaction to one generic pill but has
no negative reaction to the same brand name pill.
REPRESENTATIVE PRAX shared his understanding that the cost would
be around $600 or $700 per year, or $10 to $60 per month. He
asked if this is correct.
MS. TOMSEN responded yes, the price of contraception varies
considerably, but may be as little as $10 per month. She shared
that she doesn't know the kinds of deals the pharmacy, the
pharmacy benefit managers, and insurance companies are making.
She said that she is looking at it from the retail side, just as
patients are, because more detailed information about the actual
cost and price isn't available to her.
4:53:45 PM
REPRESENTATIVE SPOHNHOLZ expressed her understanding that HB 58
is not about the patient and doctor relationship, which she said
is a relationship that already exists, but instead about the
insurance company and patient relationship. She opined that the
issue is that the insurance company is not fulfilling a full
twelve-month prescription that has already been provided for by
the doctor. She asked Ms. Kubitz whether her understanding was
correct.
MS. KUBITZ responded yes, and that health care plans are
currently not required to cover a twelve-month supply, and the
insurance company can therefore determine whether a twelve-month
supply will be covered.
REPRESENTATIVE SPOHNHOLZ referred to Representative Prax's
earlier question on whether the mandate was economic and not
medical, and offered her understanding that the economic
constraint was on the part of the insurance companies trying to
limit the amount of birth control being covered in a given month
and not necessarily anything else. She asked whether this is
Ms. Kubitz' understanding as well.
MS. KUBITZ responded that that is her understanding as well, and
that her research has indicated that covering the twelve-month
supply does not raise insurance premiums, but instead would be a
cost-savings measure in the long run, particularly when it comes
to costs associated with an unintended pregnancy.
REPRESENTATIVE SPOHNHOLZ shared that there is research that
shows that about 50 percent of all pregnancies, nationwide but
also in Alaska specifically, are unintended. She opined that
one of the most important things that can be done to help
support families to reduce child abuse and neglect and also
create more economic independence, as was heard earlier in the
meeting from ACT, is to allow women the ability to choose
whether to conceive. She noted that this likely saves money on
things such as insurance co-pays, however reducing unintended
pregnancy also saves money. She noted that it is very expensive
to have babies, and not nearly as expensive to prevent a
pregnancy that was unintended in the first place.
4:57:05 PM
CO-CHAIR ZULKOSKY asked Ms. Kubitz whether she could speak to
the fiscal note, and if there is a fiscal impact brought on by
the legislation.
MS. KUBITZ responded that there are three zero fiscal notes: one
from the Division of Retirement and Benefits, within the
Department of Administration; another from the Medicaid Services
Division, within the Department of Health and Social Services
(DHSS), and a third from an insurance operation overseen by the
Department of Commerce, Community, and Economic Development.
She said that previous iteration of this legislation involved a
unique situation where there was an analysis done by DHSS'
Medicaid Services Division that showed a cost savings, based on
research done by the California Medicaid Program [hard copies
included in committee packets], in which patients were given a
twelve-month supply at one time. She relayed that the analysis
reported a cost savings of $1.4 million. She said she doesn't
know the reasoning behind a zero fiscal note for this iteration
of the legislation but would defer to the department on that
matter.
CO-CHAIR ZULKOSKY recommended that department representatives be
available to speak about the potential cost savings at the next
meeting and presumed that there should still be a cost-savings
as she didn't see a reason why it should change substantively
since the analysis was done.
4:59:26 PM
REPRESENTATIVE FIELDS asked Dr. Tomsen whether there would be
any reason to not allow insurance coverage of emergency
contraception provided by a pharmacist, without first requiring
a patient to go to a doctor. He shared his understanding that
if there is a need for emergency contraception, there would also
be a tight timeframe, and asked why insurance coverage would not
be accepted as payment.
DR. TOMSEN responded that she agrees, but that the only
difficulty is that many patients who seek to use emergency
contraception do not want to talk to a pharmacist. She said
that for this reason, over-the-counter availability is useful,
and the patient can then use the receipt as proof to bill
insurance. She shared that she is astonished that many patients
were unaware that there is an improved emergency contraceptive
[Ella] that insurance companies would pay for, but that the
patient would need to go to the pharmacy window in order to
obtain it. When patients understand that there is a better
product that costs $60 out of pocket or covered if the patient
has a prescription for it, she explained, the patients are
usually interested in having the prescription available. She
said that she doesn't see any reason why patients should have to
pay for over-the-counter contraception, except that it has
likely been a motivator for insurance companies.
REPRESENTATIVE FIELDS added that he would be interested in
pursuing an amendment to require that insurance companies pay
for emergency contraception.
[HB 58 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 58 Additional Document - HRSA Women’s Preventive Services Guidelines.pdf |
HHSS 4/15/2021 3:00:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Additional Document - Insurance Coverage of Contraceptives 4.1.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 105 v. A 2.19.2021.PDF |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Transmittal Letter 2.18.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Fiscal Note DOC-IDO 2.8.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Fiscal Note DHSS-PS 2.10.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Fiscal Note DPS-AST 2.12.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Fiscal Note JUD-ACS 3.4.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HJUD 3/5/2021 1:30:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Supporting Document - ABADA & AMHB Letter 3.5.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Testimony - Received as of 3.8.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 Additional Document - Memo from DJJ to HJUD 3.9.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 v. A Amendments #1-2 HJUD 3.10.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 v. A Amendments #1-2 HJUD Final Votes 3.10.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 3/10/2021 1:30:00 PM |
HB 105 |
| HB 105 v. B (Distributed by HJUD Committee) 3.12.2021.PDF |
HHSS 4/15/2021 3:00:00 PM HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HJUD 4/14/2021 1:00:00 PM |
HB 105 |
| HB 58 Sponsor Statement v. A 3.30.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM |
HB 58 |
| HB 58 Supporting Document - Guttmacher Alaska Statistics 2016 3.30.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - Guttmacher Public Costs from Unintended Pregnancies February 2015 3.30.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - Unintended Pregnancies Study March 2011 3.30.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 HSS Hearing Request 3.30.2021.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM |
HB 58 |
| HB 168 DHSS FN.pdf |
HHSS 4/15/2021 3:00:00 PM HHSS 4/17/2021 3:00:00 PM |
HB 168 |