04/14/2014 01:30 PM Senate HEALTH & SOCIAL SERVICES

        HB 134-MEDICAID PAYMENT FOR MEDISET PRESCRIPTION                                                                    
                                                                                                                                
1:31:25 PM                                                                                                                    
CHAIR  STEDMAN  announced  the consideration  of  HB  134.  [CSHB
(HSS)  was before  the  committee.]He said  it  was the  first                                                               
hearing of the bill. The intent  is to have the sponsor introduce                                                               
the  bill, take  public testimony,  and  set the  bill aside  for                                                               
further review.                                                                                                                 
                                                                                                                                
1:31:50 PM                                                                                                                    
CHARLES  GUINCHARD, Staff,  Representative  Mia Castello,  Alaska                                                               
State Legislature, Juneau, Alaska, presented  HB 134 on behalf of                                                               
the sponsor. He related that the  bill is the sponsor's intent to                                                               
memorialize  in statute  a program  that exists  at the  level of                                                               
regulation. The goal of the mediset  program is to save the state                                                               
long-term  costs by  helping the  most  vulnerable Alaskans  stay                                                               
compliant with  their medications.  He referred to  a legislative                                                               
research  brief  in members'  packets  that  shows cost  of  care                                                               
decreases  when patients  are  compliant  with their  medication.                                                               
Medication management  services such  as mediset helps  them stay                                                               
compliant.                                                                                                                      
                                                                                                                                
He listed the support for the  bill from the Alaska Mental Health                                                               
Board,  the   Chugiak-Eagle  River  Senior  Center,   the  Alaska                                                               
Commission on  Aging, the Alaska  Mental Health  Trust Authority,                                                               
the  Alaska   Nurses  Association,  the  Governor's   Council  on                                                               
Disabilities,  Hope Community  Resources,  the Alaska  Pharmacist                                                               
Association, and various assisted living homes and pharmacies.                                                                  
                                                                                                                                
1:33:56 PM                                                                                                                    
MR. GUINCHARD  showed a video  relating to  mediset prescriptions                                                               
and who  they apply to.  It described the difficulties  the frail                                                               
and  elderly  have  with taking  prescriptions  and  how  mediset                                                               
assists  them.  It explained  some  of  the  costs saved  by  the                                                               
dispensing services.                                                                                                            
                                                                                                                                
1:38:35 PM                                                                                                                    
MR. GUINCHARD  explained the sections  of the bill. In  Section 1                                                               
(a)  the   Department  of  Health  and   Social  Services  (DHSS)                                                               
establishes  the   fee  to  pay   a  qualified  pharmacy   for  a                                                               
prescription that requires scheduled units  of use to a qualified                                                               
medical assistance  recipient. He pointed  out on line 9,  "for a                                                               
prescription that requires"  is the language that  will result in                                                               
a  physician  needing  to  physically   write  "Mediset"  on  the                                                               
prescription.                                                                                                                   
                                                                                                                                
He related that  in Section 1 (b), the  bill addresses pharmacies                                                               
that are  qualified to dispense  with five qualifiers -  the cost                                                               
drivers when preparing and dispensing  a mediset. These five cost                                                               
drivers will be  incorporated into one mediset  fee determined by                                                               
DHSS. He  said that  Section 1 (c)  addresses who  under Medicaid                                                               
will  qualify  for  a  mediset.  It was  language  added  at  the                                                               
department's  request  so  that  the bill  will  not  expand  nor                                                               
contract the  scope of who  is currently eligible. Section  1 (d)                                                               
consists  of two  definitions; "medication  compliance packaging"                                                               
and "units of use."                                                                                                             
                                                                                                                                
He  related that  Sections 2  and 3  are a  complicated effective                                                               
date.  Because of  any  change to  the  state's Medicaid  program                                                               
requires federal  approval, Section  2 specifies that.  Section 3                                                               
says when DHSS has received  approval, the statute will come into                                                               
effect.                                                                                                                         
                                                                                                                                
CHAIR  STEDMAN noted  one  zero fiscal  note  from Department  of                                                               
Health and Social Services (DHSS).                                                                                              
                                                                                                                                
He opened public testimony.                                                                                                     
                                                                                                                                
1:43:23 PM                                                                                                                    
GERALD  BROWN,   Pharmacist,  Fairbanks,  Alaska,   testified  in                                                               
opposition  to  several   provisions  in  HB  134.   He  noted  a                                                               
restriction  included in  the  bill  that says  75  percent of  a                                                               
pharmacy's business must be medisets  in order to receive payment                                                               
for  unit-dosing  prescriptions  for  individuals.  He  said  his                                                               
pharmacy  does not  have that  ratio,  yet does  over 900  bubble                                                               
packs per month.  He maintained that the ratio  is not reasonable                                                               
and all pharmacies should be  eligible to receive the unit dosing                                                               
fee. As  written, the  bill is limited  to certain  pharmacies in                                                               
Anchorage.                                                                                                                      
                                                                                                                                
MR.  BROWN   addressed  the  dispensing   fee,  which   was  last                                                               
established on 50  cents per unit. He  said it takes $3  to do so                                                               
now. He requested  that it be equitable to the  pharmacy costs in                                                               
preparing the units  and keeping records. He  emphasized that the                                                               
mediset service  is much  needed. It is  important that  the fees                                                               
cover the actual costs.                                                                                                         
                                                                                                                                
CHAIR  STEDMAN  noted  a forthcoming  committee  substitute  that                                                               
would address those issues.                                                                                                     
                                                                                                                                
MR. BROWN  suggested the  bill provisions should  be open  to all                                                               
pharmacies.                                                                                                                     
                                                                                                                                
1:47:42 PM                                                                                                                    
ARLENE  BRISCOE,  Registered  Nurse, Alaska  Nurses  Association,                                                               
Anchorage, Alaska,  testified in  support of  HB 134.  She shared                                                               
that  many of  her  patients suffer  from  severe mental  illness                                                               
which precludes them from remembering  to take their medications.                                                               
She stressed  that they need  the assistance this  bill provides.                                                               
She voiced  concern about  the department's  reimbursement policy                                                               
for  pharmacies -  that  75  percent of  their  business must  be                                                               
providing medisets  in order  to qualify. She  noted that  at her                                                               
hospital patients often  have to be kept longer  because they are                                                               
waiting for  mediset medications,  which is costing  Medicaid and                                                               
other  insurance  plans  money.  She stressed  that  the  program                                                               
should be  available to  all pharmacies  in the  state, including                                                               
rural pharmacies.                                                                                                               
                                                                                                                                
1:50:24 PM                                                                                                                    
BERRY  CHRISTENSEN, Co-Chair,  Alaska  Pharmacists Association  -                                                               
Legislative  Committee, Ketchikan,  Alaska, testified  in support                                                               
of  the concept  of mediset,  but in  opposition to  limiting the                                                               
number of pharmacies who can quality for the dosage unit fee.                                                                   
                                                                                                                                
1:51:26 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN held HB 134 in committee.