Legislature(2021 - 2022)ADAMS 519

03/11/2022 09:00 AM House FINANCE

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                  HOUSE FINANCE COMMITTEE                                                                                       
                      March 11, 2022                                                                                            
                         9:03 a.m.                                                                                              
9:03:10 AM                                                                                                                    
CALL TO ORDER                                                                                                                 
Co-Chair Merrick called the House Finance Committee meeting                                                                     
to order at 9:03 a.m.                                                                                                           
MEMBERS PRESENT                                                                                                               
Representative Kelly Merrick, Co-Chair                                                                                          
Representative Dan Ortiz, Vice-Chair (via teleconference)                                                                       
Representative Ben Carpenter                                                                                                    
Representative Bryce Edgmon                                                                                                     
Representative DeLena Johnson                                                                                                   
Representative Andy Josephson                                                                                                   
Representative Bart LeBon                                                                                                       
Representative Sara Rasmussen (via teleconference)                                                                              
Representative Adam Wool                                                                                                        
MEMBERS ABSENT                                                                                                                
Representative Neal Foster, Co-Chair                                                                                            
Representative Steve Thompson                                                                                                   
ALSO PRESENT                                                                                                                  
Representative   Andi    Story,   Sponsor;    Kris   Curtis,                                                                    
Legislative Auditor,  Alaska Division of  Legislative Audit;                                                                    
Sara Chambers, Director,  Division of Corporations, Business                                                                    
and   Professional   Licensing,  Department   of   Commerce,                                                                    
Community and Economic Development.                                                                                             
PRESENT VIA TELECONFERENCE                                                                                                    
Representative Jonathan Kreiss-Tompkins; Justin Ruffridge,                                                                      
Chair, Board of Pharmacy.                                                                                                       
HB 246    ACCESS TO MARIJUANA CONVICTION RECORDS                                                                                
          HB 246 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
HB 306    EXTEND BOARD OF PHARMACY                                                                                              
          HB 306 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
Co-Chair Merrick reviewed the agenda for the meeting.                                                                           
HOUSE BILL NO. 246                                                                                                            
     "An Act restricting the release of certain records of                                                                      
    convictions; and providing for an effective date."                                                                          
9:03:59 AM                                                                                                                    
Co-Chair Merrick indicated there was one amendment from                                                                         
Legislative Legal.                                                                                                              
9:04:25 AM                                                                                                                    
AT EASE                                                                                                                         
9:05:08 AM                                                                                                                    
Co-Chair Merrick OPENED public testimony.                                                                                       
9:05:26 AM                                                                                                                    
Co-Chair Merrick CLOSED public testimony.                                                                                       
9:05:31 AM                                                                                                                    
AT EASE                                                                                                                         
9:20:03 AM                                                                                                                    
Co-Chair Merrick stated that HB 246 was set aside.                                                                              
HB 246 was HEARD and HELD in committee for further                                                                              
HOUSE BILL NO. 306                                                                                                            
     "An Act extending the termination  date of the Board of                                                                    
     Pharmacy; and providing for an effective date."                                                                            
9:20:19 AM                                                                                                                    
REPRESENTATIVE ANDI STORY, SPONSOR,  indicated that the bill                                                                    
amended the  statute to extend  the termination date  of the                                                                    
Board of Pharmacy to June  30, 2028. The current sunset date                                                                    
was  June  30,  2022.  The  bill  would  have  an  immediate                                                                    
effective date.  She emphasized the importance  of the board                                                                    
to protect  the public's safety and  wellbeing and described                                                                    
the responsibilities  of pharmacists  and of  board members.                                                                    
The Prescription  Drug Monitoring Program (PDMP)  was housed                                                                    
within  the  Board  of  Pharmacy,  and  board  members  were                                                                    
responsible  for  adopting  regulations and  monitoring  the                                                                    
program. The  board was composed  of seven members,  five of                                                                    
which must  be licensed pharmacists actively  engaged in the                                                                    
state  for a  period  of three  years immediately  preceding                                                                    
appointment.   The   remaining   two  board   members   were                                                                    
prohibited from  having a direct  financial interest  in the                                                                    
healthcare  industry. She  read from  the sponsor  statement                                                                    
(copy on file):                                                                                                                 
     House  Bill 306  extends  the termination  date of  the                                                                    
     Board  of Pharmacy  until June  30,  2028. The  current                                                                    
     sunset date is June 30, 2022.                                                                                              
     The  first  Alaska Board  of  Pharmacy  was created  in                                                                    
     1913. Those provisions were repealed  in 1955 and a new                                                                    
    board was enacted with many of the same functions.                                                                          
     The Board  of Pharmacy benefits Alaskans  by regulating                                                                    
     pharmacies,  pharmacists,   pharmacy  technicians,  and                                                                    
     pharmacy   interns,  and   ensuring  the   practice  of                                                                    
     pharmacy is done safely and  within the bounds of state                                                                    
     law. Allowing  the board to  terminate would not  be in                                                                    
     the best interest of the state.                                                                                            
     The Division of Legislative  Audit (DLA) found in their                                                                    
     2021 audit  of the  Board of  Pharmacy that  the "board                                                                    
     served the public's  interest by effectively conducting                                                                    
     its   meetings  and   actively  amending   regulations;                                                                    
     however,  improvements   over  the   board's  licensing                                                                    
     functions  are needed."  DLA recommended  the extension                                                                    
     of the  board for  six years to  reflect "the  need for                                                                    
     more timely  oversight of the board's  evolving role in                                                                    
     combating the public health opioid crisis."                                                                                
     I respectfully ask  for your support in  the passage of                                                                    
Representative   Story   highlighted   the   importance   of                                                                    
pharmacists  during the  COVID-19  pandemic and  appreciated                                                                    
the  committee's  consideration  of  the  extension  of  the                                                                    
Co-Chair  Merrick invited  the  legislative  auditor to  the                                                                    
9:23:37 AM                                                                                                                    
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE  AUDIT,  reviewed  the Division  of  Legislative                                                                    
Audit's sunset  review for the  Board of Pharmacy.  She read                                                                    
directly from the audit report (copy on file):                                                                                  
     Overall, the audit concluded that  the board served the                                                                    
     public's   interest  by   effectively  conducting   its                                                                    
     meetings  and actively  amending regulations;  however,                                                                    
     improvements  over the  board's licensing  function are                                                                    
     needed. Further,  the audit concluded that  Division of                                                                    
     Corporations,   Business  and   Professional  Licensing                                                                    
     (DCBPL) staff investigated  complaints unrelated to the                                                                    
     controlled substance prescription  database (CSPD) in a                                                                    
     timely manner  and activity worked  toward implementing                                                                    
     new CSPD requirements.                                                                                                     
     At the time of the  audit, occupational boards were not                                                                    
     effectively monitoring or  enforcing CSPD requirements.                                                                    
     Additionally,   DCBPL   licensing    staff   were   not                                                                    
     consistently   entering  the   existence   of  a   Drug                                                                    
     Enforcement  Administration  (DEA) registration  number                                                                    
     into  DCBPL's licensing  database, which  prevented the                                                                    
     licensing   database  from   being   used  to   monitor                                                                    
     compliance with CSPD registration requirements.                                                                            
     In accordance  with AS  08.03.010(c)(16), the  board is                                                                    
     scheduled to  terminate on June 30,  2022. We recommend                                                                    
