Legislature(2021 - 2022)BARNES 124
04/12/2021 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Board of Certified Real Estate Appraisers | |
| SB87 | |
| HB145 | |
| HB90 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 87 | TELECONFERENCED | |
| *+ | HB 145 | TELECONFERENCED | |
| += | HB 90 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HB 145-EXPAND PHARMACIST AUTHORITY
3:41:55 PM
CO-CHAIR SPOHNHOLZ 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."
3:42:29 PM
REPRESENTATIVE SNYDER, as prime sponsor, introduced HB 145,
which she described as a "housekeeping bill" as it pertains to
the business of pharmacy and pharmacy services. She paraphrased
the sponsor statement, which read as follows [original
punctuation provided]:
Passage of House Bill 145, "The Pharmacist
Mobilization Act," increases access to care and
ensures Alaska's pharmacists are reimbursed when
providing services.
I am introducing it at the request of the Alaska
Pharmacists Association in partnership with the Alaska
Board of Pharmacy and the University of Alaska/Idaho
State Doctor of Pharmacy Program.
The coronavirus pandemic has shown that pharmacists
can engage at an elevated level to help deliver
necessary healthcare to all Alaskans. Pharmacists have
provided COVID-19 testing, vaccinations, and
telehealth visits, and have helped patients manage
chronic health conditions. This bill will update
outdated statute so pharmacists can continue providing
these services.
HB 145 defines the patient care services that
pharmacists and pharmacy support staff can
independently provide, allows pharmacist technicians
to administer vaccines when under the direct
supervision of a licensed pharmacists, and empowers
the Board of Pharmacy to regulate pharmacists, student
pharmacists, and pharmacy support staff who provide
these services.
Furthermore, the bill updates the current provider
anti-discrimination statute to support insurance
coverage of these patient care services when provided
by a pharmacist. Currently, pharmacists are one of the
only healthcare professionals not listed in this
statute.
HB 145 largely updates outdated statutes to align with
current practices. Its passage benefits Alaskans by
increasing healthcare access during and after the
pandemic. Please support this common sense,
housekeeping bill that will help your local, patient-
oriented pharmacies continue to provide essential
services.
3:45:13 PM
ALLIANA SANGUIT, Staff, Representative Liz Snyder, Alaska State
Legislature, on behalf of Representative Snyder, prime sponsor,
detailed the sectional analysis of HB 145 [original punctuation
provided]:
Sec. 1: Adds language to AS 08.80.030(b) Powers and
Duties of the Board, statute that outlines the Board
of Pharmacy's powers, that allows the Board of
Pharmacy to adopt rules to regulate the independent
monitoring of drug therapy and independent pharmacist
prescribing of vaccines and naloxone.
Sec. 2: Adds a new subsection to AS 08.80.045
Nonprescription Drugs that aligns statute with the
current practice of pharmacists recommending non-
prescription medications and devices for treating
minor and self-limited conditions.
Sec. 3: Amends AS 08.80.155 Emergency Permit to
increase the Board of Pharmacy's flexibility to grant
emergency licenses for all relevant licenses used in
pharmacies.
Sec. 4: Amends AS 08.80.168(a) Administration of
Vaccines and Related Emergency Medications by adding
"prescribe" to existing vaccine administration
statute.
Sec. 5: Amends AS 08.80.168(b) by replacing "dispense"
with "prescribe and administer" in regards to
administering an opioid overdose drug.
Sec. 6: Adds a new subsection to AS 08.80.168 that
allows a pharmacy technician to administer a vaccine
or related emergency medication but only if they have
been authorized by the Board of Pharmacy to do so AND
if they are under the direct supervision of a licensed
pharmacist who meets the requirements in AS 08.80.168
(a).
Sec. 7: Adds language to AS 08.80.297(a) Prescription
Prices Available to Consumer that allows personnel who
are not licensed pharmacists to disclose the cost of
filling a prescription when directed by a pharmacist
working at the same institution.
