CS FOR SENATE BILL NO. 196(FIN) am "An Act relating to establishing a controlled substance prescription database." 12:56:42 PM GINGER BLAISDELL, STAFF, SENATOR LYDA GREEN, presented an overview of the bill. She indicated that the medical community and the Alaska Pharmacy Association brought this need to the attention of Senator Green. Ms. Blaisdell described the legislation as a compilation of existing bills from forty other states. She referred to the PowerPoint presentation (Prescription Drug Monitoring Program and Database, copy on file). She reported that: All states have laws and regulations that govern the distribution and handling of controlled substances. Diversion of controlled substances and other pharmaceuticals is generally recognized as a serious problem throughout the United States. Ms. Blaisdell referenced available support materials, including letters from the White House designating drug diversion as one of President Bush's top priorities. Ms. Blaisdell expressed that: States have found that Prescription Drug Monitoring Programs (PDMPs) are among the most effective tools available to identify and prevent drug diversion. Ms. Blaisdell defined drug diversion: Diversion is taking a legal prescriptive substance and altering it to provide a different effect or selling/giving it to someone other than the person to whom it was intended. Diversion affects the health of our citizens. Diversion often promulgates other criminal activity. Ms. Blaisdell indicated the goals: Prescription Drug Monitoring Programs are intended to promote pharmaceutical care while deterring diversion through education and law enforcement. Prescription Drug Monitoring Programs are aimed at upholding statutory mandates in a manner that is most supportive of and least disruptive to medical and pharmacy practices. Ms. Blaisdell noted it would only take two minutes a day to download information from the database; the new legislation is meant to be a helpful tool not a new mandated task. Ms. Blaisdell described national ads produced for the $30 million U.S. drug awareness campaign. She stressed the importance of education: There is a national presumption that the misuse of prescription drugs is safer than using illicit "street" drugs. Prescription and over-the-counter medications are fast becoming the new "party" drugs for many teenagers and adults. Twenty-five to forty percent of MySpace users include postings on how to get prescription medication on the internet. Ms. Blaisdell revealed the most commonly abused medications: Pain Killers Stimulants Sedatives and Tranquilizers Over-the-Counter Drugs She described prescription abuse to include: Children through elderly individuals abuse for themselves or for personal profit. Nearly seventy percent of prescription drugs are obtained for free from friends and family. Pain killers are the number one abused drug because of the feeling of euphoria and/or high resale value. Ms. Blaisdell stressed the importance of this legislation, noting that: The Department of Commerce, Community and Economic Development (DCCED), Board of Pharmacy, currently conducts research and licensee investigations regarding drug diversion practices. A Prescription Drug Monitoring Program will provide the direction and tools for collecting accurate and timely prescription drug information to assist in the prevention of diversion and promote safe and effective health care for Alaska's citizens. 1:03:24 PM Ms. Blaisdell continued on the importance of this legislation: State and local law enforcement agencies are experiencing a rise in prescription drug diversion criminal activity. This legislation was requested by Alaskan pharmacists, doctors and law enforcement officials. With legislation, the state will be eligible for federal funding. Ms. Blaisdell reported that this legislation: Establishes a Prescription Drug Monitoring Program within the Board of Pharmacy. Tracks all schedule I-V controlled substances in state and federal law. Data will be electronic rather than paper. Ms. Blaisdell explained: Data can be used by licensed prescribers who have the authority to prescribe when caring for a patient. Data can be used by a licensed or registered dispenser who is considering a controlled substance to an individual. Data can be used by the personnel of the Board of Pharmacy regarding licensing inquiries, and for database management. Data can be requested through the Board by law enforcement entities with a subpoena or court ordered warrant. Ms. Blaisdell continued that data can be used to: Improve health care for patients Identify prescribing and dispensing practices that may be of question; and Identify individuals who show a pattern of inappropriate use. 1:06:03 PM Ms. Blaisdell revealed that the data is confidential and not subject to public disclosure: Health Insurance portability and Accountability Act exceptions are allowed for state Prescription Drug Monitoring Programs. Patient privacy is secured by the details of the contract for the vendor who will capture the data. Privacy is insured by the Class A misdemeanor and Class C felony charges that would accompany inappropriate use of the data. Ms. Blaisdell referred to the fiscal notes from the Department of Commerce, Community and Economic Development and the Department of Health and Social Services. Ms. Blaisdell indicated that statewide insurance providers and individuals who self-pay are expected save $1.4 million in the first year. She remarked that: Senate Labor and Commerce adopted a committee substitute that addressed almost all concerns voiced by the medical community and government agencies. The side-by-side document is in the bill packet. Senate Labor and Commerce adopted intent language regarding the impact of future funding. The intent memo is in bill packet. She reassured the Committee that after checking through the bill with legislative legal every sentence and every paragraph has some sort of privacy protection or data security written into the bill. 1:09:14 PM Representative Nelson questioned if the Native Health Service would have access to this database. Ms. Blaisdell replied that Maine is the only state to enter voluntary contracts with military and tribal health providers. Military and tribal health is governed by federal law rather than state law so they are exempt from participating. She added that those providers who choose to participate can receive permission. Representative Nelson asked if this would be phrased as anyone who contracts and compacts with Indian Health Service. Ms. Blaisdell agreed that most people are entering into contracts. 1:10:28 PM Representative Gara questioned if the main purpose of the bill would be to provide a database accessible to all pharmacists in the state. Ms. Blaisdell responded that the database would be accessible to all pharmacists who apply to have access to retrieve information. All pharmacists in the state would be required to report any dispensing of controlled substances. Representative Gara asked if one of the purposes of the database would be for pharmacists to check on the other medications a patient may have been prescribed. He also inquired if this information would be available to the physician when prescribing a drug for a patient. Ms. Blaisdell emphasized that not every prescription will be in the database. The database will only indicate drugs in Schedule I-V: painkillers, sedatives, tranquilizers, or stimulants. She provided the example of an elderly person, always going to the same pharmacy, would have a prescription history at that pharmacy. A medical provider can access this database to look at the person's history when they are writing a prescription. 1:13:20 PM Representative Gara inquired if pharmacists now have access to a database to determine if there is potential drug interaction. Ms. Blaisdell responded that pharmacists are not the primary individual trying to discover every drug interaction. Discovering potential drug interactions will start with the medical provider. She signified that patients who "doctor shop" using multiple pharmacies could be tracked with this database. 1:14:40 PM Vice-Chair Stoltze questioned the access individuals have to the database. He requested information on any fees involved. Ms. Blaisdell remarked that any individual can request the report of their own history in the database. She reported that the fee will not exceed ten dollars but the patient can also ask their physician to run a history. She revealed that prescriptions listed in the database will use the medical term for the medication not the brand name. Vice-Chair Stoltze asked if the database would be available to other professional boards, primarily for disciplinary cases. He also asked for comment on how the large chain pharmacies handle prescription information. 1:16:47 PM Ms. Blaisdell reported letters of support from the National Association of Chain Drug Stores (Safeway, WalMart, etc). A large corporate drug store can share data within their own corporate chain but not among different drug store chains. The proposed database would capture all this information. Vice-Chair Stoltze asked again about the availability to other professional boards. Ms. Blaisdell responded that this information is only accessible by a court ordered warrant or subpoena. 1:18:32 PM Representative Nelson referred to another database set up for antihistamines that expunges the records after one year. She asked if there was a time frame to expunge records in this bill. Ms. Blaisdell responded that there is a two year provision to dispose of the information. The database is looking for someone with a pattern of use, not a one-time incident. Representative Nelson asked if pharmacists are privy to patient's drug history through a patient's insurance provider. 1:20:02 PM Ms. Blaisdell responded that a patient's drug history can not be obtained through their insurance provider. She noted that the use of cash to pay for a prescription is one of the key data elements that may reveal drug diversion. 1:20:50 PM Representative Gara stressed concern about information becoming accessible to the general public. He pointed to a provision in the bill indicating that law enforcement may obtain information from the database through a search warrant or subpoena. He noted in civil cases information can be obtained through a "discovery process" and voiced his concern that information may be obtained in this manner. 