Legislature(2015 - 2016)CAPITOL 106
03/01/2016 03:15 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB344 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 344 | TELECONFERENCED | |
| += | HB 227 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 1, 2016
3:32 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Neal Foster
COMMITTEE CALENDAR
HOUSE BILL NO. 344
"An Act relating to the controlled substance prescription
database; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 227
"An Act relating to medical assistance reform measures; relating
to administrative appeals of civil penalties for medical
assistance providers; relating to the duties of the Department
of Health and Social Services; relating to audits and civil
penalties for medical assistance providers; relating to medical
assistance cost containment measures by the Department of Health
and Social Services; relating to medical assistance coverage of
clinic and rehabilitative services; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 344
SHORT TITLE: DRUG PRESCRIPTION DATABASE
SPONSOR(s): REPRESENTATIVE(s) SEATON
02/24/16 (H) READ THE FIRST TIME - REFERRALS
02/24/16 (H) HSS
03/01/16 (H) HSS AT 3:15 PM CAPITOL 106
WITNESS REGISTER
SUSIE EDWARDSON, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 344 on behalf of
Representative Seaton, bill sponsor.
TANEEKA HANSEN, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 344 on behalf of
Representative Seaton, bill sponsor.
JAY BUTLER, MD, Chief Medical Officer/ DPH Director
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of HB 344.
JANEY HOVENDEN, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 344.
BILL ALTLAND, Pharmacist
Board of Pharmacy
Prince of Wales Island, Alaska
POSITION STATEMENT: Testified and answered questions during the
presentation of HB 344.
SCOTT WATTS, Pharmacist
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 344.
MATT KEITH, Vice President of Pharmacy
Geneva Woods Health Care
Wasilla, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 344.
DAN NELSON, Pharmacist
Fairbanks, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 344.
ACTION NARRATIVE
3:32:37 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:32 p.m.
Representatives Seaton, Vazquez, Talerico, and Wool were present
at the call to order. Representatives Stutes and Tarr arrived
as the meeting was in progress.
HB 344-DRUG PRESCRIPTION DATABASE
3:33:04 PM
CHAIR SEATON announced that the first order of business would be
HOUSE BILL NO. 344, "An Act relating to the controlled substance
prescription database; and providing for an effective date."
3:35:00 PM
SUSIE EDWARDSON, Staff, Representative Paul Seaton, Alaska State
Legislature, paraphrased from a prepared statement, which read
[original punctuation provided]:
Talking points for HB 344
· The point of HB 344 is to strengthen the existing
Prescription Drug Database into a tool that will
better assist providers with knowing and understanding
the status of their patients' prescriptions.
· It does this by:
o requiring near real time entry of information into the
database-to make sure the information is as up to date
as possible and to prevent excessive prescriptions
within a short time frame.
o allowing a pharmacist or practitioner to delegate
access and submittal authority to an authorized
employee or agent- to remove some of the
administrative burden from the practitioner in charge
o requiring that all practitioners who interact with
controlled substances shall register with the
database- to allow them to truly evaluate their
patient's information.
o Requiring that dispensers check the database prior to
dispensing.
o And by creating an automatic alert system within the
database, which will push unsolicited reports to
prescribers and pharmacists if a patient's dosage or
number of prescriptions reach a level of concern.
· HB 344 also allows database access to the Medicaid
Pharmacist and the Medicaid Drug Utilization Review
Committee, to allow them to review prescription drug
utilization rates under the program, and to the state
medical examiner for the purpose of investigating a
cause of death.
· De-identified data will be supplied to the Department
of Public Health to allow them to monitor overall
health trends in the state.
3:37:59 PM
MS. EDWARDSON further explained that:
· Our current prescription drug database is not as
strong as it could be.
o Data is only required to be submitted on a monthly
basis, which can leave large gaps in the information
that would allow one patient to fill multiple
prescriptions without anyone knowing. Some
pharmacists send in information more frequently than
this, but the database as a whole is only updated
monthly.
o While all pharmacies are required to submit
prescription information, registration with the
database is not mandatory. Today, approximately 40%
of dispensers and only 13.5% of prescribers are
registered. The remaining 86.5% of prescribers have
no way of knowing if their patient is receiving
prescriptions from another prescriber or at what
dosage.
o The Board of Pharmacy is in charge of the database.
