Legislature(2015 - 2016)HOUSE FINANCE 519
04/16/2015 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB71 | |
| SB26 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 26 | TELECONFERENCED | |
| + | SB 71 | TELECONFERENCED | |
| += | HB 81 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 71
"An Act relating to the practice of pharmacy; and
relating to the administration of vaccines and related
emergency medications."
2:50:38 PM
SENATOR CATHY GIESSEL, SPONSOR, discussed the legislation.
She explained that SB 71 allowed pharmacists in Alaska to
administer vaccines without a collaborative practice
agreement. She detailed that a collaborative practice
agreement, established in 2001, was a contract between the
pharmacist and a medical provider which allowed the
pharmacist to administer vaccines. The contracts cost
between $50 and $500 and often proved difficult for the
pharmacist, especially those in rural areas, to find a
provider who will oversee the vaccine administration which
involved paperwork. The legislation authorized certified
pharmacists to administer the vaccinations without the
oversight agreements in place. She relayed that pharmacists
had been educated in vaccine administration since 2005 as
part of their curriculum and were entering the profession
with a doctorate degree in pharmacology. The bill mandated
that pharmacists educated prior to 2005 would have to take
a specific course approved by the Board of Pharmacy. She
described the training that the pharmacists already
received in the administration of vaccinations including
adverse reactions response and interactions with other
medications. She shared that as a nurse practitioner
herself, she relied on the pharmacist's specialized
knowledge when prescribing. The bill would particularly
help rural pharmacies by removing the collaborative
agreement mandate. She shared that in states where
pharmacists possessed the independent authority to
administer vaccines immunization rates rise. She informed
the committee that Alaska had a low vaccination rate.
Currently, all vaccinations were recorded in a system
called Vactracks and all healthcare providers had access to
the information. Alaskan pharmacists administered over 13
thousand flu vaccines in the previous year. She believed
that the bill would improve access to immunizations in the
state.
2:55:14 PM
Vice-Chair Saddler wondered if the system of recording
immunizations needed to be improved or strengthened.
Senator Giessel answered that the VacTracks system had been
in place for a number of years and all healthcare providers
used the system. She elaborated that the system "vastly"
improved the tracking of vaccines and she was not aware of
any flaws.
Representative Kawasaki asked for details on how
pharmacists currently administered vaccinations. Senator
Giessel answered that the healthcare provider must fill out
paperwork and review records; they were not required to be
physically present. She added that the system for
pharmacist administered immunizations was already in place.
The bill merely removed the paperwork requirements and
allowed highly trained professionals "administer
medication." Representative Kawasaki asked whether the
State Medical Board or the Medical Association had an
opinion about the legislation. Senator Giessel replied that
she had not received any opposition from the medical
community.
Representative Guttenberg asked whether the bill required
pharmacists to administer an expanded list of vaccines that
were currently not administered by pharmacists. Senator
Giessel responded that she was not sure and deferred to
pharmacists to answer the question. She noted that
pharmacist routinely administered flu vaccines, which
required needles, syringes, refrigeration, and other
relevant supplies therefore, were already equipped.
Representative Guttenberg wondered about logistics and how
things would change for the pharmacist and the pharmacy
space with passage of the bill, particularly for rural
pharmacies.
DIRK WHITE, PHARMACIST AND FORMER PRESIDENT, BOARD OF
PHARMACY, SITKA (via teleconference), answered that
internally and procedurally the pharmacy would not change.
He revealed that a limitation of the collaborative practice
agreement was that the agreement was specific to a location
and the pharmacist could not leave the pharmacy to
administer vaccinations. He highlighted pharmacists'
inability to travel to community health fairs as an
example. The bill would enable pharmacists to go to other
locations and travel to rural areas to administer
immunizations.
3:03:52 PM
Representative Gara asked whether there were any safety
issues with the bill.
DR. JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, communicated that pharmacists
currently delivered a large number of vaccines throughout
the state and therefore, did not have any safety concerns
or reservations with allowing pharmacists to administer
vaccines. Representative Gara asked whether his answer
extended to the ability of the pharmacist to administer
emergency medications due to an adverse reaction. Dr.
Butler answered that allergic reactions to a vaccine was a
rare occurrence and that under the collaborative agreement
the pharmacist was currently allowed to administer
emergency medications.
Representative Kawasaki stated that currently under a
collaborative physician agreement reports were written and
reviewed. He asked whether, absent an agreement reporting
would still be required. Dr. Butler replied that completion
of the vaccine adverse event reporting system was
mandatory. He explained that the system was a tool
available to pharmacists and patients and was monitored by
the federal Food and Drug Administration and Centers for
Disease Control.
Vice-Chair Saddler noted that the bill included
administration of emergency medications and asked for an
example of emergency medications. Dr. Butler answered that
epinephrine administered for rare allergic reactions to
immunizations called "anaphylactic reactions" was an
example of emergency medication. Vice-Chair Saddler asked
whether pharmacists received specialized emergency
medication response training. Dr. Butler responded that the
critical issue was the ability to recognize the adverse
reaction.
