Legislature(2021 - 2022)ADAMS 519
03/15/2022 09:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB306 | |
| HB308 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 306 | TELECONFERENCED | |
| + | HB 308 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 306
"An Act extending the termination date of the Board of
Pharmacy; and providing for an effective date."
9:02:25 AM
Co-Chair Merrick relayed that the bill had last been heard
on March 11 where extensive discussion had taken place on
the Prescription Drug Monitoring Program (PDMP). The bill
pertained to how long to extend the Board of Pharmacy whose
primary job was the regulation of pharmacists. She invited
the bill sponsor to make opening comments.
REPRESENTATIVE ANDI STORY, SPONSOR, provided opening
remarks and thanked the committee for hearing the bill
again so quickly. She reminded the committee that the Board
of Pharmacy regulated the admission into the practice of
pharmacy; licensed pharmacists, pharmacy interns, and
pharmacy technicians; established and enforced competency
by ensuring compliance with professional standards; and
adopted regulations amongst other duties. She highlighted
the importance of regulating the practice for the public's
health, safety, and welfare.
Representative Story appreciated the committee's discussion
in the previous hearing on the bill. She remarked that the
opioid epidemic and substance abuse disorders had impacted
many Alaskan families greatly. She stated it was critical
for the state to continue to address the issue. As noted in
the audit, the Board of Pharmacy was just one regulated
profession with responsibility to the PDMP and the
controlled substance prescription database. The Medical
Board, Board of Nursing, Board of Dental Examiners, Board
of Examiners and Optometry, and the Board of Veterinary
Examiners also had responsibility to ensure the safe
prescribing and distribution of controlled substances. The
Department of Commerce, Community and Economic Development
(DCCED) also had compliance and enforcement
responsibilities. There may also be a need for additional
investment in the department and the divisions that support
the PDMP and the regulatory boards.
Representative Story shared that she had some conversations
on the best venue and process to keep focus and drive
improvements related to the PDMP and had confirmed that the
[House] Labor and Commerce Committee would be holding a
hearing on the program. She referenced a couple of ideas
that had been suggested including a consultant to help
shepherd a taskforce, a workgroup on the PDMP, and a
special audit. She reminded committee members that the
focus of an audit was on compliance with existing laws, not
necessarily changes. She hoped they could all agree on
extending the board for a reasonable time.
Co-Chair Merrick OPENED public testimony.
BARRY CHRISTENSEN, PHARMACIST, ALASKA PHARMACIST
ASSOCIATION, KETCHIKAN (via teleconference), thanked
Representative Story for introducing the legislation to
extend the board. He provided information about his
personal history and work with the association that went
back to 2008. He shared that in 2008 he had worked with
former Senator Lyda Green to put the PDMP legislation
forward aiming to limit prescription abuse and diversion of
controlled substances. He believed it had done an excellent
job in helping to do so, but it was only a tool. He
remarked that if he had been a layman listening to the
previous hearing on HB 306, he would have perhaps concluded
the PDMP was broken; however, he did not believe that was
the case. He detailed that he and his staff used the
database daily and he thought it worked well for what it
was intended to do. He remarked there were areas that
needed to be tweaked, but he did not believe shortening the
sunset date would necessarily fix the issues.
Mr. Christensen believed the key was for the other
prescribing boards (mentioned by Representative Story) to
work with the Board of Pharmacy on putting some corrections
in place to ensure the PDMP program worked as well as
possible. He remarked there had been very effective leaders
and members on the Board of Pharmacy during his career,
including the current chair Dr. Ruffridge. He encouraged
the committee to pass the bill.
9:08:11 AM
Vice-Chair Ortiz thanked Mr. Christensen for his testimony.
He addressed a question about whether the board extension
should be six years or a different number. He surmised the
question was not directly related to issues related to the
PDMP. He stated his understanding that the Board of
Pharmacy and a number of other boards and agencies were a
part of the PDMP program. He asked for verification that
the effectiveness of the PDMP should not necessarily tie
into the Board of Pharmacy extension time.
Mr. Christensen agreed. He stated the Board of Pharmacy did
many things outside of administering the PDMP. He explained
that pharmacies could not exist without the board providing
the necessary licensing and oversight. For example,
pharmacies could not credential with insurance companies to
do business without a valid pharmacy license for the State
of Alaska. He characterized the functioning of the PDMP
monitoring program as "a totally different animal." He
believed the Board of Pharmacy had been effectively
administering the PDMP since 2008. He thought the key was
communication between the Board of Pharmacy and the other
prescribing healthcare boards. He thought it could be done
in a manner that did not impact the board's sunset date.
Representative Carpenter asked about the relationship
between the other boards and the Board of Pharmacy and what
may be standing in the way of better communication.
Mr. Christensen deferred the question to Dr. Ruffridge, the
chair of the board. He gave an example of a frustrating
experience when the pharmacy identified a patient had
received a prescription from multiple providers and the
pharmacy called a provider to ask if they were aware of the
situation. He relayed that sometimes the provider was
unaware, which meant they had not checked the PDMP. He
stated it was a professional frustration.
Co-Chair Merrick noted that Dr. Ruffridge would be heard
from after public testimony.
