Legislature(2019 - 2020)BUTROVICH 205
02/06/2019 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB37 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 37 | TELECONFERENCED | |
SB37 Renewal of Vaccine Assessment Program
1:30:36 PM
CHAIR WILSON announced the consideration of SB 37. He stated his
intention to hear from the sponsor, take public testimony, and
move the bill from committee.
1:31:14 PM
SENATOR CATHY GIESSEL, speaking as prime sponsor of SB 37,
stated that she has no ethical conflict in preparing and
promoting this bill.
SENATOR GIESSEL explained that SB 37 reauthorizes the statewide
Alaska Vaccine Assessment Program (AVAP). Since its inception in
2014 the program has been monitoring, purchasing, and
distributing all childhood vaccines and a select number of adult
vaccines to health care providers. This has made vaccines
universally available to Alaskans. She said it was an innovative
solution in 2014 to the challenge of low vaccine rates and
difficulties providers faced with having vaccines in their
clinics and paying for them. This is private-public partnership
between the state of Alaska and health care payers (essentially
insurance companies). The program is fully funded through a
vaccine assessment account. Insurers pay for the vaccines ahead
of time for their insured populations. No unrestricted general
funds are used.
SENATOR GIESSEL said the program has been highly successful. It
leverages the state's ability to buy vaccines in bulk and then
distributes them to the health care providers. This reduces the
cost of vaccines. Previously, providers had to maintain two
different supplies of vaccines and could not borrow between the
two. Now providers have just one supply of vaccines that
insurers pay for in advance.
SENATOR GIESSEL said AVAP lowered the cost of vaccines by 20 to
30 percent. Providers administer the vaccines at no charge,
except for the office charge. She referenced the many letters of
support in the committee packets. She said at first there was
opposition to bill from PhRMA, a manufacturer of
pharmaceuticals, because they did not want adults included, but
Alaskans, particularly seniors, need vaccines such as the
pneumococcal and shingles vaccine. Alaska was the first state to
include adults.
SENATOR GIESSEL said she expects to hear from parents concerned
that the bill is taking away their ability to exempt their
children from vaccines for religious reasons. She emphasized
that parental rights are not changing at all.
SENATOR GIESSEL noted that the committee would hear from Dr.
Lily Lou, the new Chief Medical Officer for Department of Health
and Social Services (DHSS).
1:36:26 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 37 (version A).
Section 1:
Amends AS 18.09.200(b) by removing the "phase in"
language from statute as the Alaska Vaccine Assessment
Program is now fully implemented.
Section 2:
Amends AS 18.09.220(a) by removing the "phase in"
language from statute as the Alaska Vaccine Assessment
Program is now fully implemented.
Section 3:
Repeals AS 18.09.220(e) by removing the opt out option
for assesses since the program is no longer in the
"phase-in" stage
Section 4:
Repeals the sunset provisions (to repeal the program
in 2021) that were in section 5 of the original bill,
SB 169 in 2014.
SENATOR COGHILL asked her to explain the opt out provision in
section 3.
MS. CONWAY explained that during the phase-in period under the
original bill, insurers had the ability to opt-in to the
program. Now so many plans are fully accepting of the program
that is no longer part of the phase-in.
1:39:06 PM
At ease
1:39:44 PM
Lily Lou, M.D., Chief Medical Officer, Department of Health and
Social Services (DHSS), Anchorage, Alaska, said she had been on
the Alaska Vaccine Assessment Council for three years. She
mentioned that the committee packets contained a letter of
support she had written as the president of the American Academy
of Pediatrics-Alaska Chapter, before she became the Chief
Medical Officer. She said SB 37 reauthorizes a program that is
very important to all Alaskans because it makes vaccine access
universal at no cost to the state. The payers are happy to pay
for vaccines that they would pay for anyway, but at full price.
DR. LOU said that in 2018, AVAP covered 366,000 Alaskans, which
is 50 percent of the population. As a member of the Vaccine
Assessment Council and as a provider, she worked collaboratively
with the payers toward a common goal.
DR. LOU said one of the greatest benefits to providers is that
it took a multilayered program where some providers had to have
two sets of locked refrigerators and streamlined that into a
simpler, single system. Efficiencies were gained in bookkeeping
and ordering of vaccines. Payers benefitted from the 20 to 30
percent savings in costs.