DANIEL NELSON, PRESIDENT, ALASKA PHARMACISTS ASSOCIATION,
FAIRBANKS (via teleconference), stated his strong support
of the legislation.
RYAN RUGGLES, PHARMACIST AND DISTRICT PHARMACY MANAGER,
ALBERTSON-SAFEWAY, ANCHORAGE (via teleconference),
testified in support of the bill. He shared that Alaskan
pharmacist currently administered many types of vaccines.
The legislation would remove the collaborative physician
agreement mandate which was "difficult to obtain" and
limited the pharmacists' ability to serve their patients.
He believed that passage of SB 71 would strengthen the
continuity of care that pharmacists endeavored to provide
patients.
3:11:31 PM
LIS HOUCHEN, NORTHWEST REGIONAL DIRECTOR, STATE GOVERNMENT
AFFAIRS, NATIONAL ASSOCIATION CHAIN AND DRUG STORES,
OLYMPIA, WASHINGTON (via teleconference), spoke in favor of
the bill. She listed the organization's members. She shared
that in 2012 only 1.2 percent of Alaskans had received the
flu immunization. The association believed that the
legislation would increase access to vaccinations in rural
areas.
BARRY CHRISTENSEN, CO-CHAIR, ALASKA PHARMACIST ASSOCIATION
LEGISLATIVE COMMITTEE, KETCHIKAN (via teleconference),
testified in support of the legislation. He thought that
the bill would help reduce the cost of healthcare. He
relayed that the association had met with other medical
providers prior to the bills introduction to inform them
about the legislation.
Co-Chair Thompson CLOSED public testimony.
Representative Kawasaki spoke to the fiscal notes. He
pointed to Fiscal Note 1 (CED) and wondered why it cost
$2.5 thousand to amend the regulation. He previously had
not seen a fiscal note accompany a bill changing a
regulation.
Co-Chair Thompson assumed it was a one-time cost.
Senator Giessel deferred the question to the Department of
Commerce, Community and Economic Development.
SARA CHAMBERS, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION
OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING,
DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT,
answered that the Department of Commerce, Community and
Economic Development (DCCED) was implementing the practice
of requesting receipt authority for the average cost of a
division "regulation project" in an effort "to best and
conservatively manage licensing fees" that were charged to
the licensees. She elaborated that the division handled
"competing interests" between the division and the various
board's mission related and statutory authority. In
situations when the division had other bills related to
regulations and were managing tens of thousands of dollars
dealing with regulation changes, the fiscal note added
transparency to the process and alerted the boards that
their funds were being spent in case funding for their
other mission purposes was curtailed.
Representative Kawasaki supported adding the receipt
authority in the fiscal note as long as the practice would
continue into the future.
Representative Wilson wondered how many hours it would take
to amend the regulation and how the department calculated
the $2.5 thousand expenditure.
3:17:14 PM
Ms. Chambers replied that the expense was calculated based
upon a variety of expenses including the charges from the
Department of Law (DOL) review and DCCED regulation
specialist time. She added that the bulk of the cost came
from printing and postage for sending copies of the new
regulations to the licensees'; mandated by statute. She
shared that $2.5 thousand was an average board expense.
Representative Wilson asked whether there was an option to
send the regulations by email. Ms. Chambers answered that
the department was exploring the option with DOL. The
current legal interpretation required the paper option.
Representative Wilson believed the email option should be
pursued.
Representative Pruitt voiced that previously the division
spread the cost among all boards. He thought that the
division was attempting to shift to using the receipt
authority to charge the actual costs on to the specific
board affected. He hoped it would be the direction the
department would take on any future adjustments or
regulation projects for any licensee group. He asked for
confirmation on his comments. Ms. Chambers agreed with his
comments and related that the division was ensuring that
"the expenses were directly correlated to the licensing
fees of the particular licensed profession that incurred
the costs."
Representative Kawasaki cited Fiscal Note 3 (DHS) and
relayed that the analysis noted that the Medicaid program
would be expected to incur costs resulting from changes
needed to the claims processing system. He wondered what
the total costs amounted to. Dr. Butler replied that the
original fiscal note had included a one-time capital
request of $50 thousand for the claims processing without
the collaborative agreement. Subsequently, it was
discovered that the bonus performance money from the
Children's Health Insurance Program (CHIP) could be used to
implement the changes to the claims processing system.
Therefore, the fiscal note had been zeroed out.
3:22:15 PM
Vice-Chair Saddler MOVED to REPORT SB 71 out of committee
with individual recommendations and the accompanying fiscal
notes. There being NO OBJECTION, it was so ordered.
SB 71 was REPORTED out of committee with a "do pass"
recommendation and with one previously published fiscal
impact note: FN1 (CED); and one previously published zero
fiscal note: FN3 (DHS).
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 26 CS WORKDRAFT FIN 041615 F version.pdf |
HFIN 4/16/2015 1:30:00 PM |
SB 26 |