They currently do sometimes send out unsolicited
reports, which can alert unsuspecting providers to
concerning behavior, but they do not expressly have
that authority. HB 344 gives them that authority.
3:39:43 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, paraphrased from the Sectional Analysis [included
in members' packets], which read:
Section 1 (Pg 1, Line 4) This section allows
pharmacists or providers delegate the submittal of
information to the database to an authorized employee
or agent. This section also requires that pharmacists
submit data in near real time, in the procedure
established by the Board of Pharmacy.
Section 2 (Pg 2, Line 20) This section requires that
the information in the database remain confidential
and describes who is permitted to access the database.
Under this bill, a practitioner or pharmacist may
delegate access to an authorized agent or employee.
Access is also granted to the lead Medicaid pharmacist
and the Medicaid Utilization review committee to
review drug utilization in the Medicaid program. It is
also granted to the State Medical Examiner for
investigation into cause of death. Finally, this
section allows that authorized employees of Health and
Social Services may receive de-identified information
from the database for public health.
3:41:22 PM
MS. HANSEN continued with the review of the Sectional Analysis,
which read:
Section 3 (Pg 4, Line 5) AS 17.30.200 (e) is amended
to state that the failure of the pharmacists or
providers to register or submit information to the
database is grounds for the board to take disciplinary
action.
3:41:43 PM
MS. HANSEN further explained the Sectional Analysis, which read:
Section 4 (Pg 4, Line 11) Deletes language stating
that dispensers or practitioners are not obligated to
check the database prior to dispensing, to conform to
the requirement on dispensers in section 5.
3:42:01 PM
MS. HANSEN moved on to the next section, which read:
Section 5 (Pg 4, Line 20) This section requires that a
dispenser or their authorized agent or employee shall
check the database prior to dispensing and submit the
prescription information to the database in near real
time.
3:42:30 PM
MS. HANSEN discussed Section 6 of the proposed bill, which read:
Section 6 (Pg 5, Line 6) This section adds new
subsections that include in subsection (o) an
exemption made for practitioners or pharmacist who
cannot update the database in near real time due to
technological barriers and in subsection (p) creates
an automatic electronic alert system when someone has
prescriptions inconsistent with general standards.
Subsection (q) requires all healthcare providers who
prescribe, dispense, or administer a controlled
substance to register with the prescription drug
database and subsection (r) directs the board of
pharmacy to notify the necessary medical board when a
practitioner registers with the database.
3:44:15 PM
MS. HANSEN continued her discussion of the Sectional Analysis,
which read:
Section 7 (Pg 5, Line 27) This section allows the
board of pharmacy to adopt the regulations necessary
to implement this act.
Section 8 (Pg 6, Line 2) This section directs that all
dispensers and prescribers shall register with the
database within 180 of the effective date of the bill,
allowing additional time to register. The board of
pharmacy shall provide information to other boards on
how to register and comply with database.
3:45:13 PM
MS. HANSEN concluded the presentation of the sectional analysis,
which read:
Section 9 (Pg 6, Line 12) The regulatory authority
under this act takes effect July 1, 2016.
Section 10 (Pg 6, Line 13) Except in section 9, the
changes created by this act take effect January 1,
2017.
3:45:38 PM
CHAIR SEATON asked about the proposed changes to the bill.
MS. HANSEN replied that, although currently there were not any
draft amendments, there were some concerns. She explained that
in order to relieve the burden of time demands from an emergency
room doctor or the pharmacist in charge, it was important to be
able to delegate authority. She pointed out that it was
important for delegation to be to a state licensed or registered
employee, to allow for enforcement action for the proper use of
information, and that language to change this was being
considered. The delegation would include a wide range of
providers connected with the state medical boards, such as
certified nurse assistants and dental hygienists.
3:47:04 PM
MS. HANSEN shared that there were also concerns for the cost of
the near real time requirement, noting that committee members
had letters commenting on this issue. She reported that the
data base could be updated weekly for a minimal additional cost,
and there was also investigation for the ability and the cost to
update on a daily basis. She pointed out that the term for
"near real time" allowed some flexibility, even while implying a
certain urgency.
3:47:48 PM
REPRESENTATIVE WOOL asked what people, other than the
pharmacist, were licensed in a pharmacy.
