04/22/2021 03:00 PM House HEALTH & SOCIAL SERVICES

               HB 145-EXPAND PHARMACIST AUTHORITY                                                                           
                                                                                                                                
3:30:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  announced that  the  next  order of  business                                                               
would be  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."                                                                                                          
                                                                                                                                
3:30:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  moved to adopt  Amendment 1 to  HB 145,                                                               
labeled 32-LS0720\A.1, Fisher, 4/19/21, which read as follows:                                                                  
                                                                                                                                
     Page 5, following line 18:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 12. AS 21.42 is amended by adding a new                                                                     
     section to read:                                                                                                           
          Sec. 21.42.440. Coverage for costs of services                                                                      
     provided  by   pharmacists.  A  policy,   contract,  or                                                                  
     prepaid plan  for individual or group  health insurance                                                                    
     issued  or   delivered  in  the  state   that  provides                                                                    
     coverage for  services within the scope  of practice of                                                                    
     a pharmacist  licensed under AS 08.80 must  provide for                                                                    
     coverage  of  and  reimbursement for  the  services  if                                                                    
     performed by  a pharmacist  for a person  covered under                                                                    
     the policy, contract, or plan."                                                                                            
                                                                                                                                
3:30:58 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY objected for discussion purposes.                                                                             
                                                                                                                                
3:31:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ explained that  the purpose of Amendment                                                               
1  would  be   to  require  insurance  to   cover  services  that                                                               
pharmacists  are trained  to provide,  but for  which pharmacists                                                               
are not currently  able to receive reimbursement.   She said that                                                               
this would help provide health care in the community.                                                                           
                                                                                                                                
3:31:40 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER  commented that the amendment  would add language                                                               
to the bill  that would further ensure that  pharmacists could be                                                               
reimbursed for the services provided.                                                                                           
                                                                                                                                
3:32:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY removed her objection.   There being no further                                                               
objection, Amendment 1 was adopted.                                                                                             
                                                                                                                                
3:32:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY moved  to adopt  Amendment 2  to HB  145,                                                               
labeled 32-LS0720\A.2, Fisher, 4/19/21, which read:                                                                             
                                                                                                                                
     Page 4, following line 12:                                                                                                 
     Insert a new subsection to read:                                                                                           
          "(c)  This section does not authorize a                                                                               
     pharmacist to  prescribe a  prescription drug  that the                                                                    
     pharmacist is not otherwise authorized to prescribe."                                                                      
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
3:32:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY objected for discussion purposes.                                                                             
                                                                                                                                
3:32:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY explained that  Amendment 2 would insert a                                                               
new  section   that  would  recognize  the   authorization  of  a                                                               
pharmacist  under the  guidelines of  the scope  of practice  for                                                               
pharmacy.  It would ensure that  pharmacists would not be able to                                                               
prescribe beyond the scope of practice, he added.                                                                               
                                                                                                                                
3:33:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA  shared  his  understanding  that,  when  a                                                               
doctor prescribes a  new medication, the doctor looks  at all the                                                               
other medications the patient might  be taking to ensure that the                                                               
medications  will not  react poorly  with each  other.   He asked                                                               
whether  prescribing pharmacists  would have  access to  the same                                                               
information to ensure  that there would be  no negative reactions                                                               
with a patient's other medications.                                                                                             
                                                                                                                                
CO-CHAIR  SNYDER  responded  that  Amendment 2  aims  to  further                                                               
narrow   the   scope   of    pharmacists,   which   may   address                                                               
Representative  Kurka's concern,  and  deferred  the question  to                                                               
invited testifiers.                                                                                                             
                                                                                                                                
3:34:31 PM                                                                                                                    
                                                                                                                                
TOM  WADSWORTH, PharmD,  Administrative  Director, University  of                                                               
Alaska/Idaho  State   University  Doctor  of   Pharmacy  Program,                                                               
responded  absolutely,  and  explained that  pharmacists  have  a                                                               
patient  care  process  that  is  similar  to  all  patient  care                                                               
processes.     He  said  that  it   includes  collaboration  with                                                               
documentation,  which  includes   collecting  Electronic  Medical                                                               
Records  (EMR),  paper  records, referrals,  laboratory  studies,                                                               
past medical histories,  and histories of the  chief complaint of                                                               
the patient.   He explained  that pharmacists have access  to all                                                               
this  information, and  if for  some reason  that information  is                                                               
missing,  pharmacists either  order or  ask for  the information.                                                               
He opined  that it  would be unprofessional  for a  pharmacist to                                                               
proceed without proper access to that information.                                                                              
                                                                                                                                
