HB 145-EXPAND PHARMACIST AUTHORITY  3:30:15 PM CO-CHAIR ZULKOSKY announced that the next order of business would be HOUSE BILL NO. 145, "An Act relating to the Board of Pharmacy; relating to health care services provided by pharmacists and pharmacy technicians; and relating to the practice of pharmacy." 3:30:56 PM REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 1 to HB 145, labeled 32-LS0720\A.1, Fisher, 4/19/21, which read as follows: Page 5, following line 18: Insert a new bill section to read: "* Sec. 12. AS 21.42 is amended by adding a new section to read: Sec. 21.42.440. Coverage for costs of services  provided by pharmacists. A policy, contract, or prepaid plan for individual or group health insurance issued or delivered in the state that provides coverage for services within the scope of practice of a pharmacist licensed under AS 08.80 must provide for coverage of and reimbursement for the services if performed by a pharmacist for a person covered under the policy, contract, or plan." 3:30:58 PM CO-CHAIR ZULKOSKY objected for discussion purposes. 3:31:01 PM REPRESENTATIVE SPOHNHOLZ explained that the purpose of Amendment 1 would be to require insurance to cover services that pharmacists are trained to provide, but for which pharmacists are not currently able to receive reimbursement. She said that this would help provide health care in the community. 3:31:40 PM CO-CHAIR SNYDER commented that the amendment would add language to the bill that would further ensure that pharmacists could be reimbursed for the services provided. 3:32:10 PM CO-CHAIR ZULKOSKY removed her objection. There being no further objection, Amendment 1 was adopted. 3:32:22 PM REPRESENTATIVE MCCARTY moved to adopt Amendment 2 to HB 145, labeled 32-LS0720\A.2, Fisher, 4/19/21, which read: Page 4, following line 12: Insert a new subsection to read: "(c) This section does not authorize a pharmacist to prescribe a prescription drug that the pharmacist is not otherwise authorized to prescribe." Reletter the following subsection accordingly. 3:32:27 PM CO-CHAIR ZULKOSKY objected for discussion purposes. 3:32:31 PM REPRESENTATIVE MCCARTY explained that Amendment 2 would insert a new section that would recognize the authorization of a pharmacist under the guidelines of the scope of practice for pharmacy. It would ensure that pharmacists would not be able to prescribe beyond the scope of practice, he added. 3:33:06 PM REPRESENTATIVE KURKA shared his understanding that, when a doctor prescribes a new medication, the doctor looks at all the other medications the patient might be taking to ensure that the medications will not react poorly with each other. He asked whether prescribing pharmacists would have access to the same information to ensure that there would be no negative reactions with a patient's other medications. CO-CHAIR SNYDER responded that Amendment 2 aims to further narrow the scope of pharmacists, which may address Representative Kurka's concern, and deferred the question to invited testifiers. 3:34:31 PM TOM WADSWORTH, PharmD, Administrative Director, University of Alaska/Idaho State University Doctor of Pharmacy Program, responded absolutely, and explained that pharmacists have a patient care process that is similar to all patient care processes. He said that it includes collaboration with documentation, which includes collecting Electronic Medical Records (EMR), paper records, referrals, laboratory studies, past medical histories, and histories of the chief complaint of the patient. He explained that pharmacists have access to all this information, and if for some reason that information is missing, pharmacists either order or ask for the information. He opined that it would be unprofessional for a pharmacist to proceed without proper access to that information. MR. WADSWORTH referenced Section 8 of HB 145, which discusses the collaborative authority of pharmacists, and said that the collaborative practice agreements that pharmacists already have with physicians involve drawing up specific protocols and procedures in the patient care process that the pharmacist and the collaborating provider will adhere to. He explained that those protocols and procedures are reviewed by the Board of Pharmacy and the Board of Medicine in Alaska before they can be implemented. He said that these precautions prevent pharmacists from going outside of their area of expertise or scope of practice. 3:38:32 PM JUSTIN RUFFRIDGE, PharmD, State Board of Pharmacy, added that the information flow between pharmacists and providers goes both directions. Pharmacists, he said, access medical histories of patients to ascertain if there may be any medication conflicts or other potential issues. He explained that many pharmacies keep and use those records if a patient transfers to a different prescriber or goes into the hospital. Pharmacists are involved in reviewing patient charts with the intake nurse if a patient were to enter a hospital or intake facility, he said. 3:40:04 PM The committee took an at-ease from 3:40 p.m. to 3:41 p.m. 3:41:38 PM CO-CHAIR ZULKOSKY removed her objection. There being no further objection, Amendment 2 was adopted. 3:41:56 PM CO-CHAIR SNYDER said she sees the need for legislation that would ensure that the Board of Pharmacy can oversee pharmacists, and that pharmacists can be reimbursed for the services provided. She also emphasized the need for clarity to ensure that pharmacists' scope of practice is not being expanded by the proposed legislation. She said she would offer a conceptual amendment to accomplish this. 3:43:58 PM CO-CHAIR SNYDER moved to adopt Conceptual Amendment 3 to HB 144, as follows [original punctuation provided]: Page 4, Line 1: Delete "for a disease or condition with an  existing diagnosis and for a condition that does not  require a new diagnosis."    