DR. LOU said one unique aspect of the program is the ability to
opt in for uninsured adults. This program covers all children.
Vermont and Rhode Island offer adult vaccines, but only to
insured adults. Some of highest-risk Alaskans are uninsured
adults. DHSS won a Centers for Disease Control (CDC) award for
increasing pneumococcal vaccines for adults in the over-65 age
range. She noted that any group of high-risk people can spread
infectious diseases to others.
DR. LOU added that the ability to opt in for uninsured adult
patients benefits the providers who step up to take care of
members of the community who have the least in resources. The
program also benefits smaller providers. Some pediatricians said
they couldn't afford to vaccinate patients because of the cost.
This makes sure that all patients have access to vaccines.
Dr. Lou reported that the vaccine assessment program eliminated
the need to have a big warehouse. The simple, streamlined
process allows suppliers to get vaccines to most places directly
in a time-efficient manner. The downsized depot can help
providers who don't want to order a full box. Providers can
order just what they need and the extra can be distributed to
another practice without any waste.
DR. LOU said providers who don't opt in can still get vaccines
but without the discount. She recounted that before the Alaska
Vaccine Assessment Program, some providers may not have invested
in more expensive vaccines such as the HPV vaccine. (She noted
the second award the CDC gave Alaska was for most improved among
adolescents for HPV.)
DR. LOU said the Alaska Vaccine Assessment Council evaluates
evidence to determine what vaccines to provide, so small
providers can also provide these vaccines. Last year Alaska had
a mumps outbreak, which was one of the first major tests of the
vaccine program. A third dose was recommended for anyone not
vaccinated five years previously. The program handled the
additional doses and was able to get adequate stock. The AVAP
price per dose was $45.65 compared to the full price of $75.04,
about a 40 percent savings.
DR. LOU explained that measles is different from mumps in a
number of ways. One, it is much more infectious. The other is
that the vaccine is very effective. Someone who has received a
complete measles immunization is 97 percent protected for life
whereas the mumps vaccine wanes after a few years. She said
measles was declared eradicated around 2000, but with increasing
hesitation about vaccination across the country, there have been
increasing cases of measles in the past few years. Currently
measles have been reported in Texas, Connecticut, Washington,
Oregon, and New York.
DR. LOU said AVAP has clearly been successful. The three-year
phase-in period is over and all the payers now support the
program. She described it as being ready to remove the training
wheels.
1:51:25 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
said SB 37 removes the sunset provision, takes out the obsolete
language about the phase-in period, and uses the state vaccine
assessment account to fully fund the program.
MS. LEWIS said AVAP targets the privately insured but allows
providers who serve the uninsured to opt in. Alaska is the only
state that has figured out how to do that, she said.
MS. LEWIS said payers pay assessments, which pays for the cost
of the vaccines and program operation. By pooling that money,
the program can buy vaccines with bulk contracts from the
Centers for Disease Control at a 20 to 30 percent savings. The
vaccine is distributed to the providers at no cost because
payers have already paid for the vaccine. The healthcare
provider can still charge for the office visit, but the actual
vaccine is without charge. The insurance company has basically
paid for it. Without this program, providers would have to
purchase the vaccines and wait to be reimbursed.
MS. LEWIS reported that Alaska is one of 11 states that has a
universal childhood vaccine program funded by these types of
assessments, one of only three states that includes adults, and
the only state that serves uninsured adults. Uninsured children
are covered under a federal program.
MS. LEWIS reviewed a diagram that showed how the program works:
Alaska Vaccine Assessment Council sets the annual
assessment rate
Payers pay into the assessment quarterly based on their
reported covered lives
The Division of Public Health purchases vaccine off a
discounted bulk contract
The Division of Public Health ships vaccine at no cost to
providers or through the Vaccine Depot
Providers vaccinate covered patients, only billing payers
for office visit
Providers report administered vaccines to the Division of
Public Health
The Division of Public Health provides data to the Council
for rate setting
MS. LEWIS noted the importance of the data reported to the
council for managing inventory, rate setting, and forecasting
how much vaccine will be needed in the future.
MS. LEWIS said the program has many steps, but it works
seamlessly. The private sector cost to vaccinate a person
through 18 years of age is $3,319, compared to $2,379 with AVAP,
a savings of almost a $1,000.
