Legislature(2021 - 2022)DAVIS 106
05/05/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| SB98 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 132 | TELECONFERENCED | |
| += | SB 98 | TELECONFERENCED | |
| + | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:08:32 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be SENATE BILL NO. 132, "An Act exempting veterinarians
from the requirements of the controlled substance prescription
database."
3:08:28 PM
The committee took an at-ease from 3:08 p.m. to 3:10 p.m.
3:10:33 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 1 to SB 132,
labeled, 32-LS0861\A.1, Ambrose, 4/27/22, which read as follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, line 4, through page 2, line 6:
Delete all material and insert:
"* Section 1. AS 17.30.200(k) is amended to read:
(k) In the regulations adopted under this
section, the board shall provide
(1) that prescription information in the
database shall be purged from the database after two
years have elapsed from the date the prescription was
dispensed;
(2) a method for an individual to challenge
information in the database about the individual that
the person believes is incorrect or was incorrectly
entered by a dispenser;
(3) a procedure and time frame for
registration with the database;
(4) that a practitioner review the
information in the database to check a patient's
prescription records before dispensing, prescribing,
or administering a schedule II or III controlled
substance under federal law to the patient; the
regulations must provide that a practitioner is not
required to review the information in the database
before [DISPENSING, PRESCRIBING, OR ADMINISTERING]
(A) dispensing, prescribing, or
administering a controlled substance to a person who
is receiving treatment
(i) in an inpatient setting;
(ii) at the scene of an emergency or in an
ambulance; in this sub-subparagraph, "ambulance" has
the meaning given in AS 18.08.200;
(iii) in an emergency room;
(iv) immediately before, during, or within
the first 48 hours after surgery or a medical
procedure;
(v) in a hospice or nursing home that has
an in-house pharmacy; [OR]
(B) dispensing, prescribing, or administering a
nonrefillable prescription of a controlled substance
in a quantity intended to last for not more than three
days; or
(C) prescribing a controlled substance if
the practitioner is a veterinarian."
Renumber the following bill sections accordingly.
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator,":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SNYDER shared that Amendment 1 resulted from
multiple conversations with veterinarians, and it would address
veterinarian concerns, public health concerns, and interests of
the state. She explained that if veterinarians prescribe
opioids but do not dispense the drugs, the veterinarians are
still required to report to the Prescription Drug Management
Program (PDMP). She noted that some exemptions exist. She
stated that Amendment 1 would exempt veterinarians who prescribe
Schedule II, III, or IV controlled substances, but do not
dispense the drugs, from reviewing the PDMP in all instances.
She stated that the amendment would shift the responsibility of
querying PDMP to pharmacists who dispense the controlled
substances.
3:12:31 PM
REPRESENTATIVE KURKA questioned whether pharmacists experience
the same issues with animal data as veterinarians, and if so, he
questioned how the pharmacy would track the animal data in PDMP.
REPRESENTATIVE SNYDER stated that, according to conversations
with stakeholders, the Alaska Board of Pharmacy, and PDMP
reports, pharmacists are more adept at properly utilizing PDMP.
She recognized that the issue of human and animal data
comingling would not be solved by the amendment; however, she
voiced the opinion that it would relieve some pressure from
veterinarians, while maintaining opioid tracking. She suggested
that additional work to the functionality of PDMP would still be
needed.
REPRESENTATIVE KURKA questioned how Amendment 1 would address
the issue of entering data for animals without owners, such as
those living in animal shelters.
REPRESENTATIVE SNYDER expressed uncertainty and deferred to the
PDMP manager.
3:15:29 PM
LAURA CARRILLO, MPH, Executive Administrator, Alaska Board of
Pharmacy, Prescription and Drug Monitoring Program, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community and Economic Development, explained that
with the amendment, any prescribed Schedule II, III, or IV
controlled substances would still need to be reported.
REPRESENTATIVE SNYDER added that with Amendment 1, veterinarians
who prescribed and dispensed opioids to animals onsite would
still be required to query and report to PDMP. She mentioned
that the upcoming Amendment 2 would further address exemptions
based on the length of the prescription, and she explained that
the intention of both amendments would be to reduce the burden
on veterinarians, while maintaining tracking capabilities.
3:18:41 PM
REPRESENTATIVE MCCARTY expressed the opinion that if PDMP is not
working as intended with the animal data, the amendment would be
shifting the burden of dealing with a broken system to the
pharmacist. He pointed out that the person who takes the animal
to the veterinarian may not be the same person picking up the
prescription from the pharmacist. He questioned whether this
issue would be addressed.
