Legislature(2001 - 2002)

02/01/2002 03:20 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 318-UNIFORM PRESCRIPTION DRUG CARD                                                                                         
                                                                                                                                
Number 0884                                                                                                                     
                                                                                                                                
CHAIR MURKOWSKI announced  that the next order  of business would                                                               
be HOUSE  BILL NO. 318,  "An Act  relating to a  health insurance                                                               
uniform prescription drug information  card; and providing for an                                                               
effective date."                                                                                                                
                                                                                                                                
AMY  ERICKSON, Staff  to  Representative  Lisa Murkowski,  Alaska                                                               
State Legislature,  speaking as the committee  aide, presented HB
318  on  behalf   of  the  House  Labor   and  Commerce  Standing                                                               
Committee, sponsor.  Ms. Erickson  informed the committee that HB
318 was  introduced at the  request of the  Alaska Pharmaceutical                                                               
Association.   Similar legislation has  been enacted in  19 other                                                               
states,  and  is in  progress  in  several  other states.    This                                                               
legislation  is  intended  to provide  practical  guidelines  for                                                               
organizations producing member identification  (ID) cards, and to                                                               
provide  consistent standards  for those  using IDs.   She  added                                                               
that  the  waiting  time  for consumers  in  pharmacies  will  be                                                               
reduced, and pharmacists  will have the information  they need at                                                               
their fingertips.                                                                                                               
                                                                                                                                
MS.  ERICKSON   said  the  card  contains   basic  but  essential                                                               
information  such  as  the  name  or logo  of  the  card  issuer.                                                               
Implementation of  the uniform card will  greatly aid pharmacists                                                               
and improve  patient care by  minimizing confusion.   She offered                                                               
that the  uniform card will also  eliminate unnecessary paperwork                                                               
and decrease administrative burdens and processing claims.                                                                      
                                                                                                                                
Number 1002                                                                                                                     
                                                                                                                                
MS.  ERICKSON  informed the  House  Labor  and Commerce  Standing                                                               
Committee  that there  is a  proposed committee  substitute (CS),                                                               
Version J.                                                                                                                      
                                                                                                                                
Number 1067                                                                                                                     
                                                                                                                                
REPRESENTATIVE ROKEBERG  moved to  adopt the  proposed CS  for HB
318, version 22-LS1061\J, Ford, 1/21/02,  as a work draft.  There                                                               
being no objection, Version J was before the committee.                                                                         
                                                                                                                                
REPRESENTATIVE  ROKEBERG   asked  for   an  explanation   of  the                                                               
differences [between  the proposed  uniform card and  the current                                                               
prescription cards].                                                                                                            
                                                                                                                                
Number 1090                                                                                                                     
                                                                                                                                
MS. ERICKSON explained that the  card has been fine-tuned to look                                                               
similar to  the National Council for  Prescription Drug Program's                                                               
pharmacy card.                                                                                                                  
                                                                                                                                
Number 1180                                                                                                                     
                                                                                                                                
GUY   BELL,  Director,   Division  of   Retirement  &   Benefits,                                                               
Department of Administration, said  that his division administers                                                               
the health insurance for Select  Benefits for approximately 5,000                                                               
state employees,  and for approximately 23,000  retirees from the                                                               
public employees'  and teachers'  retirement systems.   He stated                                                               
that the  Division of Retirement  & Benefits uses  a prescription                                                               
drug card.   He said, "Based on conversations we've  had with ...                                                               
the staff,  we believe our  prescription drug card  complies with                                                               
the  standards,  and  we  have   submitted  a  zero  fiscal  note                                                               
associated with the legislation."                                                                                               
                                                                                                                                
REPRESENTATIVE HAYES  asked Mr. Bell  if he sees any  downside to                                                               
HB 318.                                                                                                                         
                                                                                                                                
Number 1122                                                                                                                     
                                                                                                                                
MR. BELL replied in the negative.                                                                                               
                                                                                                                                
REPRESENTATIVE ROKEBERG said  that he is surprised  to hear that.                                                               
He asked  whether "the  card we  have that  we carry  around with                                                               
us," although it looks different, meets the requirements.                                                                       
                                                                                                                                
Number 1240                                                                                                                     
                                                                                                                                
MR. BELL said yes.                                                                                                              
                                                                                                                                
REPRESENTATIVE ROKEBERG  asked what the  outcome would be  if the                                                               
state decided to make a change in the formulary.                                                                                
                                                                                                                                
