SB 147-PHARMACIST PRESCRIPTION AUTHORITY  1:46:30 PM CHAIR BJORKMAN reconvened the meeting and announced the consideration of SENATE BILL NO. 147 "An Act relating to the prescription and administration of drugs and devices by pharmacists; relating to reciprocity for pharmacists; and providing for an effective date." 1:46:52 PM SENATOR CATHY GIESSEL, District E, Alaska State Legislature, Juneau, Alaska, as the sponsor of SB 147 she read the following: [Original punctuation provided.] SB 147 is a collaborative effort with the Alaska Board of Pharmacy and the Alaska Pharmacy Association. In 2022, Alaska passed a bill that added "other patient services" to pharmacy services (AS 08.80.337). SB 147 clarifies the intent of that legislation in regard to • independent prescribing and • allowing pharmacists to practice at the top of their education, training and experience. 1:47:37 PM SENATOR GIESSEL continued with the following for SB 147: Pharmacists are seeing an evolution • in their role in the healthcare system and • ability to provide direct patient care: minor and chronic ailments, especially in rural areas. Alaska in general has a limited number of hospital beds, ER space and other healthcare services. Utilizing every possible provider will increase timely and appropriate care. The Alaska Board of Pharmacy already regulates pharmacists under a standard of care, which aligns with this legislation. Expanded pharmacist services have already been established federally. • Public Readiness and Emergency Preparedness (PREP post exposure prophylaxsis for HIV) act • Mainstreaming Addiction Treatment (MAT medication assisted treatment) Act - allows for pharmacists to prescribe treatment for opioid use. • Aligns with federal models including care provided in the Veterans' Health Administration Community pharmacists are among the most-trusted healthcare professionals among patients. (not first on the ranking, like nurses, but up there) They have the education and knowledge to assess a patient's ailments and refer if needed to more acute care when needed • Pharmacists complete a Doctor of Pharmacy degree that requires 1,170 hours of clinical training. • 6-8 years of education in pharmacotherapy, disease management and clinical decision-making. • Many go on to complete post-graduate residencies, fellowships and board certifications in specialty areas. • State boards of pharmacy regulate to ensure safe care through accreditation reviews. 1:49:21 PM SENATOR GIESSEL continued with the following for SB 147: What kinds of services are we talking about here? • Test to Treat if appropriate • Prescribe remedies for flu, cold, urinary tract infections, strep throat, COVID-19, pregnancy tests and more. • 30 states now authorize pharmacists to order and administer CLIA-waived tests such as COVID-19, strep, flu, RSV, UTI HIV, and more • (Clinical Laboratory Improvement Amendments = CLIA) 1:50:06 PM JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State Legislature, Juneau, Alaska, provided the sectional analysis for SB 147 and read the following: [Original punctuation provided.] Sectional Analysis  "An Act relating to the prescription and administration of drugs and devices by pharmacists; relating to reciprocity for pharmacists; and providing for an effective date." Section 1. Amends AS 08.80.030(b) Powers and duties of  the board.  to require that a licensed pharmacist who prescribes, administers, or dispenses a controlled substance under state law or federal law to a person in the state register with the controlled substance prescription database (PDMP).   Section 2. Amends AS 08.80.110 Qualifications for  licensure by examination  to require that a pharmacist who holds a Drug Enforcement Agency (DEA) number applying for licensure (via examination) receive education in pain management and opioid use and addiction, in alignment with other practitioners in Alaska who hold DEA numbers. 1:51:03 PM MS. CONWAY continued with the sectional analysis for SB 147: Section 3. Amends AS 08.80.145 Reciprocity; license  transfer  to require that a pharmacist who holds a DEA number applying for licensure (via reciprocity) receive education in pain management and opioid use and addiction, in alignment with other practitioners in Alaska who hold DEA numbers and pay the associated fees. Section 4. Amends AS 08.80.165 Continuing education  requirement  to require a pharmacist who holds a DEA number and renews licensure in Alaska meet continuing education requirements including at least two hours of education in pain management and opioid use and addiction in the two years preceding license renewal, in alignment with other practitioners in Alaska who hold DEA numbers. A pharmacist whose practice does not include pain management and opioid prescription, or administration is exempt from this requirement. Section 5. Amends AS 08.80.337 Other patient care  services  (a)to clarify that a pharmacist may not provide patient care services under a collaborative agreement with another pharmacist. Section 6. Amends AS 08.80.337 Other patient care  services  (d) to clarify that "patient care services" mean medical care services that include the prescription or administration of a drug or device to a patient for the purposes of curing or preventing a disease, reduction of patient symptoms or for slowing the disease progression. 