04/22/2024 03:15 PM House LABOR & COMMERCE

                HB 226-PHARMACIES/PHARMACISTS/BENEFITS MANAGERS                                                             
                                                                                                                                
4:29:05 PM                                                                                                                    
                                                                                                                                
VICE    CHAIR     JUSTIN     RUFFRIDGE       announced      that    the    next    order     of                                 
business      would    be   HOUSE     BILL   NO.    226,    "An   Act    relating     to   the                                  
Board      of     Pharmacy;         relating       to     insurance;         relating        to                                 
pharmacies;         relating       to    pharmacists;         relating        to    pharmacy                                    
benefits      managers;      relating      to   patient     choice     of   pharmacy;      and                                  
providing       for   an   effective       date."       [Before      the    committee      was                                  
CSHB 226(HSS).]                                                                                                                 
                                                                                                                                
4:29:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         SADDLER      moved     to   adopt     the    proposed      committee                                     
substitute        (CS)     for    HB     226,     Version      33-LS0955\D,         Wallace,                                    
4/20/24, as a working document.                                                                                                 
                                                                                                                                
VICE CHAIR JUSTIN RUFFRIDGE objected.                                                                                           
                                                                                                                                
4:29:45 PM                                                                                                                    
                                                                                                                                
MS.    HACKENMILLER,         on    behalf     of    Representative         Sumner,      prime                                   
sponsor,      read   the   explanation       of   changes     in   version     D  [included                                     
in     committee        packet],        which      read      as     follows       [original                                     
punctuation provided]:                                                                                                          
                                                                                                                                
              Title  Amends title removing reference to the Board                                                               
       of Pharmacy.                                                                                                             
                                                                                                                                
       Ver. R Section 1 removed.                                                                                                
                                                                                                                                
       Section 1  Ver. R Section 2, no change.                                                                                  
                                                                                                                                
       Section 2  Ver. R Section 3, no change.                                                                                  
                                                                                                                                
       Section 3  Ver. R Section 4, no change.                                                                                  
                                                                                                                                
       Section 4  Ver. R Section 5, no change.                                                                                  
                                                                                                                                
       Section 5  Ver. R Section 6, no change.                                                                                  
                                                                                                                                
       Section 6  Ver. R Section 7, no change.                                                                                  
                                                                                                                                
            AS 21.27.945               Drug pricing list; procedural                                                            
       requirements:                                                                                                            
                                                                                                                                
               Section      7        Modifies       Ver.     R    Section      8,    AS                                         
               21.27.945(a)                                                                                                     
                                                                                                                                
               Modifies      (a)(5),      reinstating        language      from     the                                         
               original       bill     draft     (Ver.      B)    regarding       list                                          
               prices.                                                                                                          
                                                                                                                                
               Section 8  Ver. R Section 9, no change.                                                                          
                                                                                                                                
               Section      9        Modifies       Ver.    R    Section      10,    AS                                         
               21.27.945(d)                                                                                                     
                                                                                                                                
               Modifies      (d)(3)(A),      removing      second     phrase     "from                                          
               60     percent       or     more      of    the      pharmaceutical                                              
               wholesalers doing business in the state."                                                                        
                                                                                                                                
       Section 10  Modifies Ver. R Section 11.                                                                                  
                                                                                                                                
                Removes Patient choice of pharmacy (previous new                                                                
       section 21.27.951), following sections renumbered.                                                                       
               Sec.     21.27.951.        Patient      access      to     clinician-                                            
               administered drugs.                                                                                              
                                                                                                                                
               Previous      section       21.27.952       with     modifications:                                              
               Modifies     (a)(2)     removing      "or   reduce     payment     to   a                                        
               provider"      on    line    20.    Removes      (a)(3);      replaces                                           
               with    new    language.       New     (a)(3)     states      that    an                                         
               insurer      or   PBM    may    not    require      a   pharmacy      to                                         
               dispense       a    clinician-administered              drug     to     a                                        
               covered     person    to   then   transport      it   to  a   provider                                           
               for    administration.          Removes     (a)(5)      and    (a)(6),                                           
               following paragraphs renumbered.                                                                                 
                                                                                                                                