MR. WADSWORTH  referenced Section  8 of  HB 145,  which discusses                                                               
the  collaborative authority  of pharmacists,  and said  that the                                                               
collaborative practice  agreements that pharmacists  already have                                                               
with  physicians  involve  drawing   up  specific  protocols  and                                                               
procedures in  the patient care  process that the  pharmacist and                                                               
the collaborating  provider will  adhere to.   He  explained that                                                               
those  protocols and  procedures  are reviewed  by  the Board  of                                                               
Pharmacy and the  Board of Medicine in Alaska before  they can be                                                               
implemented.  He said that  these precautions prevent pharmacists                                                               
from  going  outside of  their  area  of  expertise or  scope  of                                                               
practice.                                                                                                                       
                                                                                                                                
3:38:32 PM                                                                                                                    
                                                                                                                                
JUSTIN  RUFFRIDGE, PharmD,  State Board  of Pharmacy,  added that                                                               
the information flow between pharmacists  and providers goes both                                                               
directions.   Pharmacists, he said,  access medical  histories of                                                               
patients to  ascertain if there  may be any  medication conflicts                                                               
or other  potential issues.   He  explained that  many pharmacies                                                               
keep and use those records if  a patient transfers to a different                                                               
prescriber or goes  into the hospital.   Pharmacists are involved                                                               
in reviewing  patient charts with  the intake nurse if  a patient                                                               
were to enter a hospital or intake facility, he said.                                                                           
                                                                                                                                
3:40:04 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:40 p.m. to 3:41 p.m.                                                                       
                                                                                                                                
3:41:38 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY removed her objection.   There being no further                                                               
objection, Amendment 2 was adopted.                                                                                             
                                                                                                                                
3:41:56 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER said  she  sees the  need  for legislation  that                                                               
would ensure that the Board  of Pharmacy can oversee pharmacists,                                                               
and  that   pharmacists  can  be  reimbursed   for  the  services                                                               
provided.   She also  emphasized the need  for clarity  to ensure                                                               
that pharmacists' scope of practice  is not being expanded by the                                                               
proposed  legislation.   She said  she would  offer a  conceptual                                                               
amendment to accomplish this.                                                                                                   
                                                                                                                                
3:43:58 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER moved to adopt  Conceptual Amendment 3 to HB 144,                                                               
as follows [original punctuation provided]:                                                                                     
                                                                                                                                
     Page 4, Line 1:                                                                                                            
           Delete "for a disease or condition with an                                                                         
      existing diagnosis and for a condition that does not                                                                    
     require a new diagnosis."                                                                                                
                                                                                                                              
     Page 4, Line 5:                                                                                                            
          Delete "and                                                                                                         
          Insert "or"                                                                                                           
                                                                                                                                
     Page 4, Line 6:                                                                                                            
          Delete "optimization of medication therapy for"                                                                     
                                                                                                                                
REPRESENTATIVE FIELDS objected for discussion purposes.                                                                         
                                                                                                                                
CO-CHAIR SNYDER explained her  conceptual amendment would further                                                               
clarify that the bill would  not interfere with the collaborative                                                               
practice authority (CPA) regulation  and would remove language so                                                               
as  not  to  imply  an   expansion  of  pharmacists'  prescribing                                                               
authority.                                                                                                                      
                                                                                                                                
3:45:30 PM                                                                                                                    
                                                                                                                                
MR. WADSWORTH  expressed his support for  Conceptual Amendment 3.                                                               
He  explained that,  in  working with  the  Alaska State  Medical                                                               
Association,  he realized  the language  that was  chosen in  the                                                               
bill sought  to modify  the CPA regulation  that's been  in place                                                               
since 2002.  He  said that the intent is not  to modify or change                                                               
that process as  it already works well in its  current state.  He                                                               
shared his understanding  that other language in  the bill seemed                                                               
to  broaden independent  prescriptive authority  for pharmacists,                                                               
and Conceptual Amendment  3 would clarify the intent  of the bill                                                               
and ensure that prescriptive authority would not be broadened.                                                                  
                                                                                                                                
3:47:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY asked whether there  would be a need for a                                                               
period after "services"  in Section 8 of HB 145,  on page 4, line                                                               
1,  ["provide  patient  care services"],  given  that  Conceptual                                                               
Amendment 3  proposes the  deletion language on  page 4,  line 1,                                                               
[text provided previously].                                                                                                   
                                                                                                                                
CO-CHAIR ZULKOSKY responded  that when a motion  comes before the                                                               
committee,  there  will  likely   be  a  recommendation  to  make                                                               
technical  and conforming  changes  as needed.    She said  those                                                               
changes would be made by Legislative Legal Services.                                                                            
                                                                                                                                
