HB 324-CONTROLLED SUBST. PRESCRIPTION DATABASE  4:05:08 PM VICE CHAIR KELLER announced that the next order of business would be HOUSE BILL NO. 324, "An Act relating to the controlled substance prescription database." 4:06:34 PM JIM POUND, Staff, Representative Wes Keller, Alaska State Legislature, addressed the proposed committee substitute (CS) for HB 324, labeled 28-LS1427\N, Strasbaugh, 3/7/14 which proposed to answer some of the concerns from the previous meeting. He directed attention to page 3, line 9, which added "directly" so that the hospital would administer the drugs. He noted that some rural providers did not have access to a database, so "through an electronic database or another method" was added on page 3, line 10. He pointed to page 3, line 30, which added "a secure real-time" and stated that once the prescription was given to the client the information would be input to the database. Noting page 4, line 22, "who is licensed" was added to ensure that access to data was only by a licensed individual. He stated that the final change was on page 4, line 29, whereby "provider" was changed to "practitioner." 4:09:05 PM REPRESENTATIVE PRUITT moved to adopt the proposed committee substitute (CS) for HB 324, labeled 28-LS1427\N, Strasbaugh, 3/7/14, as the working draft. VICE CHAIR KELLER objected for discussion. REPRESENTATIVE TARR asked if the payment portion would remain the same as the previous draft. MR. POUND replied that it would remain the same. 4:09:47 PM [VICE CHAIR KELLER opened public testimony]. WARD HURLBURT, M.D., Chief Medical Officer/Director, Division Of Public Health, Central Office, Department of Health and Social Services, stated that the administration had not taken a position on the proposed bill. He referred to the passage of a similar law in Missouri, noting that all 50 states now had a controlled substance prescription data base program. He said there was an array for how robust the programs were, and he pointed to the Oklahoma program with a 10 minute real time accessibility. He declared that had been a benefit to the program. He reported that Alaska downloaded the information on a monthly basis. He declared that all the programs had value for addressing the national epidemic of controlled substance prescription drug abuse. He said that annual deaths from the illicit use of these legal controlled substances had now surpassed the annual deaths from automobile accidents. He stated that the more robust the program, the more it would cost. He noted that the responsible department would have to determine the program with the greatest value for the cost. He shared an anecdote of his work prior to working in Alaska. He stressed that availability of these databases was helpful and important to medical professionals. 4:12:48 PM REPRESENTATIVE REINBOLD asked who paid for these programs, and for his recommendations for funding. DR. HURLBURT replied that he clearly recognized the challenge for a reasonable, prudent approach to funding for this important program. 4:14:01 PM REPRESENTATIVE TARR asked for clarification that the fees through the Board of Pharmacy would finance the program. DR. HURLBURT replied that it was a reasonable cost to impose on the health care businesses. REPRESENTATIVE TARR asked if any other programs were charging the patient for this service. DR. HURLBURT replied that he did not know, though he offered his belief that it would be difficult. If a cost was imposed at the point where the controlled substance was dispensed, then the patient, or the third party payer, would bear the cost. 4:16:58 PM MARGARET BRODIE, Director, Director's Office, Division of Health Care Services, said that it was necessary to study who would benefit from the database, and look for funding from those who benefited. VICE CHAIR KELLER offered his belief that the funding would need to come from the pharmacists. He suggested that there could be other funding sources, including private donations, and he asked for any suggestions from Department of Health and Social Services (DHSS). 4:18:37 PM MS. BRODIE stated that DHSS supported the database and would work with whomever to make it successful. REPRESENTATIVE REINBOLD declared that the community, as a whole, benefited from the database. She suggested finding funding alternatives to avoid conflict with the pharmacies. 4:20:27 PM DIRK WHITE, Chairman, Board of Pharmacy, reported that the Board of Pharmacy had taken on the responsibility of overseeing the program when it was passed in 2008. At that time, there was a letter of intent that there would not be a financial burden on the Board of Pharmacy or the pharmacists for running the program. He declared that it was a public safety issue, and that everyone in the state benefited by the prevention of narcotics and other dangerous prescription medication from reaching the street. He said that, as all the citizenry benefited, there should not be fees imposed on the providers. He asked how the fees would be collected and then disseminated. He said that this would become a non-funded state mandate, and he listed other non-funded federal mandates for which pharmacists were responsible. He said that all the providers had similar fees. He stated that this benefit to all the citizens of the state needed to be funded by the state. 