       Section 11  Modifies Ver. R Section 12.                                                                                  
                                                                                                                                
       Removes Sec. 21.27.960 Coverage for dispensing fees.                                                                     
                                                                                                                                
               Sec. 21.27.975. Definitions.                                                                                     
               Removes     the   definition      of   "independent        pharmacy,"                                            
               previous paragraph (8).                                                                                          
                                                                                                                                
       Section       12        Modifies       Ver.    R    Section      13,     amends                                          
       21.36.520 - Unfair trade practices.                                                                                      
                                                                                                                                
       Removes         Ver.       R     (e)(1),        following          paragraphs                                            
       renumbered.          Removes        reference         to      statutes        in                                         
       renumbered        (e)(1)      through       (e)(3).      Removes       Ver.     R                                        
       (e)(8),      following      paragraphs       renumbered.       Removes     Ver.                                          
       R   (e)(10),       following       paragraphs       renumbered.        Removes                                           
       (f)(7) "mail-order pharmacy."                                                                                            
                                                                                                                                
       Section 13  Ver. R                                                                                                       
                                                                                                                                
       Section     14,   no   change.     Section     14     Ver.    R  Section     15,                                         
       no change.                                                                                                               
                                                                                                                                
       Section 15  Modifies Ver. R Section 16.                                                                                  
                                                                                                                                
       Updates referenced sections.                                                                                             
                                                                                                                                
       Section 16  Ver. R Section 17, no change.                                                                                
                                                                                                                                
       Section 17  Modifies Ver. R Section 18.                                                                                  
                                                                                                                                
       Updates referenced transition regulations.                                                                               
                                                                                                                                
       Section 18  Modifies Ver. R Section 19.                                                                                  
                                                                                                                                
       Updates      referenced      section      and   changes     effective      date                                          
       from July 1, 2025, to January 1, 2026.                                                                                   
                                                                                                                                
REPRESENTATIVE FIELDS asked Steve Ramos to speak to Version D.                                                                  
                                                                                                                                
4:34:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         FIELDS     shared     his    understanding        that     Version     D                                 
eliminates       the   ability     to   do   spread     pricing     within     in   Title    21                                 
plans;     however,       he   asked     whether      AlaskaCare       could     still     use                                  
spread pricing.                                                                                                                 
                                                                                                                                
STEVE     RAMOS,      Acting     Chief     Health      Administrator,         Division       of                                 
Retirement       &   Benefits,       Department       of   Administration,          answered                                    
yes; however, that's not the intent.                                                                                            
                                                                                                                                
REPRESENTATIVE         FIELDS     said    if   the    provision      of   spread     pricing                                    
were    prohibited,       per    Version     D,   would     it   preserve      the   ability                                    
for AlaskaCare to use spread pricing.                                                                                           
                                                                                                                                
MR. RAMOS said his answer remained the same.                                                                                    
                                                                                                                                
4:36:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         PRAX   asked     how   Version     D   would    affect     the   plans                                   
Mr. Ramos manages for the state.                                                                                                
                                                                                                                                
MR.   RAMOS    said   it   would    not   affect    [the    division].        He  explained                                     
that    the   provisions       in   the   previous      version     of   bill    that   would                                   
have     added     expenses      were     removed.         In    addition,       the    plans                                   
regulated      under     AS   39.30.090-AS       39.30.091       were    removed,     so   the                                  
bill no longer applies to the division.                                                                                         
                                                                                                                                
4:37:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE        FIELDS     sought    to   confirm     that   both    AlaskaCare      and                                  
Arisa    plans    could    continue      to   use   spread    pricing      if  they    wished                                   
with no direct impact on cost.                                                                                                  
                                                                                                                                
MS.   WING-HEIER       answered     yes.      She   explained      that    the   only   plans                                   
that    could     be   touched     by    Version     D   are   plans     regulated      under                                   
Title 21.                                                                                                                       
                                                                                                                                
