HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST  3:00:34 PM CHAIR BJORKMAN announced the consideration of CS FOR HOUSE BILL NO. 17(HSS) am(efd fld), "An Act relating to insurance coverage for contraceptives and related services; and relating to medical assistance coverage for contraceptives and related services." 3:01:15 PM REPRESENTATIVE ASHLEY CARRICK, District 35, Alaska State Legislature, Juneau, Alaska, sponsor of HB 17, introduced herself and gave an overview of HB 17. She said, since the mid- 1990s, 28 states have required health insurance plans regulated by the state to provide coverage of prescription drugs and devices to also cover prescription contraceptives. Federal law, under a provision in the Affordable Care Act (ACA), expanded on state policies in several ways. The ACA's contraceptive coverage guarantee stems from the Public Health Service Act, which requires non-grandfathered health insurance coverage and employer sponsored group health plans to cover preventative services without cost sharing and requires coverage of women's preventative services as defined by the Health Resources and Services Administration. Since the time [ACA took effect], 22 states and the District of Columbia have [through legislation] ensured that women can receive an extended supply of a [prescribed contraceptive] method at one time, usually a 12- month supply, which is provided for in HB 17, rather than the current guidelines of a one-to-three-month supply. 3:02:33 PM REPRESENTATIVE CARRICK said HB 17 would put into Alaska statutes language that is consistent with standards set in the federal contraceptive coverage guarantee and HB 17 would mandate coverage for dispensing up to 12 months of prescription contraceptives at one time. REPRESENTATIVE CARRICK said HB 17 was being brought forward because Alaskans often face numerous challenges when trying to access prescription contraceptives. She said that women, especially those living or working in rural Alaska often cannot take multiple trips a year to the pharmacy, not without great cost and inconvenience. Additionally, the many women working in high demand careers that take them away from regular providers, such as working up on the North Slope, working in the field doing research in our commercial fishing industry, in mining or in other professions, makes this barrier a consistent one for contraceptive access. A one-year supply of contraceptives will assist many women in Alaska to balance their personal health with work and family life. She referred to research provided to the committee members from the Journal of Obstetrics and Gynecology, which shows that women who are dispensed a 12-month supply of contraceptives show a 30 percent drop in unplanned pregnancies and a 46 percent drop in the likelihood of abortion compared to women dispensed just a one-to-three-month supply. 3:03:57 PM REPRESENTATIVE CARRICK said she brought HB 17 forward, not only because it's often time consuming and deeply inconvenient to obtain these [contraceptive] prescriptions every one to three months, but also because she said she knew improved access to contraceptives would mean improved health for women and better family planning. She said, under HB 17, providers would still be able to make decisions in consultation with their patients to decide what type and length of prescription contraceptive to provide. She said HB 17 would not change that relationship, or those diagnosis decisions. However, HB 17 would remove insurance coverage as a barrier to access. In other words, HB 17 wouldn't change what happens in a doctor's office, it would change what happens at the pharmacy counter. 3:04:40 PM REPRESENTATIVE CARRICK briefly addressed the changes to the committee substitute for HB 17, noting the bill had gone through several changes on the House side and the Senate side. • On the House side, in its first committee of referral, emergency contraception, and all reference to emergency contraception was removed from HB 17. HB 17 does not cover Plan B or emergency contraceptives. • On the House floor, religious exemption language was also added - more robust religious exemption language than what currently exists in statute. • The religious exemption language was clarified to more accurately reflect the intent of the sponsor of that amendment on the floor. • Technical changes were added at the request of the Department of Health and the Division of Insurance to ensure that HB 17 would be neutral and would not generate any fiscal note. • Effective dates were adjusted to be appropriate to the HB 17. REPRESENTATIVE CARRICK noted the presence of individuals to answer questions from the committee and an invited testifier online for the Committee's consideration. 3:06:28 PM CHAIR BJORKMAN announced invited testimony on HB 17. 3:06:47 PM ROBIN HOLMES, M.D., Family Medicine Physician, Homer, Alaska, said she was testifying in favor of HB 17 and HB 17 would dramatically improve access to the full range of contraceptive methods by requiring insurance to cover a year's supply of birth control at one time, building on the Affordable Care Act's contraceptive coverage mandate to ensure all people have timely access to contraceptive care. She said HB 17 would also ensure that patients and providers have full control over what contraceptive method is used without arbitrary restrictions such as prior authorizations or insurance-mandated management techniques. DR. HOLMES said, as a board-certified family medicine physician, she had seen how access to contraception affected the lives of Alaskans every day and had the privilege of supporting her patients through the entire lifespan with evidence-based medical care that empowered them to choose when and if to have a family, as well as raising the family they had in the healthiest way possible. Unfortunately, she said part of her job and advice entailed anticipating barriers to accessing medications, including insurance denials and restrictions on quantity. She said it was known that one in three women missed their contraception doses because they could not pick up a refill in time. Barriers to contraception imposed by insurance companies make no sense for Alaskans and cause significant economic and physical harm to our population. She said she regularly had patients who were in school and could not make it to the pharmacy during the limited hours they are open to pick up another pack of pills, or a motivated college attendee or commercial fisher who is unable to fill enough contraception [prescriptions] to get them through until they are back in town. In many cases, her patients must rely on family or friends who have their own families and work schedules to get the medication they need. She said she often had patients with disabilities whose insurance plans deny their access to certain contraceptives, leaving them with no coverage for the methods that are safest and most effective for them and forcing them to use medications they cannot take due to their disability. She said she had seen patients who at the height of their careers, working multiple jobs or working while raising a family, who could not get to the pharmacy to pick up contraceptive prescriptions. 3:09:16 PM DR. HOLMES said whether to use contraception or which contraceptive method to use, is a private medical decision that should be made by a patient in consultation with their healthcare provider. Medical providers are extensively trained in how to prescribe contraceptives safely and when restrictions may be warranted. HB 17 does not supersede a doctor's judgment if a short supply is warranted. When insurance companies force people to use ultimate contraceptive methods, they are not recommended for them. She said, in order to get what they actually need, they cause inefficiencies in the systems that may cause harm to the patient. DR. HOLMES advocated for Alaska to have fewer barriers to medications than other states. Even for those on the road system, she said her patients have to travel for hours to access prescriptions; and with contraception, even one or two days can make a huge difference in a person's life. Outside of Alaska, there are fewer baseline barriers to accessing birth control, and we have seen how expanding access makes a positive difference in other states. 3:10:15 PM DR. HOLMES reported that the CDC named birth control one of the top 10 public health achievements in the past century, and birth control is widely credited for contributing to women's societal educational and economic gains. Access to contraception allows people to avoid unintended pregnancy, and unintended complications. She said, when women were able to obtain a full year of birth control on time, their odds of an unintended pregnancy decreased by 30 percent and odds of an abortion decreased by 40 percent versus when they were given a one-to- three-month supply. Dr. HOLMES concluded her testimony and said access to contraception should be up to a provider and patient, not insurance companies. She said birth control was incredibly safe. She said the patients [providers] care for were smart and aware of their needs and their goals and regarding decisions about if and when and how they build their families. She urged the committee to support HB 17 to allow Alaskans meaningful access to contraception. 3:11:18 PM CHAIR BJORKMAN held HB 17 in the Senate Labor and Commerce Standing Committee.