MS. HANSEN, in response, said that "it would be more than just
the lead pharmacist." She offered her belief that pharmacist
techs were also registered with the state, and that most of the
people in the office would be registered or licensed with the
state. She relayed that the current law required the lead
pharmacist in charge to enter the information.
REPRESENTATIVE WOOL asked for the reasons to the requirement for
a license.
MS. HANSEN, in response, stated that registration allowed for
disciplinary action and sanctions through the corresponding
board.
CHAIR SEATON pointed out that it was not only the dispensers,
but also the providers who would delegate someone to check the
database. He explained that there were "way too many
prescriptions for way too many pills." This had allowed for
addictions, and he noted that there were more deaths from
overuse of prescription drugs than from heroin. He explained
that the intent for this current solution had been to "make
prescribers check and find out if the person they're prescribing
has had more than recommended filling the prescriptions..." He
allowed that some prescribers did not want "to go through the
bother, but it's a huge problem in the state." He declared
that, as it was necessary for a solution, this had been the
genesis of the proposed bill. He pointed out that there was now
a proposed change for both the dispenser and the prescriber to
update the database.
MS. HANSEN clarified that currently only the pharmacist was
required to submit information. She acknowledged that there had
been testimony that a prescription could be entered in the
database, but if the prescription was not filled, there were not
any "pills out there to be concerned for and then it might
actually muddy the waters of the information" as a higher
prescription amount would be reflected for a patient who was not
actually acting on the prescription. She reiterated that
currently only the dispensers were required to submit the
information, although the current proposed bill version would
require all practitioners to register with the database. She
shared that there had been consideration for a requirement that
the providers check the database prior to prescription, but it
had been decided to require mandatory registration in order to
"get people connected with the data base as a first step." She
pointed out that a similar proposed bill, SB 74, included a
component which required prescribers to check the database prior
to a prescription. She emphasized that this was the crux of the
conversation.
3:53:52 PM
REPRESENTATIVE TARR directed attention to the fiscal note
[included in members' packets] and asked about a return to fees
required for the pharmacists. She pointed out that this had
been considered by some to be problematic during earlier
discussions, and she questioned if there could be a "more
holistic sort of solution to accomplish that." She also
questioned whether this would be better served through the
Department of Health and Social Services.
MS. HANSEN, in response, shared that her office had discussed
the issue of spreading the fees over the other boards which were
registering, although there was not yet a proposed amendment.
She offered her belief that there was a federal grant for
funding through the Department of Health and Social Services,
although it was still under the Alaska Board of Pharmacy as they
had the investigative and licensing authority over the
dispensers. She directed attention to Section 6 of the proposed
bill, which allowed access to the Medicaid pharmacist, Medicaid
drug utilization review committee, and the state medical
examiner, and would identify information to the Department of
Public Health. She noted that these were suggestions received
from the controlled substance advisory group and that DHSS
access would offer a better idea of prescription utilization in
the Medicaid program and for public health trends.
REPRESENTATIVE TARR mused that she could not find any mention of
the Department of Public Health. She stated that she wanted to
ensure that this was not only viewed "from that lens, but the
important health implications."
MS. HANSEN pointed out that the reference to the Department of
Public Health was at the top of page four.
3:58:51 PM
CHAIR SEATON asked for a comparison between the two proposed
bills [HB 344 and SB 74].
MS. HANSEN stated that SB 74 did not currently allow for
delegation of the submittal of information, as was allowed in
Section 1 of proposed HB 344, although proposed SB 74 did allow
the delegation of access which proposed HB 344 also allowed. HB
344 required submittal of prescription information at near real
time, whereas SB 74 required a weekly submittal of this
information. HB 344 only required dispensers to check the
database prior to dispensing, although it required all health
care practitioners dealing with controlled substances to
register with the data base. SB 74 required everyone to
register, and it required that providers check prior to
dispensing, prescribing, or administering a drug. She opined
that the requirement to check may be amended so as to not
interfere with emergency or trauma care. HB 344 provided an
exemption for pharmacists who were not able to update the
database in near real time due to technological barriers;
whereas, SB 74 did not contain this exemption. Although HB 344
required registration with the database, it allowed 180 days
from the effective date to register, whereas SB 74 did not allow
this delay in registration.
REPRESENTATIVE WOOL walked through the sequence of events as an
individual brought a controlled substance prescription to the
pharmacy: the pharmacist would check the database for
permission to a determined threshold, and, after dispensation of
the prescription the data would be entered into the database
within 24 hours or so.