Sec. 8: Amends AS 08.080 Pharmacists and Pharmacies by
adding a new section, AS 08.80.337 Other Patient Care
Services, that:
? Allows a pharmacist to provide patient care
services for a disease or condition with an
existing diagnosis under an agreement made with
and approved by a practitioner
? Limits patient care services that pharmacists
can provide to those that are minor,
selflimiting, and have a CLIA-waived laboratory
test which guides clinical decision making.
? Provides language that allows pharmacists to be
reimbursed for providing these services 04/07/21
Sec. 9: Amends AS 08.80.480 Definitions by removing
"dosage form" as a definition of "equivalent drug
product". This allows pharmacists to make minor, non-
therapeutic changes to prescriptions using clinical
judgement and expertise without contacting the
prescriber for verbal or written approval. This does
not allow a pharmacist to substitute a dosage form
that would negatively impact patient outcomes, safety,
or cost effectiveness. Examples of appropriate
substitutions under this section include changing from
a tablet form of medication to a capsule form of the
same medication and strength.
Sec. 10: Amends AS 08.80.480(30) by adding
"dispensing" and "independent prescribing" to the
definition of the "Practice of Pharmacy" to align with
the changes made in Section 4 & 5 (AS 08.80.168) of
this bill. These additions better represent actual
provision of naloxone and vaccine by pharmacists.
Sec. 11: Amends AS 21.36.090(d) Unfair Discrimination
to include "pharmacists" as protected health care
providers in the provider anti-discrimination statute.
This aligns the state statute with federal statute
(CFR 438.12) and afford pharmacists the same
protection as all other healthcare providers when
engaging health plans for covered services such as
ordering laboratory tests, point-of-care testing,
vaccine prescribing and administration, preventative
health services, managing minor self-limiting
conditions, and participating in collaborative disease
state management.
3:49:30 PM
TOM WADSWORTH, PharmD, Chief Administrative Officer, University
of Alaska/Idaho State University Doctor of Pharmacy Program,
informed the committee that his testimony doesn't represent any
official position of the University of Alaska and that he was
speaking as a practicing pharmacist and educator. He explained
that the Doctor of Pharmacy program trains students in every
area proposed under HB 145, noting that graduates of the program
are prepared to engage in a variety of patient care settings.
He said that only about half of all practicing pharmacists are
engaged in the community setting such as what one would find at
a Walgreen's or Safeway pharmacy; pharmacists are often embedded
inside physician clinics doing medicine management or post-
diagnostic disease management. Pharmacists can specialize in
pediatrics, oncology, infectious diseases, and psychiatry, he
explained, and in each case are medication experts tasked with
improving the medication experience for the patient. He
expressed that HB 145 is a needed update to pharmacy practice
laws, empowering the Board of Pharmacy to regulate patient care
services not related simply to dispensing.
3:51:59 PM
GRETCHEN GLASPY, PharmD, President, Alaska Pharmacists
Association, testified in support of HB 145. She informed the
committee that the Alaska Pharmacists Association represents
over 250 pharmacists, pharmacy technicians, and student
pharmacists in Alaska. She said she has been a pharmacist for
15 years and is presently with Bartlett Regional Hospital as a
clinical informatics pharmacist, or expert in pharmaceutical
technology. She stated her strong support for HB 145.
3:53:24 PM
JUSTIN RUFFRIDGE, PharmD, Board of Pharmacy, explained that the
Board of Pharmacy was tasked with regulating support for
pharmacists' COVID-19 response and having the emergency
regulations in place to take effect post-pandemic to facilitate
recovery and expanding access to healthcare. One of the most
difficult areas, he said, was consistent friction due to state
statutes existing in conflict with current pharmacy practices.
Current statutes, he said, are largely relevant only to
dispensing pharmacists, without considering the many other areas
of pharmaceutical practice. He characterized HB 145 as
legislation that would empower the Board of Pharmacy to continue
to regulate pharmacies, pharmacists, pharmacy technicians, and
interns at the highest possible level.
