Legislature(2013 - 2014)CAPITOL 106

03/20/2014 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 324(HSS) Out of Committee
         HB 319-DRUG/DEVICE DISTRIBUTORS; COMPOUNDED RX                                                                     
3:09:30 PM                                                                                                                    
VICE  CHAIR KELLER  announced  that the  next  order of  business                                                               
would be HOUSE  BILL NO. 319, "An Act relating  to wholesale drug                                                               
or device  distributors; relating to prescription  benefits under                                                               
the state health  insurance plan; and providing  for an effective                                                               
3:10:25 PM                                                                                                                    
REPRESENTATIVE  TAMMIE WILSON,  Alaska State  Legislature, stated                                                               
that the proposed  bill had started as a simple  bill that "got a                                                               
little bit  more complicated  along the way,"  and she  read from                                                               
the sponsor statement:                                                                                                          
     Currently wholesale companies of drugs and medical                                                                         
     devices that are outside the state of Alaska are not                                                                       
     required to be licensed with the State creating an                                                                         
     unfair disadvantage to our local businesses.  This                                                                         
     bill will level the playing field by requiring these                                                                       
     out of state wholesalers to be licensed as those are                                                                       
     in the state.  Additionally, with the potential for                                                                        
     the counter fitting of products by rogue companies,                                                                        
     this legislation will help insure Alaskans receive                                                                         
     quality products.                                                                                                          
     It also adds verbiage which would include "pharmacy or                                                                     
     pharmacist" as a "provider" under section 6 (d) which                                                                      
     defines those occupations in which unfair                                                                                  
     discrimination is prohibited against a person who                                                                          
     provides a service within the scope of the providers                                                                       
     occupational license.  This bill would also require                                                                        
     the State of Alaska to pay for and/or reimburse                                                                            
     compounded prescription within the same scope and                                                                          
     manner as manufactured prescriptions.  Pharmacy                                                                            
     compounding is the creation of a particular                                                                                
     pharmaceutical product to fit the unique need of a                                                                         
     patient.  To do this, compounding pharmacists combine                                                                      
     or process appropriate ingredients using various                                                                           
     tools.  This is done for medically necessary reasons,                                                                      
     such as to change the form of the medication from a                                                                        
     solid pill to a liquid, to avoid a non-essential                                                                           
     ingredient that the patient is allergic to, or to                                                                          
     obtain the exact dose(s) needed or deemed best of                                                                          
     particular active pharmaceutical ingredient(s).                                                                            
     Currently, a compound prescription that contains at                                                                        
     least one legend (RX only) drug is generally covered                                                                       
     by most insurance plans.  However, the compounding                                                                         
     pharmacy may only be reimbursed for the legend drug(s)                                                                     
     in the compounded prescription, not the other                                                                              
     ingredients used or for the time it took to make the                                                                       
     compound.  (This may mean that the pharmacy is unable                                                                      
     to make up the medication per the designed formula                                                                         
     and/or unable to dispense the intended product to the                                                                      
     patient.)  This will negatively impact our local                                                                           
     businesses, in-fact it could put many out of business.                                                                     
     Alaskans deserve to have coverage of compounded                                                                            
     medications for potentially life-saving indications as                                                                     
     well as for quality of life.                                                                                               
     Many of these drugs were previously covered, now the                                                                       
     customer must bear the cost anywhere from as little as                                                                     
     $80.00 to as much as $800.00 depending on the                                                                              
REPRESENTATIVE  T.  WILSON said  that  she  had spoken  with  the                                                               
Department  of  Administration  after the  change  of  "insurance                                                               
groups for retirees."  She  relayed that she had received e-mails                                                               
from  constituents   questioning  why   prescriptions  previously                                                               
covered  were no  longer being  covered.   She  shared her  prior                                                               
understanding that medication  would be covered if  it included a                                                               
legend  drug.   Subsequently,  she  was  informed that  only  the                                                               