Representative Carpenter remarked that the caller had
indicated that the other boards just work with the Board of
Pharmacy. He was trying to get an understanding of the
reason for the comment. He wondered if it meant the boards
were not working with the Board of Pharmacy.
9:12:57 AM
Representative Wool referenced the comment made by the
testifier about what a layman may think listening to the
prior committee conversation about the PDMP. He asked if
Mr. Christensen believed the layman may put undue burden on
the PDMP. For example, he asked if people believed the PDMP
should stop all diversionary action and severely improve
the opioid crisis. He asked if there was too much burden
put on the PDMP and that expectations were too high.
Mr. Christensen responded that he did not believe so. He
referenced enhancements made to the database and relayed
that logging in and using the database was far simpler than
it had been when introduced in 2008. He remarked that the
data was much improved. He thought that former Senator
Green would likely be amazed by how well the data reporting
worked. He did not believe it was overly burdensome. He
remarked that it would be great if the database could be
discontinued because patients' compliance with opiates
vastly improved; however, he did not believe that had
occurred yet.
Representative Josephson stated his understanding of the
scenario provided by Mr. Christensen that when the pharmacy
called providers to ask if they were aware a patient had
received a duplicate prescription from another provider,
sometimes the provider was not aware. He asked if his
understanding of the situation was accurate.
Mr. Christensen confirmed the statement. He stated it was
not as common presently as it had been several years back
prior to the last major tweak to the PDMP in 2017 or 2018.
He detailed the tweak required prescribers to register and
use the PDMP prior to prescribing a controlled substance.
He confirmed that it still happened.
Representative Josephson pointed out it was a lawsuit.
9:16:14 AM
DR. JAMES DELKER, SELF, SOLDOTNA (via teleconference),
spoke in support of the legislation. He shared that he is a
board member on the Alaska Veterinary Medical Association.
He followed some of the Board of Pharmacy meetings and
activities. He stated that the bill was truly about
allowing the Board of Pharmacy to continue to perform its
necessary duties and oversight of an ever evolving pharmacy
profession. He stated that the board had an incredible
number of diverse issues, not limited to licensing
pharmacists and technicians, but also dealing with a
daunting new world of online pharmacy sales that included
dealing with illegal and not approved or safe drugs.
Mr. Delker remarked that the discussion about the bill
seemed to revolve primarily around the PDMP; however, it
was only a portion of what the Board of Pharmacy did. He
believed there were changes needed to make the PDMP more
effective in fighting the opioid epidemic. He stated it was
the reason veterinarians had pushed for change through
bills like HB 91 and SB 132 to allow the database to
contain useable data. He believed it made little sense to
shortchange the Board of Pharmacy with a two-year sunset.
He suggested a six-year sunset. In terms of the PDMP issue,
he suggested the formation of a much broader taskforce
including legislators and all potentially impacted parties.
He stated that the veterinarians had not historically been
given a seat at the planning table. He was happy to offer
his services going forward to provide input and insight
from a veterinary perspective. He hoped members would
support the bill with a reasonable sunset period.
9:18:43 AM
RENEE ROBINSON, SELF, LICENSED PHARMACIST, ANCHORAGE (via
teleconference), spoke in support of the bill. She was a
practicing pharmacist and spoke about the vital role the
Board of Pharmacy played in current practice and practice
advancement. She was a faculty member at the University of
Alaska Anchorage College of Pharmacy where they relied on
the Board of Pharmacy to provide licenses and support to
students, new graduates, and expanding faculty members. She
shared that oversight from the board was necessary to
ensure standards were maintained, practice was advanced,
and that patients' safety was paramount. She stated that
without a strong Board of Pharmacy, the profession of
pharmacy would be at risk. She stated that the practice
would be guided by individuals outside of the profession,
driven by different and often conflicting agendas such as
money or profit. She stated that the Board of Pharmacy had
done an incredible job, especially in the past several
years in keeping up with the changing healthcare landscape.
She asked the committee to extend the board for six-years.
9:20:10 AM
RONALD WAGONER, PHARMACIST INTERN, ANCHORAGE (via
teleconference), testified in support of the legislation.
He shared that he was currently a fourth year pharmacy
student. He had seen in practice the implications and
barriers to care that waiting for licensing could have on
practice sites. He highlighted that the longer a
technician, intern, or pharmacist had to wait for their
license, the more patient care was delayed, and pharmacies
suffered from loss of business and productivity. He shared
that graduation was quickly approaching in May and
licensing was a major priority for him. He continued that a
quick and efficient licensing period meant he could begin
practicing as a licensed pharmacist sooner. As an intern,
he was allowed to do everything a pharmacist could do with
their supervision but being able to do everything without
supervision sooner would be a major benefit to pharmacies
and patients in Alaska.
Representative Rasmussen thanked Mr. Wagoner for
testifying. She asked if he had noticed a lack of
pharmacists being available. It was her understanding that
nothing could be filled if a pharmacist was not present.
Mr. Wagoner confirmed Representative Rasmussen's last
statement. He shared that the pharmacy had experienced some
issues and had needed to call people into work who had not
been working recently. He elaborated that the pharmacy
almost had to close on a recent Saturday because a
pharmacist had been working 12 days in a row. He stated it
was an issue having to go above and beyond to recruit
people to fill in as needed to keep pharmacies open.
Co-Chair Merrick CLOSED public testimony.
