Legislature(2021 - 2022)ADAMS 519
04/25/2022 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB145 | |
| SB80 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 145 | TELECONFERENCED | |
| + | SB 80 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 145
"An Act relating to the Board of Pharmacy; relating to
health care services provided by pharmacists and
pharmacy technicians; and relating to the practice of
pharmacy."
2:07:35 PM
REPRESENTATIVE LIZ SNYDER, SPONSOR, thanked the committee
for hearing the bill. She relayed that the bill allowed
pharmacists to practice within the full scope of their
practice. The statute needed to be updated to reflect the
ongoing evolution of the field. The bill defined the
patient care services that pharmacists and pharmacy support
staff could independently provide, it allowed pharmacy
technicians to administer vaccines and emergency
medication, and it empowered the Board of Pharmacy to
regulate pharmacists of all types to provide pharmacy
services. Lastly, the bill updated the current provider
anti-discrimination statute to support insurance coverage
of patient care services when provided by a pharmacist. She
noted that the bill did not expand pharmacists'
prescriptive authority or allow them to practice outside of
their scope, training, or knowledge. The bill was a result
of collaboration between pharmacists and medical groups.
2:10:08 PM
Representative Wool wondered if pharmacists would be able
to bill individual patients for services rendered, or if
billing independently was what pharmacists wanted to do. He
asked for clarification regarding the process for insurance
payments.
Representative Snyder replied that when pharmacists were
providing care within the scope of their practice, it would
allow for those services to be billable to insurance even
if those services were normally provided by a physician.
She noted that testifiers would be speaking to their
experience in this realm later in the meeting.
Representative Rasmussen was aware pharmacists could
administer vaccines, but there were other services she was
surprised to learn about that could be provided by
pharmacists. She wanted to hear more examples of the
different services pharmacists could provide.
2:13:01 PM
Representative Johnson asked about how standards were
applied for pharmacists. She wondered if pharmacists had
the same standards for patient care as physicians.
Representative Snyder deferred to the chairman of the Board
of Pharmacy.
2:13:28 PM
JUSTIN RUFFRIDGE, CHAIRMAN, BOARD OF PHARMACY, SOLDOTNA
(via teleconference), responded that pharmacists held two
forms of liability. As an independent pharmacy owner, he
held liability to cover the facility itself, and each of
the pharmacists who worked for him held their own
individual liability. He indicated that was the standard of
practice. Most insurance plans would refuse to credential
or contract with a provider without proof of liability
insurance coverage. The policies would usually run from $1
million to $3 million.
Representative Johnson thought the amount seemed
surprisingly low.
Dr. Ruffridge replied that the amount was the minimum
requirement for most insurance companies. Many pharmacists
carried greater amounts for their own personal wellbeing.
2:15:14 PM
Representative Wool wondered about the process for billable
services by pharmacists. He asked if people made
appointments with pharmacists in a similar way that people
made appointments with physicians. If so, he wondered
whether these appointments were billable.
Dr. Ruffridge responded in the affirmative. There had been
a recent pattern where pharmacists were prescribing
medications for "self-limiting diagnoses." It was helpful
for pharmacists to be empowered to prescribe medications to
remove some of the burden off of overwhelmed physicians.
However, there were statutory limitations that did not
allow pharmacists to fully perform the duties they had been
trained to do. The statutory language simply did not match
what had been in practice. The bill was representative of
what pharmacists were able to do and were already doing.
Representative Wool had been unaware that people could make
appointments with pharmacists. He noted that naturopaths
wanted to be able to prescribe antibiotics, but medical
doctors did not want to relinquish control. He wondered
whether this was as contentious with pharmacists if
pharmacists were already prescribing antibiotics.
Dr. Ruffridge responded that pharmacists had been
prescribing antibiotics for quite some time by working with
physicians through collaborative practice agreements. The
service was not done unilaterally nor without oversight.
The bill established the few things that pharmacists would
be permitted to do independently of the collaborative
practice agreement. The independent duties were also things
pharmacists had been doing for quite some time.
Representative Wool was not aware of collaborative practice
agreements. He wondered if other states had this option. He
understood pharmacists were overburdened just as medical
doctors were and asked how the redistribution of work would
help. He asked if there was a shortage of licensed
pharmacists.