4:38:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         PRAX     asked     how    much     of    the    market      would     be                                 
impacted by the bill.                                                                                                           
                                                                                                                                
MS.    WING-HEIER      answered      15   percent      of   the   total     population       of                                 
Alaska.                                                                                                                         
                                                                                                                                
4:38:56 PM                                                                                                                    
                                                                                                                                
VICE    CHAIR   JUSTIN     RUFFRIDGE      asked    Ms.   Wing-Heier      to   speak    to  the                                  
fiscal note from DCCED.                                                                                                         
                                                                                                                                
MS.   WING-HEIER       said    there    was    a  concern      that    the   bill    may   not                                  
make    it    to   the    floor     before     the    end    of   session      due    to   its                                  
finance      referrals      and    large     fiscal     notes;     consequently,        there                                   
were    discussions        about     removing       all    fiscal     notes,     which     was                                  
accomplished         in    Version      D.       She    noted     that     the    following                                     
important      provisions      to   protect     independent       pharmacists       remained                                    
in   the    bill:     prohibiting        spread     pricing      and    brown    and    white                                   
bagging;       requiring        pharmacists         to    register;        the    fiduciary                                     
section     of  the    bill;    and   the   unfair    trade    practices      that   provide                                    
important      consumer      protections.         Anything      to  do   with    dispensing                                     
fees    or   reimbursements         were    removed     from    the   bill,     as   well    as                                 
references to AlaskaCare, Arisa plans, and government entities.                                                                 
                                                                                                                                
4:40:33 PM                                                                                                                    
                                                                                                                                
SYLVAN     ROBB,    Director,       Division      of   Corporations,        Business,      and                                  
Professional         Licensing,       Department        of    Commerce,       Community       &                                 
Economic     Development,        said   the   Version     D  removes     sections      of  the                                  
bill    that   would    impact     the   division,      resulting      in   a  zero    fiscal                                   
note.                                                                                                                           
                                                                                                                                
4:41:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE          PRAX    expressed        concern      that     Version      D   would                                   
increase prices for 15 percent of the market.                                                                                   
                                                                                                                                
MS.   HACKENMILLER        emphasized       the   importance       of   the   bill,     adding                                   
that    this   would    not   be   the   last    the   committee      sees    of  reform     to                                 
the pharmacy benefit managers.                                                                                                  
                                                                                                                                
VICE     CHAIR     RUFFRIDGE      declared       a   conflict      of    interest,       as   a                                 
pharmacist       and    a   pharmacy      owner     in    Alaska.        He   opined      that                                  
guardrails       are    necessary      and    rejected      the    idea    that    the    bill                                  
would    increase     the   cost    of  healthcare.         He  stated     that   Version     D                                 
would    set   sideboards       and   help    Alaskans     get    their    medications       in                                 
a  timeframe      that    works    for   them,    which    is  particularly       important                                     
at a time when pharmacies are being eroded in the state.                                                                        
                                                                                                                                
4:45:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         PRAX    empathized        with    pharmacies       and    reiterated                                     
that    only    15   percent      of   the    market     would    be   dealt     with.       He                                 
shared     his    belief     that    providers      and    insurers      need    to   have    a                                 
conversation to figure out what works for everyone.                                                                             
                                                                                                                                
REPRESENTATIVE         FIELDS      said    passing      the    bill    would     teach     the                                  
legislature       by   providing      insight     into    15  percent     of   the   market.                                    
He   acknowledged        the    complexity       of   the    problem     and    opined     the                                  
further      action     could     be   considered       after     observing       a  limited                                    
part of the market.                                                                                                             
                                                                                                                                
4:47:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE         SADDLER      moved    to    report     CSHB    226,     Version     33-                                  
LS0955\D,       Wallace,      4/20/24,      out    of    committee       with    individual                                     
recommendations         and   the   accompanying       fiscal     notes.    no   objection,                                     
bill    advanced.          There    being     no    objection,       CSHB    226(L&C)      was                                  
reported from the House Labor and Commerce Standing Committee.