MR. BELL deferred to a member of his staff.                                                                                     
                                                                                                                                
Number 1270                                                                                                                     
                                                                                                                                
JANET  PARKER,   Deputy  Director,   Division  of   Retirement  &                                                               
Benefits,  Department of  Administration, asked  if the  question                                                               
was in  regard to what would  happen if there were  any formulary                                                               
changes.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  ROKEBERG  restated his  question:    What if  the                                                               
third-party  administrator  under  the  direction  of  the  state                                                               
changed the formulary?                                                                                                          
                                                                                                                                
MS. PARKER said that the  state doesn't actually use a formulary,                                                               
so "you're  allowed to use any  drugs you want, and  maybe that's                                                               
the issue...."   She said that over 90 percent  of the pharmacies                                                               
participate in the state's card  program.  She asked whether this                                                               
is designed to address formularies.                                                                                             
                                                                                                                                
REPRESENTATIVE ROKEBERG said that  he eventually wants to address                                                               
that issue, but if the state  doesn't have a formulary, then it's                                                               
moot.                                                                                                                           
                                                                                                                                
Number 1344                                                                                                                     
                                                                                                                                
ERIN  CAREY  BYRNE,  Executive  Director,  Alaska  Pharmaceutical                                                               
Association,  testified via  teleconference.   She said  that the                                                               
Alaska  Pharmaceutical   Association  wants  to   become  uniform                                                               
throughout the Lower  48.  She said that  similar legislation has                                                               
been enacted quickly  in 19 other states in order  to achieve the                                                               
uniformity.   She said,  "We are just  simply complying  with ...                                                               
different language  that's already  been drafted in  other states                                                               
... to keep the model and the template uniform."                                                                                
                                                                                                                                
Number 1388                                                                                                                     
                                                                                                                                
MS. BYRNE stated  that she thought Ms. Erickson  did an excellent                                                               
job of summarizing the intent of  HB 318.  She said that everyone                                                               
can appreciate  the time spent  waiting behind the counter  [at a                                                               
pharmacy],  not  waiting for  a  prescription  to be  filled  but                                                               
waiting  while the  pharmacist  is  gathering simple  information                                                               
that should  be on  the front  of the card.   She  indicated that                                                               
statistically 70 percent  of a pharmacist's time  is spent trying                                                               
to gather information.                                                                                                          
                                                                                                                                
REPRESENTATIVE ROKEBERG asked Ms. Byrne  if she could verify that                                                               
the state's  card is consistent  with the  ID card that  would be                                                               
required for  [HB 318].   He specified  that he was  referring to                                                               
the  current  card  that's  issued  by  Aetna  as  a  third-party                                                               
administrator to  the Select Benefits group  of Alaskan employees                                                               
and to retirees.                                                                                                                
                                                                                                                                
MS. BYRNE  said that  she would  have to look  at the  Aetna card                                                               
specifically, but most of the  major [insurance] carriers already                                                               
have that information on the card.                                                                                              
                                                                                                                                
Number 1480                                                                                                                     
                                                                                                                                
ROGER  PENROD,  President,   Alaska  Pharmaceutical  Association,                                                               
testified  via teleconference.   He  responded to  Representative                                                               
Rokeberg's question  and said  that the  Aetna card  does contain                                                               
all  of  the  necessary  information  that  is  required  by  the                                                               
proposed legislation, as do most  of the Blue Cross of Washington                                                               
and  Alaska  cards.    He   said  that  difficulties  arise  when                                                               
pharmacists run  into people from  "Outside" who have  cards from                                                               
[an  insurance]   carrier  that   does  not  have   the  required                                                               
information on its cards.                                                                                                       
                                                                                                                                
MR. PENROD said that there is  a nationwide trend showing that [a                                                               
uniform  prescription  drug  card]  is  "a  viable  aspect,"  and                                                               
allowing  [the Alaska  Pharmaceutical Association]  to have  this                                                               
type of  legislation will only  make its  job easier.   He added,                                                               
"The real  winner is  the guy  on the other  side of  the counter                                                               
because it reduces their wait time.   It does allow us to provide                                                               
for them that  pharmaceutical care which has  become so prominent                                                               
in this last decade."                                                                                                           
                                                                                                                                
MR. PENROD added that historically  pharmacy has primarily been a                                                               
"cash-and-carry  thing,"  and  only  in the  last  15  years  has                                                               
insurance become  a big player.   He  said, "Ten or  twelve years                                                               
ago, it  might have made up  10 percent of our  business, whereas                                                               
today  it makes  up  in excess  of  80 percent."    He said  that                                                               
because of the  increase, from time to time a  pharmacist may run                                                               
into billing  problems, and that is  what [he hopes] HB  318 will                                                               
help to alleviate.                                                                                                              
                                                                                                                                