Page 4, Line 5: Delete "and Insert "or" Page 4, Line 6: Delete "optimization of medication therapy for"  REPRESENTATIVE FIELDS objected for discussion purposes. CO-CHAIR SNYDER explained her conceptual amendment would further clarify that the bill would not interfere with the collaborative practice authority (CPA) regulation and would remove language so as not to imply an expansion of pharmacists' prescribing authority. 3:45:30 PM MR. WADSWORTH expressed his support for Conceptual Amendment 3. He explained that, in working with the Alaska State Medical Association, he realized the language that was chosen in the bill sought to modify the CPA regulation that's been in place since 2002. He said that the intent is not to modify or change that process as it already works well in its current state. He shared his understanding that other language in the bill seemed to broaden independent prescriptive authority for pharmacists, and Conceptual Amendment 3 would clarify the intent of the bill and ensure that prescriptive authority would not be broadened. 3:47:02 PM REPRESENTATIVE MCCARTY asked whether there would be a need for a period after "services" in Section 8 of HB 145, on page 4, line 1, ["provide patient care services"], given that Conceptual Amendment 3 proposes the deletion language on page 4, line 1, [text provided previously].  CO-CHAIR ZULKOSKY responded that when a motion comes before the committee, there will likely be a recommendation to make technical and conforming changes as needed. She said those changes would be made by Legislative Legal Services. CO-CHAIR SNYDER commented that she would request that Legislative Legal Services add a period as it is needed. 3:47:59 PM REPRESENTATIVE KURKA asked for clarification of the changes being made by the amendment, and whether it would widen the scope of pharmacists. CO-CHAIR SNYDER responded that the first part of Conceptual Amendment 3, which proposes the deletion of language on page 4, line 1, would make HB 145 consistent with the CPA. She explained that it is not about widening or narrowing the scope of pharmacists, but simply making it consistent with existing CPA regulations. She added that the second component of the conceptual amendment would further clarify that the scope of services that pharmacists can provide is not being broadened. 3:49:43 PM REPRESENTATIVE FIELDS removed his objection. There being no further objection, Conceptual Amendment 3 was adopted. 3:49:55 PM REPRESENTATIVE KURKA shared his understanding that the bills main purpose is to expand the ability of pharmacists to help consult patients and administer tests, particularly COVID-19 tests. He asked to what extent the scope of pharmacists would be increased or not increased should HB 145 pass. CO-CHAIR SNYDER answered that the intent is to provide clarification on the range of practices that pharmacists are already engaged in to ensure that "out of date" statutes reflect the current state of practice. She mentioned testing, vaccination, and administration of Naloxone as additional details that needed to be captured. She explained that the final intent of the bill is that pharmacists have already been providing this type of care for an extended period of time, but pharmacists were not able to be reimbursed by insurance due to a lack of language [in statute]. 3:52:12 PM MR. RUFFRIDGE added that the Board of Pharmacy is attempting to regulate the areas in which pharmacists are engaged, ensure that pharmacists are seen as practicing within their scope, and pharmacists are able to be reimbursed for their practices. He emphasized that pharmacists both dispense medications and act as a "middle manager" in health care. He said that pharmacists rarely find themselves in entities such as hospitals where insurances can be billed for the services that pharmacists provide. He said the conceptual amendment wouldn't change the ways in which pharmacists dispense medications but would remove limitations to ensure that pharmacists are able to perform fully as a "manager of care in the middle." He offered clarification that pharmacists are providers of services, not just dispensers, and said that the proposed legislation with the conceptual amendment would allow for that. 3:54:42 PM REPRESENTATIVE MCCARTY requested clarification on the potential for pharmacists to offer treatment through the dispensing of Buprenorphine. MR. RUFFRIDGE responded that work needs to be done nationwide on this issue. He noted that there are other requirements to be a part of a medication-assisted treatment (MAT) program, one of which is a federal change that would have to happen. He said that pharmacists are already engaged in this in primary care settings. As far as a wider offering [of the medication] that Representative McCarty is suggesting, HB 145 is a step in that direction, he said. He explained that the bill would well- position the state to be available to implement those additional types of therapies should the federal changes be made. REPRESENTATIVE MCCARTY commented that he hopes the state stays within the guidelines of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the MAT program. 3:57:51 PM REPRESENTATIVE FIELDS moved to report HB 145, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 145(HSS) was reported from the House Health and Social Services Standing Committee.