3:55:27 PM
REPRESENTATIVE NELSON asked for further explanation of Section 7
of HB 145.
DR. RUFFRIDGE explained that there is a wide variety of
opportunity for multiple individuals to use information related
to the cost of filling a prescription. Pharmacy technicians are
highly trained, he explained, and are usually engaged in
computer-based activity of billing, looking up prices, and
ordering medication. A pharmacist concentrates on the medicine,
looking out for things like interactions or side effects. He
characterized pharmacy technicians as "more adept and more in
the nitty gritty of the billing" than pharmacists and stated
that this is one of the ways the statutes could be aligned with
current practices.
3:57:53 PM
CO-CHAIR SPOHNHOLZ pointed out that most people visiting a
pharmacy speak with the pharmacy tech instead of a pharmacist.
3:58:12 PM
REPRESENTATIVE KAUFMAN expressed concern that parts of the
proposed legislation would encroach on primary care.
REPRESENTATIVE SNYDER replied that, while physicians and
physician groups have been contacted, no comments have been
received.
3:59:29 PM
DR. WADSWORTH explained that there is already a definition in
statute that addresses the duties of a pharmacist in providing
pharmaceutical care or drug therapy, in what is called "other
patient care services" for the intent of prevention and
treatment of disease. The goal of Section 8 of HB 145, he said,
is to determine exactly what patient care services the language
refers to. He said there are no activities outlined in Section
8 that have not been practiced by pharmacists for at least the
past 20-30 years; however, pharmacists in the private sector
have experienced difficulties in engaging health plans for
reimbursement, so such services have mainly been practiced by
pharmacists within organizations such as tribal health
organizations or U.S. Veterans Affairs facilities. He noted
that in a free market, services without a revenue stream cease
being offered. Dr. Wadsworth directed attention to Section 8,
subsection (a), describing a collaborative agreement to provide
patient care services along with a practitioner, which he said
is in accord with already-existing statutes and regulation
around what's referred to as the "pharmacist collaborative
authority," in effect since 2002.
DR. WADSWORTH addressed Section 8, subsection (b), which he said
defines what patient care services a pharmacist may provide
independently, noting that the subsection does not contain any
activity not already practiced by pharmacists. Areas such as
general health and wellness, smoking cessation, over-the-counter
recommendations, or disease prevention, he said, all are non-
prescriptive areas; minor or self-limiting conditions such as
athlete's foot are often presented to pharmacists. He discussed
certain types of tests performed by pharmacists and pointed out
that if HB 145 were to fail, these tests would still be
performed by pharmacists, just without reimbursement from health
care insurers. Collaborative agreements such as the pharmacist
collaborative authority, he said, are currently reviewed by the
Board of Pharmacy and the Board of Medicine; the clarity that HB
145 would provide regarding independent patient care services
would allow pharmacists to engage with health care plans and
companies to provide services. For instance, he said, a patient
who goes to a Soldotna pharmacy for a COVID-19 test would be
able to have it covered by insurance.
4:05:04 PM
REPRESENTATIVE KAUFMAN asked whether subsection (b) could lead
pharmacists to believe they have more authority than they
actually do.
4:06:27 PM
MR. RUFFRIDGE responded that the Board of Pharmacy discussed
subsection (b) in depth with providers, physicians, and
practitioners across the state. The intent, he said, is not to
promote prescription of medications outside of the current
purview of pharmacists. The vagueness of the subsection is to
allow for the "multitude of situations" encountered every day by
pharmacists to be covered by the proposed legislation. He
pointed out that under current statute, smoking cessation
recommendations could not specifically be made by a pharmacist.
REPRESENTATIVE KAUFMAN asked to be provided with more
information.
4:09:06 PM
CO-CHAIR FIELDS commented that he had the same question when he
initially read the proposed legislation, and expressed that HB
145 seems to "strike the right balance."
4:09:38 PM
REPRESENTATIVE MCCARTY expressed support for HB 145 discussed
having pharmacists offer eye exams.