Number 1603                                                                                                                     
                                                                                                                                
REPRESENTATIVE  ROKEBERG asked  Mr.  Penrod, "What  if there's  a                                                               
change in the  formulary on an annualized basis?   How would that                                                               
be impacted by the card?"                                                                                                       
                                                                                                                                
MR. PENROD  said that it  would not  affect the card  because the                                                               
formulary is  an agreement  between "your  insurer, which  is the                                                               
state, and the  third-party carrier."  He said, "If  they want to                                                               
try to  minimize dollar amounts  by reducing the choices  of, for                                                               
example, non-steroidal  anti-inflammatory agents, ...  they might                                                               
want  to ...  phase those  out and  say, 'Let's  use these  other                                                               
drugs.'  But it doesn't affect the card at all."                                                                                
                                                                                                                                
Number 1650                                                                                                                     
                                                                                                                                
REPRESENTATIVE  ROKEBERG inquired  as to  whether the  numbers on                                                               
the card would indicate what type of formulary existed.                                                                         
                                                                                                                                
MR. PENROD said no.                                                                                                             
                                                                                                                                
REPRESENTATIVE  ROKEBERG  asked  how   a  pharmacist  would  know                                                               
whether or not  an insurance company's formulary  would cover the                                                               
prescription being written.   He clarified that  he was referring                                                               
to one of the number of  companies that are licensed to do health                                                               
insurance in Alaska.                                                                                                            
                                                                                                                                
MR. PENROD  said that's when  they begin to  "practice medicine",                                                               
which  is a  little  beyond their  scope.   He  explained that  a                                                               
pharmacist gets  a rejected claim  back through  his/her computer                                                               
saying  that the  particular drug  - the  "NDC, meaning  National                                                               
Drug  Code, which  is  an  identifier for  that  drug"  - is  not                                                               
covered,  "and they  don't give  any explanation."   Or,  in some                                                               
cases, there  are those drugs that  have limits as to  the amount                                                               
that is covered.                                                                                                                
                                                                                                                                
REPRESENTATIVE ROKEBERG asked Mr. Penrod if he is a pharmacist.                                                                 
                                                                                                                                
MR. PENROD said yes.                                                                                                            
                                                                                                                                
REPRESENTATIVE  ROKEBERG asked  Mr. Penrod  if he  is aware  that                                                               
almost every company has a different formulary.                                                                                 
                                                                                                                                
Number 1721                                                                                                                     
                                                                                                                                
MR. PENROD said that fortunately  Alaska has not been affected by                                                               
that too much.                                                                                                                  
                                                                                                                                
REPRESENTATIVE ROKEBERG said that  he doesn't understand why this                                                               
particular card is going to make that kind of difference.                                                                       
                                                                                                                                
MR.  PENROD stated  that  sometimes  he gets  a  card without  an                                                               
individual identification number  or a group plan on  it, and the                                                               
card says, "For pharmacy claims call this 800 number."                                                                          
                                                                                                                                
REPRESENTATIVE ROKEBERG  asked how  the communication  time would                                                               
be  reduced from  the current  average of  20 minutes  [for phone                                                               
verification].                                                                                                                  
                                                                                                                                
MR. PENROD said  that [the pharmacist] wouldn't have  to make any                                                               
phone  calls because  that information  would already  be on  the                                                               
card.                                                                                                                           
                                                                                                                                
Number 1805                                                                                                                     
                                                                                                                                
REPRESENTATIVE ROKEBERG asked  Mr. Penrod if he has  run into any                                                               
difficulties as  far as the different  formularies from different                                                               
health insurance underwriters.                                                                                                  
                                                                                                                                
MR.  PENROD   said  that  he   hasn't  had  many   problems  with                                                               
formularies.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ROKEBERG said  that some  companies will  cover a                                                               
certain drug that  another company won't.  He asked,  "How do you                                                               
know the  distinction?  Is that  when you make that  contact with                                                               
them, or [do] you know because of prior experience?"                                                                            
                                                                                                                                
MR. PENROD said that sometimes  a pharmacist will know from prior                                                               
experience.    He added  that  when  an electronically  submitted                                                               
claim comes back  and says [a specific drug] is  not covered, the                                                               
pharmacist tells  the patient  that this  particular drug  is not                                                               
covered, and asks, "How would you like us to proceed?"                                                                          
                                                                                                                                
