Legislature(2017 - 2018)CAPITOL 106
04/13/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB118 | |
| SB32 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 118 | TELECONFERENCED | |
| += | SB 32 | TELECONFERENCED | |
| *+ | HB 176 | TELECONFERENCED | |
| *+ | HB 196 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 32-PRESCRIPTIONS FOR BIOLOGICAL PRODUCTS
3:12:06 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be SENATE BILL NO. 32, "An Act relating to biological products;
relating to the practice of pharmacy; relating to the Board of
Pharmacy; and providing for an effective date."
3:12:35 PM
AIMEE BUSHNELL, Staff, Senator Shelley Hughes, Alaska State
Legislature, briefly recapped the main points of the proposed
bill, which included: only bio-similars approved by the U.S.
Food and Drug Administration (FDA) as interchangeables could be
substituted for the original prescription; within three days of
dispensation of the product to the patient, a notification must
be sent to the original prescriber; and, the prescriber can
write "dispense as written" on the prescription, if this is the
only product the prescriber wants for the patient.
SENATOR SHELLEY HUGHES, Alaska State Legislature, reiterated
that access to these medications was important to many Alaskans,
and that the proposed bill described the arrangement and
notifications between the doctor and the pharmacist.
3:15:13 PM
CHAIR SPOHNHOLZ opened public testimony on SB 32.
3:15:22 PM
ROBERT THOMS stated that he was also known as Cajun Bob and that
he was a Vietnam combat veteran and a recipient of the Silver
Star medal, as well as six Purple Hearts. He declared that he
had chronic pain for more than 45 years, and that he had been
diagnosed with severe rheumatoid arthritis. He reported that
his original medication was not a biologic, which "after three
years, it almost killed me." He said that he was then
prescribed a biologic, Humera, which allowed him to enjoy a
functional life after being bed ridden. He noted that, although
he was not yet 100 percent, this had allowed him to do chores
and projects with his wife. He declared that, although this
biologic "was a miracle," he did not know if it would always
work. He emphasized that it was necessary to approve this
proposed legislation immediately, as he wanted to have
immediately available any approved substitute, should this
current biologic cease to work.
3:18:25 PM
CINDY CASERTA shared that she was also a chronic pain sufferer,
and that she spoke as an ambassador for the U.S. Pain Foundation
in support of the proposed bill. She referenced a Stanford
study of 6200 rheumatoid arthritis patients on biologics,
pointing out that 33 percent of these patients stopped taking a
biologic within two years because of a loss of effectiveness.
She surmised that bio-similars could be the answer for Alaskans.
3:20:10 PM
BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing
Home Association (ASHNHA), reported that the Alaska State
Hospital and Nursing Home Association had consulted with
hospital-based pharmacists and physicians to ensure that the
proposed bill would supply the necessary guidance to ensure safe
and effective treatments for patients, while providing the
potential to lower pharmaceutical costs. She reported that,
following this consultation, ASHNHA decided to support the
proposed bill. She declared that critical components of the
bill included its specific communication requirements and
timelines for pharmacists associated with dispensing bio-similar
medication. She stated that the proposed bill would meet the
needs of pharmacists in a variety of settings, and that the
proposed bill strikes the right balance for notification and
communication. She reported that bio-similars and
interchangeable biological products offered affordability as
they would provide competition to biologic drugs, similar to the
way generic drugs did for brand name drugs. She offered her
belief that proposed SB 32 would protect patients and would
benefit the state.
3:21:43 PM
PHIL SCHNEIDER, Alliance for Safe Biologic Medicines,
paraphrased from a letter of support [included in members'
packets], which read as follows [original punctuation provided]:
As the chairman and advisory board chair of the
Alliance for Safe Biologic Medicines (ASBM), we are
writing to urge you to support Senate Bill 32 (SB 32)
regarding the pharmacy substitution of biosimilar
medical products. ASBM is an organization of patients,
physicians, pharmacists, manufacturers of both
innovative and biosimilar medicines, researchers and
others who are working together to ensure patient
safety is at the forefront of the biosimilars policy
discussion.
As a retired pediatric rheumatologist and a former
president of the American Society of Health-system
Pharmacists, we are keenly aware of the benefits of
biologics in treating serious conditions like cancer,
rheumatoid arthritis, diabetes, and MS. "Copies" of
these medicines, called "biosimilars" have the
potential to provide these therapies at reduced cost.
Yet unlike generic versions of chemical drugs
biosimilars are not exact duplicates of their
reference products. Indeed, the complexity of
biologics and their proprietary manufacturing
processes mean that these "copies" can only ever be
similar, never the same. Even the smallest structural
difference between a biologic and its attempted copy
can have a significant impact on a patient, including
reduced efficacy or unwanted immune responses.