     that  the legislature  extend  the board's  termination                                                                    
     date six  years, to June  30, 2028, which is  less than                                                                    
     the eight-year maximum allowed  in statute. The reduced                                                                    
     extension reflects  the need for more  timely oversight                                                                    
     of the  board's evolving  role in combating  the public                                                                    
     health opioid crisis.                                                                                                      
Ms. Curtis  asked members to  turn to  page 13 of  the audit                                                                    
report and  directed attention to Exhibit  4, which detailed                                                                    
the   standard    licensing   information    and   financial                                                                    
information in  the audit.  She relayed  that as  of January                                                                    
31, 2021,  there were 4,280 active  licenses, which included                                                                    
individual licenses  and facility  licenses. There was  a 17                                                                    
percent  increase when  compared  to the  prior 2017  sunset                                                                    
audit due to three new license types.                                                                                           
Ms. Curtis directed  members to turn to page 15  to view the                                                                    
board's  schedule of  revenues and  expenditures. The  board                                                                    
had a  high surplus  of almost $800  thousand as  of January                                                                    
31,  2021.  She  explained  that  the  board  discussed  fee                                                                    
reductions  during  the  February  2021  board  meeting  and                                                                    
decided against  reducing fees. The  board planned to  add a                                                                    
new  licensing  examiner  position, which  would  result  in                                                                    
increased  expenditures.  Additionally,  there  was  concern                                                                    
that the  disciplinary matrix established  to cover  the new                                                                    
controlled    substance    prescription   database    (CSPD)                                                                    
requirements   would   result    in   future   investigative                                                                    
expenditures. Fees  were not reduced  in recognition  of the                                                                    
potential future expenditures.                                                                                                  
Ms. Curtis  relayed that  a large portion  of the  audit was                                                                    
intended to  evaluate the board's progress  in administering                                                                    
the  CSPD. The  last  sunset audit  in  2017 concluded  that                                                                    
changes to laws governing the  database would give the board                                                                    
a more  active role in  reducing the abuse and  diversion of                                                                    
controlled substances.  The prior audit recommended  a four-                                                                    
year   extension  to   monitor  the   board's  progress   in                                                                    
implementing new laws that governed the database.                                                                               
Ms. Curtis read from page 4  of the audit report in order to                                                                    
provide background information:                                                                                                 
     Senate Bill 196, passed in  2008, required the Board of                                                                    
     Pharmacy  (board) to  establish and  maintain a  CSPD.3                                                                    
     The law was  passed with the intent  to improve patient                                                                    
     care  and foster  the goal  of reducing  misuse, abuse,                                                                    
     and  diversion of  controlled  substances. The  statute                                                                    
     requires  each  dispenser  submit   to  the  board,  by                                                                    
     electronic    means,    information   regarding    each                                                                    
     prescription dispensed for  a controlled substance. The                                                                    
     CSPD electronically collects  information from in-state                                                                    
     pharmacies, as  well as other dispensers  of controlled                                                                    
     substance prescriptions.                                                                                                   
Ms. Curtis shared that important  authority was missing from                                                                    
the original legislation that  limited its effectiveness and                                                                    
prevented   the  legislation   from   meeting  its   intent.                                                                    
Significant changes  were made  to address  the deficiencies                                                                    
in 2017  and 2018, which  significantly impacted the  way in                                                                    
which the board administered the database.                                                                                      
9:28:06 AM                                                                                                                    
Ms. Curtis  directed members'  attention to  page 16  of the                                                                    
audit, which  outlined the significant changes  to the CPSD.                                                                    
She reported  that during  the audit  period, administration                                                                    
of  the  CSPD  significantly   changed  in  terms  of  legal                                                                    
authority  and organizational  structure.  The changes  were                                                                    
intended to make  the CSPD more effective  at preventing the                                                                    
misuse, abuse,  and diversion of controlled  substances. She                                                                    
read the three significant changes from the audit:                                                                              
     Register  - licensees  of the  six occupational  boards                                                                    
     that prescribe  or dispense controlled  substances were                                                                    
     required to register with the CSPD;                                                                                        
     Report  - data  regarding  prescriptions and  dispensed                                                                    
     substances were  required to be  reported daily  to the                                                                    
     CSPD; and                                                                                                                  
     Review  -  practitioners  were required  to  check  the                                                                    
     database   prior   to   dispensing,   prescribing,   or                                                                    
    administering medication, with specific exclusions.                                                                         
Ms. Curtis  noted that the  audit concluded that  changes to                                                                    
statutes and  regulations made the database  more capable of                                                                    
combating the opioid crisis.                                                                                                    
Ms. Curtis  continued to  read from  page 16  and 17  of the                                                                    
     Implementing   the   new   CSPD   laws   required   the                                                                    
     coordination   of   six    occupational   boards.   The                                                                    
     Prescription Drug  Monitoring Program (PDMP)  is housed                                                                    
     within the Board of  Pharmacy; however, each applicable                                                                    
     licensing  board  is  responsible  for  monitoring  and                                                                    
     enforcing   the  requirements   for  their   respective                                                                    
     licensees. As  of January  2021, each  applicable board                                                                    
     was at a different stage  in implementing new CSPD laws                                                                    
     and  none  of  the  boards  were  fully  monitoring  or                                                                    
     enforcing CSPD requirements.                                                                                               
Ms.  Curtis directed  members' attention  to "Exhibit  7" on                                                                    
page 17  of the  audit report,  which summarized  the degree                                                                    
each   applicable   occupational    board   monitored   CSPD                                                                    
registration  and  reporting requirements.  She  highlighted                                                                    
that only  the Board  of Pharmacy monitored  compliance with                                                                    
both  the  registration   and  the  reporting  requirements.                                                                    
However, none of the boards  monitored whether licensees had                                                                    
complied with  the requirement to  review the CSPD  prior to                                                                    
dispensing,   prescribing,   or   administering   controlled                                                                    
Ms.  Curtis turned  to page  19 of  the audit  report, which                                                                    
concluded that  the new CPSD requirements  were not actively                                                                    
enforced by the respective boards. She read from page 19:                                                                       
     Enforcement   was   further   limited   by   inadequate                                                                    
     disciplinary  matrices.   Board  disciplinary  matrices                                                                    
     needed  to help  guide the  resolution of  CSPD related                                                                    
     cases  were not  available  for all  boards during  the                                                                    
     audit  period. Exhibit  9 [on  page 20]  summarizes the                                                                    
     status of  the disciplinary matrices as  of January 31,                                                                    
     2021.  Several  board  matrices covered  a  failure  to                                                                    
     register, but not a failure  to review CSPD information                                                                    
     or  a failure  to report  controlled substances  to the                                                                    
     CSPD. The Board of  Examiners in Optometry disciplinary                                                                    
     matrix did not address the CSPD.                                                                                           
Ms. Curtis  proceeded to  page 20  and continued  reading as                                                                    
     Enforcement   was   further   limited   by   inadequate                                                                    
     disciplinary  matrices.   Board  disciplinary  matrices                                                                    
     needed  to help  guide the  resolution of  CSPD related                                                                    
     cases  were not  available  for all  boards during  the                                                                    
     audit period.  Exhibit 9 summarizes  the status  of the                                                                    
     disciplinary matrices  as of January 31,  2021. Several                                                                    
     board matrices  covered a failure to  register, but not                                                                    
     a failure  to review CSPD  information or a  failure to                                                                    
     report controlled substances to  the CSPD. The Board of                                                                    
     Examiners  in  Optometry  disciplinary matrix  did  not                                                                    
     address the CSPD.                                                                                                          
Ms.  Curtis  noted  that the  audit  contained  more  detail                                                                    