9:22:46 AM
AT EASE
9:23:50 AM
RECONVENED
Representative Carpenter MOVED to ADOPT conceptual
Amendment 1 to reduce the sunset date from a six-year
extension to a four-year extension.
Vice-Chair Ortiz OBJECTED.
Representative Carpenter explained that his desire to
reduce the sunset date had more to do with continuing the
conversation about other issues, not just about what the
board did. He believed the board had value and needed to
continue; however, he believed there was additional
scrutiny required by the legislature. He thought the
legislature needed to force itself to have another
conversation on the topic. He thought two years was likely
too soon and six years was too late.
Representative LeBon supported the amendment to set the
board's renewal date at four years. He reflected on the
audit recommendations that indicated the working
relationship needed to be improved between the state and
Board of Pharmacy.
Representative Johnson stated they would get a report back
in four years. She reasoned there was a good chance some
changes may or may not have been made. She thought the
extension was four or five years the last time. She
highlighted there had been committee discussion about the
fact that some of the members already knew what the
problems were. She believed it meant a management audit was
likely unnecessary. She thought it would be appropriate to
receive a report from the board to the committee in a year
listing the existing concerns. She thought it would give a
better sense that the legislature was paying attention.
She stated it would be a minor cost of about $25,000. She
noted the board had that amount in its account. She thought
perhaps the report could be contributed to by the other
boards. She thought it would be easier to make a small
budget amount for the legislature to do its due diligence.
She was interested in the committee's opinion and was
willing to offer a conceptual amendment.
9:28:18 AM
AT EASE
9:29:13 AM
RECONVENED
Representative Wool understood there was work to be done
and that the legislature should delve into the PDMP issue
and how it impacted the Board of Pharmacy and others. He
highlighted the committee had received public testimony
from a member of the Board of Veterinarians. He understood
the Board of Veterinarians had issues with the PDMP. He
noted that between 36 and 40 states did not require them to
use the PDMP. He believed all of the issues needed to be
brought forward. He thought shortening the Board of
Pharmacy extension and yet requiring a deeper dive was
cumbersome. He remarked that things in the legislature
moved at a glacial pace. He considered a scenario where a
taskforce was formed to perform a deeper dive, a solution
had to be implemented, and an audit was then performed to
make sure the solution worked. He highlighted that an audit
took two years. He thought a two-year window to figure out
the problem and implement change was too short. He
supported a six-year extension and including language to
form a taskforce made up of stakeholders, legislators, and
others to analyze the problem and implement a solution. He
did not support conceptual Amendment 1.
Representative Thompson asked the state auditor if the
reduction to four years would put an undue burden on the
department. He highlighted the Division of Legislative
Audit had numerous audits and one audit took two years to
complete. He wondered if a four-year extension was feasible
for the division and if the timeframe would enable the
Board of Pharmacy to accomplish its work.
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, estimated that the audit required about
1,000 hours and $850,000 [she later clarified this number
was $85,000]. She addressed the two-year mark associated
with an extension date and explained it was too late to
assign anyone to do an audit within that timeframe;
projects had already been staffed. The earliest the
division could conduct an audit was next year. She relayed
the division could never do less than a two-year extension
presently. She confirmed the division had other priorities.
She elaborated that the Legislative Budget and Audit
Committee (LB&A) approved special audit requests, which the
division conducted when it had available resources. She
explained that the financial audits and federal compliance
audits accounted for about 75 percent of the division's
time. The division then did sunset audits which were
statutorily mandated, followed by special audits when
resources were available. She highlighted that the division
had a limited pool of auditors and audit resources, which
should be considered when looking at resources to do other
things. She noted that because the audit was statutorily
mandated it would take precedence over other audit
requests.
9:33:09 AM
Representative Thompson asked if changing the extension
date from six years to four years would give the Board of
Pharmacy time to accomplish its work.
Ms. Curtis answered there were 11 or 12 criteria in statute
associated with conducting a sunset audit. She explained
that LB&A could tell the division specifically what it
wanted in regard to a special audit, which would provide a
deeper dive into issues she had heard discussed by the
House Finance Committee. She clarified that a sunset audit
would only update information the committee already had and
would not necessarily provide answers to the complex
questions she had heard [voiced by committee members]. She
furthered that a taskforce would require dedicated funding.
She detailed that audits were expensive because they had to
follow audit standards and provided a high assurance to the
reader. She elaborated that a consultant did not have to
comply with audit standards and was a lower level of
assurance; however, it may serve the need of the committee
if there were specific things it wanted to know. She noted
that facilitating a taskforce was not something the
division would do; it would be a different mechanism to
reach some of the questions committee members may have. She
observed that the Board of Pharmacy had an evolving role,
and she had no problem if it was the committee's wish to
have an audit in four years. She noted it would take
resources away from other things.
Vice-Chair Ortiz spoke to the division's original extension
recommendation of six years. He stated his understanding of
Ms. Curtis's testimony that an audit in four years would be
similar to the current audit and would not necessarily
delve into the issues of interest discussed by the
committee. He thought Ms. Curtis stated that a more
specific audit would more suitably come from LB&A with a
specific direction. He asked if his understanding was
accurate.
Ms. Curtis agreed. She clarified the division would update
the committee on the status of the current recommendations.