We believe that when interchangeable biosimilar
products are substituted, communication between
patients, pharmacists, and health care providers is
essential to patient care. We fully support and are
concerned that patient safety will be compromised if
this legislation is not enacted.
Since 2012, ASBM has conducted surveys of physicians
in eleven countries, to gather their perspectives on
biosimilars. The results of these surveys have since
been shared with policymakers in the U.S., Canada,
Europe, and the World Health Organization in Geneva,
Switzerland.
Our survey of 376 U.S. physicians found that 80% of
those surveyed called communication in the event of a
biosimilar substitution "very important" or
"critical".
Further, 82% of U.S. physicians called the authority
to block a substitution by indicating "do not
substitute" or "dispense as written" on a prescription
"very important" or "critical".
These results are consistent with those of physicians
around the world, including those surveyed in Canada
and Europe, where biosimilars are currently in
clinical use. All ASBM surveys are available on our
website at www.safebiologics.org/surveys.
It is our view that SB 32 appropriately reflects the
importance of pharmacist-physician communication and
keeping treatment decisions the purview of the
physician and patient, without posing undue or onerous
burdens upon the pharmacist:
It provides that only "interchangeable" biosimilars
(those determined by the FDA to produce the same
effects in a patient as the reference product without
additional risks) may ever be substituted.
It allows a physician to prevent a substitution they
consider inappropriate for their patient by writing on
the prescription "dispense as written".
It provides that the pharmacist receive the patient's
consent in order to make a substitution. The Alliance
for Safe Biologic Medicines - PO Box 3691 Arlington,
VA 22203 www.safebiologics.org - (703) 971-1700
Finally, SB 32 requires that the pharmacist
communicate to the physician within a reasonable time
frame (3 days) which biologic the patient actually
received whether that prescribed by the physician,
or a substituted biosimilar- so that an accurate
patient record can be kept by all parties.
SB 32 will extend these valuable protections to
Alaska's patients while increasing their access to
biologic therapies. For these reasons, lawmakers in 26
states and Puerto Rico have passed similar bills in
the past few years.
3:24:49 PM
CHAIR SPOHNHOLZ asked about the substantial differences for side
effects and efficacy for interchangeables. She asked whether it
was safe for pharmacists to recommend changes at the pharmacy
point of sale, rather than from the prescriber.
MR. SCHNEIDER explained that biologics were medicines produced
by living cells and that bio-similars were biologics, similar
for the therapeutic effect and safety profile, but with minor
differences which needed to be considered. He clarified that
these were not considered to be interchangeable. He said that
the third category was interchangeable bio-similar, which had
been categorized by the FDA, based on studies which involved
switching patients back and forth between the reference product
to the bio-similar, and then back again. These studies had to
demonstrate that the interchangeable bio-similar had no
differences for both its effectiveness and its safety. He
stated that the proposed bill only related to interchangeable
bio-similars as considered by the FDA based on the switching
studies. He added that the FDA stated that a pharmacist could
switch those medicines. The purpose of the state laws was to
ensure communication with the prescriber, even though that
happened after the fact.
3:28:09 PM
KERRY McCLELLAND, Colon Cancer Alliance, stating that he was
advocating for all cancer patients, shared his history with
cancer and various treatments. He declared that it was
important to pass the proposed bill so that Alaskans would not
have to travel out of state.
3:30:11 PM
MARK GUIMOND, Director, Legislative Affairs, Arthritis
Foundation, stated that the Foundation fully supported proposed
SB 32. He pointed out that arthritis was a lifelong chronic
disease, which could be debilitating. He stated that biologics
offered a benefit, as they changed lives to a good quality of
life. He pointed out that these were complex medications
because they were live cells and were also very expensive.
These represented .01 percent of prescriptions filled at
pharmacies. He expressed hope that bio-similiars would have the
same effect on the market as generic drugs. He suggested that
it was best to pass this legislation immediately. He declared
that the communication aspect of the proposed bill was
essential, as it created a complete medical record for the
patients. He declared support for the proposed bill.