REPRESENTATIVE  ROKEBERG asked  if  the electronically  submitted                                                               
claim is done through the Internet.                                                                                             
                                                                                                                                
MR. PENROD said, "Just through the telephone lines."                                                                            
                                                                                                                                
Number 1850                                                                                                                     
                                                                                                                                
MS. BYRNE said this card  is simply a uniform identification card                                                               
for  insurance  carriers.    She   stated  that  "the  electronic                                                               
transmittal will  take place closed-circuit."   She  compared the                                                               
proposed uniform  prescription card  to a state  driver's license                                                               
where each state  has a driver's license number  somewhere on the                                                               
front of  the license;  in other  words, it  provides uniformity.                                                               
She  said  that  the  formulary is  completely  specific  to  the                                                               
carrier  itself and  that's all  handled  electronically.   Those                                                               
[pharmacists] who  have been  around for  a while  certainly know                                                               
some of the major carriers and  what they will cover and will not                                                               
cover.   She said, "The smaller  carrier that we don't  see often                                                               
up here ... presents a problem."                                                                                                
                                                                                                                                
Number 1902                                                                                                                     
                                                                                                                                
REPRESENTATIVE  ROKEBERG  asked  what  happens when  there  is  a                                                               
tourist or  visitor from outside  [Alaska] and he or  she doesn't                                                               
have the uniform card.                                                                                                          
                                                                                                                                
MR.  PENROD said  that if  he or  she doesn't  have an  insurance                                                               
card, then  it's pretty  cut and  dried; the  person gets  to pay                                                               
cash.   If  the  person  has an  insurance  card with  inadequate                                                               
information, then it requires a telephone call.                                                                                 
                                                                                                                                
Number 1926                                                                                                                     
                                                                                                                                
CHAIR MURKOWSKI asked if she  understood correctly that right now                                                               
there are 19  states that have signed on to  some kind of uniform                                                               
template,  with  the  goal  being  that  one  could  travel  from                                                               
Wisconsin to  Alaska and  would pretty much  have the  same basic                                                               
information on the front of the card.                                                                                           
                                                                                                                                
MR. PENROD said that was correct.                                                                                               
                                                                                                                                
Number 1950                                                                                                                     
                                                                                                                                
LIS MERTEN, Director, North West  Region, National Association of                                                               
Chain Drug  Stores, testified via teleconference.   She addressed                                                               
the question regarding formularies and  said that having the card                                                               
in Alaska and having it standardized  will cut down on the amount                                                               
of  time that  the pharmacists  in Alaska  are going  to have  to                                                               
spend with  someone from  a state  that hasn't  passed a  law and                                                               
doesn't  have  a standardized  card.    She said  that  currently                                                               
pharmacists have to deal with  multiple people coming in, and the                                                               
pharmacists have  to stop  and make  phone calls.   She  asked if                                                               
this answers Representative Rokeberg's question.                                                                                
                                                                                                                                
REPRESENTATIVE ROKEBERG said yes.                                                                                               
                                                                                                                                
Number 2000                                                                                                                     
                                                                                                                                
MS.  MERTEN thanked  the committee  for introducing  HB 318,  and                                                               
said that [the members of  the National Association of Chain Drug                                                               
Stores] support  HB 318 with some  minor changes.  She  said that                                                               
currently in Alaska,  [43 percent] of all  prescriptions are paid                                                               
for by a third party.   [Ms. Merten later clarified by phone that                                                               
this  does not  include  Medicaid.]   She  said that  pharmacists                                                               
currently  spend 20  percent  of each  working  day dealing  with                                                               
problems  just related  to processing  prescription drug  claims.                                                               
She  said that  the  pharmacists would  much  rather be  spending                                                               
their time  dealing directly with  patients doing  counseling and                                                               
helping them comply with their drug  regimen.  She noted that the                                                               
bill  asks simply  that  the information  needed  to process  the                                                               
claim  be included  on the  card, and  she said  that is  all her                                                               
organization is asking  for.  She complimented  the committee and                                                               
the  drafters  for  having  the director  of  [the  Division  of]                                                               
Insurance  be   a  big   part  of   the  implementation   of  the                                                               
legislation.                                                                                                                    
                                                                                                                                