CHAIR SEATON asked about "the push notification."
MS. HANSEN directed attention to subsection (p), which created
an automatic electronic alert system, although this still
required the dispenser check the database for the alert. She
shared that the current threshold was set for five prescriptions
from five providers and five pharmacies in three months.
CHAIR SEATON noted that the Board of Pharmacy could be
questioned for whether this was the right threshold.
4:04:01 PM
REPRESENTATIVE TARR pointed out that the proposed bill used both
the terms pharmacist and practitioner, even though practitioner
was not defined in the proposed bill. She asked if this was
defined elsewhere in statute, or it was necessary to define.
MS. HANSEN replied that she was not sure if it was defined in
statute, although she opined that the proposed bill was clear as
it said, "practitioners that have the ability to dispense,
administer, or prescribe" and then listed the schedule of drugs.
She stated that, as sections of the proposed bill did refer to
health care providers who had interactions with these controlled
substances, it was "kind of defined right there." She offered
to check on the definition.
REPRESENTATIVE TARR suggested to provide anything that was not
obvious, so there would not be an unintended consequence.
CHAIR SEATON pointed out that there were two different possible
scenarios to allow exemptions for emergency care, one where
review is not required prior to administration of medication,
and the second option which would say that nothing in this
section prevents emergency care for taking priority.
4:06:04 PM
CHAIR SEATON opened public testimony.
4:06:57 PM
JAY BUTLER, MD, Chief Medical Officer/ DPH Director, Central
Office, Division of Public Health, Department of Health and
Social Services, reflected on the earlier discussions on opioids
and the issues for opioid and heroin overdose, which required
prevention, treatment, and reversal of overdose. He stated that
the current discussion was for prevention, as it was clear that
those dependent on opioid pain relievers were at much higher
risk to eventual use of heroin and the associated conditions.
He stated that proposed HB 344 incorporated all of the
recommendations of the controlled substances advisory committee,
and he offered a brief overview of the group, which had been
established in 1982 with a goal to advise the governor and the
board on controlled substances and its regulation, evaluation of
enforcement policies, review of budget requests for
interventions, and the effectiveness of treatment programs. He
opined that the group may never have met prior to this year. He
listed the designees, which included the Attorney General, the
Commissioner of Department of Health and Social Services, and
the Commissioner of Department of Public Safety, or their
designees. He reported that the committee had discussed a
number of topics, which included models for state regulation of
controlled substances, prescription opioid pain reliever and
heroin abuse, and discussion with the Alaska Criminal Justice
Commission. He referenced the white paper from the controlled
substances advisory committee [Included in members' packets]
which addressed the Alaska prescription drug monitoring program,
one part of which addressed the opioid issue. He listed the
nine recommendations from the committee, which included a
requirement for all pharmacists and prescribers to register with
the Alaska prescription drug monitoring program, as evidence
showed increased utilization resulted in declining rates of
opioid use and prescription; and, to review the data base when
prescribing or dispensing a controlled substance.
DR. BUTLER offered the third recommendation, which authorized
prescribers and pharmacists to delegate database access to
supervised employees or clinical staff. He opined that this
would make the system more workable by removing barriers to its
utilization. He reported that no providers he had spoken with
had any reservations for this recommendation, and that the
ability for the provider to see the information prior to the
visit with the patient would be very helpful.
DR. BUTLER offered the fourth recommendation, which authorized
the Board of Pharmacy to forward unsolicited notifications to
prescribers and dispensers about patients possibly obtaining
controlled substances in a manner inconsistent with generally
recognized standards of care. He referenced this as the "push
notifications." He declared that this was a powerful
communication tool supported by many of the providers.
DR. BUTLER stated the fifth recommendation for collecting the
dispensing data and updating the database weekly. He shared
that many other states had weekly or more often reporting
requirements. He acknowledged the difficulties for regular
reporting by smaller pharmacies in remote areas, particularly
with the challenges posed by internet access. He suggested that
the definition could be to update "at least weekly."
