SB 196-PRESCRIPTION DATABASE    2:43:50 PM  CHAIR ELLIS announced SB 196 to be up for consideration. GINGER BLAISDELL, staff to Senator Green, sponsor of SB 196, presented an overview on Prescription Drug Monitoring Program (PDMP). She said PDMP is referred to as the prescription database in the bill. She said that all states have laws and regulations that govern the distribution of controlled substances, but Alaska doesn't have a way to track it. Diversion of controlled substances and other pharmaceuticals is generally recognized as a serious problem throughout the US. The White House is starting a new media campaign to start educating everyone about this problem. Most states have found the prescription monitoring programs are the most effective tools because they stop some of the abuse at the front end at the prescriber or the pharmacy. The goals of the programs vary from state to state - some are under the Department of Law or a health and social service agency. Most states have found, however, they get the best results by having them located in their Board of Pharmacy because medical professionals are reviewing the data for abnormal patterns of use by doctors or patients. 2:45:02 PM Slide 6 showed how prescription drug diversion accounts for 2 percent of private insurance and Medicaid claims. In Alaska that would amount to a $1.4 million savings to insurance providers as well as Medicaid. Diversion and inappropriate drug use promulgates other criminal activity. 2:45:38 PM MS. BLAISDELL said the national and state goals are education and information about misuse of pharmaceuticals. Early intervention is the key for prescribers and dispensers by reducing the availability of prescriptions. The goals of PDMPs are to promote pharmaceutical care while deterring diversion through education and law enforcement. They are aimed at upholding statutory mandates in a manner that is most supportive of and least disruptive to medical and pharmacy practice. 2:46:47 PM She hoped the Board of Pharmacy would consider looking at some of the national computer databases that have already been designed. It seems to take most pharmacies two minutes at the end of every day to provide data to the feds and they could provide the state with the same data. Statistics on 2005 data show that 9 - 12.6 percent of Alaskans ages 12 and over use illicit drugs. The reason that prescriptions are listed with illicit drugs show that nonmedical pain relievers are starting to be used. The medications are illicit because of the ways they are used. 2:49:01 PM MS. BLAISDELL said the legislation supports practices that are already being done. The Department of Commerce, Community & Economic Development has already started to do some of the planning and they already have an investigator who is conducting research on drug diversion and use. A database would certainly help him; law enforcement could also use this information. She added that this bill streamlines current paper tracking practices. 2:49:56 PM She said that over the summer a number of doctors and pharmacists contacted the sponsor's office on this issue. An interesting quote said, "You don't want to be the low spot when everyone else is draining their swamps." This means that people who abuse prescription drugs are going to those states that do not track and control how they are managed. She said that federal funding is available for setting up these systems. 2:50:50 PM On November 26 she said CNN reported that Alaska is one of 15 states without a prescription monitoring program. The 20/20 program had a show about a university study that contacted every person returning from Iraq. It found that rather than the 10 percent of military personnel using prescription drugs, 50 percent were using them. Further she said that while President Bush's five-year goal to reduce illicit drug use by 25 percent was almost there at 24 percent, prescription abuse has increased by about 52 - 53 percent. She said a survey of teenagers by the Partnership for a Drug- Free America found that 1 in 5 teens has tried Vicodin, a powerful addictive narcotic pain reliever; 1 in 10 has tried Oxycontin, another prescription narcotic; 1 in 10 has used the stimulants Ritalin or Adderall for nonmedical purposes; and 1 in 11 teens has admitted to getting high on cough medicine. 2:51:44 PM Slide 17 indicated that controlled substance abuse has increased by 81 percent before 2003 and it has almost doubled that by now. Over 15 million people in the US are abusing prescription drugs and the rate of individuals using controlled substance prescriptions has increased at a rate greater than all other prescription medications; and pain reliever use is increasing in Alaska at four times the national rate. MS. BLAISDELL stated that over-the-counter medications are becoming the new party drugs. An unfortunate college trend is for kids to grab whatever pills they can find at a relative's house and put them in a bowl for people to take. Prescription drugs are perceived to be safer than illegal street drugs, but that's rapidly changing. 2:53:26 PM Another chart from Substance Abuse and Mental Health Services Administration (SAMHSA) showed that for the first time in 2006 the number of first-time users of drugs is higher than first time marijuana-use. Further, she said, numerous websites tell anyone how to make these drugs more powerful. Forty percent of all Myspace.com websites have a drug abuse link. Most commonly used are pain medications, stimulants, sedatives and tranquilizers and over-the-counter drugs. She found that pharmacists are now prescribing fewer Vicodin and going with Oxycontin because it is less euphoric, but Oxycontin seems to be the illicit drug of choice right now. 2:55:06 PM She said that stimulants like Ritalin that are used on ADHD kids can be very addictive and can cause heart attacks when mixed with over-the-counter decongestants. Tranquilizers, like Valium, can be mixed with cold and allergy medications for an extreme effect. Over the counter drugs like Alka-Seltzer and Coldease can cause liver damage and coma. Just recently, health professionals started saying small children should not take cold medicines. 