Additionally, the audit would use the 12 [statutory]
criteria to report on how the board was doing at that
moment in time. She clarified that an audit looked back and
not forward. She heard committee members wanting to
determine how to make changes going forward. She did not
think the sunset audit was necessarily the right tool for
the job.
9:37:27 AM
Vice-Chair Ortiz stated his understanding that the audit
that would be performed in four years would cost $850,000.
Ms. Curtis answered that it was her approximate estimate.
She elaborated that the division had done a lot of work on
the audit and had experienced numerous problems with the
data. She explained the auditors had done a lot of "bunny
trail chasing" to try to get their arms around what was
going on to provide policy makers with the information. She
was guessing the audit had taken about 1,000 hours and
their standard rate was around $85 per hour. She stated it
was a significant investment into this type of review.
Representative Josephson referenced the cost of $850,000
estimated by Ms. Curtis.
Ms. Curtis corrected that the cost for the audit was
approximately $85,000.
Representative Josephson asked for verification it was the
division's team doing the work.
Ms. Curtis agreed. She elaborated that the division did an
annual cost allocation plan where it determined the cost of
providing its services in order to bill the federal
government. The division also developed budgets for every
audit. She highlighted that the audit for the Board of
Pharmacy was more complex given all of the surrounding
issues. She estimated the audit had taken about 1,000
hours.
Representative Josephson remarked that if he supported the
amendment, it was not punitive in any way. He stated it was
a system where they Board of Pharmacy was doing what it
could, but there were numerous complexities and other
participants.
9:39:47 AM
Representative LeBon had read many audits on banks. His
conclusion from the Division of Audit's findings led him to
believe that shortening the date was in the mutual best
interest of the state and board. He asked if he arrived at
a right conclusion. Alternatively, he wondered if he read
too much into the audit conclusions that a six-year renewal
was normal. He had an impression from the audit results and
conclusions that told him maybe four years was more
appropriate.
Ms. Curtis answered that the audit recommendation always
came from the evidence gathered through the audit process.
She believed six years was appropriate, but she came from a
different view and respected the wisdom of the policy
makers on whatever additional information members may have
and how important the subjects were to their constituents.
She stated that if the committee wanted to reduce the
extension it was fine from her perspective. She often had a
hard time when she recommended a shorter extension, and it
was extended. She explained that she would not make a
recommendation if she did not feel there was a need for
oversight and a shorter extension. She deferred to the
committee in regard to reducing the extension time.
9:41:53 AM
Representative Wool deferred to Ms. Curtis on her expertise
on audits and she had recommended six years. He pointed out
that the problems the committee was discussing were not
only with the Board of Pharmacy, but with a tool used by
the board and many others. He provided a scenario where a
broad solution was agreed upon that went beyond the Board
of Pharmacy. He believed Ms. Curtis had indicated an audit
may not be the standard sunset audit because it may not
answer the questions being asked; it would be a deeper
audit that would require potentially more hours and
questions. He asked if the needed changes could be done in
four years. He thought Ms. Curtis had recommended six years
for a reason.
Ms. Curtis replied that if there would be legislation that
changed the PDMP she would wonder when it would be passed.
She remarked there should be an amount of time before
Legislative Audit did another audit for evaluation. She
stated that the Board of Pharmacy was responsible for
administering and maintaining the database, which the audit
should look at. She considered how much time it would take
to pass legislation and for any changes to be determined.
She explained they would want some time to see how the
board was doing in administering the changes. She had not
thought through six years with that in mind, but it had
come to mind as she was considering it.
Representative Wool supported the six-year extension. He
asked if whatever problems pointed out in the audit were a
threat to public health or something that just needed to be
fixed immediately. Alternatively, he wondered if the
database needed to be fixed to be easier to use and more
effective in the future.
Ms. Curtis answered that she had strong feelings about the
need to reduce the opioid crisis. She believed the law in
place was imperfect and could be improved. She encouraged
policymakers to look at improving the laws and database and
doing everything possible to clarify the board's role in
administering the database and to get other boards onboard.
She recommended vigorous enforcement of laws, meaning
investigative sections needed to be staffed. She stated
there were many things that could be done, and the
extension bill was likely not the mechanism.
9:45:59 AM
Representative Wool thought work was needed by the
legislature and others separately. He thought it would take
time. He supported the six-year extension.
Vice-Chair Ortiz perceived that the issues with the PDMP
and the opioid crisis was a separate question from the
extension time.
Ms. Curtis answered that the question relevant to her job
was how well the board was implementing changes based on
laws passed by the legislature.
Vice-Chair Ortiz asked for clarification that it was not
just about how well the Board of Pharmacy was doing with
the PDMP but other boards as well.
Ms. Curtis answered that a sunset audit had been conducted
for the Board of Optometry during the current session as
well. She noted the audit for the Medical Board was
upcoming. She relayed that the division took the
opportunity when it did the sunset audits for the other
boards to do a deep dive on how well they were monitoring
registration and reporting.
9:47:57 AM
Representative Edgmon stated it felt awkward because there
was a board extension before the committee in addition to
very important policy question in the middle that the
committee was basically unable to address in the
legislation. He recalled recent testimony from the
department [DCCED] and he had inferred that there was an
understaffing issue pertaining to the database. He stated
that the audit addressed not being able to quantify the
reduction of inappropriate use or prescription of
controlled substances because the database did not contain
related prosecutorial data regarding diversion cases. He
did not believe the database was doing what was intended.