1:52:35 PM MS. CONWAY continued with the sectional analysis for SB 147: Section 7. Amends and adds a new subsection to AS 08.80.337 Other patient care services. (e) requiring that a pharmacist prescribing or administering a drug or device under this section recognize the limits of the pharmacist's education, training, and experience and consult with and refer to other practitioners as appropriate. This aligns with standard of care and pharmacy regulation. Section 8. Amends AS 08.80.480 Definitions. (30) to clarify that the "practice of pharmacy" includes providing patient care services in accordance with AS 08.80.337. This includes patient care services provided independently or under collaborative practice. Section 9. Amends and adds a new paragraph to AS 08.80.480 Definitions. (40) adds to the definition of opioid to include opium and opiate substances and opium and opiate derivatives Section 10. Repeals AS 08.80.337 Other patient care  services (c) to align with clarifications in Section 6. Section 11. Provides for an effective date of January 1, 2026. 1:54:12 PM SENATOR GIESSEL clarified the acronym PDMP's meaning as Prescription Drug Monitoring Program (PDMP). All clinicians who prescribe controlled substances are required to register and maintain active records. 1:54:38 PM CHAIR BJORKMAN announced invited testimony on SB 147. 1:54:48 PM ASHLEY SCHABER, Pharmacist, Alaska Native Medical Center (ANMC), Anchorage, Alaska, testified by invitation on SB 147 and moved to slide 2. She spoke to the 2024 strategic plan from the Alaska Board of Pharmacy: [Original punctuation provided.] I have included the 2024 Alaska Board of Pharmacy Strategic Plan. Each decision our board makes regarding removing, changing, or adding statutes or regulations is filtered through the Strategic plan. SB 147 aligns with our strategic plan through Goal number 4 which is to: grow the economy while promoting community health and safety. Specifically, to advocate for legislation addressing access to pharmacies as the pharmacy profession advances and new opportunities for improved patient safety arise. 1:55:50 PM MS. SCHABER moved to slide 3 and read the following: [Original punctuation provided.] SB 147 is the result of several years spanning multiple Board of pharmacy chairs as we reviewed our statutes and regulations to align licensee authority with their education, training, and experience with the ultimate goal to increase access to care. House Bill 145 passed the 2021-22 session and added a new section of Pharmacy statutes called "other patient care services" recognizing that pharmacists provide services other than traditional medication dispensing, both under collaborative practice agreements or independently. After this statute section was added, the Board received multiple questions from businesses and licensees, so it was determined clarification was needed, specifically in regards to pharmacist- prescribing and administering. SB 147 increases access to care by giving statutory authority to established models of care while encouraging interdisciplinary engagement and teamwork. 1:56:59 PM MS. SCHABER moved to slide 4 and read the following: [Original punctuation provided.] SB 147 increases access to pharmacist-provided patient care services, while closing the gap between state statute and pharmacist education and training. SB 147 encourages interdisciplinary engagement between pharmacists and other healthcare practitioners. Specifically, SB 147 requires a pharmacist prescribing or administering a drug or device under this section shall recognize the limits of the pharmacist's education, training, and experience and consult with and refer to other practitioners as appropriate. 1:57:40 PM MS. SCHABER moved to slide 5 and read the following: [Original punctuation provided.] SB 147 gives Alaska pharmacists statutory authority to established models of care that have been proven effective. A standard of care regulatory model empowers pharmacists by regulating them similarly to other health professions such as nursing and medicine, providing regulatory consistency across the health care system. Standard of Care (SOC) regulatory model supports practitioners delivering patient care within their scope of practice and clinical training. Patient safety is maintained by measuring care against other practitioners within the same practice setting while supporting practitioners practicing at the top of their clinical ability. The changes in SB 147 align with recent federal legislation that optimize the roles of pharmacists in public health responses as well as established federal models for pharmacist-delivered care such as what is provided through the Veterans Health Administration. 1:58:38 PM MS. SCHABER moved to slide 6 and read the following: [Original punctuation provided.] In conclusion, on behalf of the Alaska Board of Pharmacy, I request your support of SB 147 as it aligns with our Mission and Strategic plan. 1:59:09 PM BRANDY SEIGNEMARTIN, Executive Director, Alaska Pharmacists Association, testified by invitation on SB 147 and read the following: [Original punctuation provided.] I'm Dr. Brandy Seignemartin here to speak on behalf of the Alaska Pharmacy Association in strong support of Senate Bill 147. I'm a pharmacist by training and serve as the executive director of the Alaska Pharmacy Association as well as a clinical assistant professor at our UAA ISU Doctor of Pharmacy Program. 