MS.  MERTEN said  that [the  National Association  of Chain  Drug                                                               
Stores] would  like to see a  couple of changes as  [HB 318] goes                                                               
through the  process.  She  said, "We'd like the  bill clarifying                                                               
who has  to comply with this  law, and we'd also  like to clarify                                                               
some language  for the insurance  (indisc.)."  She said  that she                                                               
doesn't  anticipate  that  [insurance companies]  would  have  to                                                               
issue  new cards  every  time  there is  a  little  change.   She                                                               
offered her  understanding that  in Alaska a  sticker is  used on                                                               
the driver's license [to note  changes], for example.  Ms. Merten                                                               
said  this  certainly would  be  an  acceptable format  that  the                                                               
pharmacists  would be  very comfortable  with if  the information                                                               
were to  change.  She added,  "We're trying to make  this as easy                                                               
on the  insurance as  possible and  not make  this ...  tough for                                                               
them to comply."                                                                                                                
                                                                                                                                
Number 2096                                                                                                                     
                                                                                                                                
CHAIR  MURKOWSKI  thanked  Ms.   Merten  for  her  testimony  and                                                               
explained to  her that it  is the policy  of the House  Labor and                                                               
Commerce  Standing  Committee  to have  legislation  "practically                                                               
perfect" before moving  it from committee.   She inquired whether                                                               
one could just put  a sticker on a card and  have it be reissued,                                                               
or if that would be problematic.   In terms of who has to comply,                                                               
she  thought it  was any  health benefit  plan that  provides for                                                               
prescription  drugs or  devices and  that issues  or uses  cards.                                                               
She said  she thought that was  relatively clear.  She  asked how                                                               
Ms. Merten would make that more specific.                                                                                       
                                                                                                                                
Number 2140                                                                                                                     
                                                                                                                                
MS.  MERTEN apologized  for  not knowing  the  insurance laws  in                                                               
Alaska and  said, "If  these are included,  then [it's]  fine the                                                               
way it is."   She emphasized the need to  ensure that included in                                                               
that broad language [describing  health care insurers] are health                                                               
benefit  plans,   health  care  insurance  plans,   managed  care                                                               
entities, and third-party administrators.                                                                                       
                                                                                                                                
CHAIR MURKOWSKI  said that she  doesn't have the answer  in terms                                                               
of  whether a  health benefit  plan  in fact  includes all  those                                                               
mentioned.   She said that  the committee  should ask one  of the                                                               
experts waiting to testify.                                                                                                     
                                                                                                                                
MS. MERTEN said  she had hoped that when that  language was added                                                               
it would  be broad enough  to incorporate all of  those entities,                                                               
and she isn't sure that it is.                                                                                                  
                                                                                                                                
Number 2190                                                                                                                     
                                                                                                                                
BARRY   CHRISTENSEN,   Chair,   Legislative   Committee,   Alaska                                                               
Pharmaceutical     Association     (AKPhA),     testified     via                                                               
teleconference.   He  stated  that  both he  and  his father  are                                                               
practicing pharmacists,  and one  of the most  frustrating things                                                               
they deal  with in  the day-to-day  pharmacy practice  is someone                                                               
handing them  a card that  has information on different  areas of                                                               
the card.   He expressed that this is a  standardization that [he                                                               
thinks] is going to be the  standard for the United States across                                                               
the line, and  it would be nice to have  Alaska [adopt] it sooner                                                               
rather than later.                                                                                                              
                                                                                                                                
Number 2226                                                                                                                     
                                                                                                                                
REPRESENTATIVE  HAYES said  that it  sounds  as if  this type  of                                                               
legislation is  going through one state  at a time; he  asked why                                                               
the  people   who  introduced   this  legislation   first  didn't                                                               
introduce it  at the federal level.   He commented that  it would                                                               
have been  a lot easier to  pass it on the  federal level instead                                                               
of going state by state.                                                                                                        
                                                                                                                                
CHAIR MURKOWSKI  said that  she will direct  the question  to Mr.                                                               
Christensen  because in  his letter  he stated  that new  federal                                                               
guidelines  issued under  the Health  Insurance Portability  [and                                                               
Accountability] Act  (HIPAA) will  require insurers to  issue new                                                               
prescription cards in the very near future.                                                                                     
                                                                                                                                