regarding  the CSPD,  but  she intended  to  advance to  the                                                                    
findings and recommendations made by the audit.                                                                                 
9:31:25 AM                                                                                                                    
Representative Carpenter wanted to hear more details.                                                                           
Ms. Curtis  obliged and continued  to read from page  20 and                                                                    
page 21:                                                                                                                        
     Only  two of  the  applicable  boards set  prescription                                                                    
     limitations in regulation. The  State Medical Board set                                                                    
     a  limitation  of  50  morphine  milligram  equivalents                                                                    
     (MME)  for initial  opioid prescriptions  only and  the                                                                    
     Board of Dental  Examiners set a limitation  of 60 MME.                                                                    
     (See Recommendation 3)                                                                                                     
     The  Board of  Pharmacy may,  but is  not required  to,                                                                    
     send  patient  specific  utilization  notifications  to                                                                    
     pharmacists  and  practitioners.   Instead  of  sending                                                                    
     patient-specific  notifications,  the PDMP  coordinator                                                                    
     provided  summary   data  to   applicable  occupational                                                                    
     boards  as  part  of  standard  board  reports  and  to                                                                    
     practitioners as  part of prescriber report  cards. The                                                                    
     following  three  metrics,  referred  to  as  "clinical                                                                    
     alerts," were provided:                                                                                                    
     1.  Number of  patients treated  with over  90 and  120                                                                    
     2.   Number   of   patients  treated   with   dangerous                                                                    
     combinations; and                                                                                                          
     3.   Number  of   patients   who  received   controlled                                                                    
     substances from  five prescribers, at  five pharmacies,                                                                    
     over a three month period.                                                                                                 
9:33:07 AM                                                                                                                    
Representative Wool  did not know what  the morphine amounts                                                                    
meant as he had not  gotten morphine prescriptions. He asked                                                                    
whether 60 MME of morphine was a significant amount.                                                                            
Ms. Curtis responded  that she did not know  what the amount                                                                    
meant either  and had researched  it prior to  the committee                                                                    
Representative Wool  wanted to  put the  amount in  terms of                                                                    
equivalence  to  understand it  better.  He  asked what  the                                                                    
equivalent amount of Percocet  or Tylenol with Codeine would                                                                    
Ms. Curtis admitted  that she did not have  the knowledge to                                                                    
properly answer the question and  suggested that it would be                                                                    
better suited for the chair of the board or a board member.                                                                     
Co-Chair Merrick indicated the  chair would testify later in                                                                    
the meeting.                                                                                                                    
Representative  LeBon speculated  that  in-state control  of                                                                    
substances via a database would  be effective and manageable                                                                    
with  robust   opportunity  for  oversight.  He   asked  how                                                                    
medications coming  from other states were  entered into the                                                                    
Ms.  Curtis understood  that  pharmacies  from other  states                                                                    
were  required to  enter  prescriptions  into the  database.                                                                    
There were  exceptions to this requirement,  and she offered                                                                    
that it would  be a good idea to confirm  the details of the                                                                    
exceptions.   For   example,   she   relayed   that   Native                                                                    
corporations  and  army bases  were  not  required to  enter                                                                    
prescriptions into the database.                                                                                                
9:35:52 AM                                                                                                                    
Ms. Curtis continued  to read from the audit  report on page                                                                    
21 through page 22:                                                                                                             
     The  process of  sending board  reports evolved  during                                                                    
     the audit period.  Not all boards were  sent reports on                                                                    
     a routine basis and not  all board reports included the                                                                    
     three  metrics. Exhibit  10  identifies  the number  of                                                                    
     board reports  issued during the  audit period  and the                                                                    
     number  of reports  that included  one or  more of  the                                                                    
     three clinical alert metrics.                                                                                              
     Beginning  FY  18,  CSPD information,  referred  to  as                                                                    
     Prescriber  Report Cards,  was provided  to prescribing                                                                    
     practitioners. The  report cards were intended  to give                                                                    
     practitioners the  ability to review  their prescribing                                                                    
     activity   and   compare    the   activity   to   other                                                                    
     practitioners within  the same occupation and  within a                                                                    
     specific specialty.                                                                                                        
     Quarterly report cards included:                                                                                           
         the three clinical alerts;                                                                                          
         the prescriber's current prescribing controlled                                                                     
          substance   volume    sand   duration,   including                                                                    
          comparison to peers;                                                                                                  
         the top three prescribed controlled substances;                                                                     
         the number of patients searched in the CSPD.                                                                        
     Exhibit 11 illustrates the  number of practitioners who                                                                    
     received  a  prescriber  report  card  by  occupational                                                                    
9:37:04 AM                                                                                                                    
Ms. Curtis reviewed the recommendations beginning on page                                                                       
     The  board chair  and DCBPL's  director should  improve                                                                    
     procedures  and  training  to  ensure  applicants  meet                                                                    
     requirements prior to licensure.                                                                                           
     Three   of  25   individual  applications   tested  (12                                                                    
     percent)  were missing  affidavits of  moral character.                                                                    
     Regulation  12 AAC  52.120(b)(8) requires  an applicant                                                                    
     provide  two affidavits  from  reputable citizens  that                                                                    
     the  applicant   has  known  for  at   least  one  year                                                                    
     attesting  to  the  applicant's good  moral  character.                                                                    
     Auditors noted that the DCBPL  checklist used to ensure                                                                    
     applications were complete  was missing the requirement                                                                    
     for  affidavits of  moral character,  which contributed                                                                    
     to the deficiency.                                                                                                         
     Five  of 25  facility license  applications tested  (20                                                                    
     percent) did  not include  all the  required regulatory                                                                    
Ms. Curtis identified what the audit found to be the most                                                                       
concerning lack of documentation on page 26 through page                                                                        
     One out-of-state  wholesale drug distributor,  one out-                                                                    
     of-state  pharmacy,  and  one  in-state  pharmacy  were                                                                    
     issued licenses  when the applicants answered  yes to a                                                                    
     professional  fitness  question   and  the  applicants'                                                                    
     licensing fi les lacked documentation  of approval by a                                                                    
     supervisor   prior   to    issuance.   Alaska   Statute                                                                    
     08.80.261(a) states  that the board may  deny a license                                                                    
     if the board finds the  applicant has been convicted of                                                                    
     a crime  or acted  in a  way that  does not  conform to                                                                    
     minimum  professional standards.  To  help evaluate  an                                                                    
     applicant's professional fitness,  the application asks                                                                    
     a  series   of  questions.  Division   policy  (DOL-28)                                                                    
     requires  the licensing  supervisor review  and approve                                                                    
     applications    that   contain    "yes"   answers    to                                                                    
     professional  fitness  questions.   Two  of  the  three                                                                    
     licenses  were issued  without follow-up  due to  human                                                                    
     error.  DCBPL   management  stated  that   the  fitness                                                                    
     questions were  reviewed by a supervisor  for the third                                                                    
     license; however,  no evidence  was included in  the fi                                                                    
     le to demonstrate the review  and there was no evidence                                                                    
     that additional information was  obtained upon which to                                                                    
     base the review.                                                                                                           
     According   to  DCBPL   management,  turnover   in  the                                                                    
     licensing examiner  position, a  lack of  training, and                                                                    
     human error contributed to  the facility license errors                                                                    
     noted above.                                                                                                               