4:11:09 PM
CO-CHAIR SPOHNHOLZ clarified that the invited testifiers are
Doctors of Pharmacy, not of medicine. She then asked whether HB
145 would allow pharmacists to perform eye exams.
4:12:10 PM
DR. WADSWORTH replied that HB 145 does not specifically propose
eye exams to be included in the covered activities, but that it
would not be above the purview of a pharmacist to have an eye
chart and perform a simple eye exam.
CO-CHAIR SPOHNHOLZ pointed out that Representative McCarty's
question referred to a test currently administered by people not
trained in healthcare or optometry, such as employees of the
Department of Motor Vehicles.
DR. WADSWORTH agreed and noted that there is a precedent for
every item in Section 8. He pointed out that the Board of
Pharmacy would be the regulator of the statute. He then said
that diabetes or high blood pressure screenings are performed by
pharmacists as part of the general disease prevention activities
in Section 8.
4:14:15 PM
REPRESENTATIVE SNYDER emphasized that HB 145 would update the
statute to reflect current, modern practices.
4:14:42 PM
CO-CHAIR SPOHNHOLZ announced that HB 145 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 90 Opposition Received as of 4.10.21.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 145 Supporting Document - AK Pharmacists Association Fact Sheet.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 145 Sponsor Statement, Ver. A.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 145 Supporting Document - AK Pharmacists Association Talking Points.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 145 Ver. A.PDF |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 145 Fiscal Note - DCCED, 4.09.21.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 145 Sectional Analysis, Ver. A.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 90 v. A 2.18.21.PDF |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Sponsor Statement 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Sectional Analysis 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Supporting Document - State by State P2P Collecting Map 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Supporting Document - Anchorage Ordinance PVRN 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Supporting Document - Revenue Stream Chart 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Supporting Document - State by State DOR Collection Map 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Fiscal Note - DOR, 4.2.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Fiscal Note - DOA, 4.3.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 90 Sponsor Presentation 3.30.21.pdf |
HL&C 4/9/2021 8:00:00 AM HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| SB 87 Fiscal Note 1.pdf |
HL&C 4/12/2021 3:15:00 PM SL&C 3/8/2021 1:30:00 PM |
SB 87 |
| SB 87 v. A.PDF |
HL&C 4/12/2021 3:15:00 PM SL&C 3/8/2021 1:30:00 PM |
SB 87 |
| SB 87 Transmittal Letter.pdf |
HL&C 4/12/2021 3:15:00 PM |
SB 87 |
| SB 87 v. A Sectional Analysis.pdf |
HL&C 4/12/2021 3:15:00 PM SL&C 3/8/2021 1:30:00 PM |
SB 87 |
| SB 87 NAIC Credit for Reinsurance Model Law Briefing.pdf |
HL&C 4/12/2021 3:15:00 PM SL&C 3/8/2021 1:30:00 PM |
SB 87 |
| SB 87 SLAC Answers to Members' Questions.pdf |
HL&C 4/12/2021 3:15:00 PM SL&C 3/19/2021 1:30:00 PM |
SB 87 |
| Justin Ruffridge Board Application.pdf |
HL&C 4/12/2021 3:15:00 PM |
HL&C Confirmations 2021 |
| Rachel Berngartt Resume.pdf |
HL&C 4/12/2021 3:15:00 PM |
HL&C Confirmations 2021 |
| Justin Ruffridge Resume.pdf |
HL&C 4/12/2021 3:15:00 PM |
HL&C Confirmations 2021 |
| Mae Sprague Hayes Board Application.pdf |
HL&C 4/12/2021 3:15:00 PM |
HL&C Confirmations 2021 |
| HB 145 Support Received as of 4.10.21.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |
| HB 90 Supporting Document, DOR Response 4.12.21.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 90 |
| HB 145 Support Received as of 4.12.21.pdf |
HL&C 4/12/2021 3:15:00 PM |
HB 145 |