Legislature(2023 - 2024)ADAMS 519
05/08/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HJR2 HB38 | |
| HB21 | |
| HB112 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 112 | TELECONFERENCED | |
| + | HB 21 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HJR 2 | TELECONFERENCED | |
| += | HB 38 | TELECONFERENCED | |
HOUSE BILL NO. 112
"An Act relating to the Board of Pharmacy; relating to
the practice of pharmacy; relating to pharmacies;
relating to prescription drug manufacturers; relating
to prescriptions for epinephrine; relating to the
administration of epinephrine; and providing for an
effective date."
3:17:20 PM
REPRESENTATIVE JUSTIN RUFFRIDGE, SPONSOR, introduced HB
112. He explained that the bill came about after being
discussed for multiple years by the Alaska Board of
Pharmacy. The board was tasked with regulation changes by
the administration, and it thoroughly examined the
regulations of the profession of pharmacy. The regulation
changes were referred to as "right touch" regulations and
modernized the profession as it had changed immensely over
the past 25 years. The board started keeping a list of the
items that would need to be changed in statute in order to
implement the right touch regulations. The bill was a
collection of the statute changes to help modernize the
profession and it would also give the board the authority
to continue the regulatory process. He relayed that the
chair of the board would offer a presentation to explain
the bill in more detail.
DR. ASHLEY SCHABER, CHAIR, ALASKA BOARD OF PHARMACY (via
teleconference), introduced the PowerPoint presentation
"House Bill 112: Profession of Pharmacy" dated May 8, 2023
(copy on file). She began on slide 2 which detailed the
board's 2023 strategic plan. There had been a cumulative
effort over the last several years to ensure that the board
had statute changes that would allow it to meet its
mission. She highlighted that one of the board's four goals
[listed on the slide] was to grow the economy while
promoting community health and safety. Many of the changes
related to the aforementioned goal, particularly to
routinely review the effectiveness of regulations that
reduced the barrier to licensure without compromising
patient health and safety. She relayed that the board
currently had seven members, five of whom were pharmacists
and two of whom were public members.
Dr. Schaber continued to slide 3 and offered some
background information on HB 112. She explained that the
bill would address necessary changes by doing the
following:
• Streamlining licensure process while improving
public safety
• Compliance with the Drug Supply Chain and Security
Act
• Alignment with other professional boards in Alaska
and pharmacy boards in other states
• Clarification of pharmacists' roles in epinephrine
access
Dr. Schaber indicated that the bill was a collaborative
effort between the board and the Alaska Pharmacists
Association.
Dr. Schaber continued on slide 4. The first goal was to
streamline the licensure process while improving public
safety. The bill eliminated unnecessary forms currently
required in statute. The forms were redundant and included
information that was already part of the licensure process.
The elimination of the forms would reduce the burden on the
applicant and on the board. It also clarified that only
pharmacists who dispensed controlled substances would be
required to register with the Prescription Drug Monitoring
Program (PDMP). It would also add a national criminal
background check for all applicants, which would add
another layer of protection. The background check was
required in 30 other states and was a statutory requirement
for nursing and other professions.
3:23:48 PM
Representative Hannan asked what details were included in
the national background check when it was returned to the
board. She asked if included specific information or simply
showed whether an applicant had committed a criminal
violation.
Dr. Schaber responded that she did not know which details
were included in the background check. She thought that the
background check acted as a flag to prompt additional
review.
Representative Ruffridge responded that the application for
licensure currently had a "self-selection" response, which
meant that the application asked whether an individual had
been convicted of a crime or was currently under
investigation for a crime. Applicants were able to select
"no" on the application even if the true answer was "yes,"
and there would be no follow-up. During his time on the
board, there were at least a few cases in which the answer
checked on the application was no, but the actual answer
was yes. The reason for the request was to ensure that
applicants were answering truthfully on their applications.
If a person were to lie, there would be reason to deny the
individual a license.
Representative Hannan noted that the committee spent time
in the prior week talking about background checks for
cannabis convictions that were no longer convictions under
the law and how the process should be changed. She could
see a problematic situation occurring in which a pharmacist
applicant had a cannabis conviction in another state, but
it was not considered a criminal offense in Alaska. She was
hoping that there would be more detail than a yes or no as
the answer was often more complicated. She did not think
answering yes should be an automatic denial, but she was
unsure if federal law would allow nuances to be considered.