Ms.  Curtis  reported that  recommendation  2  [on page  27]                                                                    
advised  the   board  to  adopt  regulations   for  renewing                                                                    
outsourcing  facilities and  third-party logistics  provider                                                                    
licenses. The renewal regulations  were not updated when two                                                                    
new  license types  were  originally added  and  would be  a                                                                    
simple fix.                                                                                                                     
Ms. Curtis added that  recommendation 3 suggested applicable                                                                    
occupational boards and DCBPL's  director should continue to                                                                    
coordinate   efforts   to   improve   the   monitoring   and                                                                    
enforcement  of CSPD  requirements.  An  advisory group  had                                                                    
been  formed  in  September  2020   consisting  of  all  six                                                                    
occupational  boards  to  help  improve  compliance  amongst                                                                    
licensees. She  recommended the utilization of  the group to                                                                    
improve compliance.                                                                                                             
9:39:33 AM                                                                                                                    
Ms. Curtis continued to read recommendation 4 on page 29:                                                                       
     The  Department of  Commerce,  Community, and  Economic                                                                    
     Development's  (DCCED)   commissioner  should  allocate                                                                    
     sufficient  resources  to  ensure licensees  holding  a                                                                    
     Drug  Enforcement   Administration  (DEA)  registration                                                                    
     number are  consistently recorded in  DCBPL's licensing                                                                    
Ms. Curtis  reported that consistent record  keeping had not                                                                    
been  happening, and  that data  matches with  the CSPD  and                                                                    
registration monitoring were  not possible without completed                                                                    
licensing database records.                                                                                                     
9:39:49 AM                                                                                                                    
Ms. Curtis  read recommendation  5 on page  30 of  the audit                                                                    
     DCCED's   commissioner   should   allocate   sufficient                                                                    
     resources   to  ensure   the   CSPD  requirements   are                                                                    
Ms.  Curtis  explained that  related  cases  were not  being                                                                    
investigated due to a lack of resources.                                                                                        
9:40:02 AM                                                                                                                    
Ms.  Curtis  continued  to   management's  response  to  the                                                                    
recommendations, which began  on page 46 of  the report. She                                                                    
relayed  that   the  DCCED  commissioner   [Julie  Anderson]                                                                    
generally   agreed   with   the  report   conclusions.   The                                                                    
commissioner reported that corrective  action had been taken                                                                    
in  response  to  the audit,  such  as  providing  training,                                                                    
instituting  additional  procedures   to  address  licensing                                                                    
deficiencies, adding  two additional grant  funded positions                                                                    
to the PDMP,  and approving a new  investigative position to                                                                    
oversee enforcement of the CSPD requirements.                                                                                   
The  response  from  the  chair of  the  Board  of  Pharmacy                                                                    
[Justin Ruffridge, PharmD] was found  on page 51. He came to                                                                    
the same conclusions as the commissioner.                                                                                       
9:40:58 AM                                                                                                                    
Representative Edgmon asked why  the legislative auditor was                                                                    
recommending a six-year extension.  He referenced page 23 of                                                                    
the audit report:                                                                                                               
     The  board explained  in  the  2021 legislative  report                                                                    
     that it was  not possible to quantify  the reduction of                                                                    
     inappropriate   use  or   prescription  of   controlled                                                                    
     substances because the CSPD does  not contain or relate                                                                    
     prosecutorial  data regarding  diversion  cases and  is                                                                    
     not informed  when an individual, whether  a patient or                                                                    
     provider,    has   avoided    inappropriate   use    or                                                                    
Representative   Edgmon  indicated   the   issue  had   been                                                                    
discussed during deliberations of  SB 76 [Legislation passed                                                                    
in  2016  regarding  real   estate  licensees  for  licensee                                                                    
relationships].  He relayed  that  the  discussion had  been                                                                    
controversial due  to concerns about privacy  and overreach.                                                                    
He  offered  his  perspective that  the  six-year  extension                                                                    
seemed incongruent with previous legislation.                                                                                   
9:42:26 AM                                                                                                                    
Ms. Curtis  responded that in  the 2021, the  auditors "came                                                                    
down fairly hard" on the  board and recommended an extension                                                                    
of  only  four years.  At  that  point,  new laws  had  been                                                                    
introduced to  fix issues associated with  the database. She                                                                    
opined that there  were poor laws in place,  such as monthly                                                                    
reporting   requirements,  voluntary   compliance,  and   an                                                                    
ineffective database.  As the opioid crisis  progressed, the                                                                    
legislature made attempts to correct  the issues. She wanted                                                                    
to  recognize the  great strides  the board  had made  after                                                                    
previous  prescriber report  cards  and  board reports  were                                                                    
Ms.  Curtis  commented that  page  23  of the  audit  listed                                                                    
performance  measures  that  could not  have  been  realized                                                                    
within the  parameters of the law  at the time. She  did not                                                                    
factor in  the inability  to meet the  performance standards                                                                    
because  the  standards were  impossible  to  meet. She  had                                                                    
considered  whether  the  board  was  placed  in  the  right                                                                    
department  due  to  the  focus of  the  licensing  and  the                                                                    
regulation of  the board. She  researched what  other states                                                                    
had done in  similar situations and had found  it was common                                                                    
to implement  these requirements  at the board  level within                                                                    
DCCED. The  six-year extension  recognized the  strides that                                                                    
had been made by the board.  She noted that the board needed                                                                    
additional    recognition    and    support,    particularly                                                                    
considering the  resource and hiring restraints  of the last                                                                    
few years.                                                                                                                      
9:45:28 AM                                                                                                                    
Representative Edgmon  agreed and noted that  the department                                                                    
had been  reduced by  78 percent since  2015. He  added that                                                                    
this issue  was readdressed  in 2016 and  again in  2017 and                                                                    
suggested  shortening extension  to around  three years.  He                                                                    
thought there  was a need  for statutory change. He  did not                                                                    
want  to overcomplicate  the process  and acknowledged  that                                                                    
the board  had been  tasked with  a significant  amount work                                                                    
and responsibility.  The database played a  significant role                                                                    
and he  supposed that  it had not  been utilized  enough. He                                                                    
noted  that  was  due  to  "political  landmines"  regarding                                                                    
reporting requirements and data access.                                                                                         
9:46:56 AM                                                                                                                    
Representative  LeBon  asked  Ms.  Curtis  about  the  audit                                                                    
frequency. He  wondered whether there  would be  a follow-up                                                                    
Ms. Curtis indicated that the  auditors would reevaluate the                                                                    
need   for  an   additional  audit   the  year   before  the                                                                    
termination   date.  The   extension  date   given  by   the                                                                    
legislature  would  determine  the timeframe  for  the  next                                                                    
Representative LeBon  asked whether it would  be appropriate                                                                    
to  shorten the  extension timeframe  given the  findings of                                                                    
the audit.                                                                                                                      
Ms.  Curtis  indicated  that  none  of  the  recommendations                                                                    
factored into  her reduced extension  decision. The  role of                                                                    
the board was  constantly evolving, and she did  not want to                                                                    
wait eight years to reassess  the situation. She pointed out                                                                    
that all five recommendations  were administrative in nature                                                                    
and  were easily  manageable.  Some  of the  recommendations                                                                    
were  resource  issues, which  was  the  responsibly of  the                                                                    
legislature.  She  stated  that   the  amount  of  time  the                                                                    
legislature  wanted to  wait to  send  her "back  in" was  a                                                                    
policy call.                                                                                                                    
9:48:36 AM                                                                                                                    