CO-CHAIR   SNYDER  commented   that   she   would  request   that                                                               
Legislative Legal Services add a period as it is needed.                                                                        
                                                                                                                                
3:47:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA  asked  for clarification  of  the  changes                                                               
being  made by  the amendment,  and  whether it  would widen  the                                                               
scope of pharmacists.                                                                                                           
                                                                                                                                
CO-CHAIR  SNYDER  responded that  the  first  part of  Conceptual                                                               
Amendment 3, which  proposes the deletion of language  on page 4,                                                               
line  1,  would  make  HB  145 consistent  with  the  CPA.    She                                                               
explained that  it is not  about widening or narrowing  the scope                                                               
of  pharmacists, but  simply making  it consistent  with existing                                                               
CPA  regulations.   She added  that the  second component  of the                                                               
conceptual  amendment would  further  clarify that  the scope  of                                                               
services that pharmacists can provide is not being broadened.                                                                   
                                                                                                                                
3:49:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS removed  his  objection.   There being  no                                                               
further objection, Conceptual Amendment 3 was adopted.                                                                          
                                                                                                                                
3:49:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA shared  his understanding  that the  bills                                                                
main  purpose is  to expand  the ability  of pharmacists  to help                                                               
consult  patients  and  administer tests,  particularly  COVID-19                                                               
tests.   He asked to what  extent the scope of  pharmacists would                                                               
be increased or not increased should HB 145 pass.                                                                               
                                                                                                                                
CO-CHAIR  SNYDER   answered  that   the  intent  is   to  provide                                                               
clarification  on the  range of  practices  that pharmacists  are                                                               
already engaged in to ensure  that "out of date" statutes reflect                                                               
the  current   state  of  practice.     She   mentioned  testing,                                                               
vaccination,  and   administration  of  Naloxone   as  additional                                                               
details  that needed  to be  captured.   She  explained that  the                                                               
final intent  of the bill  is that pharmacists have  already been                                                               
providing this type  of care for an extended period  of time, but                                                               
pharmacists were not able to be  reimbursed by insurance due to a                                                               
lack of language [in statute].                                                                                                  
                                                                                                                                
3:52:12 PM                                                                                                                    
                                                                                                                                
MR. RUFFRIDGE added  that the Board of Pharmacy  is attempting to                                                               
regulate the areas in which  pharmacists are engaged, ensure that                                                               
pharmacists  are  seen  as practicing  within  their  scope,  and                                                               
pharmacists are  able to be  reimbursed for their practices.   He                                                               
emphasized that pharmacists both  dispense medications and act as                                                               
a  "middle manager"  in health  care.   He said  that pharmacists                                                               
rarely  find  themselves  in entities  such  as  hospitals  where                                                               
insurances  can  be  billed for  the  services  that  pharmacists                                                               
provide.   He said the  conceptual amendment wouldn't  change the                                                               
ways in  which pharmacists dispense medications  but would remove                                                               
limitations to ensure that pharmacists  are able to perform fully                                                               
as a "manager  of care in the middle."   He offered clarification                                                               
that pharmacists are providers of  services, not just dispensers,                                                               
and  said  that  the  proposed legislation  with  the  conceptual                                                               
amendment would allow for that.                                                                                                 
                                                                                                                                
3:54:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY  requested clarification on  the potential                                                               
for  pharmacists to  offer treatment  through  the dispensing  of                                                               
Buprenorphine.                                                                                                                  
                                                                                                                                
MR. RUFFRIDGE responded that work  needs to be done nationwide on                                                               
this issue.   He noted that there are other  requirements to be a                                                               
part  of a  medication-assisted treatment  (MAT) program,  one of                                                               
which is  a federal change  that would have  to happen.   He said                                                               
that  pharmacists are  already engaged  in this  in primary  care                                                               
settings.   As far as a  wider offering [of the  medication] that                                                               
Representative McCarty  is suggesting, HB  145 is a step  in that                                                               
direction,  he said.   He  explained  that the  bill would  well-                                                               
position the state to be  available to implement those additional                                                               
types of therapies should the federal changes be made.                                                                          
                                                                                                                                
REPRESENTATIVE MCCARTY  commented that  he hopes the  state stays                                                               
within the  guidelines of the  Substance Abuse and  Mental Health                                                               
Services Administration (SAMHSA) and the MAT program.                                                                           
                                                                                                                                
3:57:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS moved to report  HB 145, as amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSHB  145(HSS)  was                                                               
reported  from  the House  Health  and  Social Services  Standing                                                               
Committee.