Legislature(2019 - 2020)DAVIS 106
02/27/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB189 | |
| HB242 | |
| HB184 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 242 | TELECONFERENCED | |
| *+ | HB 189 | TELECONFERENCED | |
| *+ | HB 184 | TELECONFERENCED | |
HB 242-PRESCRIPTION OF OPIOIDS; DATABASE
3:33:18 PM
CHAIR ZULKOSKY announced that the next order of business would
be HOUSE BILL NO. 242, "An Act relating to the prescription of
opioids; relating to the practice of dentistry; relating to the
practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to the practice
of nursing; relating to the practice of optometry; relating to
the practice of pharmacy; relating to the practice of veterinary
medicine; relating to the state medical examiner; relating to
the controlled substance prescription database; relating to the
duties of the Board of Pharmacy; and providing for an effective
date."
3:33:30 PM
The committee took a brief at-ease.
3:34:36 PM
REPRESENTATIVE ANDY JOSEPHSON, Alaska State Legislature, stated
that there was a problem which needed to be addressed, and,
although the proposed bill presented some ideas, he was open to
solutions. He paraphrased from a prepared statement [Included
in members' packets], which read:
The purpose of this bill is to reduce addiction and
overdose death from opioids prescribed by health care
professionals, by improving the effectiveness of the
State's controlled substance prescription database by
requiring healthcare licensing boards to set
prescription standards for their professions.
Alaska's controlled substance prescription database
was created and placed under the responsibility of the
Board of Pharmacy in 2008. The database was designed
as a tool to help healthcare providers identify
patients who were "doctor shopping" or deliberately
obtaining prescriptions from multiple unknowing
providers to feed addictions.
As opioid addition has increased in Alaska and the
nation so has our understanding of links between legal
prescription, addiction and illegal use of controlled
substances. Healthcare providers and policy makers are
looking for ways to turn the tide of addiction and
death. Strengthening the prescription database system
is one positive step we can take.
HB 242 will improve the prescription practice of
Alaska's many great healthcare providers and help
identify and remove the small minority of prescribers
who deliberately or negligently over prescribe
controlled substances.
I encourage you to support this legislation and to
reach out to my office with any questions and
suggestions.
REPRESENTATIVE JOSEPHSON paraphrased a KTUU news story [Included
in members' packets], which addressed a doctor from Soldotna and
a nurse practitioner from Eagle River who were accused of
illegally overprescribing opiates for years, raising questions
about how the state tracked prescription drug abuse. He
reported that the news story ended by noting the state had no
prescription limit flags that automatically alerted licensing
boards when someone appeared to be overprescribing. He reported
that his office had done exhaustive research, acknowledging
there was a problem, and that he wanted to discuss a solution.
He said that making changes to prescriptions of controlled
substances and the use of the database required reviewing the
statutes of each of the five professions that were able to
prescribe controlled substances: physicians, advanced practice
nurses, dentists, optometrists, and veterinarians. He added
that it was also necessary to review the pharmacy statutes.
REPRESENTATIVE JOSEPHSON stated that the basis of the proposed
bill: (1) gave each of the five licensing boards explicit
responsibility to adopt regulations establishing opiate
prescription standards for their respective professions,
referred to as MMEs; standards would enable the Department of
Commerce, Community & Economic Development employees who staff
the licensing boards to proactively identify prescribers who
deviated from standards, share that information with the
practitioners and the boards, and investigate when appropriate;
(2) addressed the problem of prescribers who failed to register
with the database or failed to review the patient information
before prescribing. He opined that the boards did not enforce
registration by the prescribing physicians. The proposed bill
(3) upgraded the database software to record when a prescriber
enters the database and reviews the patient records, and (4)
required licensing boards to take disciplinary action against
licensee who fail to register a review; To require pharmacists
to check the data base before filling a prescription to confirm
that the prescriber reviewed the patient's record in the
database as was required by law.