Representative Edgmon relayed that he had come into the
discussion being a solid supporter of a four-year extension
and may ultimately maintain his support for that timeframe.
He did not know how else to keep the needed attention on
the topic unless a taskforce was created, and the issue was
brought to the top of other issues. He stressed the
importance of the database. He underscored that the opioid
crisis was every bit as challenging as it had been several
years earlier. He asked what other tools the legislature
had to address the issue. He believed there was a
legislator who planned to take the issue on in the next
legislature; however, there were no guarantees for
anything. He asked how to make the issue rise to the top of
the heap, albeit shortening the extension period to four-
years to require the auditor to have continued focus on the
issue. He directed the question to the bill sponsor.
9:50:33 AM
Representative Story reminded committee members that as the
bill had been going through the process, the House Labor
and Commerce Committee had been concerned about the PDMP
and the chair was going to have a meeting on the topic. She
did not know what would come from the meeting. She stated
there were other legislators interested in delving into the
important issue.
Representative Edgmon appreciated it, but it did not create
the imperative the issue needed. He stressed there was not
a lever to create the imperative for the legislature to
act. He highlighted that the issue was thorny, and the
stakeholders were vast. Additionally, there were differing
viewpoints and the privacy aspect in terms of the public
safety impact was multifaceted. He thought the legislature
needed a mandate to address the issue.
Representative Story agreed that legislators were all
concerned about the issue. She thought they should consider
whether LB&A should order a special audit. She believed
more money should be put into the investment personnel in
DCCED. She believed it was what the department had
highlighted. She thought it would take some personnel to
investigate the issue. She considered funding for a special
audit. She stated it was the legislature's responsibility
to get a handle on the laws it wanted to have to address
the opioid crisis. She understood the Board of Pharmacy
housed the PDMP and if the legislature asked it to do
something she believed it would be all of the involved
boards contributing. She stated it was the dues collected
from members for targeted needs. She appreciated the focus
on the issue.
9:53:08 AM
Representative Edgmon asked if something like the idea
mentioned by Representative Story could be put in a board
extension bill.
Ms. Curtis answered that she had just finished a sunset
audit of the Alcohol Beverage Control (ABC) Board and a
special audit request to look at the ABC Board license
process had been merged with the sunset, which was an
efficient way of doing both separately focused requests.
She explained it would involve a special request approved
by LB&A that was done at the same time as the next sunset.
Representative Edgmon asked if it would be brought forward
to LB&A by Ms. Curtis based on the legislature's
recommendation.
Ms. Curtis replied that a legislator would have to submit a
request for a special audit to LB&A. She clarified she did
not have a problem with a four-year extension if it was the
will of the committee. She suggested it may be a better
timeline to look at an additional topic at the same time.
She encouraged any legislator who may be interested in
submitting a special audit request to work with her on
drafting the questions to be auditable questions that
specified specific criteria to measure against.
Representative Edgmon communicated he would be steadfast in
his recommendation that the bill should be accompanied by
some set of recommendations to do what Ms. Curtis had
discussed. He did not know where the issue would go
otherwise, and he did not want to be back revisiting the
situation again in several years.
9:55:13 AM
AT EASE
9:56:29 AM
RECONVENED
Representative Johnson associated herself with the remarks
made by Representative Edgmon. She thought his comments
were spot on. She referenced page 23 of the audit requiring
the board to annually report performance measures to the
legislature. She pointed out that the board was
specifically required to report on the CSPD [Controlled
Substance Prescription Database] security and reductions.
She moved to the next paragraph and remarked that it
specified the board had indicated the action was not
possible. She wanted standards that the board could comply
with. She was not certain where to fix the problem (e.g., a
via a taskforce, amendment, or other). She stated that if
people were set up to fail, that is what ended up
occurring.
Vice-Chair Ortiz requested to ask a question of the Board
of Pharmacy chair Dr. Ruffridge. He referred to the
committee's conversation about whether to extend the Board
of Pharmacy for four or six years. He referenced concerns
illustrated by different members about the PDMP. He asked
for comment by Dr. Ruffridge and what he viewed to be the
best way to move forward.
9:59:40 AM
JUSTIN RUFFRIDGE, CHAIR, BOARD OF PHARMACY, SOLDOTNA (via
teleconference), provided information about his time on the
board. He was extremely appreciative for the opportunity to
speak. He shared that he had joined the board two years
earlier at the same time the pandemic had started. He
elaborated that during his tenure on the board, they had
been adapting to what the situation had been brought to
their world. During the time, he had clearly seen that the
PDMP was a somewhat functioning tool. He confirmed that the
PDMP could function more efficiently and adeptly.
Mr. Ruffridge referenced an earlier question by
Representative Carpenter about communication with other
boards. He stated the answer was a "resounding yes." There
was a group of board chairs mentioned in the audit report
that met twice monthly for a total of three hours to
discuss the PDMP. He explained it was a boots-on-the-
ground, highly trained, highly motivated group with great
insight on the PDMP, changes that may be needed, existing
issues, and how the tool was currently used. He opined that
another audit was not needed to determine the information.