legend  drug part  of the  prescription  would be  covered.   She                                                               
asked that testimony from more knowledgeable sources be allowed.                                                                
3:14:17 PM                                                                                                                    
VICE CHAIR KELLER opened public testimony.                                                                                      
REPRESENTATIVE  SEATON asked  if there  were other  circumstances                                                               
that required  wholesalers selling  in Alaska  to have  an Alaska                                                               
business license.                                                                                                               
REPRESENTATIVE  T.  WILSON  deferred  to  Dick  Holm,  and  other                                                               
MARCIA  HOLT explained  that she  was speaking  for a  friend who                                                               
used  compound medications,  and they  were both  retirees.   She                                                               
said  that  her friend  received  treatment  for spinal  stenosis                                                               
which  included shots  and other  medications, although  the most                                                               
effective  treatment  was  "a   compounded  cream  that  includes                                                               
numerous medications."  She was not  able to identify each of the                                                               
medications in the cream, but pointed  out that this cream was no                                                               
longer covered by her insurance.                                                                                                
MS. HOLT, in response to Vice  Chair Keller, said that her friend                                                               
was  available to  testify,  but  was content  to  have Ms.  Holt                                                               
testifying for her.                                                                                                             
MEMOREE CUSHING stated  that she was a retiree from  the State of                                                               
Alaska,  and that  she  was no  longer able  to  obtain the  bio-                                                               
identical hormones  for her rheumatoid  arthritis.   She reported                                                               
that she  had previously used pharmaceutical  hormones, which had                                                               
been  covered  under her  health  benefits.   [Due  to  technical                                                               
difficulties, testimony was terminated]                                                                                         
JAMES McCLAIN shared that he was  a retired state worker, and, as                                                               
he  had prostate  cancer in  2004, he  needed a  compound mix  of                                                               
medications which  were made  locally.   He requested  that these                                                               
compounds be allowed.                                                                                                           
VICE  CHAIR  KELLER asked  for  clarification  that the  compound                                                               
medication had previously been covered by his insurance.                                                                        
MR.  McCLAIN  replied  that this  compound  medication  had  been                                                               
covered by  his state retirement  insurance since 2004,  but that                                                               
had changed since the state changed  to AETNA at the beginning of                                                               
the current year.                                                                                                               
3:21:54 PM                                                                                                                    
RICHARD HOLM, Pharmacist, said that  his North Pole pharmacy, one                                                               
of three pharmacies  that he owned, was  a compounding specialty.                                                               
He noted  that he was  a former chair  on the Board  of Pharmacy.                                                               
He directed attention  to the issue of  wholesaler licensing, and                                                               
explained  that,  although  the   Alaska  State  Legislature  had                                                               
revised these statutes  in the mid-1990s, the  licensing for out-                                                               
of-state  wholesalers  of  drugs  and  medical  devices  had  not                                                               
changed.   In 2006, the  Board of  Pharmacy had decided  to write                                                               
regulations  addressing this  change,  but  the Attorney  General                                                               
informed  the  board  that  they   did  not  have  the  statutory                                                               
authority  for this.   These  proposed  regulations had  recently                                                               
become  an issue,  as a  new  U.S. Food  and Drug  Administration                                                               
(FDA)  category  of  pharmacy,  compounding  manufacturers,  were                                                               
dealing  interstate  with  sterile   products.    He  stated  the                                                               
necessity for  better regulations to protect  the state's rights,                                                               
instead of  allowing the  federal government  to "take  it over."                                                               
He  explained that  pharmacies should  be listed  along with  the                                                               
other medical providers in the  insurance code, an oversight that                                                               
needed correction.  He said there  was no cost associated, and he                                                               
offered his belief that there was not any opposition.                                                                           
MR. HOLM  addressed the compounding  issue in the  proposed bill,                                                               
noting  that the  changes in  insurance had  brought it  to bear.                                                               
Although it had  been stated that there were not  going to be any                                                               
changes  in  coverage, a  purported  55,000  calls complained  of                                                               
changes.   He offered his  belief that the majority  of complaint                                                               
calls regarded compound prescriptions.   He opined that the State                                                               
of Alaska  could request this  coverage, as [AETNA] was  only the                                                               
plan  administrator.    He  reported  that  this  sort  of  thing                                                               
happened when the  state changed [management], and  that a change                                                               