Dr. Ruffridge would be happy to talk about the topics at
hand for hours and suggested that they talk outside of the
committee. He responded that many other states had similar
language that allowed for similar practice agreements. He
relayed that Alaska actually had an abundance of
pharmacists. One of the issues was that retail pharmacies
were often chaotic which he thought related to pharmacists'
inability to reimburse themselves for medications. This
resulted in diminished personnel hired in pharmacies due to
things like direct and indirect remuneration fees, which
could sometimes amount to hundreds of thousands of dollars.
If some of the issues were resolved, pharmacists would be
able to employ more people and the environment would be
less chaotic.
2:22:51 PM
Representative Rasmussen asked for more detailed
information on the training completed by pharmacists. It
was her understanding that some pharmacists were more
experienced than some medical doctors.
Dr. Ruffridge responded pharmacists were highly trained
professionals. For the past twenty years, a student could
not graduate from pharmacy school with anything less than a
doctorate. Pharmacists also were trained in diagnostic
tools, which included things like COVID-19 testing and flu
testing. Pharmacists were a highly motivated, highly
educated workforce. He suggested that Dr. Tom Wadsworth
could provide more detailed information.
Representative Rasmussen asked how much leeway a pharmacy
had in dispensing medication prescribed by a doctor.
Dr. Ruffridge responded that pharmacists had a small amount
of leeway, but there were a few things they could not
change. Pharmacists could not change the patient, the drug
itself, or the ultimate dosage form without speaking to the
prescribing doctor. Some of the language in HB 145
suggested allowing pharmacists to have the authority to
change dosage form. For example, if a parent did not want
their child to take prescribed medication in a pill form,
the pharmacist could change it to a liquid form.
2:26:13 PM
DR. TOM WADSWORTH, ASSISTANT DEAN OF UNIVERSITY OF ALASKA
ANCHORAGE AND IDAHO STATE UNIVERSITY PHARMACY PROGRAM,
WASILLA (via teleconference), spoke in support of the bill.
He indicated that the bill was a collaboration between the
Alaska Pharmacist Association, the University Pharmacy
Program, and the Board of Pharmacy. It was a "housekeeping"
bill because all the activities expanded by the bill were
tasks that pharmacists were already performing. He reported
that for over 30 years, pharmacists had been providing non-
dispensing healthcare services and prescribing medicines.
He relayed that 60 percent of pharmacists practiced in the
healthcare industry rather than in retail stores such as
Walgreens. Many pharmacists were in disease management and
post-diagnostic disease management and prescribed
medication along with physicians through collaborative
practice agreements. It might seem as though there were not
many pharmacists, but most pharmacists were not public
facing. There was a tendency to lump all pharmacists into
the field of community pharmacy, but it was not an accurate
representation of the entire field.
Dr. Wadsworth emphasized that the bill would update
regulation to ensure that all pharmacists were represented
in statute. The bill would also help the board to regulate
practices outside of the community setting. Many
pharmacists were imbedded with primary care physicians and
provided non-dispensing healthcare services in
collaboration with practitioners. The pharmacists helped
improve the patient experience and worked to lower drug
costs. He reemphasized there were many tasks done by
pharmacists of which the general public was not aware. He
urged the passage of the bill so the Board of Pharmacy
could properly regulate the profession.
2:31:00 PM
Representative Wool asked whether the Chief Andrew Isaac
Health Center (CIHC) and Fairbanks Memorial Hospital (FMH)
operated in the same manner because of the difference
between federal and state regulations.
Dr. Wadsworth responded that pharmacists often had
difficulty engaging with commercial or private insurances
due to difficulty getting enrolled in credentials. In
Alaska, pharmacists had been designated as rendering and
billing providers by statute. He had been involved in some
consultation with health centers to try to establish
practices in the facilities to employ pharmacists. The bill
would help to provide better access to pharmacists of all
types.
Representative Wool indicated his child had a history of
strep throat. He wondered how the process of getting
antibiotics would change if a pharmacist was imbedded in a
clinic. He wondered if he could take his daughter to a
pharmacist in a retail store like Fred Meyer for a test for
strep throat and be prescribed antibiotics immediately.