DR. BUTLER shared the sixth recommendation which addressed
database access, the Medicaid pharmacy program and the Medicaid
drug utilization review committee. He stated that the only
current visibility for these was with regard to opioids for
which there was a Medicaid claim. He reported that other state
investigations revealed that patients could attain opioids under
the Medicaid program, and then sell them on the street. He said
the recommendation also included the state medical examiner as a
source of opioid use information. He offered his belief that
expanded authority was an appropriate balance between the
guarantee for patient privacy and the need to know by those
responsible for programs in public health in order to address
this opioid challenge.
4:18:54 PM
CHAIR SEATON asked if there were any problems with restriction
for delegation of database use to those licensed for
registration.
DR. BUTLER expressed his agreement that this raised the
questions of appropriate safeguards for patient privacy, and
that licensure should be under board authority to allow for
disciplinary action, although he was unclear on the
certification process.
CHAIR SEATON asked that more information on the terms be offered
in any testimony. He asked about a proposal by the State of
Maine on a 3-day limitation for a prescription on its first
issuance.
DR. BUTLER, in response, said that these were clinical
guidelines and specific issues related to maximum doses, but
that these were not directly linked to the database. He stated
that the database was not intended to dictate practice or tell
doctors what to do, that it was intended to be used as a
communication tool to provide visibility for prescriptions to a
given patient or by a given provider. He shared that nationally
there were some draft chronic pain management guidelines with
the conversion equivalent to morphine. He stated that two of
the biggest risk factors for opioid overdose were escalating
dose and co-administration of benzodiazepine. He pointed out
that a value of the database was to recognize these risk
factors, as a single provider may not be aware of the
prescriptions from another provider.
CHAIR SEATON stated that the focus was for curing the problem,
not just addressing the database. He stated that the
legislature was alarmed, even though he was unsure how active
the medical community was toward the opioid problem.
REPRESENTATIVE TARR reiterated her earlier request for the
definition of practitioner.
DR. BUTLER replied that the general intent was for persons
authorized to prescribe, in this case, specifically for
controlled substances. He listed physicians, dentists, and
advance practice registered nurses.
REPRESENTATIVE VAZQUEZ directed attention to AS 08.80.480(28),
the definition for practitioner, and read: "an individual
currently licensed, registered or otherwise by the jurisdiction
in which the individual practices to prescribe and administer
drugs in the course of professional practice." She stated that
there was also a definition for a pharmacy technician, "a
supportive staff member who works under the immediate
supervision of a pharmacist." She read the definition for a
pharmacist in charge, "a pharmacist who accepts responsibility
for operation of a pharmacy in a manner that complies with laws
and regulations applicable to the practice of pharmacy and the
distribution of drugs and who is personally in charge of the
pharmacy and the pharmacy's personnel." She stated that the
definition for pharmacist was "the individual currently licensed
by the state to engage in the practice of pharmacy."
CHAIR SEATON directed attention to page 1, line 10, of the
proposed bill, that the definition of practitioner was for the
person who directly dispenses the scheduled controlled
substances. He questioned whether the definition should be
extended to prescribers. He pointed out that registration for
the database was predicated on reading seven pages of very small
font, and asked if this was stopping providers and practitioners
from registering.
DR. BUTLER offered his support for the removal of any obstacles
to registration. He shared that it took him about 7 minutes to
complete the on-line form for the database registration,
including the search time for his national provider number. He
opined that it was a bigger barrier to have the form printed,
notarized, and mailed, which took him 9 minutes. He suggested
an option to link the database registration with license renewal
and do it all on-line. He expressed his hope that this could
remove the need for notarization.
4:32:43 PM
JANEY HOVENDEN, Director, Division of Corporations, Business,
and Professional Licensing, Department of Commerce, Community &
Economic Development, in response to the question for linkage
with licensing and use of the database, explained that it had
not yet been determined if that was possible, but, she stated
that "would be something that we would always strive to do and
always look for options and opportunities to technologically
advance."
CHAIR SEATON asked if renewal of the license and registration
for the data base could be combined.
MS. HOVENDEN replied that a reminder or a link could be easily
included with any documentation at renewal.
CHAIR SEATON asked if the license renewal had to be notarized.
MS. HOVENDEN said that the division had not yet explored the use
of My Alaska as a signing option. She stated that the division
was always looking for ways to streamline and make things easier
for the applicants and registrants.
REPRESENTATIVE VAZQUEZ asked how proposed HB 344 would apply to
registered pharmacies located outside the state.
MS. HOVENDEN stated that these licensed pharmacies would be
treated the same as those located in-state.
