Legislature(2021 - 2022)DAVIS 106
04/21/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB295 | |
| Confirmation Hearing(s): | |
| HB382 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 382 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 295 | TELECONFERENCED | |
HB 382-INSULIN COVERAGE:INSURANCE;MEDICAID
3:30:11 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 382, "An Act relating to insurance
coverage for pharmacy services."
3:30:58 PM
CO-CHAIR SNYDER, as prime sponsor, explained that HB 382 had two
main focuses: promoting prevention to produce better health
outcomes and improving health care access. She stated that the
bill was motivated by the "astronomically high" price of
insulin, citing that the current $300 cost of a single vial is
four times what it was in 1996, including inflation. She
reported that in Alaska, 50,000 people were diagnosed with
diabetes, with an average of 5,000 new diagnoses every year, and
an additional estimated 15,000 people have diabetes but are
unaware. She shared that there is also a large population of
pre-diabetic people in the state and mentioned that the high
cost of insulin can force patients to choose between their
medication and paying for rent or groceries or to "ration" their
prescriptions and not use them as prescribed. She stated that
the bill would put a monthly cap on insulin copay which is
similar to legislation that has been passed in other states.
She addressed the concern about increased premiums by reporting
findings from various studies that said the cost per insured
individual would increase by somewhere between 70 cents to $3 a
year. She shared that there were states that saw a decrease in
premium costs, and that even those where their costs did
increase to the highest end of the estimate described that
increase as "negligible." She went on share that the cap would
allow more people to have regular utilization of insulin at the
appropriate dosage, which would save additional money on
healthcare overall by reducing the number and length of
hospitalizations and the severity of disease.
3:36:24 PM
JAMES HOLZENBERG, Staff, Representative Liz Snyder, on behalf of
Representative Snyder, prime sponsor, read the sectional
analysis for HB 382 [included in the committee packet], which
read as follows [original punctuation provided]:
Sec. 1: Adds conforming language to AS 21.42.390 (a)
Coverage for treatment of diabetes
stating that coverage for other kinds of medicines
required by this section are still subject to
standard policy provisions, except as provided in a
new section, (d), which is in section 2 of the
bill.
Sec. 2: Adds a new section to AS 21.42.390 that states
that a private health care insurer that
operates within the State cannot charge more than $100
in copays for a 30-day supply of insulin.
There is an exception, if necessary, for some high
deductible health plans that are eligible for a
health savings account tax deduction under 26 U.S.C.
223.
Sec. 3: Adds conforming language to AS 21.42.420
Coverage for prescription drugs; specialty
drug tiers prohibited, ensuring that all other kinds
of medicine are still subject to standard policy
provisions defined in other statutes.
Sec. 4: Adds a new section stating that these
provisions apply to all insurance policies created on
or after the bill's effective date.
3:37:51 PM
REPRESENTATIVE FIELDS asked whether the attorney general had
attempted to pursue legal action against the insurance companies
for unfair trade practices under the Alaska Consumer Protection
Act.
CO-CHAIR ZULKOSKY noted that there were no representatives from
the Department of Law (DOL) available for questions and asked
Co-Chair Snyder to follow up with the department and share her
findings with the committee later.
CO-CHAIR SNYDER confirmed that she would provide that
information to the committee and noted that HB 382 is the first
step in solving the problem of increasing medicine costs; it
focuses on the relationship between insurers and patients. She
acknowledged that there are many other factors centered around
the actions of pharmaceutical companies but said she does not
see those factors being altered by the presence or absence of a
cap. She stated that she would want to work with the
administration to create future legislation to combat those
other factors.
REPRESENTATIVE FIELDS commented that he wants to look at the
full range of options for tackling the "predatory pricing
practices" and would welcome the opportunity to work on
legislation complimentary to HB 382.
3:39:58 PM
CO-CHAIR ZULKOSKY proceeded with invited testimony.
3:40:26 PM
LAURA KELLER, Managing Director of Advocacy, American Diabetes
Association, referred to a non-partisan study on copay cap
legislation from California that projected a raise in premiums
by less than one percent and a decrease in emergency room visits
and hospitalization costs by ten percent. She referenced the
same State of Washington legislation Co-Chair Snyder had
mentioned and said that the initial cap of $100 had lowered
premiums, allowing the state to pass further legislation
dropping the copay to $35, matching the recently passed national
Medicaid cap. She highlighted that there is no generic form of
insulin on the market at more affordable costs unlike other
major pharmaceuticals, and this has forced families in Alaska to
choose between paying their rent or getting the needed insulin.
She suggested that the committee consider lowering the cap to
align with the $35 national cap but emphasized that "any cap
would be better than none" and would work towards increasing a
sense of security for people with diabetes and saving lives.
She reported that the State of Alaska spends an estimated $575
million on diabetes and associated complications every year due
to the cost-prohibitive nature of insulin for many Alaska
patients.
3:43:26 PM
REPRESENTATIVE FIELDS asked how many people have had to seek
more expensive care after not receiving their insulin due to
"price gouging by drug companies."
MS. KELLER responded that she would work to provide that
information to the committee.
3:44:06 PM
REPRESENTATIVE SPOHNHOLZ requested further details on some of
the complications of improperly managed insulin-dependent
diabetes that can send patients to emergency care.
MS. KELLER explained that insulin allows blood cells to take in
nutrients, and for people like herself with Type 1 diabetes that
do not produce any insulin on their own, they must take insulin
to survive. She described what happens within the bloodstream
when there is no insulin present to process nutrients as high
blood sugar levels creating a "sludge" within the blood. She
stated that being unable to process sugar through the
bloodstream can lead to many different complications, including
retinopathy, neuropathy, potential amputations, kidney failure
and dialysis, increased dental issues, the possibility of heart
disease, and even death. She concluded that being able to
manage blood sugar appropriately with insulin allows diabetics
to reduce their chances of these costly and sometimes deadly
complications.