MR. CHRISTENSEN  said it is  his understanding that  the pharmacy                                                               
associations  have  tried  to  work with  the  insurers  and  the                                                               
[National Council for Prescription  Drug Programs (NCPDP)] to try                                                               
to  get the  insurers online  so  [a uniform  card] is  voluntary                                                               
rather  than a  state  or  federal mandate,  but  it just  hasn't                                                               
happened very fast.   He mentioned that it has  been in the works                                                               
for about  four years.   Mr. Christensen said that  "HIPAA really                                                               
doesn't ... require  the issuance of prescription  cards with the                                                               
fact that  they're out there."   He  said that currently  most of                                                               
the prescription drug  cards are identified by  a social security                                                               
number (SSN)  and he  has been  told that in  the future  the SSN                                                               
will probably not  be on the card anymore due  to patient privacy                                                               
protection.  He  said, "I wish that it would  come down federally                                                               
- we wouldn't  have to be here  - but the fact is  that it hasn't                                                               
come  down, so  state  by  state, ...  it  seems  like ...  we're                                                               
working through it."                                                                                                            
                                                                                                                                
Number 2304                                                                                                                     
                                                                                                                                
REPRESENTATIVE  ROKEBERG   said  that  states  have   primacy  on                                                               
insurance and this is a health insurance issue.                                                                                 
                                                                                                                                
Number 2334                                                                                                                     
                                                                                                                                
MIKE   WIGGINS,  Vice   President,   National  Accounts,   Aetna,                                                               
testified via  teleconference.   He said that  he's glad  to hear                                                               
that there's no  problem with the State of Alaska  ID card and it                                                               
appears to be  working.  He said that he  has unfortunately spent                                                               
most of his time  working on the prior version of  HB 318 and not                                                               
Version J because he was told it was the most current.  He said:                                                                
                                                                                                                                
     Based on  our review  of that,  we have  some questions                                                                    
     about the bill; and we're  not sure that the current ID                                                                    
     card, as it  stands today, will meet  that because [of]                                                                    
     the bill.   We  spent most of  today also  working with                                                                    
     the  health care  identification card  pharmacy ID  ...                                                                    
     paper put out by  the National Council for Prescription                                                                    
     Drug Programs.  First of  all, just a couple of general                                                                    
     ... comments.   The ID card  that goes out is  not just                                                                    
     specifically  for  prescription  drugs.     It  is  for                                                                    
     medical.   It is  a piece of  document that  [has] some                                                                    
     pretty pertinent information that  is not just specific                                                                    
     to  prescription drug  plans  but is  also our  medical                                                                    
     card.                                                                                                                      
                                                                                                                                
MR.  WIGGINS said  that many  people have  two ID  cards and  the                                                               
state has a single ID card.   He again apologized for not working                                                               
off of  Version J and  commented that in  the state of  Alaska it                                                               
appears that the  card would not apply to  federally funded plans                                                               
that have  (indisc.) prescription drug management  programs, like                                                               
Medicaid.  So  as it's written today, it's  very narrowly defined                                                               
as  to whom  it would  actually affect.   He  said although  many                                                               
states  have  adopted  this  [type  of  legislation],  it's  been                                                               
different in  every single state.   He expressed that  Aetna does                                                               
support a standardized ID card, but  feels that it can it only be                                                               
done at  the federal  level.  Mr.  Wiggins explained  that having                                                               
these different  bills passed in  several states is  making Aetna                                                               
have to comply  with [those laws] and  make identification cards,                                                               
for  both  medical  and  prescription  drugs,  for  19  different                                                               
states.                                                                                                                         
                                                                                                                                
MR. WIGGINS  said that Aetna  is currently processing  claims for                                                               
approximately 60,000  members in  all 50 states  and a  number of                                                               
foreign  countries; [the  members] don't  seem to  be having  any                                                               
problems with the card, which  [Aetna thinks] doesn't comply with                                                               
the current bill.                                                                                                               
                                                                                                                                
Number 2481                                                                                                                     
                                                                                                                                
CHAIR MURKOWSKI asked how the card doesn't comply.                                                                              
                                                                                                                                
MR. WIGGINS  asked if the committee  would like to hear  an item-                                                               
by-item description.                                                                                                            
                                                                                                                                
CHAIR MURKOWSKI said yes.                                                                                                       
                                                                                                                                
TAPE 02-9, SIDE B                                                                                                               
Number 2448                                                                                                                     
                                                                                                                                
MR.  WIGGINS offered  to  submit written  comments  after he  had                                                               
received Version J.                                                                                                             
                                                                                                                                
CHAIR MURKOWSKI  said that would be  helpful.  She asked  him for                                                               
his  fax number  so that  he could  receive a  copy of  Version J                                                               
quickly.                                                                                                                        
                                                                                                                                