Representative  Carpenter noted  that  Ms.  Curtis spoke  of                                                                    
potential statutory  change. He  wondered whether  the board                                                                    
had made any recommendations for statutory changes.                                                                             
Ms. Curtis  responded that the  board had  helped individual                                                                    
legislators  propose changes  to the  database. She  thought                                                                    
there   were   some   existing  bills   regarding   proposed                                                                    
improvements to the database.                                                                                                   
Representative  Carpenter suggested  that it  would be  wise                                                                    
for  the  committee  to request  a  summary  of  recommended                                                                    
statutory changes.                                                                                                              
Co-Chair Merrick thought the bill  sponsor could work on the                                                                    
9:50:03 AM                                                                                                                    
Representative Wool understood  that pharmacists and doctors                                                                    
were  the users  of the  PDMP.  He wondered  if the  medical                                                                    
board had similar issues related to the PDMP.                                                                                   
Ms. Curtis responded  that the auditors were  in the process                                                                    
of starting to  work on the medical board.  The auditors had                                                                    
recently completed work on the  Alaska Board of Examiners in                                                                    
Optometry and  had significant problems  discovering whether                                                                    
individuals had registered  for the CSPD. It  could not even                                                                    
be  tested   due  to  problems  with   the  DCBPL  licensing                                                                    
database. The  auditors performed  a deep  investigation and                                                                    
found many  applicants that were  in the  licensing database                                                                    
that were not  in the CSPD, and many applicants  who were in                                                                    
the CSPD  but not  in the licensing  database due  to lapsed                                                                    
licenses. The  contractor who ran  the CSPD  was responsible                                                                    
for discovering problems of this  nature, but that oversight                                                                    
had  not been  occurring.  She reiterated  that a  similarly                                                                    
thorough investigation  would be  performed for  the medical                                                                    
board.  She  highlighted  that  boards  were  not  typically                                                                    
enthusiastic  to engage  in investigations  and that  it was                                                                    
typically a  self-policing system. She explained  it was not                                                                    
coming from "the ground up, but  more the top down." She was                                                                    
certain  that   the  boards   would  have   input  regarding                                                                    
suggested changes.                                                                                                              
Representative Carpenter  appreciated Ms.  Curtis' feedback.                                                                    
He suggested that  if the database was considered  a tool to                                                                    
assist against  the opioid epidemic,  but the board  was not                                                                    
appropriately managing  that tool, perhaps it  should not be                                                                    
managed by  the board.  He speculated  that the  DCCED might                                                                    
have  been  a  more   appropriate  entity  to  entrust  with                                                                    
managing  the  database  due  to  increased  accountability,                                                                    
budgets,   and    supervision.   He   asked    whether   the                                                                    
administration might make a similar recommendation.                                                                             
Ms. Curtis had  come to the same conclusion in  terms of the                                                                    
most appropriate entity to house  the database. The database                                                                    
had not been effective as anticipated.                                                                                          
Representative  Carpenter  commented  that if  a  tool  that                                                                    
intended  to  solve  the  opioid   epidemic  was  not  being                                                                    
utilized, it was  a failure and needed to  be reassessed. He                                                                    
suggested that extending the board  another two years or six                                                                    
years would not solve the problem.                                                                                              
Ms.  Curtis explained  it was  the reason  for the  six-year                                                                    
recommendation.  The  board  was succeeding  in  registering                                                                    
people and  providing licenses, but success  in managing the                                                                    
CPSD was  an entirely  different situation. She  opined that                                                                    
each  administration   over  the  past  10   years  had  not                                                                    
appropriately dealt with the issue.                                                                                             
Co-Chair Merrick  noted Ms. Chambers with  DCBPL was nodding                                                                    
her head.                                                                                                                       
Representative  Wool  commented  that  there  may  be  other                                                                    
issues preventing the success of  the boards that dealt with                                                                    
the  PDMP  and  CSPD.  He thought  there  were  also  issues                                                                    
regarding software  integration with databases.  He reminded                                                                    
the  committee of  Representative  LeBon's earlier  question                                                                    
about online  sales and suggested that  individuals who made                                                                    
illegal  online  sales  of  drugs were  likely  not  in  the                                                                    
database.  He   remarked  that  illegal   sales  contributed                                                                    
significantly to the opioid overdose problem.                                                                                   
9:55:56 AM                                                                                                                    
SARA CHAMBERS, DIRECTOR,  DIVISION OF CORPORATIONS, BUSINESS                                                                    
AND   PROFESSIONAL   LICENSING,  DEPARTMENT   OF   COMMERCE,                                                                    
COMMUNITY   AND   ECONOMIC  DEVELOPMENT,   appreciated   the                                                                    
discussion  from the  auditor's  team. She  agreed that  the                                                                    
issue was  difficult because there were  so many independent                                                                    
governors of  the system.  The board did  not answer  to the                                                                    
departments or  the administration, but to  the legislature.                                                                    
The board was a group  of volunteers that spent personal and                                                                    
free  time  dedicated  to  working   on  board  issues.  She                                                                    
explained that  DCBPL helped facilitate  board conversations                                                                    
and helped guide  agenda items. There was also  a meeting of                                                                    
the chairs  of all boards and  a second meeting of  just the                                                                    
PDMP chairs  to help  facilitate conversation.  The meetings                                                                    
happened twice a month on a  Tuesday at 4:30 p.m., which she                                                                    
relayed  was difficult  timing because  everyone was  tired.                                                                    
For several  years, there had been  discussions within DCCED                                                                    
with  the  boards and  with  the  Department of  Health  and                                                                    
Social   Services   (DHSS)   surrounding   suggestions   for                                                                    
statutory change.  She thanked Representative  Josephson for                                                                    
introducing legislation based  on her recommendations. There                                                                    
had been  conversations in other committees  that recognized                                                                    
a need  to revisit the  PDMP because  some of the  laws were                                                                    
setting the program up with expectations it could not meet.                                                                     
9:59:12 AM                                                                                                                    
Ms. Chambers  suggested there  needed to  be a  reframing of                                                                    
the  PDMP from  the  legislature. She  was  involved in  the                                                                    
committee  hearings  mentioned   earlier  by  Representative                                                                    
Edgmon and  recalled that  the PDMP was  not intended  to be                                                                    
used  to  crack  down   on  doctors,  nurses,  optometrists,                                                                    
dentists, and  veterinarians. It  was not  intended to  be a                                                                    
heavy-handed  enforcement tool,  but  to  be an  educational                                                                    
tool.  It  was  meant  to  provide  accountability  so  that                                                                    
prescribers could learn more about  the opioid epidemic. She                                                                    
explained  that  it  enabled prescribers  to  compare  their                                                                    
prescribing habits with those  of other prescribers and with                                                                    
patient histories.  If there  was a  significant difference,                                                                    
it  enabled prescribers  to determine  whether  there was  a                                                                    
legitimate reason for the difference.  The PDMP needed to be                                                                    
utilized in the  way the law was written in  order to elicit                                                                    
the results desired by the legislature.                                                                                         
Ms.  Chambers provided  an example.  She  opined that  there                                                                    
needed to be an increased  ability to communicate with other                                                                    
databases  within the  state. There  were tools  within DHSS                                                                    
that  would  help  link  other  data  with  PDMP  data.  She                                                                    
emphasized that  it was  illegal under  the current  law for                                                                    
DCCED to share  with DHSS data that  linked prescribing data                                                                    
with overdose deaths. She suggested  that that connection be                                                                    
made  legal in  order  to elicit  the legislature's  desired                                                                    
Ms. Chambers explained that cases  were often brought to the                                                                    
medical board  regarding medical  and office  assistants who                                                                    
would access  the PDMP to  prepare the computer  display for                                                                    
the physician.  This was illegal because  medical assistants                                                                    
