05/12/2021 03:15 PM House LABOR & COMMERCE

       HB 58-CONTRACEPTIVES COVERAGE: INSURE; MED ASSIST                                                                    
                                                                                                                                
4:14:18 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the next  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."                                                                                 
                                                                                                                                
4:14:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MATT  CLAMAN, Alaska  State Legislature,  as prime                                                               
sponsor,  introduced HB  58.   He  said that  HB  58 would  bring                                                               
Alaska's   statutes    into   consistency   with    the   federal                                                               
contraceptive  coverage  guarantee,   and  mandate  coverage  for                                                               
dispensing up to 12 months of  contraceptives at a time.  He said                                                               
Alaskans   often   face   challenges    in   trying   to   access                                                               
contraceptives; for  women in  rural areas,  multiple trips  to a                                                               
pharmacy  can   be  an   insurmountable  barrier   to  consistent                                                               
contraception, and a one-year's  supply would help balance health                                                               
with work  and family  life.   He said  that research  shows that                                                               
women who are allowed 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 who  are allowed                                                               
only a  one- or three-month  supply.  He  pointed out that  HB 58                                                               
would  also save  money  for the  state, due  to  a reduction  in                                                               
unplanned  pregnancies.     He  said  that   improved  access  to                                                               
contraception  improves health  for  women and  families, and  he                                                               
pointed  out that  HB 58  would support  victims of  reproductive                                                               
coercion, or  "contraceptive coercion," by  providing long-acting                                                               
reversible contraceptives  (LARCs) or a 12-month  supply of birth                                                               
control.   He said that  a strong, longstanding body  of evidence                                                               
recognizes contraceptives  as vital  components of  public health                                                               
care  that  help women  avoid  unintended  pregnancy and  improve                                                               
birth  spacing,  which  have  positive  consequences  for  women,                                                               
families,  and  society.   The  evidence  strongly suggests  that                                                               
insurance coverage of contraceptive services,  he said, is a low-                                                               
cost or even cost-saving means of helping women.                                                                                
                                                                                                                                
4:20:49 PM                                                                                                                    
                                                                                                                                
LIZZIE KUBITZ,  Staff, Representative  Matt Claman,  Alaska State                                                               
Legislature, detailed the sectional analysis  for HB 59 on behalf                                                               
of Representative Claman, prime sponsor.   She read the sectional                                                               
analysis, 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  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 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.                                                                                  
                                                                                                                                
4:24:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY asked  whether insurance  companies would                                                               
be  required  to  pay  for  12  months  of  contraceptives.    He                                                               
expressed  the  concern  that  a  person  may  receive  the  full                                                               
prescription and then  no longer be covered by  insurance, and he                                                               
asked whether  there exists a  requirement for  other medications                                                               
to be covered in a similar manner.                                                                                              
                                                                                                                                
REPRESENTATIVE CLAMAN  responded that a  person would be  able to                                                               
continue taking  their prescribed medication in  such a scenario.                                                               
He  pointed out  that  if  someone receives  12  months of  birth                                                               
control, then changes  jobs after six months,  the new employer's                                                               
insurance wouldn't have  to pay for the birth  control the person                                                               
was previously prescribed.                                                                                                      
                                                                                                                                
REPRESENTATIVE MCCARTY  asked what  concerns have  been expressed                                                               
by representatives in the insurance industry.                                                                                   
                                                                                                                                
REPRESENTATIVE  CLAMAN replied  that the  insurance industry  has                                                               
expressed no concerns.                                                                                                          
                                                                                                                                
4:27:12 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:27:35 PM                                                                                                                    
                                                                                                                                
LORI WING-HEIR,  Director, Division  of Insurance,  Department of                                                               
Commerce,   Community,  and   Economic  Development,   said  that                                                               
insurance companies  are aware of  the existence of  the proposed                                                               
legislation, but  that they  have not  contacted the  Division of                                                               
Insurance with any comments.                                                                                                    
                                                                                                                                
4:28:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted that  this is the  third time  that the                                                               
sponsor has  introduced the proposed legislation.   She commented                                                               
that other medications are available for longer periods of time.                                                                
                                                                                                                                
MS. WING-HEIR  said, "That is  a very  good point."   She pointed                                                               
out that  most prescriptions  have a 90-day  or even  a six-month                                                               
supply, and  she said that  the Division of  Insurance encouraged                                                               
health  care providers  to allow  longer  supplies of  medication                                                               
during the pandemic.                                                                                                            
                                                                                                                                
4:29:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY   expressed  concerns  about   setting  a                                                               
precedent for longer supplies of medications.                                                                                   
                                                                                                                                
MS. WING-HEIR explained that insurance  plans operate on either a                                                               
fiscal year  or calendar year.   If a patient has  an appointment                                                               
in November and receives a  three-month supply of medication, she                                                               
said, the  patient may have a  new insurer or plan  on January 1.                                                               
She stressed  that it's  quite common  for insurance  coverage to                                                               
change midway through a prescription supply.                                                                                    
                                                                                                                                