3:33:24 PM
THOMAS FELIX, MD, Amgen, stated support for the proposed bill,
and he discussed one of the five provisions, key to the bill,
which was a departure from existing generic substitution law in
Alaska. He pointed to the requirement for a pharmacist to
communicate with a physician following the substitution of an
interchangeable bio-similar. He said that this ensured that
members of the health care team were talking with each other, as
this created transparency and accessibility to needed
information. He allowed that some had advocated for no
communication as it was too burdensome. He stated that there
had been work with both pharmacists and stakeholders to make
sure their perspectives were represented in the proposed bill to
make it less burdensome. He said that communication prior to
the substitution went against the spirit of the designation of
interchangeability. He shared that the federal law which
allowed the bio-similar pathway, the description for
interchangeability was for the pharmacist to exercise their
discretion for substitution without the consent of the
prescriber. He relayed that it was important to understand that
this facilitated drug safety surveillance, which was required
for all biologics, and that bio-similars were also included. He
reminded the committee that there were currently four approved
bio-similars in the United States, of which two had not yet been
distributed. He pointed out that, as two were self-
administered, this legislation provided clear terms of use to
both the health care team and the patient. He directed attention
to a recent draft guidance for interchangeability, which was
intended to provide clarity to the community for what was
required to receive an interchangeability designation. He added
that, as the FDA was very busy developing bio-similars which
were trying to mimic 23 reference products coming off patent,
there was a need to ensure that the health care community and
patients had a clear understanding for use of these products,
both when they were interchangeable and when they should not be
substituted. He reminded that the FDA had set an appropriate
scientific bar for approval of these products and that, once
approved, they would be highly similar to an existing reference
product and the differences in efficacy and safety should not be
a concern. When an interchangeable was approved, it signaled
that there was not a concern for its use when switching with the
original product. Patients suffering from grievous illness will
be comforted by knowing that the appropriate measures that
comport with new technologies were being passed.
3:41:11 PM
CRYSTAL KOENEMAN shared her personal story for the use of a
biologic, Humera. She reported that, although this allowed her
to play with her young child and function on a day to day basis,
these were "scary. They change your chemical make-up and you
are no longer the same." She reported that she had recently
developed three lesions on her brain, which appeared similar to
multiple sclerosis. She was then unable to take biologics for a
few months, and now she relied on a name brand. She expressed
her concern that with bio-similars, insurance companies would no
longer cover name brands. She expressed her understanding that
others could not afford the cost and that some bio-similars
would work for some when the name brand did not. She expressed
support for the proposed bill as it allowed for choice, but she
expressed concern for her ability to choose to be taken away as
an unintended consequence. She reported that she was not able
to take any other biologic that would in any way affect her
nervous system. She asked that the committee be cautious.
3:47:10 PM
CHAIR SPOHNHOLZ closed public testimony.
3:47:20 PM
CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30-
LS0188\J.3, Wallace/Bruce, 4/13/17, which read:
Page 4, following line 10:
Insert a new bill section to read:
"* Sec. 8. AS 21.42 is amended by adding a new
section to read:
Sec. 21.42.435. Coverage for biological products.
(a) A health care insurer that offers, issues for
delivery, delivers, or renews in this state a health
care insurance plan that provides coverage for
biological products shall provide coverage for a
biological product or interchangeable biological
product without requiring prior authorization if the
biological product or interchangeable biological
product is to be dispensed as prescribed.
(b) In this section, "biological product" and
"interchangeable biological product" have the meanings
given AS 08.80.480."
Renumber the following bill sections accordingly.
Page 4, line 17:
Delete "Section 8"
Insert "Section 9"
Page 4, line 18:
Delete "sec. 9"
Insert "sec. 10"
CHAIR SPOHNHOLZ objected for discussion.
CHAIR SPOHNHOLZ explained that a "tsunami" of as many as 41
biologic interchangeables was coming and working through the FDA
process. She noted how important biologics were for those who
took them, as well as the transformative nature they could have
for individuals. She shared the story of a biologic that cost
$2000 each day. She explained that her proposed amendment would
require that health insurance plans provide coverage for
biological products, both interchangeables and biologicals,
without prior authorization if the product was to be dispensed
as prescribed. She said that this would require coverage of a
medication prescribed by a doctor and not necessarily the
cheapest one, as a small difference in a product could have a
big impact on the health and well-being of an individual. She
wanted to ensure that people with serious health care issues in
the state be able to have health care coverage by the insurance
providers, and that cost not be the only consideration.
3:50:09 PM
REPRESENTATIVE KITO reflected on the history of the change to
generic drugs from name brand drugs, noting that, as there were
some changes, some individuals reacted adversely. He encouraged
that the insurance companies be sensitive to provide medications
as needed for the patient as identified by the medical team.
3:51:26 PM
CHAIR SPOHNHOLZ withdrew proposed Amendment 1.
3:51:40 PM
REPRESENTATIVE EASTMAN expressed his support of the proposed
bill.
3:51:45 PM
REPRESENTATIVE EDGMON moved to report SB 32 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 32 was moved from the House
Health and Social Services Standing Committee.