CHAIR SEATON asked if this would include medical providers and
telemedicine.
MS. HOVENDEN deferred to the chair of the State Pharmacy Board.
REPRESENTATIVE TARR directed attention to the fiscal note which
included a program manager position. She asked about the cost
for databases communicating.
MS. HOVENDEN, in response to Representative Tarr, said that
there was a cost associated with the database vendor, as it was
a third party software program contract. She explained that
this additional expense would be for modification to the
existing database to make it easier for registrants.
CHAIR SEATON asked about an estimate for the weekly database
updates.
MS. HOVENDEN explained that the vendor had given a cost estimate
of $26,000 annually for either weekly or daily updates. She
replied to Chair Seaton that she would clarify whether that had
been included in the fiscal note.
REPRESENTATIVE STUTES asked about any problems with facilitating
this in a timely fashion.
MS. HOVENDEN said that a program coordinator could manage it on
behalf of the Board of Pharmacy, although there was some
concern, as it was necessary that the effective date be prior to
the requirement for registrants.
4:42:47 PM
BILL ALTLAND, Pharmacist, Board of Pharmacy, stated that he was
a pharmacist practitioner from a rural remote area. He shared
that he had been part of the workgroup studying the idea of the
prescription drug monitoring program eight years prior, as it
was a big problem in the state. He offered an example as a
provider in rural remote areas for the concerns and challenges
with out of state pharmacies, and licensed pharmacies or
practitioners, especially in the context of tribal providers.
He referenced an opinion by the state attorney general that
tribal providers did not have to be licensed in Alaska. He
expressed his concern for this decision, sharing that he felt it
important for practitioners to be licensed, as well as important
that any delegation for access to the database be to a licensed
technician. He asked how a prescriber would know what the
leverage was to get the not licensed providers into the system.
He pointed out that Seattle was a major health provider hub for
southern Southeast Alaska. He shared that there was a system on
Prince of Wales Island to talk about patients with pain
management issues.
REPRESENTATIVE VAZQUEZ read from the statutes that they did not
cover "control of drugs in the federally operated hospital
institution."
MR. ALTLAND shared that the military was a closed system for
federal beneficiaries, and that Metlakatla was a reservation;
however, there was concern for the decisions not to include
tribal health care providers.
REPRESENTATIVE TARR asked if there had been any scale back in
prescriptions.
MR. ALTLAND said there had been difficult decisions and he
lauded the monitoring program, noting that it was needed.
4:54:37 PM
SCOTT WATTS, Pharmacist, reported that he was an independent
pharmacist. He lauded the intent of the proposed bill. He
expressed his concerns, which included that real time submission
was difficult for many pharmacies, although nightly or weekly
submission would accomplish the intent of the proposed bill. He
reported that it was most important for the database to be
checked when the prescription was being written, that this would
cut down the time involved for all. He opined that people who
were licensed and registered had more to lose should they do
something incorrectly. He said that the amount of the
prescription should start with the prescriber. He declared that
this was a very important, worthwhile program, and expressed his
concern that this was not put solely on the shoulders of the
pharmacists.
REPRESENTATIVE TARR asked for a comprehensive list of all of the
users.
4:58:45 PM
MATT KEITH, Vice President of Pharmacy, Geneva Woods Health
Care, stated his support for the program, and noted that he was
also a pharmacist. He acknowledged the challenges for opiate
use and controlled substances. He expressed his support for the
database and the new portal, as it was quicker, easier to
access, and more flexible. He supported the concept of the
proposed bill, although he shared a disconnect for how it would
be accomplished. He stated that the requirement for a mandatory
review for every prescription of all controlled substances would
be logistically burdensome and would add cost. He expressed
agreement with the licensure of pharmacy technicians, although
there was not a lot of capacity to do these extra tasks. He
pointed to programs related to prescription drugs which required
registration of patients on websites, with additional
information put in prior to dispensing. He pointed out that a
review of the database prior to every prescription and prior to
its dispensation would have an impact on the service and
response level. He echoed the sentiment that drug abuse and
overdose would not happen if the prescription was not written in
the first place, and, doctors needed to look at this information
before writing a prescription. This meant that pharmacists were
having to be reactive. He reported that there were some
disconnects between the two proposed bills, which needed to be
ascertained, including the exemption for the word, "administer,"
as this was not something that pharmacists did. He directed
attention to the holistic oversight for patients, especially for
those in a chronic pain program, and he described his company's
clinical practitioner approach. He asked whether the proposed
bill was to address chronic opiate use, or all forms of all
controlled substances, as the proposed bill was currently
written.