He believed what was needed and what he was hearing from
the legislature was the need for starting support for the
process of adjusting the use and access to the PDMP. He
communicated that multiple board chairs were ready to have
the conversation. He relayed that the board chairs
communicated well with one another; however, they could
only regulate and could not make any statutory changes.
Mr. Ruffridge referred to an earlier question by
Representative Wool about whether the PDMP was the only
source of solving the opioid crisis. He referenced
testimony from multiple people including Ms. Curtis that
the issue was near and dear to people's hearts. He
underscored that the issue was near to the hearts of the
board chairs as well. He stated they were all invested in
the issue and wanted the tools to work well. He relayed
that if the committee was hearing the tools were not
working well, it was more of a function of needing to adapt
them. He explained that just like drug diversion and drug
use was adapted because people would always seek out
opiates and had always done so. He remarked that the opium
trade was a huge part of the world's history. He elaborated
that the state needed to be able to adapt its tools to meet
the adapting, changing environment. He referred to one of
the committee member's comments about the glacial pace. He
stated it was true; sometimes, the state was behind what
changes needed to be happening.
Mr. Ruffridge referenced Representative Edgmon's point
about needing a lever. He was not certain a lever was
needed, he thought teamwork was what was needed. He thought
they needed people who were willing to sit in a room to
determine the situation, how to get from point A to point
B, and the steps needed to get there. He believed the
committee had heard from Dr. Delker that there were
multiple individuals standing by to have the conversation.
He considered the questions of who wanted to start the
conversation and when needed to be answered by the
committee. From the Board of Pharmacy perspective, it was
something the board held dear and believed it was doing a
good job. He communicated that the board wanted to be able
to do a better job if given the tools to do so. He
supported a six-year extension because it would take time.
He emphasized that the boards wanted to do the work, but
they were unsure of the path to take to get there and
needed help.
10:04:28 AM
Vice-Chair Ortiz asked if one viable idea would be to add
legislative participation in the recurring meetings held by
board chairs twice a month. He highlighted that ultimately
any needed changes would have to take place through
legislation.
Mr. Ruffridge replied, "Absolutely." He shared that in his
brief tenure as board chair, the participants had discussed
the need for legislative sponsorship and activity were
uncertain as to how to even address that issue to begin
with. He shared that the board chairs were uncertain how to
find someone from the legislature willing to come to a
meeting. He was incredibly grateful that the topic was
coming forward because he was finding there were multiple
individuals who hold the issue very seriously. He
emphasized the board chairs would welcome any and all
legislative participants to attend the meetings. He shared
there was a meeting the current afternoon at 4:30 p.m. for
anyone interested. He provided his email address for
interested parties.
10:06:54 AM
Representative Carpenter stated that held the audits
provided by Legislative Audit in high regard and he
understood the board was comprised of volunteer members. He
referenced Ms. Curtis's estimate that the division spent
1,000 hours on the audit and some of the time was spent
going down rabbit holes. He did not know whether that meant
the system was complex or there were more requirements than
resources for the board to deal with, or whether they were
looking at processes in place that were not effective or
there were management issues. The committee had had
testimony from a pharmacist there were still multiple
people not doing what they should be doing in regard to
checking the database.
Representative Carpenter referenced the audit report
recommendation 3 specifying the failure of a pharmacist in
charge or a pharmacist to register or submit information to
the database as required in statute was grounds for the
board to take disciplinary action. He read additional
detail from the requirement. He considered the idea of a
special audit and thought it could look across multiple
boards and jurisdictions to determine the number of claims
of failure there had been to the Board of Pharmacy. He
wondered how many investigations had been conducted and how
many disciplinary actions had been taken.
Representative Carpenter stressed there was a law in place
and the authority rested with the board to take action. He
recognized in a small state it was difficult to take
disciplinary action against one's peers. He stated there
was some peer pressure involved. He thought it may be part
of the issue, but he did not know. He highlighted there was
evidence from one testifier that the process was not
working. He remarked that with all due respect to the board
chair, the board had some authority it may not be using. He
thought more investigation was needed, which was the reason
be believed a four-year sunset was applicable. He
underscored there was a serious problem with one of the
audit recommendations that the legislature ought to be
looking at sooner rather than later.
10:10:53 AM
Vice-Chair Ortiz referenced Dr. Christensen's earlier
testimony and had understood it to be that the pharmacy had
been referring to communications with doctors and other
participants in the program rather than pharmacists. He
asked Dr. Christensen for clarification.
Co-Chair Merrick stated they would get clarification from
Dr. Christensen prior to the next meeting.
Vice-Chair Ortiz thought it was important to get
clarification. He agreed with Representative Carpenter if
his testimony had been referring to other pharmacists who
were not complying with the program. He stated it would be
a serious situation. However, he believed Dr. Christensen
had been referring to conversations with other participants
in the program, not necessarily pharmacists.
Co-Chair Merrick reiterated that her office would reach out
to Dr. Christensen prior to the next hearing on the bill.
Ms. Curtis responded to comments made by Representative
Carpenter. She relayed that the audit addressed an issue
discussed by Representative Carpenter in recommendation 5.
She elaborated that the occupational boards were not
enforcing the requirements. She pointed to Exhibit 8 on
page 18 of the audit report showing the percent of
subscribers actually reviewing the database. She
highlighted there was a 35 to 43 percent rate of reviewing
the database prior to prescribing, dispensing, and
administering medications. She stressed the number was low.