REPRESENTATIVE JOSEPHSON suggested that, as two pharmacy
organizations had submitted concerns regarding this, there may
be a database solution. He went on to state that the proposed
bill required the state medical examiner to inform the Board of
Pharmacy when a death was caused by an overdose, as that board
was responsible for managing the database. The Board, in turn,
would inform healthcare providers and their licensing boards if
a provider prescribed a controlled substance during the three
months preceding death; this provision was intended to educate
prescribers who may not be aware that a patient had addictions
and to bring investigators' attention to events. He reiterated
that he was receptive to suggestions on this proposed
legislation. He acknowledged that there were important medical
practices such as pain clinics which prescribed more controlled
substances, and that he wanted to develop a system as seamless
as possible. He pointed out that not only was there patient
addiction, but that there also existed "pill mills."
3:42:12 PM
CATHERINE REARDON, Staff, Representative Andy Josephson, Alaska
State Legislature, presented the Sectional Analysis [Included in
members' packets], which read:
Section 1: Amends the powers and responsibilities of
the Dental Board to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 2: Amends the powers and responsibilities of
the State Medical Board to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 3: Amends the powers and responsibilities of
the Board of Nursing to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 4: Amends the powers and responsibilities of
the Board of Optometry to require the board to adopt
regulations establishing opioid prescription dosage
standards for practitioners licensed by the board.
Section 5: Adds a new subsection to the Board of
Pharmacy statutes requiring pharmacists to confirm,
before filling a prescription for a Schedule II-IV
controlled substance, that the prescriber reviewed the
patient's prescription records in the controlled
substance prescription database before prescribing.
Section 6: Amends the powers and responsibilities of
the Board of Veterinary Examiners to require the board
to adopt regulations establishing opioid prescription
dosage standards for practitioners licensed by the
board.
Section 7: Adds a new subsection to the statutes
governing investigation of death by the State Medical
Examiner, directing the Medical Examiner to report to
the Board of Pharmacy when a person's death was caused
by an overdose of a schedule II-IV controlled
substance. The Medical Examiner shall report the
deceased person's name, address and date of birth to
the Board of Pharmacy which shall act as directed in
Section 15 of the bill.
Section 8: Amends the statutes governing the
Controlled Substance Prescription Database to specify
that the database will identify healthcare
practitioners who fail to review patient information
in the database as required by law and that the
database will identify each occurrence of failure to
review.
Section 9: Clarifies that security and confidentiality
of the database is a requirement rather than an
aspiration by deleting the words "undertake to" on
page 8 line 11.
Section 10: Requires licensing boards to take
disciplinary action against practitioners who fail to
register with the database or review patient
information as required by law.
Section 11: Removes protection from civil liability
for healthcare practitioners who fail to access
information in the database.
Section 12: Deletes the requirement that prescription
information in the database be purged after two years
and removes the requirement that the Board of Pharmacy
establish a "time frame" for healthcare practitioners
to register with the database.
Section 13: Makes mandatory rather than optional, the
notification by the Board of Pharmacy, to the relevant
practitioner, licensing board and pharmacist when a
patient receives a prescription for controlled
substances in quantities or frequency inconsistent
with generally recognized standards of safe practice.
Section 14: Makes mandatory rather than optional, the
issuance of annual reports that compare individual
healthcare practitioner's opioid prescribing practice
with other practitioners of the same occupation and
similar specialty. Section 14 also requires copies of
the reports to be sent to the practitioner's licensing
board and to the medical director of a group practice.
Those copies will exclude information that identifies
patients. Recipients of reports may only disclose
information to other individuals who have access to
the database.
Section 15: Directs the actions of the Board of
Pharmacy when the board receives notice from the
Medical Examiner as required by Section 7 of the bill,
that a person's death was caused by an overdose of a
schedule II-IV controlled substance. The board shall
review the database to identify healthcare
practitioner who prescribed a schedule II-IV
controlled substance to the person during the three
months preceding death and notify the practitioner and
relevant licensing board.