4:31:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   NELSON  asked   for  information   on  receiving                                                               
medications via mail.                                                                                                           
                                                                                                                                
REPRESENTATIVE  CLAMAN replied  that  his  understanding is  that                                                               
insurers prefer  mail order  plans due to  lower costs,  but that                                                               
mail order plans are optional.                                                                                                  
                                                                                                                                
REPRESENTATIVE  NELSON  expressed  that  mail order  would  be  a                                                               
better way to receive medications.                                                                                              
                                                                                                                                
REPRESENTATIVE  CLAMAN  responded  that  he  always  has  been  a                                                               
supporter  of  mail   order,  but  that  many   patients  want  a                                                               
consultation with a pharmacist, and  he wouldn't want to stand in                                                               
the way of consumer choice.                                                                                                     
                                                                                                                                
4:34:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR FIELDS  interjected that  he contacted  a representative                                                               
from  Aetna,  and he  said  the  company  expressed that  it  was                                                               
"neutral" on HB 58.                                                                                                             
                                                                                                                                
CO-CHAIR  SPOHNHOLZ pointed  out that  the insurance  industry is                                                               
well-represented, and  the committee and  sponsor would  be aware                                                               
of any concerns.                                                                                                                
                                                                                                                                
4:34:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SNYDER  added that  the  provisions  under HB  58                                                               
would  result in  fewer visits  to the  doctor, which  would help                                                               
recover  any costs  to the  insurance company.   She  pointed out                                                               
that several  states allow contraceptive coverage  for periods of                                                               
between 15 and 22 months.                                                                                                       
                                                                                                                                
CO-CHAIR  SPOHNHOLZ added  that  reducing unintended  pregnancies                                                               
would also save money for insurance companies.                                                                                  
                                                                                                                                
4:35:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KAUFMAN referred  to page 1, line 11,  of the text                                                               
of  the  proposed  legislation and  asked  Representative  Claman                                                               
about the inclusion of emergency contraception.                                                                                 
                                                                                                                                
MS.   KUBITZ   responded   that  the   inclusion   of   emergency                                                               
contraception was made during the hearings  of HB 58 in the House                                                               
Health  and Social  Services Standing  Committee.   She said  the                                                               
intent of the inclusion was  to allow someone who needs emergency                                                               
contraception to purchase it over-the-counter  and then submit to                                                               
the insurance company for reimbursement.                                                                                        
                                                                                                                                
REPRESENTATIVE  KAUFMAN asked  about being  covered by  insurance                                                               
with which a patient is "philosophically aligned."                                                                              
                                                                                                                                
MS. KUBITZ  referenced the religious  exemption discussed  in the                                                               
sectional  analysis,  and she  pointed  out  that employers  that                                                               
object to  emergency contraception  have the  option to  choose a                                                               
certain plan.                                                                                                                   
                                                                                                                                
4:37:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN  suggested a discussion with  Ms. Wing-Heir                                                               
on religious exemptions for contraceptive coverage.                                                                             
                                                                                                                                
4:38:18 PM                                                                                                                    
                                                                                                                                
MS.  WING-HEIR stated  that an  employer does  not have  to offer                                                               
employees a plan that includes contraception.                                                                                   
                                                                                                                                
REPRESENTATIVE KAUFMAN asked for clarification.                                                                                 
                                                                                                                                
MS.  WING-HEIR responded  that an  employer chooses  an insurance                                                               
plan for a group.                                                                                                               
                                                                                                                                
4:40:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KAUFMAN  referred to  the  text  of the  proposed                                                               
legislation, page 2, lines 28-30, which read as follows:                                                                        
                                                                                                                                
     In   this   subsection,    "cost   containment"   means                                                                    
     incentivizing  the   use  of  generic  or   lower  cost                                                                    
     medications  or the  use of  health  care providers  or                                                                    
     pharmacies that  offer services  or prescriptions  at a                                                                    
     lower negotiated rate.                                                                                                     
                                                                                                                                
REPRESENTATIVE KAUFMAN asked whether  the language "avoids" other                                                               
opportunities for cost containment.                                                                                             
                                                                                                                                
MS. KUBITZ  responded that the  inclusion of that language  was a                                                               
compromise.   She  said that  the  sponsor wanted  the option  to                                                               
encourage the use of generic medications.                                                                                       
                                                                                                                                
REPRESENTATIVE KAUFMAN  expressed the  opinion that,  as written,                                                               
it looks like it is defining cost containment.                                                                                  
                                                                                                                                
4:41:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  shared her understanding that  this provision                                                               
relates  directly  to  contraception, so  that  cost  containment                                                               
measures could  exist without  interfering in  the doctor-patient                                                               
relationship.  She pointed out  that birth control has uses other                                                               
than simply  preventing pregnancy, and generic  options sometimes                                                               
don't meet the therapeutic need.                                                                                                
                                                                                                                                
[HB 58 was held over.]