2:56:55 PM MS. BLAISDELL explained that the prescription abuser type is very different from the regular street drug abuser type. It could be a child who needs a pain reliever that the parent has left over from dental surgery. She said people who find themselves in a financial crisis are filling their prescription and maybe selling half to pay for their ongoing living costs. Most drugs are being supplied by a friend or relative for free. 2:57:16 PM Alaska's prescription drug problem is that more schedule I - V drugs are prescribed here per capita than any other state. While she was unable to find evidence of this, every pharmacist she spoke to said that. Alaska is in the top 10 percent nationally for prescription drug abuse; we have transient populations and use a lot of mail order drugs and telemedicine. 2:58:23 PM She explained this bill would establish a drug monitoring database program with the responsibilities being governed by the Board of Pharmacy. All data from every prescription that dispensed schedule I-V drugs would be provided electronically for drugs under both state and federal law. She said that all data would be confidential and not subject to public disclosure. 3:00:07 PM MS. BLAISDELL stated the data could be used by the Board of Pharmacy for license inquiries, for operational and review purposes, and it can be requested through the board by an individual who is the recipient of a controlled substance. It can be used by licensed practitioners when considering prescribing, licensed or registered pharmacists who are considering dispensing a controlled substance to an individual and by law enforcement by request through the board by affidavit, subpoena or court order. Possible data requesters include Medicaid and Medicaid fraud units, Medicare, Workers' Compensation, Department of Corrections, Medical Examiner and others, but it is up to the Board to fulfill those requests. 3:00:53 PM She said misuse of the database is a Class A misdemeanor; and intentional access to alter or destroy data without authority is a Class C felony. She concluded that this legislation is trying to stop the problem at the front end. 3:02:10 PM SENATOR BUNDE asked her how this would coincide with the Health Insurance Portability and Accountability Act (HIPAA) requirements. MS. BLAISDELL replied she found that all states qualify to use an exception to the HIPAA rule, which says basically if a state implements a drug or prescription monitoring program in statute, it is exempt from HIPAA rules - as long as there are controls - which Alaska has. 3:03:18 PM GINNY STRICKLER,, Chief Licenser,, Division of Corporations, Business and Professional Licensing, in the Department of Commerce, Community & Economic Development, turned testimony over to her investigator, Brian Howes. 3:04:06 PM BRIAN HOWES, Senior Investigator, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community & Economic Development, said he was available to answer questions on SB 196. He supported Ms. Blaisdell's explanation of the programs features. CHAIR ELLIS asked if this is a significant problem in Alaska and if the bill was a good approach. 3:04:59 PM MR. HOWES replied yes and yes. SB 196 is a solution for this problem because it gets a handle on what prescriptions are going out and the problems that might come from multiple prescribers and individuals who don't always know what prescriptions they are on. It provides cost savings in the division's process when a case of overprescribing occurs - in which case he explained the division sends out letters to each of the 400 pharmacies in the state. Their information comes back in a paper format and in one case they had 10,000 scripts come in and it took the division three months to put the data into an excel program so they could make some sense out of it. It would also save lot of time in spelling of drugs. Having a database would make him a more effective investigator. 3:07:03 PM SENATOR BUNDE asked who actually provides the enforcement. MR. HOWES replied that the board would develop an administrative case. Something criminal would be referred out. He said his division is in the same office as 35 different professional boards. 3:08:07 PM WILLIAM STREUR, Deputy Commissioner, Medicaid and Health Care Policy, Department of Health and Social Services (DHSS), supported SB 196. He said it will save money and create a better society for us all. He estimated it would save $160,000 to $200,000/year or more. He said that last year Medicaid expenditures in Alaska came to $68 million and he thought additional savings could be found in a monitoring program. 3:10:09 PM DAVE CAMPANA, Pharmacist, HCS Health Purchasing Group, Department of Health and Social Services (DHSS), supported SB 196. He said it brings a balance between safe use of drugs and the need to prevent illegal activity associated with drug diversion of controlled substances. He described drug diversion as an activity where a person obtains a prescription for a controlled substance such as Oxycontin for an intended pain problem and illegally sells the contents of the prescription. This unintended use adds to the cost of the Medicaid program through improper use of drugs and medical visits to obtain them. A program like this, he said, would also assist insurance companies statewide by preventing drug diversion and inappropriate expenditures for diverted drugs. It would also help reduce fragmented care when people obtain care from several health care centers or providers. The program promotes coordination of care where health care providers work together for the good of the patient. 3:12:32 PM He explained the way it would work is that after prescriptions are filled their information would be sent electronically to the database through a secure file transfer protocol - on either a daily or a weekly basis. The diversion prevention feature allows prescribers and pharmacists to ask questions of the database to determine who has been prescribing which controlled drugs for their patients. One state's database found a Medicaid patient who received prescriptions for controlled drugs from over 40 doctors over three months. A prescriber will be able to see his name and the drugs associated with it; if he didn't write them he could quickly notify the board or law enforcement. 