Section 16: Requires the six licensing covered by this
bill boards and the Department of Commerce, Community
and Economic Development to adopt necessary
regulations within one year of the January 1, 2021
effective date of Sections 1-15.
Section 17: Establishes an immediate effective date
for the regulation adoption authority required to
implement Section 16.
Section 18: States the bill takes effect on January 1,
2021 with the exception of the authority to adopt
regulations contained in Sections 16 and 17 of the
bill.
3:55:56 PM
REPRESENTATIVE TARR directed attention to the fiscal note for
business and professional licensing and asked about the request
for two investigators and a paralegal for enforcement.
MS. REARDON replied that she had not heard anything about the
fiscal note, but that she was not surprised that it could take
those resources for effective enforcement.
3:58:15 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, reported that the proposed fiscal note was
extremely conservative, and it leaned toward a best-case
scenario. She stated that the worst-case scenario would
necessitate a doubling of the investigative team in order to
close the gap and fulfill the proposed bill.
REPRESENTATIVE TARR asked about the increase to the participant
fee in order to pay for the proposed cost.
MS. CHAMBERS replied that the current fee was $25, although the
intent language for the database had declared that it is not
funded by user fees. She stated, "we're in a pickle right now.
There isn't grant funding for enforcement." She stated that
there was a policy call for the Legislature on whether to change
the fee or use another model for payment, as there was less than
100 percent compliance with registration.
REPRESENTATIVE SPOHNHOLZ asked about the delta for the number of
registrants and the number of licensees.
MS. CHAMBERS said that she would supply that specific data but
pointed out that there were many medical professionals who did
not have the authority to prescribe controlled substances.
REPRESENTATIVE PRUITT reflected on the passage of the bill, and
relayed that the intent of the bill had been to make the
database mandatory. He asked what had been done to ensure
compliance, and would the proposed bill be fulfilling any gaps.
He then asked about the security and confidentiality.
4:05:18 PM
LAURA CARRILLO, Executive Administrator, Board of Pharmacy,
explained that the rationale for removing the two years was in
consideration of Senate Bill 74 to allow the assessment of
prescription data over time. She reported that removal of the
requirement to purge the data would not allow Department of
Health and Social Services to analyze the data.
MS. CHAMBERS stated that this database was complex and only two
people were authorized to view it. She declared that it was
used as a research tool to attack the opioid crisis, and that
the spirit of Senate Bill 74 was for this to be an educational
tool to allow prescribers to make better decisions, and not to
be used as an enforcement tool. She stated that there was
another delta between expectations and reality for the database.
She pointed out that to maintain security and confidentiality,
it had to be determined how many state employees would have
access to certain levels of data. She declared that the biggest
expense was for the technology behind this.
CHAIR ZULKOSKY asked how many states had this Prescription Drug
Monitoring Program (PDMP) database.
MS. CARRILLO said there were 43 states using this same platform
connected through [indisc.] health.
CHAIR ZULKOSKY asked for more context to how a more mature PDMP
was using that information.
MS. CARRILLO said that she would research the evolution of the
PDMP in other states.
CHAIR ZULKOSKY expressed her agreement that there was a policy
call for how to use this collected data and added that more data
would allow for better understanding for risks in the community.
She asked for more information as to how other states utilized
this data within their systems.
4:09:54 PM
REPRESENTATIVE PRUITT offered his belief that there had been a
positional shift from, in 2008, "if you want to," and no one
did, to "you're going to." He opined that there was an
insistence on wanting this to be mandatory, but there was not
any enforcement. He asked why this position had changed and
what was an appropriate balance of pressure.