MS. LEWIS said AVAP covers half of the population, 44 percent of
all children and 52 percent of all adults. She reminded the
committee that a federal program covers the remaining children.
She referred to a graph in the committee packets that
demonstrates the growth in vaccination rates with AVAP.
SENATOR STEVENS asked what percentage of children are covered in
Alaska between the two programs.
MS. LEWIS answered almost all. Children not covered by AVAP are
covered by the CDC program, Vaccines for Children. That includes
children in Medicaid, in the tribal healthcare system, and
uninsured and underinsured children, everyone who doesn't have a
payer.
MS. LEWIS called AVAP a win-win-win-win program for the
following reasons:
The Division of Public Health reduces vaccine preventable
diseases.
Providers have improved health outcomes for vaccinated
individuals and easier vaccine stock management.
The health insurance industry pays less to vaccinate
individuals.
All Alaskans save more money in the long run due to fewer
medical costs from vaccine-preventable diseases.
SENATOR BEGICH asked if there has been any effort to quantify
the savings as a result of the program.
MS. LEWIS responded that she would follow up with the
information if it was available.
DR. LOU referenced the 97 percent effectiveness rate of the
measles vaccine, and explained that of those who get measles,
one in four will require hospitalization, one in a thousand will
have serious complications such as encephalitis, and one to two
in a thousand will die. She said that provides a ballpark of
what might be saved.
2:03:21 PM
SENATOR BEGICH said he didn't want DHSS to do extensive work on
the question. He was curious but knows there will be savings.
MS. LEWIS said AVAP has removed barriers to costs and access. It
has shown it can be nimble enough to respond to an emergency and
manage inventory to avoid waste. Vaccines are expensive and
require refrigeration in a narrow temperature range.
MS. LEWIS displayed a slide that shows how every vaccine is an
investment. With routine vaccination the U.S. saves $13.5
billion in direct costs and $68.8 billion in societal costs.
MS. LEWIS concluded that reauthorizing ensures a healthier
future for all Alaskans at the lowest possible cost.
2:06:07 PM
CHAIR WILSON asked if there have been complications associated
with storing the vaccines.
MS. LEWIS answered that the vaccine depot predates AVAP by
decades and the primary difference is that all vaccines weren't
supplied before AVAP. For more than 30 years, thanks to Senator
Ted Stevens, Alaska was a universal vaccine state. When Senator
Stevens was not re-elected, the funding lapsed. Senator Giessel
facilitated temporary funding for a few years until AVAP was
established. What was in jeopardy was that without federal
funding there was no way to continue to be a universal vaccine
state. Providers were going to have to pay the cost out of
pocket to make up the difference. That would have been a lot
considering that DHSS spends $10.5 million just in the Alaska
Vaccine Assessment part of the program. During the H1N1 flu
outbreak Alaska was one of the few states able to rapidly
distribute a lot of vaccine because it is centralized.
CHAIR WILSON recalled working with the depot to get the H1N1
vaccines distributed across Alaska. He said the coordination
that the depot provided through DHSS was amazing.
DR. LOU added that anyone who touches vaccines goes through
repeated, detailed training. This program decreased the number
of people who had to be involved because the distribution system
was simplified and streamlined. She said there has been no
increased waste because product handling and has improved
significantly.
SENATOR STEVENS asked where the homeless go for vaccinations.
DR. LOU replied that they are taken care of by public health
nurses in the public healthcare system. In 2018, 14,000
immunizations were given to those people who might need services
but don't seek care through insured, private provider routes.
2:11:20 PM
CHAIR WILSON opened public testimony.
2:11:45 PM
Fred Potter, Managing Member, KidsVax, Concord, New Hampshire,
shared that KidsVax is under contract with DHSS to serve as
administrator of the Alaska Vaccine Assessment Program. They
manage the collection process, the remittances to the state, and
coordinate the advisory council meetings. KidsVax also maintains
the program website. Such programs waste. This is especially
true for Alaska because of its geography. Without this program,
vaccines must be in two separate silos under federal law. That
makes it more difficult to efficiently use a vaccine supply.