Representative Ruffridge responded that marijuana was still
considered an illicit substance because it was federally
illegal. A violation with a controlled drug of any type
would be a flag to prompt additional review of an
application. The board considered it an issue in its hiring
process even though marijuana was legal at the state level
because pharmacists would have access to controlled
substances.
Representative Coulombe asked Representative Ruffridge to
put his credentials on the record.
Representative Ruffridge responded that he was the previous
chair of the Board of Pharmacy. He had a doctorate in
pharmacy and had been a licensed pharmacist in the state
since 2008.
3:29:31 PM
Dr. Schaber continued on slide 5. The next goal was to be
compliant with the Drug Supply Chain and Security Act
(DSCSA). She read from the slide as follows:
• The federal Drug Supply Chain and Security Act
(DSCSA) further secures the U.S. drug supply through
a system to prevent harmful drugs from entering the
supply chain, detect harmful drugs if they do enter,
and enable rapid response when such drugs are found.
o Boards of Pharmacy play a key role in this
process through appropriate licensing of drug
distributors and pharmacies
• HB 112 ensures the AK Board of Pharmacy powers and
duties support the DSCSA related to manufacturers,
out-of-state pharmacies, and internet pharmacies to
ensure Alaskans receive safe medications
Dr. Schaber explained that the change would be a
modernization to the process. Currently, out-of-state
pharmacies were required to register based on a statute put
in place in 1992. The drug supply chain and pharmacy in
general had changed significantly since 1992 when the
original statute was put in place. She relayed that
compliance with DSCSA would give the board jurisdiction
over out-of-state pharmacies. There was a concern that out-
of-state pharmacies that were mailing prescriptions into
the state might not be providing the same kind of
counseling that the in-state pharmacies were required to
provide. The concern had been raised many times over the
years in the form of public comment.
Dr. Schaber continued on slide 6 and the next goal, which
was alignment. To achieve the goal, the bill would replace
one of the two public member seats with a pharmacy
technician seat. As the field of pharmacy had changed over
the years, the role of pharmacy technicians had changed
with it. Both public member seats had been vacant for about
a year and adding the pharmacy technician seat would allow
for an additional perspective. The board also hoped that it
would help fill the vacancy. The next change would be to
allow the board to adopt language to create a retired
pharmacist status. It would align the board with pharmacy
boards in other states and with other professional boards
in the state. The last change associated with the goal of
compliance was to clarify the board executive
administrator's salary which would allow the required
flexibility for a pharmacist to serve in the role in the
future. The salary was currently not flexible enough to
allow a pharmacist to apply for the position. The board did
not want to require that a pharmacist serve in the position
because applicants with other credentials were able to
serve also, but it wanted to allow for the possibility.
3:34:02 PM
Dr. Schaber continued on slide 7 which detailed the goal of
epinephrine access. The changes in the bill would move the
epinephrine training program from the authority of the
Department of Health (DOH) to be overseen by the board. It
also clarified that a pharmacist could administer
epinephrine or prescribe epinephrine auto-injectors to an
individual who had completed the training program. It would
ultimately increase epinephrine access for Alaskans with
anaphylactic emergencies or those who might not know they
were at risk for anaphylactic emergencies. She added that
access was especially important in the rural areas of the
state. Some of the changes in the bill also increased
access by decreasing barriers to dialysis fluids, which was
also important for Alaskans living in rural areas on home
dialysis by allowing patients to receive the treatment at
home.
Dr. Schaber concluded her presentation on slide 8 and
thanked the committee for its time. She urged the
committee's support of the bill.
Co-Chair Foster asked for clarity on the uses of situations
in which epinephrine would be used.
Dr. Schaber responded that epinephrine was an emergency
medication used for allergic reactions, such as eggs, bee
stings, or peanuts. Some individuals were aware that they
had anaphylaxis, and some were not aware until they were
exposed to the substance that causes a reaction.
Representative Hannan asked about the board executive
administrator's salary detailed in Section 10 of the bill.
She asked how many other professional boards allowed for
similar flexibility in salary. She wondered if there was a
salary classification for pharmacists in the state pay
schedules.
3:37:10 PM
SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE
COMMUNITY AND ECONOMIC DEVELOPMENT, responded that there
were other pharmacists that worked for the state and there
were pay schedules in place. The pay ranged depending on
duties: for example, there was a pharmacist employed in the
Alaska Psychiatric Institute (API) as well as DOH
pharmacists in for Medicaid purposes with salary ranges
from 24 through range 27. Relating to executive
administrator of other boards, six of the boards had an
executive administrator positions and one other board had a
similar position with a different title. Only the Board of
Nursing had required qualifications for the executive
administrator role as it required that the individual was a
registered nurse (RN).
