Legislature(2023 - 2024)BARNES 124
03/16/2023 08:00 AM House COMMUNITY & REGIONAL AFFAIRS
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HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST 8:46:55 AM CHAIR MCCORMICK announced that the next order of business would be HOUSE BILL NO. 17, "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date." [Before the committee was CSHB 17 (HSS).] 8:47:12 AM REPRESENTATIVE ASHLEY CARRICK, Alaska State Legislature, as prime sponsor, presented CSHB 17 (HSS). She synopsized the bill as per the sponsor statement, which read as follows [original punctuation provided]: Women in Alaska, especially rural Alaskans, face many obstacles in accessing reproductive health care and prescription contraceptives for a variety of reasons. Travel limitations can create barriers regarding consistent access to reproductive health care. Additionally, a significant number of women in Alaska work on fishing boats or on the North Slope, limiting access to reproductive health care and prescription contraceptives. Busy work schedules and family life can also be problematic in traveling to healthcare facilities or pharmacies necessary for providing these services. House Bill 17 mandates coverage by healthcare insurers, including Medicaid, for prescription contraceptives and related medical services, allowing up to a 12-month supply of prescription contraceptives. This bill is an important step in preventing unintended pregnancies by eliminating barriers associated with cost and availability. Studies show that providing a one-year supply of prescription contraceptives, including long-acting reversible contraceptives (LARCs), reduces unintended pregnancies by 30%. It also increases family planning options while reducing costs related to unintended pregnancies such as pregnancy tests, follow-up visits and other associated long-term costs. Furthermore, it empowers victims of domestic or interpersonal violence whose abusers control access to contraceptives. It reduces the number of abortions performed. Women also use birth control to alleviate symptoms from certain medical conditions such as endometriosis and acne. With greater access and increased options to reproductive health care, Alaskan women will have the necessary support to improve family planning while decreasing health care costs. REPRESENTATIVE CARRICK also noted there are zero fiscal notes attached to the bill. 8:51:59 AM CHERIE BOWMAN, Staff, Representative Ashley Carrick, Alaska State Legislature, on behalf of Representative Carrick, prime sponsor, gave the sectional analysis on CSHB 17 (HSS) [included in the committee packet], which read as follows [original punctuation provided]: Section 1 AS 21.42.427. Coverage for contraceptives. Amends AS 21.42 by adding a new section which (1) requires a health care insurer to provide coverage for prescription contraceptives and medical services necessary for those products or devices (including over-the-counter emergency contraception that was obtained without a prescription); (2) requires reimbursement to a health care provider or dispensing entity for dispensing prescription contraceptives intended to last for a 12-month period for subsequent dispensing; (3) prevents an insurer from offsetting the costs of compliance; (4) prevents an insurer from restricting or delaying coverage for contraceptives; (5) if the provider recommends a particular service or FDA-approved item based on a determination of medical necessity, the plan or issuer must cover that service or item without cost sharing; and (6) exempts religious employers if certain criteria are met. Section 2 AS 29.10.200. Limitation of home rule powers. Amends AS 29.10.200 by adding a provision applying to home rule municipalities. Section 3 AS 29.20.420. Health insurance policies. Amends AS 29.20 by adding a new section clarifying that municipal health care insurance plans that are self- insured are subject to the requirements of sec. 1. Section 4 AS 39.30.090. Procurement of group insurance. Clarifies that a group health insurance policy covering employees of a participating governmental unit is subject to the requirements of sec. 1. Section 5 AS 39.30.091. Authorization for self-insurance and excess loss insurance. Clarifies that a self-insured group medical plan covering active state employees provided under this section is subject to the requirements of sec. 1. Section 6 AS 47.07.065. Payment for prescribed drugs. Requires the Department of Health to pay for prescription contraceptives intended to last for a 12- month period for subsequent dispensing for eligible recipients of medical assistance, if prescribed to and requested by the recipient, as well as medical services necessary for those products or devices. Distributed by the Office of Representative Ashley Carrick 1.25.2023 2 The Department of Health must also provide coverage for over-the-counter emergency contraception that was obtained without a prescription. Section 7 Uncodified law - applicability Requires the Department of Health to immediately amend and submit for federal approval a state plan for medical assistance coverage consistent with sec. 6 of this Act. Section 8 Uncodified law - applicability Makes sec. 6 of the Act conditional on the approval required under sec. 7 of the Act. Section 9 If, under sec. 8 of this Act, sec. 6 of this Act takes effect, it takes effect on the day after the date the revisor of statutes receives notice from the commissioner of health under sec. 8 of this Act. 8:56:17 AM REPRESENTATIVE MCCABE said women he knows have expressed concern that if at 12 months, a birth control prescription will not be as effective, or body chemistry may change to cause the ineffectiveness. REPRESENTATIVE CARRICK responded that the medical provider has full control over what they believe to be the right prescription for the individual. She stated most providers may prescribe just a few months prescription then conduct a follow-up. 8:58:04 AM REPRESENTATIVE MCCABE reiterated the concern that had been relayed to him and asked Representative Ruffridge, who has a background in pharmacy, to address it. REPRESENTATIVE RUFFRIDGE explained that oral contraception is never 100 percent effective, and low dose versions are rigid in how you must take them. He confirmed there are very few alterations to body chemistry that affect contraception in general. He stated HB 17 can help cover some of the gaps because in the pharmacy setting some of the more emergent refill prescriptions are women who didn't realize they needed a refill, and then possibly skip their low dose medication. 9:01:21 AM REPRESENTATIVE MCKAY commented his understanding is that currently, if a female goes to a doctor, explains she will be gone several months, and asks for a 12-month dose, the issue is that insurance won't pay for it. REPRESENTATIVE CARRICK stated that is exactly the gap that would be fixed through HB 17 - that extended prescriptions, as opposed to one- to three-month prescriptions, will be covered under insurance. 9:03:27 AM REPRESENTATIVE MEARS commented on her own prescriptions and having them filled before coming to Juneau for the duration of the legislative session. Her perception of the bill is that it brings contraceptives on par with other medications. REPRESENTATIVE CARRICK replied that is correct. 9:04:40 AM LORI WING-HEIER, Director, Division of Insurance, Department of Commerce, Community & Economic Development, clarified that insurance would not "get in the middle" of a provider and the provider would not be stopped from having their responsibility to a patient; the proposed legislation is stating that once a contraceptive is provided, then the patient will have the right or ability to get a 12-month supply. It is a convenience for women to get their prescriptions for longer periods of time if they will be away for extended periods due to work, travel, or other reasons. She noted there had not been any rebuttal from insurance companies over HB 17. 9:07:07 AM REPRESENTATIVE HIMSCHOOT commented that the bill is decades overdue, and it would help women, including, for example, the women in Southeast Alaska who go out on extended fishing trips. 9:07:45 AM REPRESENTATIVE MEARS echoed the sentiments of Representative Himschoot. 9:08:03 AM REPRESENTATIVE CARRICK commented that HB 17 is an insurance bill at its core; it would not change contraception coverage or the relationship with the provider, it would change what happens at the pharmacy once a patient has a prescription. She explained there had been some opposition submitted, and she encouraged people to visit her office and speak with her and her staff to communicate with those who may still feel opposition to help illuminate the purpose of this legislation. 9:09:17 AM CHAIR MCCORMICK announced that the amendment deadline for HB 17 is March 19 and public testimony will be on March 21. [HB 17 was held over.]