cannot access  the PDMP, even  though it was legal  for them                                                                    
to view the same  medical information through paper records.                                                                    
Medical assistants were often  asked by physicians to access                                                                    
the  PDMP  without  knowing it  was  illegal.  She  wondered                                                                    
whether punishing  the assistants  and physicians  was where                                                                    
the state wanted to spend  its limited resources. She wanted                                                                    
to  paint  some  of  her frustrations  with  the  PDMP,  but                                                                    
emphasized that she believed in  the PDMP and in the boards.                                                                    
The system had the potential to be a good tool.                                                                                 
10:03:14 AM                                                                                                                   
AT EASE                                                                                                                         
10:03:37 AM                                                                                                                   
Representative   Josephson  asked   about  the   last  point                                                                    
regarding  medical  assistants.  He  recalled  working  with                                                                    
former Alaska  State Senator  Cathy Giessel  on a  bill that                                                                    
created a  new category for  medical assistants in  order to                                                                    
delegate some database authority to the assistants.                                                                             
Ms. Chambers reported there had  been a bill that would have                                                                    
created  a license  for medical  assistants,  but there  was                                                                    
concern  within the  medical  community  that prevented  the                                                                    
bill from going forward.  There was legislation that allowed                                                                    
physicians   to   delegate   certain   responsibilities   to                                                                    
unlicensed staff,  but it  did not  include PDMP  because it                                                                    
was in  statute that a person  must be licensed on  order to                                                                    
view the database.                                                                                                              
10:04:56 AM                                                                                                                   
Representative  LeBon   asked  if  the  volunteers   on  the                                                                    
pharmacy board  risked any  potential personal  liability as                                                                    
an outcome of their decisions.                                                                                                  
Ms. Chambers responded that the  state provided immunity for                                                                    
board  members  acting in  good  faith.  Board members  were                                                                    
protected  unless  they  acted egregiously  outside  of  the                                                                    
norm.  She   noted  that   licensing  boards   had  received                                                                    
discipline  all the  way  up to  the  United States  Supreme                                                                    
Court for failing to act in  good faith, and there were many                                                                    
models  that provided  examples  of  offensive actions.  She                                                                    
highlighted  that  this  sort  of  disciplinary  action  had                                                                    
thankfully not needed to take place in Alaska.                                                                                  
10:06:10 AM                                                                                                                   
Representative  LeBon  relayed  that banks  in  Alaska  were                                                                    
examined  by both  the state  and Federal  Deposit Insurance                                                                    
Corporation (FDIC) and were expected  to hire an independent                                                                    
auditor to  perform an  audit prior  to an  examination. The                                                                    
audit provided information  to the examiners on  the ways in                                                                    
which  the bank  was functioning  and  was paid  for by  the                                                                    
financial institution.  Ms. Curtis had mentioned  that there                                                                    
was about $800 thousand that  had been designated for paying                                                                    
various licensing  dues and business operation  expenses. He                                                                    
wondered if it  would be unusual for a board  to use some of                                                                    
those  funds to  hire an  independent auditor  or accounting                                                                    
firm to help  the board comply with the  expectations of the                                                                    
Ms. Chambers responded that DCCED  looked to the legislature                                                                    
and the legislative  audit process to act as  the audit. She                                                                    
saw that there  could be an opportunity for a  board to hire                                                                    
a consultant to help with audit recommendations.                                                                                
10:08:01 AM                                                                                                                   
Representative  LeBon  thought   the  profession  should  be                                                                    
collectively  thinking  about  the  potential  liability  of                                                                    
members  of  the  board.  He  suggested  that  there  be  an                                                                    
independent auditor  to confirm  that expectations  had been                                                                    
met prior to the state audit.                                                                                                   
10:08:38 AM                                                                                                                   
Representative Wool commented that there  had been a bill to                                                                    
license medical assistants to allow  them to enter data into                                                                    
the PDMP  partially because if the  assistants did something                                                                    
wrong,  the license  could  be revoked  to  punish them.  He                                                                    
shared that  he opposed  the licensure  because it  would be                                                                    
another  barrier to  entry to  a profession  and there  were                                                                    
many  licenses already.  He had  also heard  from physicians                                                                    
that they  did not get  into the profession to  simply enter                                                                    
data,  and that  data entry  was  a waste  of a  physician's                                                                    
skills.  He  wondered  if  there  were  people  leaving  the                                                                    
pharmacy profession  due to the  perceived waste  of skills.                                                                    
He didn't  know whether the  board was having issues  at the                                                                    
audit level  prior to the  PDMP implementation and  asked if                                                                    
most  of the  issues surrounded  the database.  He suggested                                                                    
that everyone  had concluded that the  database needed work.                                                                    
He  asked  about  the  source   of  the  drugs  people  were                                                                    
overdosing on, and whether the  drugs had been prescribed or                                                                    
were  illicit  drugs.  He  asked   if  the  board  had  been                                                                    
considered  good operators  prior to  the implementation  of                                                                    
the PDMP.                                                                                                                       
Ms. Curtis  answered that the  last sunset audit  received a                                                                    
four-year extension,  and she couldn't recall  the extension                                                                    
timeline prior  to that. The  changes made in 2017  and 2018                                                                    
helped  address the  extent  to which  the  licensee had  to                                                                    
enter data  into the PDMP.  She thought that there  had been                                                                    
some  changes  regarding  delegating  the  task  to  medical                                                                    
assistants,   and  that   prior   legislation  had   already                                                                    
addressed  this  issue.  She offered  to  follow-up  on  the                                                                    
information  and  send  a  memo   to  committee  members  to                                                                    
clarify.  The PDMP  was highly  federally funded,  and there                                                                    
was  consideration of  whether the  database belonged  under                                                                    
the  jurisdiction of  DCCED or  DHSS. Another  consideration                                                                    
was to what  degree did the state want  to contribute monies                                                                    
to the program.                                                                                                                 
10:12:23 AM                                                                                                                   
Ms.  Chambers commented  that  PDMP data  entry  could be  a                                                                    
delegated  task,  but  it  could  only  be  delegated  to  a                                                                    
licensed  individual.  The  original  conversation  centered                                                                    
around   registered   nurses   (RN)   and   licensed   nurse                                                                    
practitioners  (LPN), but  that  model had  been changed  as                                                                    
there   were  fewer   LPNs  and   more  unlicensed   medical                                                                    
assistants. The  law needed to  address where  the resources                                                                    
were practically occurring.                                                                                                     
Representative  Wool stated  that  pharmacy technicians  and                                                                    
veterinary technicians  were licensed and were  legally able                                                                    
to  enter information  into the  database.  He thought  that                                                                    
might be addressed in another manner.                                                                                           
Representative Edgmon  shared that it seemed  there were two                                                                    
different discussions occurring, one  of which was to extend                                                                    
the termination date of the  Board of Pharmacy. He asked for                                                                    
verification that  the board's primary duty  did not pertain                                                                    
to overseeing the PDMP.                                                                                                         
Ms. Chambers agreed.                                                                                                            
Representative  Edgmon asked  what  percentage  of time  the                                                                    
board spent on the database versus its other duties.                                                                            
Ms.  Chambers  asked for  clarification  on  whether he  was                                                                    
referring  to  the  volunteered time  itself  or  the  staff                                                                    
Representative  Edgmon  shared  his understanding  that  the                                                                    
database required a need for  increased staff time. He noted                                                                    
the  board had  many other  responsibilities in  addition to                                                                    