She stated that the database itself had shown numerous
improvements. She questioned whether it was being used and
whether individual boards were monitoring licensees'
requirements. She stated they were big questions.
Mr. Ruffridge replied it was an excellent point by
Representative Carpenter. He stated the issue was
multifaceted; however, the issue brought forward by Ms.
Curtis and Dr. Christensen was one of other boards their
requirement to review. He detailed that Chapter 30 clearly
defined that the practitioner, prior to prescribing, had a
requirement to review the PDMP. He underscored that it did
not include pharmacies. He explained that the pharmacy was
the reporter of the PDMP. He elaborated that pharmacies
could review the PDMP if they wanted, and they did
frequently. He highlighted that pharmacies and pharmacists
were the highest users of the database. He noted the
information was included in the audit report. He stated
that pharmacies and pharmacists had been the early adopters
and early users and they promoted, protected, and preserved
the PDMP.
Mr. Ruffridge addressed the question of discipline. He
communicated that the Board of Pharmacy brought forward a
disciplinary matrix the previous year because of its
importance. Additionally, the board had mailed a strongly
worded letter to licensees specifying that if they were
found to have not reported on a daily basis and the board
ran a report showing a licensee did not report, there would
be discipline and the licensee would be referred to
investigations. However, after the notice was sent out, the
Board of Pharmacy received notice from its vendor that
hosted the PDMP that the reporting information would not be
valid and could not be pulled or used. Consequently, the
board had to go back to the drawing board and were now
working with a tech company to determine how to build a
disciplinary matrix for a report that was useable to
determine who may or may not be reporting.
Mr. Ruffridge detailed that reporting did not seem to be an
issue with pharmacy, although it happened occasionally
where a pharmacy had a technological glitch, and something
would not be reported. He relayed that it was easy to go
back and clean that up. He emphasized it was not the
responsibility of the Board of Pharmacy to discipline
members of the Board of Medicine, Board of Nursing, or
other boards. He clarified that the Board of Pharmacy was
responsible for the reporting to the PDMP and the
management of the PDMP, meaning it had to work with other
boards, which was the reason the twice monthly meetings
were so important. He stated it was an issue and he hoped
it could be addressed in collaboration with the legislature
going forward.
10:16:27 AM
Representative Carpenter referenced AS 17.30.200(e) that
specified a failure of a practitioner to register or review
the database as required was grounds for the practitioner's
licensing board. He stated that if a pharmacist was having
a conversation with a prescribing doctor and there was a
disconnect because the doctor was not checking the
database, it was an issue for the Medical Board to deal
with. He remarked there were multiple boards with the power
to enforce, but it appeared they may not be in some cases.
He wondered why. He reasoned it was ultimately what another
investigation, audit, or conversation amongst the boards
needed to identify. Subsequently, if the legislature had to
get involved, it would. He thought the boards had what they
needed. He remarked that they may need additional resources
and statute changes, but they were supposed to be doing the
enforcement currently and it appeared that may not be the
case.
Co-Chair Merrick noted that Mr. Christensen had called back
into the meeting and was available online.
Vice-Chair Ortiz restated his previous question to Mr.
Christensen. He referenced Mr. Christensen's testimony
earlier in the meeting that he had had discussions with
other participants in the PDMP program and it was clear
they were not following through with reporting obligations.
He asked if Mr. Christensen had been referring to
interactions with other pharmacists or participants in the
PDMP program outside of pharmacy.
Mr. Christensen clarified that he had been referring to
other prescribers such as physicians and nurse
practitioners.
10:19:16 AM
Representative Edgmon thought the discussion was really
evolving and he hoped it got to a good place. He agreed
with Representative Carpenter and was not disagreeing with
Vice-Chair Ortiz and his line of questioning and others
around the table. He considered from a broad policy goal,
the legislature had created taskforces and groups for
criminal justice, teacher retention and recruitment,
fisheries bycatch, fiscal policy, and other. He asked if it
led to political change or momentum or getting things
through the legislature. He stated it was ultimately what
was needed.
Representative Edgmon appreciated the informed comments by
Mr. Christensen and Mr. Ruffridge; however, he underscored
that teamwork was not going to get the job done. He thought
a lever was needed. He stressed that they were falling
short on the issue. He emphasized that the audit could not
come close to measuring the issue because it was not the
objective of the audit. He did not believe the audit looked
back at the intent of the bill sponsor in 2008, the changes
made in 2016, adjustments in 2017, or the concern being
registered by the committee.
Representative Edgmon thought the committee was speaking
about two objectives including the broader goal of making
the PDMP more impactful and being able to talk to other
entities including the Department of Health and Social
Services (DHSS), which was about to become two departments.
From his perspective as the chair of the Department of
Corrections [budget subcommittee], the drug problem was
every bit as robust as it had been. He stated that the
database was supposed to help with the problem. He
elaborated that it sounded to him like the PDMP was doing
its job in terms of what was required at the pharmacy
level, but in terms of looking at the larger objectives, he
believed if it was not falling short, the questions were
still unanswered. He wanted to get the questions answered.