REPRESENTATIVE SNYDER explained that the Alaska Board of
Pharmacy has given positive feedback concerning the shift of
PDMP responsibility to pharmacists. She expressed the belief
that the state could improve the tracking of animal data within
PDMP, and she expressed support for maintaining pressure on the
administration to fix the data entry for animals.
REPRESENTATIVE MCCARTY questioned whether veterinarians had
National Provider Identifier (NPI) numbers and if they did not,
would Amendment 1 put the pharmacist "on the line" since their
NPI would be the only one associated with the prescriptions.
3:22:25 PM
The committee took a brief at-ease.
3:22:53 PM
CO-CHAIR ZULKOSKY deferred the question to the invited
testifiers.
3:23:09 PM
TRACY WARD, DVM, President, Alaska Veterinary Medical
Association, in response to Representative McCarty's question,
stated that veterinarians are not required to have NPI numbers.
She stated that the only requirement for veterinarians to
prescribe opioids is to present a Drug Enforcement Agency (DEA)
license to the pharmacy when a prescription is called in.
REPRESENTATIVE MCCARTY stated that PDMP requires a NPI number to
be entered when making a query or a report and opined that the
amendment would require the queries about animal prescriptions
to be tied to the pharmacist's NPI number. He posited that this
could lead to confusion during an investigation and stressed the
need for systematic changes to PDMP.
3:25:06 PM
REPRESENTATIVE PRAX shared the understanding that PDMP serves as
a check for other prescriptions human clients may have had
before. He posited that if pharmacists are querying the system
for animal prescriptions, they still would not be entering the
prescriptions into the PDMP.
MS. CARRILLO explained that there is a requirement to enter
animal information, including the person's last name, when a
review or investigation is made. She said that Amendment 1
would put the responsibility on the pharmacist to make those
entries.
REPRESENTATIVE PRAX requested clarification on when a human
client goes to a pharmacist to pick up a prescription for a pet,
in this situation the pharmacist would query the human client's
name; however, the prescription for the pet would not be entered
under the client's name.
MS. CARRILLO confirmed that Representative Prax's understanding
is correct. She said that the pharmacist would use the pet's
profile to enter information, and the prescription would not be
linked to the human client's profile.
REPRESENTATIVE PRAX questioned whether a human client could pick
up a prescription from one pharmacy and fill the same
prescription at another pharmacy, as a way to "defeat the
system."
MS. CARRILLO clarified that reviewing PMDP and reporting to PMDP
are two separate things. She explained that a pharmacy would be
able to see whether a prescription was already filled.
3:30:02 PM
JUSTIN RUFFRIDGE, PharmD, Alaska Board of Pharmacy, in response
to a question from Representative Spohnholz, explained that NPI
stands for National Provider Identification. In response to a
follow-up question, he stated that a NPI number is associated
with the provider but not with the patient.
3:30:41 PM
MS. CARRILLO, in response to a question from Representative
Prax, explained that the DEA registration number is the
identifier required for access to PDMP, and any query or report
made is associated with this number. She stated that NPI is
used for insurance purposes and is not required for use of PDMP.
3:32:39 PM
CO-CHAIR ZULKOSKY removed her objection to Amendment 1.
REPRESENTATIVE PRAX objected.
A roll call vote was taken. Representatives Sponholz, Fields,
Snyder, and Zulkosky voted in favor of Amendment 1 to SB 132.
Representatives McCarty, Prax, and Kurka voted against it.
Therefore, Amendment 1 was adopted by a vote of 4-3.
3:33:25 PM
The committee took an at-ease from 3:33 p.m. to 3:34 p.m.
3:34:07 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 2 to SB 132, as
amended, labeled, 32-LS0861\A.2, Ambrose, 4/27/22, which read as
follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, lines 4 - 8:
Delete all material.
Page 1, line 9:
Delete "Sec. 2"
Insert "Section 1"
Renumber the following bill sections accordingly.
Page 1, line 12, following "AS 08.98":
Insert "who is dispensing a prescription of a
controlled substance in a quantity intended to last
for not more than three days"
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SNYDER explained that Amendment 2 would reduce
the burden on veterinarians by limiting PDMP participation. She
stated that the amendment would remove the reviewing and
reporting requirement for veterinarians who prescribe and
dispense a Schedule II substance with a dosage lasting three
days or less. She reported that conversations with
veterinarians and other stakeholders informed the proposed
exemption, and she expressed the belief the prescription amounts
of three days or less to be a low risk concerning public health.
3:36:08 PM
REPRESENTATIVE MCCARTY expressed agreement with the amendment,
as it proposes similar protocol for prescribing human medicine.