1:59:33 PM MS. SEIGNEMARTIN continued with her testimony of SB 147: The Alaska Pharmacy Association represents pharmacists, student pharmacists, pharmacy technicians, and pharmacies across our statefrom Ketchikan to Fairbanks and beyond. Our mission is centered on ensuring Alaskans have access to safe,  high-quality pharmacy care in their local communities. Let's Start by Discussing Pharmacists' Roles Across  Practice Settings  Pharmacists in Alaska are already deeply embedded in patient carewhether that's in community pharmacies,  tribal health systems, hospitals, clinics, long-term  care, or public health settings. They provide immunizations, conduct health screenings, manage medications, counsel patients, and help prevent medication-related complications. Across all of these settings, pharmacists play a vital role in keeping  Alaskans healthy and informed. This bill builds on that foundation. SB 147 would allow pharmacists to provide a limited set of additional patient care servicesincluding prescribing  and services within the bounds of their education,  training, and experience; under the prevailing  standard of care; and within the bounds already  contained in AS 08.80.337 which outlines when a pharmacist may provide patient care beyond the dispensing of medications. These are services pharmacists are already well-equipped to provide. This Isn't New the Federal System Has Led the Way Pharmacists in the federal systemincluding the Indian Health Service and the Veterans Health Administration have safely provided these types of patient care services for decades. Since 1979, federal pharmacists have been practicing at the top of their education and training. The evidence is clear: when pharmacists are  empowered to act in patient care roles, patient  outcomes improve without compromising safety. 2:01:26 PM MS. SEIGNEMARTIN continued with her testimony of SB 147: I want to address a concern that's often raised whether pharmacists have the training to provide these services. The answer is unequivocally yes and of important note, SB 147 does not allow pharmacists to  do anything outside their scope of competency and  requires interdisciplinary engagement while  incorporating established models of care.  What's more, SB 147 uses the standard of care model, a framework used by other licensed providers across disciplines. That means pharmacists would be responsible for practicing only within areas in which  they are educated, trained, and experienced following evidence-based clinical guidelines and in a manner that is consistent with a reasonable and prudent healthcare provider. If a patient presents with something more complex or outside that scope, pharmacists must refer them to another providerjust like we do today. This model ensures safety and empowers pharmacists to provide care where they are qualified and able, while maintaining strong safeguards for patients. We also anticipate that closing the gap between our current education level and what pharmacists are allowed to do in statute will also help fight burnout because pharmacists will be empowered to serve their patients to the fullest extent of their clinical ability. One of the most important impacts of SB 147 is that it improves access to safe care. Pharmacists are everywherein small towns, on the road system, off the road system, and in communities where other healthcare providers may not be always available. Pharmacies tend to have extended hours, no appointment requirements, and are at times the only or  primary healthcare touchpoint for rural Alaskans. Furthermore, pharmacists practicing in clinics and  health systems can help extend the overall amount of care that can be provided by the healthcare team. 2:03:19 PM MS. SEIGNEMARTIN continued with her testimony of SB 147: When pharmacists are allowed to provide care for minor ailments, preventive services, and chronic disease support, patients can get care faster, closer to home,  and without the delays or travel associated with  limited provider availability. That means fewer people delaying care or turning to the emergency room for non-emergent issues. What Types of Services Could Be Provided?  Under SB 147, we could potentially see pharmacists providing established models of care, such as: • Test and treat for minor illnesses like strep throat or influenza • preventive services such as smoking cessation support, and pre-exposure medications for HIV prevention • Treatment for minor ailments such as seasonal allergies, pink eye, cold sores or insect bites • Working alongside or embedded in healthcare teams to manage chronic conditions like hypertension, asthma, and diabetesby adjusting medications and monitoring labs • Supporting medication assisted therapy for opioid  use disorder • And Maximizing efficiency in health systems by  utilizing all members of the care team at the right level of care These are all evidence-based models that pharmacists in other states the federal system, and even around the worldare already providing. What's the Economic Value of Pharmacist-Provided Care? Allowing pharmacists to do more doesn't just improve accessit also saves money. An economic evaluation of pharmacist-provided clinical services found that for every $1.00 invested, there  was a return of $4.81 in healthcare savingsthrough reduced hospitalizations, fewer complications, and more efficient care delivery. 