He believed whether it was via a taskforce, special audit,
or other, the committee should not leave work on the bill
without identifying a vehicle to move forward that could
involve LB&A or a legislator taking on legislation.
10:21:59 AM
Representative LeBon thanked Mr. Ruffridge for having a
conversation prior to the meeting. He had learned there was
participation by the Board of Pharmacy with outside
organizations seeking best practices to do a better job for
Alaskans. He suggested the board consider engaging in a
process to look at itself internally. He pointed out the
board was currently doing so, but he suggested formally
seeking out some type of a relationship with a consultant
or auditor to validate its best practices to ensure its
application of practices in the arena of public health,
safety, and welfare, was as effective as it could be. He
recommended the board not just wait for the state auditor
to determine best practices in four to six years, but also
to take some ownership.
Representative Josephson thought Representative Edgmon was
getting to a possible pathway. He stated that even if
Exhibit 8 showed provider participation that was twice as
good, he would find it inadequate. He highlighted it would
mean one-third of the providers were not looking at the
PDMP, which was awful. He stated that providers would say,
with some legitimacy, that they needed statutory delegates
to be able to look at the PDMP. He noted he and former
Senator Cathy Giessel had worked on a bill on that topic,
but it had been inadequate to the task. He added he had a
bill (HB 242) the previous term that was an effort to go
deep on the subject and provide a resolution. He observed,
with respect to the provider cohorts, that they did not
seem to want to play the bad cop and have levers on their
own people. He considered that perhaps he was incorrect,
but the participation was wholly inadequate. He stated
another audit would be helpful, but the situation was so
far off the mark as it was. He thought another audit would
not be sufficient to get the job done.
10:25:24 AM
Vice-Chair Ortiz reminded the committee about why they were
speaking to the issue and why the conceptual amendment had
been offered that would reduce the sunset from six to four
years. The primary motivation was a good motivation because
the committee felt they needed a lever to address issues
with the PDMP. He stated it had become clear from testimony
that it was not the appropriate lever. He stated it was a
separate question that needed to be addressed and
legislators needed to be participants in the process. He
underscored that the current issue before the committee was
the Board of Pharmacy extension. He stated that the
amendment addressed whether the extension should be four or
six years. He thought it was a different question than the
problems discussed by the committee. He supported dealing
with the extension and separating the PDMP question.
Co-Chair Merrick reminded the committee that Mr. Ruffridge
had invited any members to participate in an upcoming
meeting at 4:30 p.m.
Representative Wool agreed with Vice-Chair Ortiz. He
thought they were conflating two issues. He referred to
Representative Edgmon's mention of DOC and the continuing
drug problem. He believed DOC had stopped allowing inmates
from receiving original copies of letters from family
because DOC was concerned there were drugs in the paper. He
stated if it was true, it was a problem, but not a PDMP
problem. He thought the committee was ascribing every
existing problem to the PDMP.
Representative Wool believed the database was a necessary
tool and that people had been educated on the tool. He
thought the way doctors prescribed had changed
significantly by knowing the PDMP was there. He referenced
mention of the number of morphine milligram equivalents
prescribed. He would be interested to know how the trend
had been going since the implementation of the PDMP. He
would also be interested to hear from DHSS on the cause of
overdose. He believed the PDMP needed some tweaking, and he
supported new statutes. He thought there had to be some way
to ensure follow through on the issue. He did not know the
answer, but he thought some solutions needed to happen and
not merely the formation of a taskforce. He did not want to
pick on the Board of Pharmacy, although he noted they were
integral to the issue and needed to be at the table, along
with other boards.
Representative Wool thought a lot of good had happened with
the PDMP even though there were some problems with the
database. He considered that perhaps not all of the
providers were using the PDMP as they should, which was not
good. He remarked that when he was standing in line at the
pharmacy, he would not think everyone in line was an opioid
abuser. He thought most were merely getting a prescription
filled. He did not know and until more data was received,
they would not know. He acknowledged a problem existed and
the bill had brought up the discussion.
10:30:30 AM
Representative Carpenter shared that his wife had lost two
brothers to opioid abuse. He was very sensitive to learning
there were medical providers who were not following the law
and using the database they should be using to help stem
the problem. He did not want to wait six years to find out
if recommendation 3 had been addressed. He did not want to
wait two years. However, in the current political
environment, he was agreeing to wait four. He WITHDREW
conceptual Amendment 1. He planned to submit a written
amendment when appropriate.
Co-Chair Merrick set an amendment deadline for 6:00 p.m. on
March 23.
HB 306 was HEARD and HELD in committee for further
consideration.
10:31:59 AM
AT EASE
10:34:57 AM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 306 - PHA Bd Letter of Support - 2.25.22.pdf |
HFIN 3/15/2022 9:00:00 AM |
HB 306 |
| HB 308 CS WorkDRaft FIN v.I 031422.pdf |
HFIN 3/15/2022 9:00:00 AM |
HB 308 |
| HB 308 - Sectional on LH.pdf |
HFIN 3/15/2022 9:00:00 AM |
HB 308 |
| HB 308 Sponsor Statement.pdf |
HFIN 3/15/2022 9:00:00 AM |
HB 308 |
| HB 306 PDMP Board Chairs Letter to House Finance (3.21.22).pdf |
HFIN 3/15/2022 9:00:00 AM |
HB 306 |