Dr. Wadsworth responded that it was nuanced. Currently,
there were lab tests that anyone could perform, including
pharmacists, which would diagnose things like strep throat.
Under a collaborative practice agreement, the patient could
then receive proper treatment or a referral. Many
pharmacists were doing such tests already, yet some did not
because they had barriers with payments from insurance. The
bill would increase options for patients.
2:34:54 PM
BARRY CHRISTIANSEN, LEGISLATIVE CHAIR, ALASKA PHARMACISTS
ASSOCIATION (via teleconference), was a practicing
pharmacist in Ketchikan. He had two daughters also training
to become pharmacists. He spoke in support of HB 145. He
believed that pharmacists were in a unique position to help
patients reach their pharmaceutical needs. The statutory
updates in the bill were vital to ensure that pharmacists
could continue to meet patient needs as well as encourage
the recruitment of new pharmacists. The legislation ensured
that pharmacists could continue to practice in the manner
they had already been practicing and would not expand
prescriptive authority.
2:36:31 PM
DANIEL NELSON, DIRECTOR OF PHARMACY, TANANA CHIEF'S
CONFERENCE, FAIRBANKS (via teleconference), supported the
bill and echoed the comments of Dr. Ruffridge and Dr.
Wadsworth. The bill updated the statutes and also allowed
the Board of Pharmacy to regulate pharmacy support staff.
It was important to ensure that pharmacists could continue
to provide vaccines, which was allowed in a majority of
other states. Currently, the only way Alaska pharmacists
were able to provide vaccines was through a federal
exception waiver. The reason why pharmacies were so busy
was because of the remuneration of the pharmacy benefit
managers. Insurance companies would not reimburse
pharmacists for services because pharmacists were not
listed in the anti-discrimination statute.
2:39:10 PM
Co-Chair Merrick OPENED public testimony.
TALETHIA BOGART, SELF, ANCHORAGE (via teleconference), was
a student pharmacist at the University of Alaska Anchorage.
She supported HB 145. Patient care was her top priority and
she wanted to make a difference in the lives of her
patients. She thought the bill would improve patient access
to care and improve the overall health and wellbeing of
patients. She thought the bill needed to pass in order to
allow her to practice what she had learned in school.
2:40:24 PM
Co-Chair Merrick CLOSED public testimony.
Co-Chair Merrick invited Ms. Glenn Hoskinson to review the
fiscal note with control code diCXR by the Department of
Commerce, Community and Economic Development.
2:40:49 PM
GLENN HOSKINSON, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESSES AND PROFESSIONAL LICENSING, JUNEAU (via
teleconference), was looking for the correct fiscal note.
2:41:35 PM
AT EASE
2:42:07 PM
RECONVENED
Co-Chair Merrick referred to the control code and asked Ms.
Hoskinson if she had the correct fiscal note.
Ms. Hoskinson responded that she had been referring to the
wrong fiscal note. The fiscal note with control code diCXR
was a zero fiscal note. She relayed that the department
would absorb the costs of the bill.
2:42:58 PM
Representative Johnson asked what type of birth control
pills pharmacists could prescribe under the bill.
Representative Snyder deferred to Dr. Ruffridge.
2:44:01 PM
Dr. Ruffridge asked Representative Johnson to clarify her
question.
Representative Johnson referred to the document "Alaska's
Pharmacists: Improving People's Health" (copy on file). The
document indicated that Oregon pharmacists wrote 10 percent
of all birth control prescriptions since a landmark law was
passed and suggested that Alaska pharmacists could follow
suit. She asked what type of drugs pharmacists would be
dispensing and wondered if the morning after pill would be
included.
Dr. Ruffridge indicated pharmacists would need to have a
collaborative practice agreement with a physician in order
to prescribe birth control. The bill would not allow
pharmacists to prescribe birth control unilaterally or
independently. He explained that the morning after pill was
already available over the counter and did not require a
prescription. The decision to allow this was made at the
federal level through the Food and Drug Administration
(FDA).
Representative Johnson asked the sponsor if the
administration or the chief medical officer of the state
had any opinion on the bill.
Representative Snyder replied that there was a letter from
the Board of Pharmacy (copy on file) supporting the bill.