in the statute would ensure  that employees and retirees would be                                                               
able to  get the  necessary therapy  and medications  without any                                                               
break in service.                                                                                                               
3:30:10 PM                                                                                                                    
REPRESENTATIVE  TARR referenced  instances where  the compounding                                                               
of drugs had not  been done in a safe manner,  and asked if there                                                               
were any other issues related  to compounding prescriptions which                                                               
should be addressed.                                                                                                            
MR. HOLM  stated that  compounding was safe.   However,  as there                                                               
was  a  financial  interest,   especially  with  hormone  issues,                                                               
companies would declare  that some drugs were  dangerous in order                                                               
to achieve financial gain.  He  stated that there would always be                                                               
unforeseen  issues  with  drugs,  such  as  sensitivity,  and  an                                                               
inherent  danger for  any  drug  therapy.   He  said that  proper                                                               
handling of  patient issues could  mitigate a great deal  of this                                                               
danger.  He  explained that compounding was based  on the doctor,                                                               
pharmacist, and patient relationship, which he called the triad.                                                                
LIS  HOUCHEN,   Director,  State  Government   Affairs,  National                                                               
Association  of Chain  Drug  Stores, said  she  was available  to                                                               
answer any questions.                                                                                                           
DIRK WHITE, Chairman,  Board of Pharmacy, reported  that he owned                                                               
a  compounding pharmacy  center in  Sitka.   He  stated that  the                                                               
ability to  license the out-of-state wholesalers  was critical to                                                               
the Board  of Pharmacy.   He offered  his belief that  Alaska was                                                               
the only state not licensing the out-of-state wholesalers.                                                                      
VICE CHAIR  KELLER asked  if there  would be  an increase  in the                                                               
costs to Alaskans.                                                                                                              
MR. WHITE  said that the  wholesale licenses would  generate more                                                               
revenue for the general fund.                                                                                                   
VICE  CHAIR KELLER  asked  how many  people  buy from  unlicensed                                                               
MR.  WHITE  listed  the  three  largest  unlicensed  wholesalers,                                                               
stating that  every pharmacy in  Alaska purchased from them.   He                                                               
noted that  there was a  plethora of smaller,  generic unlicensed                                                               
wholesalers and there  would not be any increase of  costs due to                                                               
licensures to pharmacies or patients.                                                                                           
SUSAN ALT  stated she had  used compound products  previously and                                                               
had  no problem  with repayment,  but  that, with  the change  to                                                               
AETNA, she  now had to pay  for each prescription.   She declared                                                               
it  was necessary  that the  state dictate  to the  administrator                                                               
what was  covered.  She questioned  the concerns for the  type of                                                               
form  or prescription  application  as long  as  it provided  the                                                               
treatment or necessary medication.                                                                                              
GERALD BROWN,  Pharmacist, echoed the sentiments  of the previous                                                               
testifiers.   He  said some  compound products  worked when  some                                                               
commercial products did not work.   He directed attention to page                                                               
5,  line  25,  [indisc.]  cannot  provide  that  service  if  the                                                               
insurance does not pay  for the benefit.  He moved  on to page 6,                                                               
line 6,  describing the  lifetime benefit of  $1 million,  and he                                                               
offered  his   belief  that  the  Affordable   Care  and  Patient                                                               
Protection Act eliminated  those caps.  Pointing to  page 6, line                                                               
18, and  the maximum annual  benefit of $4,000 for  mental health                                                               
issues,  he shared  a personal  anecdote for  out-of-pocket costs                                                               
that were twice that amount.   He stated that these maximums were                                                               
old, and  needed to be updated  to a more appropriate  value.  He                                                               
declared his support of proposed HB 319.                                                                                        
VICE CHAIR KELLER suggested that he contact the sponsor.                                                                        
3:43:22 PM                                                                                                                    
BARRY CHRISTENSEN,  Pharmacist, Co-Chair,  Legislative Committee,                                                               
Alaska  Pharmacists  Association,  stated   his  support  of  the                                                               
proposed  bill.   He  mentioned that  the  compounding issue  had                                                               
already cost a  lot of time and energy, issues  that the proposed                                                               
bill now addressed.                                                                                                             
MS.  CUSHING  surmised that  presently  there  was only  coverage                                                               
between April  and December, and  that the problems  arose during                                                               
the changes in providers.  She  offered her belief that there was                                                               