4:24:15 PM VICE CHAIR KELLER stated that the fees would get passed on to the customers. MR. WHITE explained that these fees would not be passed on, as the pharmacists cannot change their reimbursement rates, and any increased costs had to be absorbed by the pharmacist. 4:25:27 PM PATRICIA SENNER, Family Nurse Practitioner, Alaska Nurses Association, expressed her support for the change in wording for entry data users. She relayed that the Legislative Budget and Audit Committee was holding hearings regarding the accounting practices of the Division of Corporations, Business, and Professional Licensing [Department of Commerce, Community & Economic Development], with some possible "deficiencies or problems in that area" and she did not want to add any further responsibilities to that division. She suggested a tax on the pharmaceutical companies that make the controlled substances. She pointed to the state tobacco tax and the state liquor tax, which were collected from the distributors and not the individual dispensers. She expressed support for the real time mandate, though she expressed concern for any cost increase over management of the current system. 4:27:43 PM VICE CHAIR KELLER said that the proposed bill would be held over. 4:28:09 PM LIS HOUCHEN, Director, State Government Affairs, National Association of Chain Drug Stores, directed attention to the letter [Included in members' packets] that she had submitted which listed suggestions for the proposed bill. Referring to page 2, line 31, and continuing on to page 3, line 1, she suggested deleting "other than the state." She stated that the organization was very supportive of this program, noting that only one state did not have a similar program. She noted the current lack of ability for online real time, and she asked that this be removed from the proposed bill. She explained that the program was trying to discern a history of abuse by a specific individual, and, as that was revealed by activity over a period of time, the online real time was not necessary. She asked that the pharmacist and the prescriber not be taxed, as they were already paying to provide the information and the materials. She suggested a search for alternative sources of funding, and mentioned a user fee for those who access the information. She stated that the pharmacies could not pass on this cost, as the rates were already fixed, and she asked that an alternative source of funding be sought. 4:31:43 PM VICE CHAIR KELLER replied that there was a conceptual amendment to be proposed that would address some of those concerns. 4:31:53 PM BARRY CHRISTENSEN, Pharmacist, Co-Chair, Legislative Committee, Alaska Pharmacists Association, declared support by the membership for the prescription substance data base, as it ensured public safety. He pointed out that the Alaska Pharmacists Association had submitted a letter [Included in members' packets]. He expressed appreciation for licensed staff to have access to the data base, and suggested that it include licensed staff in other medical practices. He pointed out that there was not any real time statewide data base for pseudoephedrine. He asked for a response to why there was not real time in Alaska. 4:34:47 PM DAN LYNCH referred to an earlier proposal for a similar bill in 2008 and maintained that his testimony remained unchanged, the proposed bill was "unconstitutional in the USA, including Alaska." He referred to the Fourth Amendment [Bill of Rights] and its statement against unreasonable search and seizure. He offered his belief that success statistics had determined that it "won't work now in real time or dream time." He referred to the letter of intent from the earlier proposed bill, "it is not the intent of the legislature that the professional users of the data base absorb the cost of managing this public program through their license fees or other fee structure," and declared that this had already been established. He questioned the change for increased access to the data base, or contracting with a private data base provider. He declared that the state was unable to monitor its own employees. He pointed out that the internet was now the global marketplace for purchases. He said it was a waste of funds for this "silly, incompetent, feel good legislation." He suggested using the time, effort and finances "to address reality, treatment, real issues and real solutions." 4:38:04 PM VICE CHAIR KELLER held over HB 324. 4:38:25 PM The committee took a brief at-ease. 4:38:55 PM VICE CHAIR KELLER removed his earlier objection to the proposed work draft. There being no further objection, it was adopted.