Representative Johnson wondered what medical doctors
thought about the bill. She thought it seemed like an
industry bill as most testifiers were in the industry. She
wondered whether pharmacists would be able to prevent
prescribed medication from being dispensed.
Representative Snyder indicated there was also a letter of
support from the Alaska State Medical Association (copy on
file) in member packets as well. There had not been any
opposition to the bill from physician groups. Her primary
motivation with the bill was to increase access to care.
Pharmacists were already providing important services and
the bill would simply reflect that activity in statute.
There was a shortage of primary care providers in the state
and there was other legislation in process that aimed to
address the shortage. Allowing pharmacists to provide some
of the primary care services that fell within the scope of
their training was part of the legislation. She asked
Representative Johnson to repeat her second question.
Representative Johnson wondered about the line between a
doctor and a pharmacist. She asked to what extent a
pharmacist could second-guess a doctor and decide against
filling a prescription. She did not want to allow for the
expansion of a pharmacist's authority. She wanted to put
her faith in her doctor's decisions.
Representative Snyder noted that others had expressed the
same concern. She thought that the bill had an unfortunate
and misleading title. It would not expand authority, but
instead updated statute to reflect what pharmacists already
did. She reached out to the Division of Corporations,
Business, and Professional Licensing to ensure that nothing
in the bill would expand the authority of pharmacists
beyond their scope of practice. She was told that the bill
was prescriptive and would not allow for inappropriately
expanded authority. There was a document in the bill packet
that confirmed that information.
2:51:38 PM
Representative Johnson thought the ability for pharmacists
to prescribe birth control would be expanded.
Representative Snyder responded that a collaborative
practice agreement would be required in that situation.
However, certain types of birth control such as the morning
after pill were already available over the counter. They
were not overlapping issues.
Representative Johnson clarified for the record that the
bill did not expand the ability of pharmacists to prescribe
contraception.
Representative Snyder responded that was her understanding
and suggested that Dr. Ruffridge provide his perspective
for added certainty.
Dr. Ruffridge responded that Representative Johnson was
correct. Pharmacists could not prescribe contraceptive
medications without a collaborative practice agreement with
a doctor.
Representative Johnson asked if Dr. Ruffridge could provide
more detail on situations that would allow pharmacists to
choose to not dispense prescriptions.
Dr. Ruffridge responded that there had been much discussion
on the topic. The situations in which pharmacists could
choose to not dispense prescriptions were related to birth
control prescriptions, the opioid epidemic, and COVID-19.
In each instance, pharmacists were left with a dilemma and
had to determine where to draw the line. For example,
should a pharmacist cease dispensing prescriptions to a
person who had been addicted to opiates for many years. The
Board of Pharmacy had attempted to answer such questions.
The board thought that pharmacists had to have the
patient's best interest in mind, and this language was
included in statute and regulations. If a pharmacist had a
moral barrier to dispensing birth control, the board
ensured that there was another pharmacy location where the
patient could have the medication dispensed. With opiates,
pharmacists had to do a complete assessment of patients'
mental states and there were laws in place to prevent
patients from receiving high dosages. The Board of Pharmacy
encouraged pharmacists to talk to the patient and determine
the appropriateness of the medication. The law had been
very clear that the pharmacist and prescriber had an equal
obligation to the patient. If something were to happen as a
result of a prescription, the blame would fall equally on
both the prescriber and the pharmacist. Ultimately, the
patient's best interests should be the most important
factor.
2:59:07 PM
Representative Carpenter referred to Section 8 of the bill
which added language to the statute enabling collaborative
practice agreements. He asked what defined, controlled, or
limited the boundaries of what could be included in the
collaborative practice agreement. He asked for more details
about the structure of the agreement.
Dr. Ruffridge replied that the writers of the agreement
determined the limits of the collaborative practice
agreement. The agreement then had to be reviewed by the
State Medical Board. If the agreement was approved, it
would then go to the Board of Pharmacy for additional
review. He relayed that the review process was extensive
and rigorous.
Representative Carpenter thought there might be a conflict
between independent prescription authority for vaccines and
an established collaborative practice agreement.