the  database  and wondered  whether  the  effort may  be  a                                                                    
little displaced in some respects.                                                                                              
Ms. Chambers agreed that some  of the findings regarding the                                                                    
Board  of Pharmacy  and the  other boards  mentioned in  the                                                                    
audit   related  to   policy  decisions   that  the   boards                                                                    
themselves had to make. Some  of the findings regarded staff                                                                    
ability to  perform daily licensing functions.  She deferred                                                                    
to the  Board of  Pharmacy's chair  regarding the  amount of                                                                    
time that was spent on the database.                                                                                            
10:16:02 AM                                                                                                                   
Representative Edgmon  requested to hear from  the chair. He                                                                    
stated  that  the  conversation  about  the  database  could                                                                    
continue for a long time.  He remarked that the board needed                                                                    
to continue.                                                                                                                    
JUSTIN   RUFFRIDGE,   CHAIR,    BOARD   OF   PHARMACY   (via                                                                    
teleconference),  indicated  he  had learned  a  significant                                                                    
amount   through  the   audit   process.   He  agreed   with                                                                    
Representative  Edgmon and  stated that  the board  served a                                                                    
vital role  in a wide  variety of capacities such  as public                                                                    
health, safety,  and welfare. The  last few years  the board                                                                    
had worked diligently on  regulations regarding the COVID-19                                                                    
pandemic response.  The board  regulated new  processes such                                                                    
as  the   continuation  of   therapy,  which   ensured  that                                                                    
individuals  had  uninterrupted  access  to  medication  and                                                                    
released  temporary  and  emergency licenses  that  expanded                                                                    
access to care.                                                                                                                 
Dr.  Ruffridge shared  that the  board had  spent some  time                                                                    
considering the PDMP.  The board usually had  an update from                                                                    
staff regarding use  of the database as well  as issues that                                                                    
had arisen  from other boards.  He was happy to  report that                                                                    
pharmacies and pharmacists utilized  the PDMP at the highest                                                                    
level   possible,  and   that  the   audit  reflected   that                                                                    
information.  He met  with the  chairs of  other boards  and                                                                    
discussed PDMP issues for at  least two hours twice a month.                                                                    
There were  also quarterly meetings  which included  an hour                                                                    
of  time dedicated  to discussing  the  database. He  stated                                                                    
that  a small  percentage of  board time  was spent  on PDMP                                                                    
discussions.  The  board  had many  other  responsibilities,                                                                    
such  as   managing  disciplinary  action,   licensing,  and                                                                    
regulations.  The  board  was also  working  on  an  ongoing                                                                    
regulation   review   project   at  the   request   of   the                                                                    
administration  that  promoted right-touch  regulations.  He                                                                    
explained   that  the   field   of   pharmacy  had   changed                                                                    
dramatically over  the last ten  years, and options  such as                                                                    
robotics  and  tele-pharmacy  were   not  yet  reflected  in                                                                    
regulations.  The   board  was  close  to   finishing  other                                                                    
regulation  projects and  he expressed  pride  for the  work                                                                    
that  had  been  done to  make  regulations  understandable,                                                                    
reasonable, and accessible.                                                                                                     
Dr.  Ruffridge  recalled  that  Ms.  Curtis  mentioned  that                                                                    
another  area the  board had  focused on  was its  finances.                                                                    
There was  a surplus in  dollars put  out by the  audit that                                                                    
was  mostly due  to additional  licensing categories.  Since                                                                    
the audit,  a more balanced  budget had been put  forward by                                                                    
the  board  that  included proposed  fee  reductions  across                                                                    
multiple  license types.  He highlighted  that  there was  a                                                                    
shortage  of pharmacists  and pharmacist  technicians across                                                                    
the  state, and  the new  budget proposed  reduced fees  for                                                                    
pharmacy technicians  specifically to address  the shortage.                                                                    
He supported a six-year extension.                                                                                              
10:22:02 AM                                                                                                                   
Representative  Edgmon   appreciated  the  comment   by  Dr.                                                                    
Ruffridge. He asked  if there was a mechanism  that could be                                                                    
put  in  place  to  keep the  legislature  informed  of  the                                                                    
staffing needs  for the database,  or any potential  need to                                                                    
pass new laws. Other states  were also grappling with proper                                                                    
regulation  of the  database. He  wanted assurance  that the                                                                    
issues would be brought to the legislature.                                                                                     
Ms.  Chambers responded  that the  board provided  an annual                                                                    
report  which supplied  additional  information  and was  an                                                                    
existing tool. She also suggested  doing work in the interim                                                                    
to come up with creative changes where needed.                                                                                  
10:24:22 AM                                                                                                                   
Representative Carpenter opined that  the sunset issue was a                                                                    
separate  issue from  the PDMP  database.  He was  concerned                                                                    
about there  being a  lack a  conversation in  the following                                                                    
year about the same issue  and wondered what would force the                                                                    
legislature to  have the conversation. The  problem was that                                                                    
no department seemed to have  ownership over the database or                                                                    
the opioid crisis at large.  Volunteers were responsible for                                                                    
managing the  database. He wondered  if the  legislature was                                                                    
willing to wait to bring  forward new legislation to address                                                                    
the problem. He supported  requiring an independent audit in                                                                    
addition  to the  financial audit  and opposed  the six-year                                                                    
extension. The  extension seemed  to be a  way to  force the                                                                    
legislature to have a conversation.                                                                                             
Ms. Curtis  replied that  the audit was  a sunset  audit and                                                                    
the  criteria  for sunset  audits  was  in statute.  If  the                                                                    
legislative  auditor  performed  a two-year  extension,  she                                                                    
would  likely come  to the  same  conclusions because  there                                                                    
would not  be enough time  between audits to  resolve issues                                                                    
noted  in her  report.  The criteria  for  the sunset  audit                                                                    
would  not  enable  the   action  sought  by  Representative                                                                    
Carpenter. She thought  a private audit that  looked at best                                                                    
practices  and  possible statute  changes  might  be a  good                                                                    
idea.  She  suggested it  would  be  better  to wait  to  do                                                                    
another audit until some changes were made.                                                                                     
Representative Carpenter  commented that he agreed  and that                                                                    
it did not  seem like a good use of  time to perform another                                                                    
audit so  soon. He  suggested adding  something to  the bill                                                                    
that  would  ask  the  administration   to  take  action  to                                                                    
continue the conversation.  There was diluted responsibility                                                                    
for the  problem and a  single department could not  be held                                                                    
accountable. He  thought the issue  was not owned  by anyone                                                                    
and proposed that someone should  be made responsible for it                                                                    
to  allow for  more  decision-making authority.  He did  not                                                                    
believe it was the legislature's responsibility to enforce.                                                                     
10:30:29 AM                                                                                                                   
Representative LeBon read from the audit on page 1:                                                                             
     The board was established for  the Exhibit 1 purpose of                                                                    
     controlling and regulating the  practice of pharmacy in                                                                    
     Alaska.  According to  AS 08.80.005,  effective control                                                                    
     and regulation  is necessary to promote,  preserve, and                                                                    
     protect the public's health, safety, and welfare.                                                                          
Representative  LeBon asked  the Dr.  Ruffridge whether  the                                                                    
board  had discussed  utilizing  an  independent auditor  or                                                                    
consultant to carry out the duties described in the audit.                                                                      
Dr.  Ruffridge indicated  that  although  an external  audit                                                                    
could  be  helpful,  the  board was  already  aware  of  the                                                                    
issues.  He reminded  the committee  that many  stakeholders                                                                    
were involved  and met twice a  month for at least  an hour.                                                                    
Stakeholders  had many  significant conversations  about the                                                                    
best ways  to use the PDMP  to benefit both the  citizens of                                                                    