CHAIR   MURKOWSKI  asked   how   radically   the  various   state                                                               
requirements differ.                                                                                                            
                                                                                                                                
Number 2401                                                                                                                     
                                                                                                                                
JACK  McRAE, Blue  Cross  Blue Shield  of  Alaska, testified  via                                                               
teleconference.  He  said that Blue Cross Blue  Shield has worked                                                               
with both Washington  and Oregon on similar legislation.   It has                                                               
not been specific  regarding what should be on  the card; rather,                                                               
it has given the authority  [to] the regulatory agencies - "which                                                               
you have in  your bill, 'the director shall' regulate"  - to then                                                               
work with the pharmacy groups  and the carriers to establish what                                                               
should be on the card.                                                                                                          
                                                                                                                                
MR. McRAE  said that he  isn't working  off of Version  J either,                                                               
and mentioned  that [Blue  Cross Blue  Shield] has  some concerns                                                               
regarding what is listed as  definitions for different items.  He                                                               
informed  the  committee  that  Blue Cross  Blue  Shield  is  not                                                               
opposed  to [HB  318]  and  just wants  to  make  sure that  what                                                               
happens  is as  uniform as  possible in  Washington, Oregon,  and                                                               
Alaska.   He  stated that  [Blue  Cross Blue  Shield] has  85,000                                                               
members in  Alaska; if [HB  318] would change  the [prescription]                                                               
card, it  would require sending out  85,000 new cards.   He said,                                                               
"We would  like to  work with  the committee  on ...  this issue.                                                               
But we're  not opposed to  the bill itself; we're  just concerned                                                               
about some of the definitions themselves in the bill."                                                                          
                                                                                                                                
Number 2331                                                                                                                     
                                                                                                                                
CHAIR MURKOWSKI requested  that Mr. McRae do the  same thing that                                                               
Mr. Wiggins is doing,  which is get a copy of  Version J and send                                                               
the committee his written comments.                                                                                             
                                                                                                                                
CHAIR MURKOWSKI said that she is  going to hold HB 318 over until                                                               
the committee receives the written comments.                                                                                    
                                                                                                                                
REPRESENTATIVE  ROKEBERG  addressed  the   issue  of  who  is  to                                                               
qualify.  He  said it seems to him that  even Medicaid recipients                                                               
should  have a  card,  but  right now  he  isn't  sure "a  health                                                               
benefit  plan" is  defined in  the  statute.   He addressed  this                                                               
issue to Katie Campbell.                                                                                                        
                                                                                                                                
Number 2282                                                                                                                     
                                                                                                                                
KATIE CAMPBELL,  Actuary L/H,  Division of  Insurance, Department                                                               
of Community & Economic Development,  said that she also does not                                                               
have a copy of Version J.                                                                                                       
                                                                                                                                
REPRESENTATIVE  ROKEBERG  said,  "A   health  benefit  plan  that                                                               
provides" is what  is in [HB 318]  right now.  He  asked if there                                                               
is currently a definition of that in statute.                                                                                   
                                                                                                                                
MS.  CAMPBELL noted  that  "health benefit  plan"  is defined  in                                                               
Chapter 54 [AS 21.54.500], which  applies generally, and it's one                                                               
of the  definitions that went in  "when we made all  of the HIPAA                                                               
changes."                                                                                                                       
                                                                                                                                
Number 2253                                                                                                                     
                                                                                                                                
REPRESENTATIVE ROKEBERG asked if  that would include any Medicaid                                                               
recipients.                                                                                                                     
                                                                                                                                
MS.  CAMPBELL said  that the  definition is  written in  terms of                                                               
employee  welfare  benefit  plans,  so  it's  very  general,  and                                                               
Medicaid probably wouldn't qualify.                                                                                             
                                                                                                                                
REPRESENTATIVE ROKEBERG  said that  Medicaid should  be included.                                                               
He referred to page 1, lines  5-7, Version J, which read in part,                                                               
"A health  benefit plan that  provides coverage  for prescription                                                               
drugs or devices  and that issues, uses, requires,  or reissues a                                                               
card".  He  indicated that if [Medicaid] didn't use  a card, then                                                               
it wouldn't be subject to this provision.                                                                                       
                                                                                                                                
Number 2234                                                                                                                     
                                                                                                                                
REPRESENTATIVE ROKEBERG asked  Mr. Wiggins if there  would be any                                                               
impacts  relating to  the privacy  issue and  if he  was familiar                                                               
with the so-called Alaska patient's  bill of rights [which he had                                                               
sponsored].                                                                                                                     
                                                                                                                                