Representative Hannan asked if the nursing board members
were paid on the RN pay schedule.
Ms. Robb responded that the members were not paid as
nurses. The executive administrator positions were
considered partially exempt and the salary for the position
was not specified in statute; however, it was the highest
paid position because it required that the individual be a
licensed professional and have a master's degree, it was
the highest paid of the executive administrator positions
and was a range 25.
Representative Hannan asked if the phrasing for the
pharmacy board's executive administrator was unique or if
other boards had similar required competencies. She
wondered if the administrators were adequately compensated
based on the advanced requirements.
Ms. Robb responded that not all heath care boards had
executive administrators. The nursing board was the only
board requiring the administrator to be a member of the
nursing profession. The pay for the executive administrator
positions ranged depending on the workload and on whether
the pay was dictated in statute. The executive
administrator position for the pharmacy board was currently
not filled by a pharmacist. If the board hired a pharmacist
for the position, it wanted the ability to pay the
individual fairly based on the advanced requirements.
Representative Hannan asked what the range increase would
be in order to pay the executive administrator as a
pharmacist.
Ms. Robb replied that the other pharmacists that worked for
the state were range 24 through range 27 depending on their
duties. The board would have to work with classification to
determine which other state pharmacist position the
executive administrator was most similar to in order to
determine the range.
3:41:53 PM
Representative Josephson asked if the licensees of board
paid for the executive administrator positions.
Ms. Robb responded in the affirmative and noted that the
divisions were funded through receipt-supported services.
The cost of all staff for a particular board were paid by
the licensees for that particular profession. The Division
of Corporations Business and Professional Licensing (DCBPL)
conducted time keeping in order to allow staff to indicate
which program they were working on to ensure that the
charges were allocated appropriately.
Representative Josephson understood that the boards were
providing services "out of the kindness of their hearts."
He was not aware that some boards had an executive
administrator apart from the Medical Board. He asked if the
state would pick up the extra costs if a board chose not to
hire an administrator.
Ms. Robb responded that all were paid by the licensees of a
board, and it would not matter whether the board had an
executive administrator.
Representative Josephson asked why each board would not
want their own executive administrator.
Ms. Robb responded that it depended on the scope and
complexity of the program. The Board of Nursing was a team
of 10 individuals that oversaw 28,000 licensees and it made
sense for the board to employ an executive administrator.
There were some boards with more complex licensing than
others and needed more employees. Boards with fewer
licensees and less complex licensing processes had less of
a need for an executive administrator.
3:44:36 PM
Representative Coulombe understood that out-of-state
pharmacies had to be registered but did not have to be
licensed. She asked if her understanding was correct.
Representative Ruffridge responded in the affirmative.
Representative Coulombe wanted to ensure that adding the
licensing requirement would not be too much of a
hinderance. She relayed that there were many individuals
who relied on online pharmacies. She asked what licensing
would be like for an out-of-state pharmacy.
Representative Ruffridge responded that under the current
process, registering with the Board of Pharmacy simply
indicated that a pharmacist existed and may or may not send
for medications with the state. There was no jurisdiction
by the board of the medications that entered the state to
ensure that counseling had been provided to the individuals
receiving medications. There was no ability for the board
to maintain safety measures. Over the years, mail order
pharmacies had become more popular and regulations had not
kept up with the changes. The change would not be overly
burdensome to companies that already mailed a significant
amount of medications into multiple states and would simply
put Alaska in alignment with many other states in the
nation.
Representative Coulombe asked if there were new fees
associated with registration or licensing.
Representative Ruffridge responded that there were fees
associated with licensing and registration, but the board
had gone through multiple iterations of fee reductions over
the last few years. He argued that the fee for pharmacy
technicians was essentially nonexistent. Technicians were
simply required to pay an initial $25 fee to become
registered and licensed, which was reduced from a fee of
$150.
Co-Chair Foster suggested that Representative Ruffridge
make closing comments.
Representative Ruffridge thanked the committee for its
time. The bill had been well vetted and had been overseen
by three different chairs of the pharmacy board. He thought
that the support for the bill was encouraging and that the
bill represented the desires of the profession of pharmacy
as a whole. He welcomed the support of the committee and
was happy to answer any other questions.
HB 112 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster reviewed the agenda for the following day's
meeting.