an attempt  to chip  away at the  long promised  health insurance                                                               
coverage, and there was a  national problem with health insurance                                                               
companies doing  away with benefits.   She stated that  AETNA had                                                               
claimed  that it  was not  evidence  based practice  to use  bio-                                                               
identical hormones.   She listed  a number of  synthetic hormones                                                               
which  were  harmful  to women,  and  stated  that  bio-identical                                                               
hormones, which exactly matched human  hormones, had been used in                                                               
Europe for  fifty years.   She stated that  the real crux  of the                                                               
issue was  money.  She said  that, as 2 million  women were using                                                               
these hormones today,  it would be known if there  was a problem.                                                               
She said that  compound hormones have been made  for decades, and                                                               
the business was growing.   She offered her belief that insurance                                                               
companies  were  dictating  our  medical  care,  instead  of  the                                                               
doctor, the patient, and the pharmacist making those decisions.                                                                 
SCOTT  WATTS, Pharmacist,  testified in  support of  the proposed                                                               
bill.  He  said that allowing the board to  license the wholesale                                                               
distributors was  a safety issue  for Alaskans as it  allowed for                                                               
some oversight, and  it leveled the playing field  with those who                                                               
were already  licensed and regulated by  the Board.  He  said the                                                               
decisions since January  1, 2014 regarding compounds  made in the                                                               
pharmacy for an  individual patient had made it  difficult to get                                                               
the medications to  customers.  He said  these prescriptions were                                                               
written by  all types of  prescribers, and that many  people were                                                               
either not  able, or  struggling, to get  those medications.   He                                                               
supported any necessary change to statute.                                                                                      
REPRESENTATIVE REINBOLD  expressed her  concern that none  of the                                                               
medical device  distributors had  testified.   She asked  for the                                                               
outcome  of an  operation  that  used a  pacemaker  that was  not                                                               
licensed or registered in Alaska.                                                                                               
MR. WATTS  replied that it  was only necessary for  the provider,                                                               
not the  device, to be  licensed.  In response  to Representative                                                               
Reinbold, he  expressed his inability  to respond for  the impact                                                               
if the wholesale distributor of the pacemaker was not licensed.                                                                 
VICE CHAIR  KELLER suggested that  the sponsor or  the Department                                                               
of Administration  could respond.   He expressed his  concern for                                                               
any unintended consequences.                                                                                                    
3:52:26 PM                                                                                                                    
DON HABEGER,  Director, Division  of Corporations,  Business, and                                                               
Professional  Licensing,  Department  of  Commerce,  Community  &                                                               
Economic  Development,  clarified that  a  fiscal  note had  been                                                               
forwarded with  the proposed bill  requesting $36,000 for  a half                                                               
time position  to process  new licenses  and the  required annual                                                               
reports.   He  said that  it was  "hard to  divine the  number of                                                               
licensees that might  take advantage of a  new license category."                                                               
He offered an estimate of 400 potential licensees.                                                                              
REPRESENTATIVE TARR asked for the fiscal note.                                                                                  
VICE  CHAIR   KELLER  said   that  the   fiscal  note   would  be                                                               
3:54:42 PM                                                                                                                    
MIKE BARNHILL,  Deputy Commissioner, Office of  the Commissioner,                                                               
Department   of  Administration   (DOA),   said   that  the   DOA                                                               
administered one of the state  employee health care plans and the                                                               
health care plan for the  public employee, teacher, judicial, and                                                               
elected public official retirement  systems.  These plans covered                                                               
84,000 people,  with 67,000  in the retirement  system.   He said                                                               
that, as the plan was subject  to the Alaska Procurement Code, an                                                               
RFP   [Request  for   Proposal]  had   been  issued   for  claims                                                               
administrators about every five years,  since 1998 when the state                                                               
self-insured for its health plans.   He listed the various claims                                                               
administrators which  had included  Premera, Wells  Fargo, Health                                                               
Smart, and AETNA.   There were about 30,000  medical and pharmacy                                                               
claims  each week.   During  the claims  administrator transition                                                               
process,  there  were  hundreds of  details  to  be  transitioned                                                               
appropriately, and  in this last process,  a professional project                                                               
manager  had  been  hired  to  help  with  the  transition.    He                                                               
acknowledged  that  the  compounds medications  issued  had  been                                                               