3:13:53 PM MR. CAMPANA said the department recommends two amendments; one adding the Medicaid Agency as an entity that can query the database. The second amendment would allow the pharmacy the ability to add a non-controlled substance to the database when necessary - like cough or cold drugs that can enhance the effects of controlled substances. He also wanted to see prescription data from Indian health and military facilities, because it could be very beneficial to those entities. CHAIR ELLIS agreed with him and stated his opinion that the more Medicaid fraud squeezed out of the system, the more respect and political support the program would get. 3:15:42 PM JEFF JESSE, Chief Executive Officer, Alaska Mental Health Trust Authority, supported SB 196. He related his personal experience with a separated shoulder and how easily he could have obtained a controlled substance. Also he believed that having an electronic database would improve prescribing practices. 3:17:09 PM CAPTAIN KEITH MALLARD, Commander, Alaska Bureau of Alcohol and Drug Enforcement, Alaska State Troopers, Department of Public Safety (DPS), supported SB 196 and said he would answer questions. CHAIR ELLIS asked if he sees this as a significant problem. CAPTAIN MALLARD replied yes; the number of prescriptions that are being diverted for illegal use is increasing and the database would be useful in case investigation. 3:18:12 PM PATRICIA SENNER, Chair, Legislative Committee, Alaska Nurses Association, said over the last several years they had been debating the pros and cons of establishing a controlled substance prescription database. On the pro side it has a preventive possibility; on the other side, safeguards have to be in place so the patients' confidentiality is not lost. The concern exists also that someone might access the database and "go fishing" for information about individuals they are not currently treating. She mentioned that licensed health care professionals often delegate the job of collecting data for their patients to unlicensed health care workers and she saw that as a problem. Just using a DEA number is not enough protection as some health care providers have it on their prescription pad. 3:19:48 PM Even more alarming is the prospect, she said, that someone working in a health care provider's office could go fishing on the database so they would know which homes to enter to obtain controlled substances. Another question she had about the criteria was what bar would be used to determine who is abusing prescriptive privileges - the concern being that health care providers will be afraid to adequately treat pain experienced by their patients because of fear of being accused of prescribing too much medication. She was also concerned that the database would have information about who picks up medications and maybe family members might be reluctant to pick up pain medications for relatives for fear of being labeled as drug seekers. The database should have some place to indicate the relationship of the person picking up the medication to the person it was prescribed for. She concluded if the committee could address these concerns about privacy, the Nurses Association would support the bill. 3:21:17 PM BARRY CHRISTIANSON, Co-Chair, Alaska Pharmacists' Association, emphasized that for this program to work it has to be preventative. So any program that is implemented has to be user friendly and must interface with pharmacy databases. He explained that all pharmacies use different databases. For example, his pharmacy could not comply right now with the log of pickup persons. Secondly, he was concerned that since the Alaska Pharmacists' Association is funded only through license fees, that down the road it wouldn't be able to fund this $400,000 program. He wanted to see language saying the burden of funding this program would not fall upon the board's license fees. 3:23:37 PM CHAIR ELLIS said he and the sponsor would work together to address these issues in a CS - they include adding the Medicare Agency to the list of entities that can make queries, adding non-controlled substances to the database, address privacy issues, the interface concern, and the future costs issue after federal grant funding goes away. He asked Ms. Blaisdell if she had any reaction to these suggestions. MS. BLAISDELL replied that she had already addressed some of them. She said the concern with the additional information gathering requirements is if you had to collect information on the people actually picking up the prescription, most states felt that was a very strong indicator of someone who might be an abuser and that was very good information to have. However, it doubles the workload for pharmacists who gather that information and some people don't have an i.d. with them. So, some states just keep a paper log for people who pick up a prescription medication for another person. She explained that one looks for trends in the database. They look very different for someone using a substance for a true medical purpose than someone who is abusing it personally. But the sponsor was willing to take that provision out of the statute and let the Board of Pharmacy add it where it would be more acceptable. On the continued funding, she said the first year of the program would probably cost $400,000; but the second year those costs are typically greatly reduced. New Mexico's annual cost is now $13,000 a year. However, their investigator was already on the payroll before the program started, though he did say that drug diversion has increased so much that he now spends all his time on drug monitoring issues. CHAIR ELLIS asked her to work with the state Medicaid folks, the nurses association and the pharmacists, and staff to address those concerns in a CS.