HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST  8:46:55 AM CHAIR MCCORMICK announced that the next order of business would be HOUSE BILL NO. 17, "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date." [Before the committee was CSHB 17(HSS).] 8:47:12 AM REPRESENTATIVE ASHLEY CARRICK, Alaska State Legislature, as prime sponsor, presented CSHB 17(HSS). She stated that currently there are 28 states which require health insurance plans regulated by the state to cover contraceptive prescription drugs and devises, as laid out in the 2010 Affordable Care Act. As recommended by the Institute of Medicine and defined by the U.S. Health Resources and Services Administration, she stated that women's preventative services include all contraceptives approved by the Federal Drug Administration. Preventative services also include patient education and counseling, as prescribed by a health care provider. She stated that this is collectively referred to as contraceptive services, which are required to be covered by health insurance by federal law. REPRESENTATIVE CARRICK stated that furthermore, 22 states and the District of Columbia allow women to receive a 12-month extended supply of contraception at one time. She stated that the proposed legislation would put language into statute which aligns with the federal contraceptive coverage guarantee. It also allows up to a 12-month supply of prescription contraceptives. She explained that this would allow women in rural communities and those who work extended shifts in remote locations a continuous supply of contraception. She stated that studies show providing a one-year supply of prescription contraceptives, compared to a 3-month supply, reduces unintended pregnancies by 30 percent and drops the likelihood of abortion by 46 percent. REPRESENTATIVE CARRICK argued that the proposed legislation would also save the state money, pointing out that a prior fiscal note had estimated an annual savings of $1.35 million because of the reduction in unplanned pregnancies. She continued that currently obtaining contraception can be time consuming; however, she maintained that improved access would mean improved health for women and families. She stated that the proposed legislation would take away insurance coverage as a barrier to access. She added that the bill could also protect women in the presence of domestic violence, in terms of contraceptive cohesion. She argued the benefits of contraception for family and societal health and urged support for the bill. 8:51:59 AM CHERIE BOWMAN, Staff, Representative Ashley Carrick, Alaska State Legislature, on behalf of Representative Carrick, prime sponsor, gave the sectional analysis on CSHB 17(HSS) [included in the committee packet], which read as follows [original punctuation provided]: Section 1 AS 21.42.427. Coverage for contraceptives. Amends AS 21.42 by adding a new section which (1) requires a health care insurer to provide coverage for prescription contraceptives and medical services necessary for those products or devices (including over-the-counter emergency contraception that was obtained without a prescription); (2) requires reimbursement to a health care provider or dispensing entity for dispensing prescription contraceptives intended to last for a 12-month period for subsequent dispensing; (3) prevents an insurer from offsetting the costs of compliance; (4) prevents an insurer from restricting or delaying coverage for contraceptives; (5) if the provider recommends a particular service or FDA-approved item based on a determination of medical necessity, the plan or issuer must cover that service or item without cost sharing; and (6) exempts religious employers if certain criteria are met. Section 2 AS 29.10.200. Limitation of home rule powers. Amends AS 29.10.200 by adding a provision applying to home rule municipalities. Section 3 AS 29.20.420. Health insurance policies. Amends AS 29.20 by adding a new section clarifying that municipal health care insurance plans that are self- insured are subject to the requirements of sec. 1. Section 4 AS 39.30.090. Procurement of group insurance. Clarifies that a group health insurance policy covering employees of a participating governmental unit is subject to the requirements of sec. 1. Section 5 AS 39.30.091. Authorization for self-insurance and excess loss insurance. Clarifies that a self-insured group medical plan covering active state employees provided under this section is subject to the requirements of sec. 1. Section 6 AS 47.07.065. Payment for prescribed drugs. Requires the Department of Health to pay for prescription contraceptives intended to last for a 12- month period for subsequent dispensing for eligible recipients of medical assistance, if prescribed to and requested by the recipient, as well as medical services necessary for those products or devices. Distributed by the Office of Representative Ashley Carrick 1.25.2023 2 The Department of Health must also provide coverage for over-the-counter emergency contraception that was obtained without a prescription. Section 7 Uncodified law - applicability Requires the Department of Health to immediately amend and submit for federal approval a state plan for medical assistance coverage consistent with sec. 6 of this Act. Section 8 Uncodified law - applicability Makes sec. 6 of the Act conditional on the approval required under sec. 7 of the Act. Section 9 If, under sec. 8 of this Act, sec. 6 of this Act takes effect, it takes effect on the day after the date the revisor of statutes receives notice from the commissioner of health under sec. 8 of this Act. 8:56:17 AM REPRESENTATIVE MCCABE advised that women have expressed concerns that during a 12-month prescription, birth control may become ineffective, as body chemistry could change. REPRESENTATIVE CARRICK responded that medical providers have full control over what is believed to be the right prescription for the individual. She expressed the opinion that most providers would prescribe only a few months and then conduct a follow-up. 8:58:04 AM REPRESENTATIVE MCCABE reiterated the concern that had been relayed to him and asked Representative Ruffridge, who has a background in pharmacy, to address this. REPRESENTATIVE RUFFRIDGE explained that oral contraception is never 100 percent effective, and low dose versions are rigid in how they must be taken. He confirmed there are very few alterations to body chemistry which would affect contraception in general. He advised that CSHB 17(HSS) could help cover gaps because, in the pharmacy setting, some of the emergency prescriptions are for women who did not realize a refill was needed. This could result in the possibility of a skip in the low dose medication. 9:01:21 AM REPRESENTATIVE MCKAY expressed the understanding that currently if a female explains an extended absence to the doctor, and she requests a 12-month prescription, the insurance will not pay for it. REPRESENTATIVE CARRICK responded that this is the gap the proposed legislation would fix. Women would be allowed extended prescriptions, as opposed to shorter prescriptions, and the prescriptions would be covered under insurance. 9:03:27 AM REPRESENTATIVE MEARS commented on her own prescriptions and having them filled before coming to Juneau for the duration of the legislative session. Her perception of the bill is that it would bring contraceptives on par with other medications. REPRESENTATIVE CARRICK replied that this is correct. 9:04:40 AM LORI WING-HEIER, Director, Division of Insurance, Department of Commerce, Community, and Economic Development, clarified that insurance would not "get in the middle" of a provider, and the provider would not be stopped from having responsibility to a patient. She expressed the understanding that the proposed legislation would allow that, once a contraceptive is prescribed, the patient would have the ability to get a 12-month supply. She advised that it would be a convenience for women to get prescriptions for longer periods in relation to extended absences because of work, travel, or other reasons. She noted there have been no rebuttals from insurance companies over CSHB 17(HSS). 9:07:07 AM REPRESENTATIVE HIMSCHOOT commented that the bill is decades overdue, and, for example, it would help the women in Southeast Alaska who go out on extended fishing trips. 9:07:45 AM REPRESENTATIVE MEARS echoed the sentiments of Representative Himschoot. 9:08:03 AM REPRESENTATIVE CARRICK described CSHB 17(HSS) as an insurance bill at its core, as it would not change contraception coverage or the relationship with the provider; however, it would change what happens at the pharmacy once a patient has a prescription. She alluded to opposition to the bill and encouraged these people to speak with her and her staff on the purpose of this legislation. 9:09:17 AM [CSHB 17(HSS) was held over.]