3:52:03 PM
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 32 Legislation - Version J.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB 32 Sponsor Statement - Biosimilars.pdf |
HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| SB 32 - Sectional Analysis.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Fiscal Note DCCED CBPL.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| AK SB 32 Biosimilar Support Letter.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| ALF_AK SB 32__2 1 17 support.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alliance of Specialty Medicine AK SB 32 020317.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| LADAAK support.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| NORD AK_SB 32_ltr.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| 2-6-17 biosimilar AK support.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| NFK BioSimilars State Letter - Alaska 2.1.17.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alliance for Patient Access AfAP - SB32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alliance for Safe Biologic Medicines AK-SB 32 -FNL.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| American Liver Foundation ALF_AK SB 32__2 1 17.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB 32 AARDA support.docx |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB 32 AARDA support.docx |
HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| Digestive Disease National Coalition Support for SB 32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Global Healthy Living Foundation GHLF AK SB 32 Comment Letter_Support 2-3-17.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| International Cancer Advocacy Network (ICAN) letter of support SB32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| National Hispanic Medical Association (NHMA) _AK SB 32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Pharmaceutical Research and Manufacturers of America (PhRMA) Support SB32.PDF |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Bios for Dr. Charles and Dr. Schneider.docx |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB 32 - BIO Support Letter 2-2-17 Biotechnology Innovation Organization.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB 32 - BIO Support Letter 2-2-17.pdf |
HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| RetireSafe support SB32 2-6-17 biosimilar AK.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| 1-12-17 Group letter.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB 32 - 1 page handout explaining biosimilar legislation.docx |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alaska ACS CAN Biosimilars Fact Sheet 2017.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SB032 Supporting Documents-Support Letters 04.04.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| Senate Bill 32 opposition AK Rheumatoloty Alliance.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alaska SB 32 - Merriman Comments 20170209.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| SupportLetter_Bio_SB32_psoriasis.docx |
HHSS 4/13/2017 3:00:00 PM SHSS 2/10/2017 1:30:00 PM |
SB 32 |
| Alaska Biosimilars Arth Fdn oppose amendment sb 32.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB32_ASMA.pdf |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB32 - Clarification on Questions Asked in the Committee (Sen Hughes).doc |
HHSS 4/13/2017 3:00:00 PM SHSS 2/15/2017 1:30:00 PM |
SB 32 |
| SB 32 - Sectional Analysis.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Background Document - Potential Cost Savings of Biosimilar Drugs.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Background Document - H&SS Comm. Q&A.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Background Letter - State Medical Board.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Fiscal Note - DCCED.PDF |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Opposition Letter - Alaska State Medical Association.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Support Documents - Fact Sheet.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Support Letter - Alliance of Specialty Medicine.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB032 Sponsor Statement 04.04.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| SB032 Opposing Document-Opposition Letters 04.04.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| SB032 Sectional Analysis ver J 04.04.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| SB32 Letters of Opposition.pdf |
HHSS 4/13/2017 3:00:00 PM SFIN 3/30/2017 9:00:00 AM |
SB 32 |
| SB32 Letters of Support.pdf |
HHSS 4/13/2017 3:00:00 PM SFIN 3/30/2017 9:00:00 AM |
SB 32 |
| SB 32 Am No. 1.PDF |
HHSS 4/13/2017 3:00:00 PM |
SB 32 |
| SB 32 - Support Letter - U.S. Pain Foundation.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Support Letter - State Advocacy & Alliance Development.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| SB 32 - Support Letter - Safe Biologics.pdf |
HHSS 4/13/2017 3:00:00 PM SL&C 3/7/2017 1:30:00 PM |
SB 32 |
| HB 176 Sponsor Statement 4.12.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - City of Bethel resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - FNSB memo 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - FNSB resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - Letter AK Fire Chiefs Assoc 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - letter AK Prof Firefighters Assoc 4.11.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - memo Bethel FD 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - North Pole resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 ver A.PDF |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Additional Document AK FD budget reimb process 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Additional Document DHSS review 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Draft Proposed CS ver J 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Fiscal Note DHSS--HCMS 4.10.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Fiscal Note DHSS--MAA 4.10.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 118 Sponsor Satement 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Document - Doyon support letter 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Document - Medical Compsensation by State 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Document - PBS Article 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Document - Support letters 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Document - TCC letter of support 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Supporting Documents 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 ver A 4.10.2017.PDF |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Fiscal Note DHSS--BHTRG 4.10.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Fiscal Note DOL--CJL 4.10.17.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |
| HB 118 Sectional Analysis ver A 4.10.2017.pdf |
HHSS 4/11/2017 3:00:00 PM HHSS 4/13/2017 3:00:00 PM |
HB 118 |