1:22:11 PM Ms. Blaisdell disclosed that the data is not accessible for "discovery" or civil suits only through a court order, warrant or subpoena. She cited an example that a medical doctor could not provide a person's medical history to another member of the family. Representative Gara asked where in the bill it states information may not be obtained through a discovery order. Ms. Blaisdell replied that there is no provision that says it is not accessible through a discovery order because the only provision for accessing this information, outside of the physician or pharmacist, is through a court warrant or subpoena 1:23:12 PM DANIEL LYNCH, SOLDOTNA testified via teleconference and voiced his concern about privacy information being disclosed. He noted the widespread internet and database theft. He cautioned that hackers have entered many national corporate databases and a potential hacker into this drug database would obtain personal information for possible theft or sale to insurance companies or employers. He noted the long-standing confidentiality between patients and physicians and hoped privacy can be maintained. He wondered if possible new hiring to enter these prescriptions will raise the price of medications. 1:26:30 PM PATRICIA SENNER, NURSE PRACTITIONER, ALASKA NURSES ASSOCIATION testified via teleconference spoke in support of the bill. As prescribers, the association welcomed the opportunity of receiving accurate information for controlled medication prescribed to their patients but warned that someone in a physician's office, hospital or pharmacy could go on a "fishing" expedition to locate private information, noting the recent Britney Spears case. She suggested at third layer manager who would give permission before any information could be released from the database. 1:28:37 PM LINDA BAREFOOT, REGIONAL DIRECTOR, PURDUE PHARMA testified via teleconference in support of this legislation. 1:30:03 PM BRIAN HOWES, INVESTIGATOR, OCCUPATIONAL AND PROFESSIONAL LICENSING testified via teleconference and was available for questions. 1:30:44 PM Co-Chair Meyer CLOSED PUBLIC TESTIMONY. Co-Chair Meyer MOVED to ADOPT Amendment 1 25-LS1092\V.2. Page 2, line 25: Delete "an inpatient in a licensed" Insert "those administered to a patient at a" Vice-Chair Stoltze OBJECTED for discussion. Ms. Blaisdell explained that Amendment #1 clarified language confusion in the bill. Vice-Chair Stoltze WITHDREW his OBJECTION. There being NO further OBJECTION, it was so ordered. 1:32:49 PM Co-Chair Meyer MOVED to ADOPT Amendment 2, 25-LS1092\V.1. Page 5, lines 7-9 Delete "The board may enter into agreements with dispensers that are not regulated by the state and practitioners in this state to submit information to and access information in the database subject to this section and the regulations of the board." Insert "The board may enter into agreements with (1) dispensers in this state that are not regulated by the state to submit information to and access information in the database, and (2) practitioners in this state to access information in the database, subject to this section and the regulations of the board." Vice-Chair Stoltze OBJECTED for discussion. Vice-Chair Stoltze requested if there were any other dispensers not regulated by the state. Ms. Blaisdell disclosed that originally the paragraph only mentioned military or tribal but it was broadened to include the internet or medical doctors on ships inside Alaska waters. Vice-Chair Stoltze WITHDREW his OBJECTION. There being NO further OBJECTION, it was so ordered. 1:34:58 PM Co-Chair Meyer referred to the fiscal notes. 1:35:26 PM Representative Gara questioned the date information is removed from the database. Ms. Blaisdell replied that it would be two years from the date the prescription was obtained. Representative Gara asked if there would be a problem reducing it to one year. Ms. Blaisdell replied that forty states have this database and most have a three year provision. Representative Gara inquired about the classification for the Class C and Class B offenses. 1:37:46 PM Ms. Blaisdell deferred to legislative legal or the Department of Law. She mentioned that the legislation is written this way in other states and seems to be the accepted nationwide practice. Representative Gara pointed out that "knowingly" is only written in regards to part of the crime. He wanted to make sure that the legislation is properly written so someone is not put in prison if they did not "know" what they were doing was wrong. 1:39:02 PM Ms. Blaisdell remarked that this issue was brought up before in House Judiciary with the example that if a janitor finds personal information that has been thrown in the trash of a doctor's office, the office did not "knowingly" give it away. But if the janitor then illegally uses that information, then that would be classified as "knowingly." Representative Gara wondered if someone who works for a pharmacist and "unknowingly" gives the medication to an improper individual would that be classified as "knowingly". 1:41:08 PM Ms. Blaisdell remarked that in the federal grant there is a significant emphasis on education for the proper use of the database. There has been discussions if the access to the database could be delegated to another individual on staff in a pharmacy or medical office and the resounding answer was no. 1:43:02 PM Vice-Chair Stoltze MOVED to REPORT HCS CSSB 196 (JUD) out of Committee, with a Letter of Intent, individual recommendations and accompanying fiscal notes. There being NO OBJECTION, it was so ordered. HCS CSSB 196 (JUD) REPORTED from the Committee with a Letter of Intent, no recommendations, and accompanying new fiscal note from the Department of Health and Social Services, and a previously published fiscal note from the Department of Economic Development. 1:44:15 PM