Dr. Ruffridge responded that pharmacists were limited to
independent prescribing and dispensing of medication and
required vaccines related to emergencies. Anything outside
of the two areas would require a collaborative practice
agreement. Vaccines and related emergency medications were
being supplied by pharmacists in the state already. The
bill simply described in clear language the process of
pharmacists giving vaccines. The current language in
statute stated "independently administer" but did not say
how the administration of the vaccines would come about.
The first step in the process would be to determine that a
person needed a vaccine, which would essentially involve
prescribing it. The bill provided clear distinctive
language.
3:03:21 PM
Representative Carpenter referred to Section 3 regarding
the emergency permit. He wondered what the impact of
changing the language would be.
Dr. Ruffridge indicated pharmacists had to issue many
emergency permits during the pandemic. The referenced
section allowed the board to not only issue emergency
permits to practice pharmacy, but also to practice the
other license types that pharmacies were required to have,
such as interns and pharmacy technicians. The other issue
that arose was that other emergency permits were granted
due to the governor's emergency declaration. The language
would provide clarity as to what pharmacists could and
could not do.
3:04:51 PM
Representative Wool commented that naturopathic doctors had
to study pharmacy as part of their education, and many
states allowed them to prescribe medication. He wondered
how many hours student pharmacists spent helping patients
in a clinical setting.
Dr. Wadsworth replied that pharmacy students accumulated
thousands of hours of direct patient care during their
training, and it was required for licensing. Many student
pharmacists would choose to undergo additional training
after they became licensed in order to become specialized
in a field like infectious disease or psychiatry. By the
time pharmacists were practicing independently, they had
accumulated thousands of hours of direct patient care.
Pharmacists also sat for a board exam to become board
certified. Additionally, pharmacists were required to take
continuing education to maintain their license.
Representative Wool commented that the legislature had not
heard from any medical doctors on the bill, but perhaps
doctors were simply too busy to testify. He understood that
there had been no opposition received, which seemed similar
to receiving support. He wondered if pharmacists took the
Hippocratic Oath like medical doctors.
Dr. Wadsworth replied that there was a similar code of
ethics to which pharmacists were required to adhere. Every
healthcare discipline had an ethical standard or code, and
pharmacists were no different.
3:09:53 PM
Representative Wool asked for more information about the
decision making power the corporations that owned
pharmacies had over pharmacists. He understood that
corporations could influence the type of prescription a
patient would receive.
Dr. Wadsworth added that in any medical or healthcare
discipline, medical professionals might encounter moral
quandaries that put them at odds with their employer.
Entities such as the health system, managed care
organizations, and preferred provider organizations had
significant decision-making power over medical
professionals. He agreed that pharmacists were no different
and found themselves in similar situations.
Co-Chair Foster MOVED to report CSHB 145(HSS) out of
committee with individual recommendations and the
accompanying fiscal note.
There being NO OBJECTION, it was so ordered.
CSHB 145(HSS) was REPORTED out of committee with nine "do
pass" recommendations and two "no recommendation"
recommendations and with one new zero impact note by the
Department of Commerce, Community and Economic Development.
3:12:28 PM
AT EASE
3:14:23 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 80 HSS explanation of changes B to I.pdf |
HFIN 4/25/2022 1:30:00 PM |
SB 80 |
| SB 80(HSS) Sectional Analysis Version I 1.26.22 (002).pdf |
HFIN 4/25/2022 1:30:00 PM |
SB 80 |
| SB 80 Supporting docs and written testimony 1.26.22.pdf |
HFIN 4/25/2022 1:30:00 PM |
SB 80 |
| 3. HB 145, Sectional Analysis, Ver. B.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 4. HB 145, Summary of Changes, Ver. A to Ver. B.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 5. HB 145, AK Pharmacists Assn. Talking Points.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 7. HB 145, DCCED Letter 4.14.21.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 6. HB 145, AK Pharmacists Assn. Fact Sheet.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 8. HB 145, LOS.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| 2. HB 145, Sponsor Statement.pdf |
HFIN 4/25/2022 1:30:00 PM |
HB 145 |
| SB 80 CS WorkDraft v.W 042222.pdf |
HFIN 4/25/2022 1:30:00 PM |
SB 80 |
| SB 80 MH Education Finance Committee CCHR Seattle 4-12-22.pdf |
HFIN 4/25/2022 1:30:00 PM |
SB 80 |