MS. CHAMBERS replied that boards, as was put into Title 17 and
into Title 8 as a requirement for each separate board, could
determine within the scope of their existing authority what the
penalty might be. She shared some examples for the allowable
civil authority. She reported that the Alaska State Legislature
was interested in "taking the temperature" of the position to
the opioid crisis. She pointed out that data had not been
mandatory, and that during a presentation by then-Chief Medical
Officer, Dr. Butler, it had been noted that it wasn't even known
what was being prescribed. She reported that current review of
the data indicated there was inadvertent misuse of the PDMP, as
well as over-prescription. She pointed out that, as there was
not even a definition for over-prescription, it was difficult to
set a threshold for any red flags. She noted that only the
State Medical Board had set in regulation a threshold, which
could be "squishy" depending on the type of practice. She
declared the need for determining what Alaska wanted from the
PDMP, and that each board had existing authority to determine
discipline. She added that the Alaska State Legislature could
set penalties in statute.
REPRESENTATIVE PRUITT asked if there was a need for the
legislature to make a larger statement to the boards for a
certain level of enforcement.
4:17:03 PM
MS. CHAMBERS explained that the MME requirement in the proposed
bill had not been asked of the boards, although it made sense if
a definition for over prescription was a concern. She pointed
out that the State Medical Board had taken a leadership role,
even though the other boards had not been asked to determine a
definition. She reported that some of the boards had set
extremely long time periods for allowance of non-registration as
they did not want to be "heavy-handed." She pointed to some of
the problems for registration. She reiterated that, if this was
the expectation of the Legislature, this proposed bill was a
good vehicle to offer more tools.
REPRESENTATIVE DRUMMOND referenced a report [Included in
members' packets] which stated that 49 states, as well as Guam
and the District of Columbia, had fully operational PDMPs. She
asked if the DEA (Drug Enforcement Administration) authorized
the prescribers of Schedule II to IV controlled substances and
questioned whether this information could be included in the
PDMP. She asked whether the pharmacies were aware of
prescribers who were DEA-authorized for controlled substances.
MS. CHAMBERS expressed her agreement that there was this list
and that they did work with the DEA. She pointed out that one
state, Missouri, had the PDMP as the municipal, not the state,
level. In response to Representative Drummond, she said that
Missouri used a different software.
REPRESENTATIVE SPOHNHOLZ offered her belief that the PDMP
history was good for context but did not matter for her current
decisions. She shared a list of topics she would like to hear
addressed in a future hearing.
4:22:41 PM
REPRESENTATIVE SPOHNHOLZ referenced a section of the bill which
asked pharmacists to review whether the original prescriber had
checked the database and asked whether this policy would turn
pharmacists into monitors of other providers.
REPRESENTATIVE JOSEPHSON reported that this concern was shared
by the sponsor, as he wanted that both the providers and the
pharmacists treat the patients, prescribe medication, and focus
on the job. He shared an anecdote for a pharmacist being
rebuked for refusing to fill a prescription. He pointed out
that, although the Board of Pharmacy was the ultimate decider,
it did not want to be involved in calling other boards regarding
other providers. He suggested that a system should contact the
boards when a provider had not registered or had not checked
that a patient had recently received a prescription from another
provider. He reiterated that he was "wedded to solving the
problem not to any particular solution." He pointed out that
these burdens were placed on the pharmacist because they were
"in the catbird seat, they're the ones who are entering the
data." He questioned the timing for when the data was entered
into the data base.
4:27:07 PM
HB 242 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 184A 02.17.2020.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Veterinarian Medical Association PP.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Sponsor Statement.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Legislative Alert PDMP exemption for veterinarians 12.21.2019.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Board of Veterinarian Examiners Letter.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 184 Fiscal Note DCCED.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 184 |
| HB 189 ver A 1.24.20.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 189 Sponsor Statement 1.24.20.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 189 Fiscal Note DHSS.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 189 |
| HB 242 Sectional Analysis.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Pharmacy Board Audit 2017.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 PDMP 2019 Legislative Report.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Sponsor Statement.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Audit of the Medical Board 2019.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242.PDF |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Fiscal Note DCCED.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Fiscal Note DHSS.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |
| HB 242 Overprescription by Spayd & Davidhizar.pdf |
HHSS 2/27/2020 3:00:00 PM |
HB 242 |