Alaska as well  as the board. Part of  the problem uncovered                                                                    
by the audit was that the  board was expected to measure the                                                                    
results of the PDMP, which  was a nearly impossible standard                                                                    
for one board  to satisfy on its own. He  did not know which                                                                    
results in particular the board  was intended to measure. He                                                                    
suggested  that there  be a  stakeholder group  meeting with                                                                    
interested legislators  to discuss  some of the  larger PDMP                                                                    
system issues.  He relayed  that the  Board of  Pharmacy and                                                                    
other  boards  were  ready to  have  that  conversation.  He                                                                    
believed that the  best place for the PDMP to  be housed was                                                                    
within  the   Board  of  Pharmacy  because   pharmacies  and                                                                    
pharmacists were the highest engaged users of the database.                                                                     
Representative LeBon agreed  that the board had  a huge job.                                                                    
He asked if DCCED was a good partner to the board.                                                                              
Dr.  Ruffridge  responded that  the  department  had done  a                                                                    
great  job  despite  frequently  inadequate  resources.  The                                                                    
response from  Ms. Chambers all  the way down to  PDMP staff                                                                    
was excellent.  The board was  asking one person  to perform                                                                    
the  duties of  three  or four  people  and employees  often                                                                    
needed to work beyond their required hours.                                                                                     
10:36:16 AM                                                                                                                   
Representative   Johnson   suggested    that   either   some                                                                    
additional resources  should be  considered or  there should                                                                    
be a change  to the effective date. She  wanted more clarity                                                                    
before taking final action.                                                                                                     
Co-Chair Merrick  noted that the committee  would be hearing                                                                    
public testimony in the following week.                                                                                         
10:38:13 AM                                                                                                                   
Representative  Josephson  recalled   being  involved  in  a                                                                    
meeting  where several  provider groups  indicated that  the                                                                    
groups'  own bylaws  requested that  they complied  with the                                                                    
PDMP,  provided   the  necessary  data,  and   ensured  that                                                                    
patients  were not  "doctor shopping."  However, it  was not                                                                    
compulsory, and some groups did  almost nothing. He wondered                                                                    
if  it was  true that  there had  been some  provider groups                                                                    
that were vigilant while other groups were more relaxed.                                                                        
10:39:13 AM                                                                                                                   
Ms. Curtis  suggested there were  some boards that  had been                                                                    
slow to  implement the new  changes. There had been  a grace                                                                    
period  of a  year  to  become accustomed  to  the new  data                                                                    
requirements, and some  boards had been slow  to embrace the                                                                    
changes.  She shared  that  the auditors  did  come down  on                                                                    
these boards during the audit.  She didn't recall a specific                                                                    
10:40:06 AM                                                                                                                   
Representative Josephson  asked whether  there was  a record                                                                    
of  a  board  that  suspended   a  license  because  of  the                                                                    
Ms. Curtis emphasized that enforcement  had been relaxed. It                                                                    
was reported  that more than  700 licensees  had potentially                                                                    
not been compliant, and very  little to no action was taken.                                                                    
She explained  that this was  due to lack of  a disciplinary                                                                    
matrix, lack  of resources, and  lack of  solid information.                                                                    
It  was a  new area  and  standard investigative  procedures                                                                    
were not  established. She emphasized  that little  had been                                                                    
done in the area of enforcement.                                                                                                
Representative Josephson argued that  this made criticism of                                                                    
the  role of  the Board  of Pharmacy  difficult. It  was not                                                                    
possible for the board to be the enforcer.                                                                                      
Ms.  Chambers  thought there  were  "multiple  cooks in  the                                                                    
kitchen"  which had  created  confusion  over authority  and                                                                    
resource  allocation. She  relayed  that  750 licensees  had                                                                    
failed  to  comply  with one  of  many  requirements,  which                                                                    
required  examination  by  several  investigators.  However,                                                                    
many licensees  had not  violated a  prescribing requirement                                                                    
and therefore  did not pose  an immediate health  and safety                                                                    
risk. She exclaimed that a  new investigator had been hired,                                                                    
but the position had been  unfilled for a significant amount                                                                    
of time.  This represented  the legislature's  past decision                                                                    
to qualify  the database as  an educational tool and  not an                                                                    
enforcement tool;  however, if  every PDMP  violation needed                                                                    
to  be  investigated, there  needed  to  be an  increase  in                                                                    
resources and clarity from the legislature.                                                                                     
Co-Chair  Merrick noted  that  Representative  LeBon had  an                                                                    
earlier  question  regarding   obtaining  prescriptions  via                                                                    
10:44:20 AM                                                                                                                   
Representative  LeBon  asked  Dr. Ruffridge  to  comment  on                                                                    
prescriptions  coming into  the  state  through national  or                                                                    
international sources.                                                                                                          
Dr.  Ruffridge responded  that access  to  medication was  a                                                                    
federal issue and not within  his purview. He explained that                                                                    
the   controlled   substance  statutory   chapter   required                                                                    
external pharmacies to be registered  with the state and for                                                                    
pharmacy  information  to  be  entered  into  the  PDMP.  In                                                                    
addition, there  was shared services access  within the PDMP                                                                    
that  allowed  registered  users  to  search  other  states'                                                                    
databases  to  prevent  issues   like  doctor  shopping.  He                                                                    
explained that doctor shopping was  not always a state issue                                                                    
or local  issue, and it  was important to build  an external                                                                    
link into the database.                                                                                                         
Representative   LeBon  asked   whether  individuals   might                                                                    
utilize Canadian prescriptions to get around the link.                                                                          
Dr.  Ruffridge  responded that  there  would  be no  way  to                                                                    
access the Canadian database. An  individual who traveled to                                                                    
Canada and received a prescription  from a Canadian provider                                                                    
would only be  able to fill the prescription  in Canada. The                                                                    
reverse was also true, meaning  that an individual could not                                                                    
get prescription written in Alaska  and filled in Canada. He                                                                    
agreed  that   if  an  individual  received   and  filled  a                                                                    
prescription in Canada and requested  the same medication in                                                                    
Alaska, the board would not have a way of knowing.                                                                              
Co-Chair  Merrick asked  Ms. Chambers  to review  the fiscal                                                                    
Ms. Chambers reviewed the fiscal  note with the control code                                                                    
oegIR. She reminded  members that a fiscal note  for a board                                                                    
extension  would look  unusual because  it anticipated  that                                                                    
the board  would sunset if HB  306 did not pass.  The fiscal                                                                    
note added back the authority  that the board would cease to                                                                    
have  if the  board was  to sunset.  It included  a standard                                                                    
sunset board mechanism that expected  the board to travel to                                                                    
four board  meetings every year.  The board had  become more                                                                    
adept at teleconferencing, so that  authority may or may not                                                                    
be spent.  If the bill failed  to pass and the  board was to                                                                    
sunset, the  sunset mechanism ensured that  the licensing of                                                                    
pharmacists would  continue under the  department's purview.                                                                    
She emphasized that the fiscal note mainly referred to                                                                          
required travel for board members to go to meetings.                                                                            
Co-Chair Merrick thanked the testifiers for being in the                                                                        
committee. She reviewed the agenda for the afternoon.                                                                           
HB 306 was HEARD and HELD in committee for further                                                                              
10:49:56 AM                                                                                                                   
The meeting was adjourned at 10:49 a.m.                                                                                         

Document Name Date/Time Subjects
HB306 Legislative Audit Division Sunset Review BOP 07.15.21.pdf HFIN 3/11/2022 9:00:00 AM
SFIN 5/17/2022 1:00:00 PM
HB 306
HB306 Letters of Support received by 02.22.22.pdf HFIN 3/11/2022 9:00:00 AM
HB 306
HB306 Sectional Analysis Ver A 02.09.22.pdf HFIN 3/11/2022 9:00:00 AM
HB 306
HB 246 Amendment Wool.pdf HFIN 3/11/2022 9:00:00 AM
HB 246