CHAIR SEATON asked what schedules of controlled substances
should be included.
MR. KEITH replied that a proactive approach with the biggest
concern being for opiate overdose should focus on the schedule 2
drugs. However, another factor with overdose could include the
use of other drugs. He pointed out that a requirement for the
mandatory review of schedule 2 drugs would reveal any other
currently prescribed drugs. He emphasized that the focus should
be on the patient not just on one drug.
CHAIR SEATON asked for recommendations by pharmacists for
necessary reporting, as well as what schedule level of drugs to
check prior to prescription or dispensation, to be forwarded to
his office.
REPRESENTATIVE TARR asked about any side effects from schedule 3
drugs, including suicidal tendencies, and if the information was
being tracked elsewhere.
MR. KEITH relayed that he was not sure about suicide. He stated
that if there were a requirement to report on scheduled drugs,
but only mandatorily review the schedule 2 drugs for opiates
with a primary concern for opiate abuse, then these would be
seen. He stated that it was not necessary to mandatorily review
each and every other class of drug prior to dispensation. This
would reveal the targeted population for opiate abuse and
overdose. He declared that "every anti-depressant on the market
has been associated with that [suicide] and they're not
controlled substances." He pointed out that it was important to
determine the target for improved outcomes.
REPRESENTATIVE WOOL asked what other prescriptions were listed
on the database, should the prescribers also check it. He
opined that this "would be going further upstream to prevent or
reduce the amount of delays at the pharmacy."
MR. KEITH expressed his agreement, reminding the committee that
the reporting of all controlled substances would reveal them all
on the database, including those drugs with the added risk for
negative outcome. He acknowledged that it was much more
proactive for the doctor to check the database prior to
prescribing a drug.
CHAIR SEATON opined that this was the intention of the
committee.
5:09:13 PM
DAN NELSON, Pharmacist, echoed what the other pharmacy
representatives had testified. He added that the time
requirement for checking all the controlled substance
prescriptions on the database was onerous to the pharmacies, as
some high volume retail pharmacies in Alaska were filling more
than 1000 prescriptions each day, about 10 percent of those
being controlled substances. He said that although each check
took about two minutes, any interpretation of the information
should not be a delegated task, but should be done by a
practitioner or a pharmacist. He declared that this should all
be done by a prescriber, prior to issuance of the prescription.
He offered his belief that, as the number of pharmacists
registering for the database was vastly more than the number of
prescribers, this showed that pharmacists were "very interested
in stemming the prescription drug abuse epidemic." He shared
that pharmacists wanted to play an active role. He applauded
the committee for considering this issue. He suggested
consideration of mandatory continuing education for pain
management, in order to improve some of the pain outcomes. He
reiterated that this requirement would be extremely onerous on
pharmacies, noting that it would increase the work load on his
pharmacy by two - three hours each day.
CHAIR SEATON asked if there was agreement with the idea for
schedule 2 drugs being checked by providers, and not by
pharmacists.
MR. NELSON replied that this would be a good starting point,
adding that all schedule 2 drugs were not opiates, as some
opioids were schedule 2, 3, 4, and 5. He questioned whether
limiting the proposed bill to schedule 2 drugs would effectively
capture the desired end.
CHAIR SEATON asked for any suggestions of ways for the proposed
bill to be written.
MR. NELSON, in response to Representative Tarr, relayed that the
Centers for Disease Control and Prevention (CDC) had recently
issued some draft guidelines on other substances to consider.
[HB 344 was held over.]
5:16:46 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:16 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Hb 344 Version H.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Sponsor Statement.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Sectional.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Fiscal Note- DCCED-CBPL-02-27-16.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Background-PDMP Controlled Substance advisory_1-29-16.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Background_PDMP annaul report 2016.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Background_NCSL_telehealth, PDMP, licensure_1.23.2016.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Testimony_NACDS_3.1.2016.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Testimony Tara Ruffner.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |
| HB 344 Testimony_CVS health.pdf |
HHSS 3/1/2016 3:15:00 PM |
HB 344 |