MR. POTTER said that in New Hampshire, sometimes the wastage is
nearly 50 percent with TRICARE in military clinics, whereas
wastage in the state supply is two to three percent. Alaska's
numbers are remarkably good given its unique physical
challenges. A robust body of literature maintained by the CDC
shows that $10 in direct medical cost is saved for every dollar
spent on vaccines. Now it is probably closer to $13 to $1. Since
AVAP has a budget of $10.5 million, the expected long-term
healthcare savings is more than $100 million each year.
MR. POTTER concluded with four points. 1. The Alaska vaccine
association has implemented nationally-recognized best practices
despite its relatively young age. 2. All the opt outs for payers
were withdrawn before the second year, which is a sign of payer
satisfaction. 3. The operating costs have gone down each year.
Remarkably, the assessment rates have held steady for this year
and perhaps for next year. 4 The advisory council voted
unanimously to recommend continuation of the program.
2:17:58 PM
GARY STRANNIGAN, Vice President, Congressional and Legislative
Affairs, Premera Blue Cross Blue Shield of Alaska, Seattle,
Washington, called attention to the letter of support he
submitted. He commended the program.
2:18:50 PM
ROSALYN SINGLETON, M.D., representing self, Anchorage, Alaska,
said she has seen firsthand the dramatic impact of vaccines on
the health of Alaskans. Years ago, Alaska had up to 4,000 cases
a year of hepatitis A with huge impacts on the public health
system. In the last year before vaccines, two teenagers died
from hepatitis A. Now, because of vaccines, there is virtually
no transmission of hepatitis A in the state. Washington has an
ongoing measles outbreak. The Alaska Vaccine Assessment Program
is critical to respond if Alaska did have a case imported into
the state. With AVAP the state has more flexibility to provide
vaccines to adults who may otherwise not have access.
2:20:51 PM
MATTHEW HIRSCHFELD, M.D., representing self, Anchorage, Alaska,
said he is a pediatrician and board chair of the All Alaska
Pediatrics Partnership. He said vaccines are one of true public
health successes in the history of medicine and SB 37 makes them
accessible to almost everyone in Alaska. He noted that the
partnership submitted a letter of support.
2:22:30 PM
JODYNE BUTTO, M.D., representing self, Anchorage, Alaska, said
she is an Anchorage pediatrician and AVAP board member. She
recounted that Alaska's universal vaccine program for kids
lapsed a few years ago because of funding cuts. She said that
program became cumbersome and costly for pediatricians to
maintain and track private and public vaccines and some kids
slipped through the cracks. AVAP streamlines that process and
provides access for all of Alaska's children to receive the
necessary vaccines to give Alaskans a healthy state. She said
she is speaking for her clinic and colleagues in support of SB
37.
2:24:47 PM
CHAIR WILSON closed public testimony and solicited a motion.
2:25:20 PM
SENATOR COGHILL moved to report SB 37, work order 31-LS0162\A,
from committee with individual recommendations and attached
fiscal note.
2:25:33 PM
There being no objection, SB 37 was reported from Senate Health
and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB37 AVAP Renewal vsn A 1-25-19.PDF |
HHSS 4/23/2019 3:00:00 PM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Sponsor Statement 1-28-19.cg.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Letter of Support AK Pediatric Grp 1-24-19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Letter of Support American Academy of Pediatrics - AK 1-24-19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document WA Post Anti Vaccine NC outbreak 11-18.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Alaska Public Health Advisory 1-29-19.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document AVAP Annual Report 2018.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document AVAP Status Update 2017.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Sectional Analysis 2-3-19.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document NPR 2-2-19.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document DHSS Vaccine Formulary 2019.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Letter of Support Premera 1-29-19.pdf |
SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Fiscal Note Div of Public Health Epidemiology 1.29.19.pdf |
SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document AVAP Payers.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document AVAP Providers.pdf |
HHSS 4/23/2019 3:00:00 PM SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Status Update 2018.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Who Pays AVAP.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document PPt AVAP DPH 2-5-19.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB 37 Aetna Support 2.5.19.pdf |
SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Measles Info CDC.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Vaccination Rate Trends 2013-17.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Supporting Document Measles Info DHSS.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |
| SB37 Letter of Support AK Ped Partnership 2-6-19.pdf |
SFIN 2/13/2019 9:00:00 AM SHSS 2/6/2019 1:30:00 PM |
SB 37 |