3:46:33 PM
REPRESENTATIVE FIELDS posited that the core issue is the
monopolization of insulin production and asked whether any
states have sought other ways of producing and providing insulin
in a more cost-effective manner.
MS. KELLER replied that California had looked into making
generic medications available to the public, with insulin high
on the priority list, but the process was interrupted by the
COVID-19 pandemic. She mentioned that other states had
expressed interest in joining California's efforts in this, but
that putting that project into motion would require a large
investment of time and resources. She explained that creating
the facilities, producing the drugs, and getting them into
pharmacies would be a very long-term solution, and she
emphasized that a copay cap could be implemented quickly to
provide needed relief for Alaskans while more time-intensive
options are put into place.
REPRESENTATIVE FIELDS expressed his hope that Alaska would seek
to join the consortium to produce insulin at a lower cost. He
asked whether Ms. Keller is aware of attorneys general from
other states that have pursued legal action against the
"monopoly" that pharmaceutical companies have on insulin, and he
opined that Alaska would have to pursue criminal or civil action
due to those companies' violation of multiple Alaska Statutes.
MS. KELLER said she is not aware of any attorney general
currently in that process.
3:50:12 PM}
BRANDON OUSLEY, Chief Executive Officer, Anchorage Fracture &
Orthopedic; Consultant, Capstone Endocrinology and Diabetes
Center, began invited testimony on HB 382 by sharing that his
journey with advocating for affordable diabetes care started
with his daughter, who has Type 1 diabetes. He opined that it
can be easy for people to think diabetes is "no big deal" if
they do not have direct exposure to it. He underscored the
importance of proper health care access by mentioning the
100,000 prediabetic people in Alaska, and he applauded the cap
proposed under HB 382, commenting that he would love to see it
match the $35 in the Affordable Insulin Now Act. He explained
that in his personal and professional experience dealing with
access to diabetes care, a cap on copay is only one step of
controlling the "downstream" cost.
MR. OUSLEY shared that when his daughter was diagnosed, the
closest pediatric endocrinologist that would admit them was in
Utah, exemplifying that finding a practitioner to manage one's
condition and dosage of insulin is just as difficult as
affording the insulin. He reported that there is a shortage of
endocrinologists throughout the country and that it is
particularly hard to attract those specialists to practice in
Alaska, further stating that most of the small number of
existing endocrinologists in the state are several years beyond
retirement age. He pointed out that one of the biggest
financial burdens to both patients and the state is the cost of
dialysis, and he mentioned that dialysis centers get reimbursed
by Medicare for 2,500 to 7,000 percent. In comparison to the
numerous challenges and costs associated with diabetes care, he
opined that solving the cost of insulin with a copay cap is "an
easy piece" of this complicated issue.
3:54:24 PM
REPRESENTATIVE FIELDS asked what further measures in addition to
the proposed cap Mr. Ousley would suggest to decrease the price
of insulin.
MR. OUSLEY reported that every diabetes center he has worked
with in Alaska has a very high number of self-pay patients who
are constantly in search of cheaper insulin. He strongly
advocated that the state "go out of [its] way" to address the
need of the uninsured as well.
REPRESENTATIVE FIELDS asked whether Mr. Ousley is familiar with
ways other states have provided insulin to uninsured patients.
MR. OUSELY replied that he is not.
CO-CHAIR ZULKOSKY redirected the question to Ms. Keller.
MS. KELLER described a component of the passed Utah insulin
copay bill called the "insulin purchasing program" that allows
uninsured patients to buy insulin for the same price that the
state's employee plans pay. She explained that the system is
all digital, which kept the operation costs for the program
down, and once approved, uninsured applicants receive a card via
email that allows them to pay for the medication at a pharmacy,
but at the much lower rate that is granted to the state
insurance plan. She stated that it is a widely successful
program with most pharmacies in Utah accepting the cards, and
she offered her understanding that the executive and legislative
branches of Utah's government are pleased with how it has been
implemented so far.
REPRESENTATIVE FIELDS requested "the department" analyze the
viability of instituting a program similar to Utah's in Alaska.
3:58:22 PM
REPRESENTATIVE SPOHNHOLZ questioned the copay for insulin in
Utah.
MS. KELLER replied that the cost through the purchasing program
is $75 a vial.
3:59:20 PM
REPRESENTATIVE SNYDER explained that within the context of
inflation, $75 per vial is comparable to 1994's rate of $20 per
vial. She mentioned that typically patients use two vials per
month, which translates to a $150 monthly copay.
MS. KELLER responded that the Utah cap for copay is $30 per
month, which covers as many vials as are prescribed.
4:00:19 PM
CALISTA OUSLEY began invited testimony by sharing her personal
experience as a teenager with Type 1 diabetes. She explained
that although she has a strong support system between her family
and her medical team, she still struggles with the many
challenges of managing her health. In the 8 years since her
diagnosis, she reported, she has used 176 vials, which would
have cost $35,200 without insurance. She posited that without
any change, the costs of insulin will grow to an "unimaginable
number," and she asked the committee to consider amending the
bill to have a $35 cap to ensure insulin is available for all
Type 1 diabetics. She opined that if HB 382 were not passed,
lives would be put at risk as insulin remained inaccessible to
many Alaskans. She argued that access to insulin provides a
higher quality of life to diabetics that should be a right and
not a luxury.
4:02:58 PM
The committee took an at-ease from 4:03 p.m. to 4:09 p.m.
4:09:07 PM
CO-CHAIR ZULKOSKY opened public testimony on HB 382. After
ascertaining that no one wished to testify, she closed public
testimony.
[HB 382 was held over.]