missed in the  transition.  He offered his belief  that the prior                                                               
list of  compounds that were  being processed had been  passed to                                                               
AETNA, the current  claims administrator, but that  there had not                                                               
been any  discussion regarding  it.   He acknowledged  that those                                                               
compound medications  had been denied  since January 2,  and that                                                               
there had been 50,000 calls in  January, with half that number in                                                               
February,  which,  although  in  decline,  was  still  too  high.                                                               
Directing  attention  to  compound medications  specifically,  he                                                               
opined  that   one  percent  of  pharmacy   script  was  compound                                                               
medication.    He  relayed  that DOA  became  concerned  and  had                                                               
internal discussions, as  well as discussions with  AETNA.  These                                                               
discussions revealed  a variety of issues  pertaining to compound                                                               
medications  that  were  worthy   of  additional  discussion  and                                                               
scrutiny.  He stated that  those discussions should have been had                                                               
last fall in the run-up to  the transition.  DOA instructed AETNA                                                               
to cover  the compound  medications, and  AETNA agreed  to recode                                                               
its pharmacy  claims system  to include  the process  of compound                                                               
medications at the  point of service beginning on  April 1, 2014.                                                               
He  suggested   that  pharmacists   should  currently   enter  an                                                               
override, which  AETNA would accept.   He said that DOA  had only                                                               
agreed to make the change  through December, and it was necessary                                                               
for  some serious  scrutiny  to  determine the  next  stage.   He                                                               
shared some of the issues arising  from the internal inquiry.  He                                                               
reported that, as  the FDA did not regulate  compounding by local                                                               
pharmacies, it was administered  by state pharmacy organizations,                                                               
although he  was not clear to  what extent the Board  of Pharmacy                                                               
provided regulation and oversight  of the fabrication of compound                                                               
medications within a pharmacy.   He opined that the proposed bill                                                               
was going in  the opposite direction of  many state legislatures,                                                               
which  were  discussing  the  addition   of  more  oversight  and                                                               
scrutiny  for local  compounding practices  by state  regulators,                                                               
rather  than less.   He  said  there was  no evidence  indicating                                                               
safety  oversight in  the compounding  pharmacies in  Alaska, and                                                               
that this was worthy of investigation.   He raised a question for                                                               
some of  the substances  used in compounding,  and he  pointed to                                                               
earlier  testimony for  bio-identical  replacement  therapy.   He                                                               
shared that  there was  some controversy,  with concern  from the                                                               
Mayo Clinic,  the FDA,  the Endocrine  Society, and  the American                                                               
College of  Obstetricians and  Gynecologists, for  marketing bio-                                                               
identical replacement therapy  as safe.  He pointed  out that the                                                               
FDA required  a cautionary  insert with these,  and that  all the                                                               
aforementioned  groups  had  agreed that  pharmacies  should  not                                                               
declare things are  safe, when there was  evidence that suggested                                                               
there  were risks  and  should only  be  consumed after  informed                                                               
consent.  He declared that  there were instances when compounding                                                               
was necessary, as some people  were allergic to legend substances                                                               
and  dyes,  and  there  may   not  be  a  commercially  available                                                               
medication.  He  stated that, as these patients  needed access to                                                               
an  active ingredient  that was  only available  in a  compounded                                                               
form,  this  piece of  compounding  needed  to be  preserved,  no                                                               
matter  the outcome  for  compounding  as a  whole.   This  would                                                               
ensure  access   to  compound   medications  with   no  available                                                               
alternative  for  an FDA  legend  drug.    He stated  that  these                                                               
concerns would  be reviewed  during the  upcoming year,  and that                                                               
any limit  to compound drugs  would be preceded by  education and                                                               
communication for the alternatives.                                                                                             
4:04:40 PM                                                                                                                    
MR. BARNHILL directed attention to  the proposed bill, and stated                                                               
that, as  drafted, it  did not  apply to  the Alaska  Care health                                                               
insurance program.   He reported  that Section 7 only  applied to                                                               
the  Alaska Comprehensive  Health  Insurance Association  (ACHIA)                                                               
high  risk insurance  program.   He offered  his belief  that the                                                               
intent of the  proposed bill was to target Alaska  Care, and that                                                               
Version O,  not yet proposed  to the committee,  better attempted                                                               
to  target AS  39.30.090 and  required the  coverage of  compound                                                               