2:04:57 PM MS. SEIGNEMARTIN continued with her testimony of SB 147: In a recent Washington State study that Senator Giessel referenced, comparing pharmacist care for minor illnesses to traditional care sites showed that pharmacy-based care cost $277 less per episodewith no  difference in patient outcomes or return visits. In short: Better access, lower cost, same quality.  Additionally, I personally worked on this study and  heard firsthand from patients who were so grateful that they didn't have to take time off work to get care for a minor issue. This is the kind of smart investment Alaska needs. SB 147 unlocks the value pharmacists already offer. In Conclusion; Mr. Chair and Members of the committee, SB 147 is a practical, evidence-based solution to some  of Alaska's biggest healthcare challenges.  I want to emphasize that this bill does not replace other healthcare providersIt adds capacity to a strained system by letting pharmacists do more of what they are already trainedand trustedto do. It leverages existing infrastructure, protects patient safety through standard of care guardrails, and helps address some of Alaska's most urgent healthcare access challenges. Our Association is deeply committed to improving healthcare access in Alaska, and this legislation is a critical step forward. On behalf of our members and the patients we serve, the Alaska Pharmacy Association respectfully urges your support of SB 147. 2:06:42 PM JEN ADAMS, Professor, L.S. Skaggs College of Pharmacy, Idaho State University (ISU), Meridian, Idaho, testified by invitation on SB 147. She described Idaho's experience with allowing pharmacists to provide care services, noting initial skepticism that proved unfounded. Over nearly six years, Idaho has seen no safety issues and significant improvements in access to care, especially in rural areas. She said pharmacists now practice at the top of their license, offering services such as flu testing and treatment for minor conditions, providing convenient and effective care without the need for a doctor's visit. 2:09:26 PM MS. ADAMS continued with her testimony of SB 147 and read the following: [Original punctuation provided.] National accreditation standards for the Doctor of Pharmacy degree require all colleges and schools of pharmacy to train practice-ready graduates who are prepared with the skills to diagnose and prescribe independently and provide patient-care services like those included in Senate Bill 147. This ensures that any Doctor of Pharmacy graduate from any program who may eventually practice in Alaska will have the necessary education, training, and clinical ability to safely provide these services to Alaska's residents not just those who graduate from ISU/UAA. Aligning pharmacists' authorized patient care services in Alaska with their education and training is a critical workforce and healthcare access solution. Pharmacists are among the most accessible healthcare providers in the state, particularly in communities with limited physician coverage. Authorizing pharmacists to provide timely, evidence-based patient care services will increase access to healthcare, reduce burden on emergency departments, and improve health outcomes across Alaska. Our program is committed to graduating practice-ready pharmacists who are prepared to serve their communities at the highest level. Senate Bill 147 is an essential step to ensuring that Alaska's regulatory framework keeps pace with national educational standards, best practices, and the successful models we have seen implemented in other states like Idaho. Thank you for your consideration of our strong support for SB 147. We stand ready to serve as a resource and to continue preparing future pharmacists who will help meet Alaska's healthcare needs. 2:11:47 PM CHAIR BJORKMAN asked for clarification on the repealer in Section 10, noting it relates to a change in Section 6 and referencing AS 08.80.337(c), which concerns patient care services under a statewide standing order from the Chief Medical Officer. 2:12:49 PM MS. SCHABER answered that the repealer in Section 10, incorrectly cites AS 08.80.337(c). The repealer is needed because Section 6, AS 08.80.37(d) clarifies that patient care services include medical services such as prescribing and administering drugs. 2:13:41 PM CHAIR BJORKMAN asked whether Section 5, AS 08.80.337(a)excludes any practitioners from participating in collaborative agreements. 2:13:59 PM SENATOR GIESSEL replied that the only thing Section 5 excludes is another fellow pharmacist. She said Ms. Schaber could to elaborate on Section 5. 2:14:18 PM MS. SCHABER answered that Senator Giessel was correct; the only restriction is that the collaborating practitioner cannot be a pharmacist but may be any other medical practitioner. 2:14:50 PM SENATOR GIESSEL highlighted a study in the materials titled "Expanding Access to Patient Care: Community Pharmacists for Minor Illnesses in Washington State." Led by Brandy Seignemartin, the study found that many emergency department visits were avoidable through pharmacist interventions, resulting in an estimated $18 billion in annual savings, including $4 billion for urinary tract infection treatments alone. 2:15:43 PM CHAIR BJORKMAN held SB 147 in committee.