3:36:28 PM
REPRESENTATIVE SNYDER confirmed that in existing statute there
are exemptions which apply to all physicians for PDMP reporting
and reviewing. She explained that the amendment would be
extending the existing exemption for veterinarians prescribing
these substances from 24 hours or less to 3 days or less.
3:37:16 PM
REPRESENTATIVE PRAX asked whether the exemption would also apply
to other practitioners, such as physicians and pharmacists.
REPRESENTATIVE SNYDER explained that the exemption is designed
only for veterinarians.
3:37:47 PM
REPRESENTATIVE KURKA questioned the percentage of veterinary
prescriptions of opioids which are 3 days or less. He asked the
veterinarians in the meeting whether the amendment would rectify
issues with PDMP.
3:38:54 PM
SCOTT FLAMME, DVM, Former Member, Board of Veterinary Examiners
(BOVE), explained that most of the controlled substance
prescriptions made by veterinarians are a type of seizure-
control medication.
3:39:25 PM
DR. WARD responded that she could not estimate a percentage;
however, she noted that most animal prescriptions are for short-
term pain control, such as after a dental procedure or
orthopedic surgery. She expressed agreement with Dr. Flamme,
that the most common long-term opioid prescription is
phenobarbital for seizures, with the next most common being a
cough suppressant.
REPRESENTATIVE KURKA expressed the opinion that the explanation
seemed to be in opposition to previous testimony the committee
has heard. He expressed the understanding that most opioid
prescriptions are short-term; however, it has been suggested
that it is common for veterinarians to make prescriptions for
longer than three days.
DR. WARD redefined "prescriptions" as a term of measurement and
explained that one patient may be on the same drug for many
years but, because there is a 90-day prescription limit, receive
multiple prescriptions. Although the number of long-term
prescriptions is "not negligible," she assured the committee
that the majority of patients are being prescribed short-term
supplies. She opined that exempting veterinarians who dispense
scheduled substances from zero-reporting would be beneficial.
She estimated that "definitely more than half" of opioid
prescriptions [by veterinarians] are short term; however, there
still would be many prescriptions requiring PDMP participation.
3:42:34 PM
REPRESENTATIVE KURKA expressed the belief that none of the
amendments would address the underlying barriers to veterinary
participation in PDMP, and he opined that PDMP could not be
altered to meet the needs of veterinarians.
3:43:03 PM
REPRESENTATIVE PRAX expressed agreement with Representative
Kurka. He stated that the proposed amendments would put "a new
coat of paint" on PDMP, but it would still be broken.
3:43:37 PM
REPRESENTATIVE SNYDER argued against the idea that the
amendments would be "trying to put a square peg in a round hole"
and the intention is to lessen the reporting burden for lower-
risk prescriptions, while still keeping track of longer-term
prescriptions. She expressed the concern that "we are in the
middle of an opioid crisis" and measures on the human medicine
side of the issue should be tightened. She deduced that putting
pressure on individuals to obtain opioids in other ways could
lead to veterinarian "shopping," which is a low concern at the
moment; however, as measures tightened elsewhere, prevention
would help avoid this from becoming a problem. She expressed
the belief that the amendments would greatly decrease the burden
experienced by veterinarians, while not "opening the door to a
whole other problem down the road."
3:45:31 PM
CO-CHAIR ZULKOSKY removed her objection.
REPRESENTATIVE PRAX objected and spoke to his objection. He
referred to a chart in the PDMP annual report showing the rate
of patient reviews and the rate of opioids dispensed since 2017,
when PDMP participation was put into place. He reported that
the chart shows a steady decrease in opioid prescriptions since
2018 but a sharp increase of patient reviews starting in 2019.
He deduced that the large increase of patient reviews has not
affected the amount of opioids dispensed. He opined that, in
comparison to larger societal conversations about lessening
opioid use, reporting and recording has not swayed prescription
habits. Because veterinarians are a small part of the problem,
he expressed the belief that, instead of asking veterinarians to
prove why they should not be included, it should be the
legislature's burden to show why veterinarians should be
included in the first place. He expressed agreement that the
amendments would make PDMP easier for veterinarians to use;
however, he argued that veterinarians should never have been
included in PDMP, and they should be completely exempt until the
state can prove participation beneficial and make it as
convenient as possible.
3:49:41 PM
A roll call vote was taken. Representatives Sponholz, Fields,
Zulkosky, and Snyder voted in favor of Amendment 2 to SB 132, as
amended. Representatives Kurka, McCarty, and Prax voted against
it. Therefore, Amendment 2 was adopted by a vote of 4-3.