MR.  WIGGINS said  that he  has  recently been  working with  the                                                               
State of  California on the  privacy issue, and  [California] has                                                               
basically  eliminated the  [social  security] number.   He  said,                                                               
"That's  going  to make  a  requirement  for major  re-writes  of                                                               
eligibility  systems that  are coming  off  the payroll  systems.                                                               
It's going  to cause  a big  change in  the software  for doctors                                                               
[office's]  who use  [social security  numbers] as  identifiers -                                                               
plus we're going  to have to come up with  ... encrypted software                                                               
to work  with that."   Mr. Wiggins  emphasized that privacy  is a                                                               
big issue nationwide  regarding ID cards.  He said  that ID cards                                                               
are being  looked at  for confidentiality,  and those  same cards                                                               
are being used  for prescriptions, "so they kind  of compound the                                                               
issues."                                                                                                                        
                                                                                                                                
Number 2167                                                                                                                     
                                                                                                                                
REPRESENTATIVE  ROKEBERG asked  Mr.  Wiggins to  "check with  our                                                               
benefits people  up here ...  because there's several  bills that                                                               
have been floating around about  social security numbers ... that                                                               
I'm concerned about, as well as  the patient's bill of rights and                                                               
the other privacy issues."                                                                                                      
                                                                                                                                
MR.  WIGGINS said  that  [Aetna] is  not  against a  standardized                                                               
card;  it's just  that  it is  having  to comply  with  a lot  of                                                               
different bills  being enacted  in different  states.   He asked,                                                               
"Who regulates  them?   Who's compliant?"   He  requested further                                                               
explanation of the bill.                                                                                                        
                                                                                                                                
Number 2115                                                                                                                     
                                                                                                                                
MR. McRAE said,  "At one  time under  the HIPAA  rules there  was                                                               
going to  be a  unique identifier for  every individual  that had                                                               
health care  throughout the  nation, and  that's been  thrown out                                                               
now."    He  said that  it  was  decided  to  not do  this  at  a                                                               
congressional level.   He offered that in the  future there might                                                               
be a different identifier other than social security numbers.                                                                   
                                                                                                                                
REPRESENTATIVE  HAYES asked,  "Why  haven't  any other  companies                                                               
looked at federal  legislation and then just  had the legislation                                                               
do a  reciprocity format like the  bills that we were  looking at                                                               
last year?"   He said that  this would have been  the easiest way                                                               
to go about doing this.                                                                                                         
                                                                                                                                
MR.  WIGGINS   said  that  [Aetna]  insures   18  million  people                                                               
throughout  the  country  and   is  presently  using  a  somewhat                                                               
standard card for all 18 million people throughout the country.                                                                 
                                                                                                                                
Number 2057                                                                                                                     
                                                                                                                                
MR. McRAE  commented that  Blue Cross Blue  Shield's card  in all                                                               
the  states, generally  speaking,  fulfills  the requirements  of                                                               
what's in  the legislation.   He said his  concern is that  if it                                                               
changes a little  bit, the company will have to  send out another                                                               
85,000 new  cards.  He  restated his willingness to  work through                                                               
some of the definitions pertaining to the legislation.                                                                          
                                                                                                                                
CHAIR MURKOWSKI said she doesn't  think that every time there's a                                                               
change  in the  program, a  new  card has  to be  reissued.   She                                                               
offered that  when it's time  for the  card to be  reissued, then                                                               
the appropriate  changes would  be made.   She said,  "We'll make                                                               
sure that it basically says everything  that we think you want it                                                               
to say."                                                                                                                        
                                                                                                                                
Number 2012                                                                                                                     
                                                                                                                                
MR. McRAE stated that Blue Cross  Blue Shield does not reissue at                                                               
any set  time, but rather when  the data changes on  the card for                                                               
information purposes.                                                                                                           
                                                                                                                                
MR. WIGGINS said that Aetna does  the same.  He stated that Aetna                                                               
has created  a member  service whereby  people can  request cards                                                               
when they lose them.  New members receive a new ID card.                                                                        
                                                                                                                                
Number 1984                                                                                                                     
                                                                                                                                
CHAIR  MURKOWSKI announced  that she  is going  to hold  [HB 318]                                                               
over  until  the committee  receives  the  written comments  from                                                               
Aetna, Blue  Cross, and anybody else  who would care to  weigh in                                                               
on Version J.                                                                                                                   
                                                                                                                                

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