medications,  although it  "doesn't  quite get  us there  because                                                               
we're no  longer fully insured,  we do not buy  group insurance."                                                               
He  said that  this version  would also  need additional  work to                                                               
have  it  applicable  to  the  Alaska Care  plan.    He  directed                                                               
attention  to  a list  of  Frequently  Asked Questions  (FAQ)  on                                                               
compound medications.   He said  that the  aforementioned changes                                                               
for compound medications would go into effect on April 1.                                                                       
VICE  CHAIR KELLER  said that  the  proposed bill  would be  held                                                               
over.     He  asked  if   the  compounding  of   medications  was                                                               
increasing,  and  he  asked  if   insuring  this  coverage  would                                                               
increase future expenses.                                                                                                       
MR. BARNHILL replied  that, currently, one percent  of the script                                                               
volume  was  for  compound  medications.    He  stated  that  his                                                               
research indicated  that some pharmacies had  marketed themselves                                                               
as compounding  pharmacies and used compounding  to expand profit                                                               
margins, and he acknowledged that  some individuals needed access                                                               
to  some  active  ingredients that  were  not  available  through                                                               
commercially available medications.                                                                                             
REPRESENTATIVE TARR asked for more  information about his earlier                                                               
reference to  the group plan  in Version  O [not yet  proposed to                                                               
the committee].                                                                                                                 
MR. BARNHILL  replied that the state  stopped buying commercially                                                               
available insurance in 1998, when  the state became self-insured,                                                               
under the authority of AS 39.30.091.                                                                                            
4:09:09 PM                                                                                                                    
VICE CHAIR KELLER held over HB 319.                                                                                             
REPRESENTATIVE  T. WILSON,  as the  bill sponsor,  said that  she                                                               
intended to  introduce a committee substitute  which would remove                                                               
the  issue  of  compounding.   She  requested  a  continuance  of                                                               
coverage for compound medications  until April, 2015, which would                                                               
allow legislation  to be introduced in  the following legislative                                                               
session.    Addressing  the  proposed  bill,  she  declared  that                                                               
Section 1 was  necessary "to make sure that we  level the playing                                                               
field so that  we're not charging our people  who have businesses                                                               
in  Alaska differently  than those  who are  out-of-state."   She                                                               
declared  a  need  to continue  promised  coverage  to  retirees.                                                               
Addressing an  earlier question  by Representative  Reinbold, she                                                               
noted that "device" was already defined in statute.                                                                             
REPRESENTATIVE REINBOLD expressed her  concern that there was not                                                               
any testimony  from those distributors  impacted by  the proposed                                                               
REPRESENTATIVE T.  WILSON, in response, stated  that the proposed                                                               
bill  did not  request to  license  any devices,  but only  those                                                               
selling the  devices.   She declared that  the state  was already                                                               
liable as  it was "letting anything  come into the state  with no                                                               
regulation whatsoever, while we regulate only the in-state."                                                                    
VICE CHAIR KELLER  asked that the committee  submit its questions                                                               
to the sponsor.  He held over HB 319.                                                                                           

Document Name Date/Time Subjects
HB0319A.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Sponsor Statement.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Sectional Analysis.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB319-DCCED-DOI-03-14-14.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents Natural Estrogens.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents Estriol.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Documents - Harris.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document Insurance nightmare - FAI Daily News Miner.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Thurman.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Statues and Regulations - Pharmacies.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - What is compounding.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Quality Control.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - introduction.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Compounding Resources.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Compounding & Pharmacists.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - PCCA - Alternative Medication Forms.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Jordan.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP Introduction.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP Frequently Asked Questions.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - IACP - What is compounding.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Gherman.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 319 Supporting Document - Calmes.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB0356A.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 sponsor statement.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB356-DOA-DRB-03-14-14.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB356 Support KPBSD.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 Mayo Clinic vitamin D for health a global perspective.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 319 DOA DRB FAQ 3 20 2014.PDF HHSS 3/20/2014 3:00:00 PM
HB 319
HB319-DCCED-CBPL-03-14-2014.pdf HHSS 3/20/2014 3:00:00 PM
HB 319
HB 356 Background Materials.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356
HB 356 Wellness Presentation.pdf HHSS 3/20/2014 3:00:00 PM
HHSS 4/10/2014 3:00:00 PM
HB 356