3:50:26 PM
The committee took an at-ease from 3:50 p.m. to 3:53 p.m.
3:53:41 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to SB 132,
as amended, labeled, 32-LS0861\A.4, Ambrose, 5/4/22, which read
as follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, lines 4 - 8:
Delete all material.
Page 1, line 9:
Delete "Sec. 2"
Insert "Section 1"
Renumber the following bill sections accordingly.
Page 1, line 12, following "AS 08.98":
Insert "who did not dispense a controlled
substance during the daily reporting period"
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator,":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SPOHNHOLZ explained that, in the spirit of making
PDMP reporting easier for veterinarians, Amendment 3 would
remove the "zero-reporting" requirement, so veterinarians only
have to login to PDMP when prescribing or dispensing opioids.
She shared her belief that this would reduce the "red tape and
bureaucracy" for veterinarians.
3:54:55 PM
REPRESENTATIVE KURKA expressed the intention to not dismiss the
work done to make PDMP workable for veterinarians; however, he
expressed the opinion that the original bill [fully excluding
veterinarians from PDMP participation] solves the issue.
Considering the previous amendments being passed [and full
exemption being removed from the bill], he voiced support for
Amendment 3.
3:55:28 PM
REPRESENTATIVE PRAX questioned the login time PDMP. He argued
the login time could add to the length of customer interactions.
3:56:14 PM
REPRESENTATIVE SPOHNHOLZ explained that the PDMP administrators
have provided a tutorial video which suggests the logins happen
as part of a veterinarian's end of the day routine and should
only take about 30 seconds. However, she opined that it was an
unnecessary use of time and removing the requirement for daily
logins would make veterinarians feel more comfortable with PDMP
participation.
REPRESENTATIVE PRAX expressed agreement and asked for an opinion
from a veterinarian.
3:57:08 PM
DR. FLAMME confirmed that the process does take about 30
seconds; however, he stated that he always logs out of PDMP
after every interaction to ensure privacy for his human clients,
as their medical history would be available as well. He
explained that the biggest problem entering data into PDMP is,
"half the time" the information does not appear when making
queries later. He expressed uncertainty concerning this, which
caused worry concerning data entry and PDMP violations. He
stated that as a member of BOVE, there were over 100 open
investigations for PDMP violations. He expressed the belief
that this had been because veterinarians did not know the
process to enter the data correctly. He added that this led to
the creation of the tutorial video; however, when he tried to
enter data as instructed by the tutorial, he had encountered the
same issues with animal-patient history not appearing. He
stated that he mentioned this because not being able to
consistently see patient history is a major concern. He stated
that he had spent "hours and hours" addressing the problem with
the department.
REPRESENTATIVE PRAX questioned the frequently of veterinarians
logging in to the system. He posited that an upside of frequent
logins could be the process becomes "second nature."
REPRESENTATIVE SPOHNHOLZ clarified that the amendment would
remove the daily login requirement for veterinarians who
dispense opioids. She stated that this is one of the main
points of contention for veterinarians.
4:02:39 PM
REPRESENTATIVE MCCARTY expressed the belief that shifting the
reporting and querying responsibilities to pharmacists, per
Amendment 1, conflicts with the "grace period" which would be
established in Amendment 3.
REPRESENTATIVE SPOHNHOLZ explained that Amendment 1 would
address veterinarians who choose to only prescribe opioids and
do not dispense them, while Amendment 3 would assist the
remaining veterinarians who continue to dispense from their
office. She explained that the amendments complement each
other, with each narrowing the burden on veterinarians in a
different way.
REPRESENTATIVE MCCARTY questioned whether an increase of
investigations by the Alaska Board of Pharmacy would result. To
keep investigations from occurring, he asked whether
veterinarians could prove they had not participated in PDMP for
certain cases.
REPRESENTATIVE SPOHNHOLZ reiterated that veterinarians who
dispense opioid are currently required to log into PDMP on the
days when opioid prescriptions were not made, and this
requirement has been deemed "unnecessary" and a barrier to
efficiency for veterinarians. She pointed out that especially
since there is a shortage of veterinarians and veterinary
technicians in the state. She argued that Amendment 3 would
"make life easier" for veterinarians.
4:07:24 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 3 was adopted.
4:07:44 PM
The committee took an at-ease from 4:07 p.m. to 4:08 p.m.
4:08:42 PM
REPRESENTATIVE SPOHNHOLZ moved to report SB 132, as amended, out
of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, HCSSB
132(HSS) was reported from the House Health and Social Services
Standing Committee.