SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS  4:35:14 PM CHAIR HIGGINS announced that the next order of business would be CS FOR SENATE BILL NO. 169(FIN), "An Act establishing in the Department of Health and Social Services a statewide immunization program and the State Vaccine Assessment Council; creating a vaccine assessment account; requiring a vaccine assessment from assessable entities and other program participants for statewide immunization purchases; repealing the temporary child and adult immunization program; and providing for an effective date." 4:35:38 PM SENATOR CATHY GIESSEL, Alaska State Legislature, referred to earlier testimony regarding HB 376, for extension of the termination date for the Alaska Health Care Commission. She noted that the commission reviewed the high cost of health care in Alaska, and, as revenue was declining in the state, it was necessary to be very attentive to the budget. She declared that "vaccines reduce the cost of health care," and that it was a recommendation of the Alaska Health Care Commission. She reported that SB 169 created a private/public partnership between the insurance companies and self-insured groups with the State of Alaska to address vaccine costs through a state vaccine assessment council, which would oversee a reinstatement of universal vaccines in Alaska through the Department of Health and Social Services (DHSS). She reflected on the concerns of health care in Alaska by Senator Ted Stevens, and shared an anecdote about the generous funding for vaccines he secured. She reminded the committee about the earlier high rates of polio, as well as Hepatitis A & B, and pointed out that, with vaccines, these had almost been eradicated. She noted that the last outbreak of measles in Alaska, in 2000, had been introduced by a young unvaccinated child arriving from South Korea, which resulted in the understanding for a need of a second measles, mumps, and rubella vaccine. She reported that there was currently an outbreak of chicken pox in the Kenai/Soldotna area, which was dangerous for adult men, pregnant women, and infants. She declared that vaccines could prevent chicken pox. She pointed out that earlier federal funding of $4.3 million each year to Alaska for vaccines was now only $700,000. She reported on a bill that had been introduced in 2012 as a temporary solution, Senate Bill 140, which had passed unanimously in both the House and the Senate to use $4.3 million of state funding for three years of vaccines. During this time, the DHSS had been directed to find a funding solution other than the state, resulting in proposed SB 169. The proposed bill would create a council, page 2, line 19 through page [4], line 8, which would operate under DHSS and its staff. She explained that the council would determine assessments for the insurance companies, and then use that money to buy low cost vaccines to be distributed around the state. She allowed that this public/private partnership was working in nine other states, resulting in substantial savings. She referred to 24 letters of support [Included in members' packets], including a letter of support from Premera Blue Cross. 4:43:38 PM ROSALYN SINGLETON, MD, Alaska Native Tribal Health Consortium (ANTHC) Immunization Program, stated her support for the proposed bill to improve access to vaccines for Alaskans, streamline distribution, and reduce the administrative burden for providers, and she directed attention to a PowerPoint titled "Alaska - What have vaccines done for you." She referred to slide 2, "Vaccination: an ounce of prevention saves a ton of lives," which offered a brief summary of the dramatic improvement in disease control because of universal access to vaccines in Alaska. She moved on to slide 3, "Vaccine - Preventable Disease Success, Alaska," and stated that Hib meningitis, measles, and Hepatitis A outbreaks had virtually disappeared. She pointed out that measles were most often brought in from other countries, and in Alaska, this was only a plane flight away. She declared that it was imperative to maintain a high rate of vaccination in children in order to control the disease. She discussed slide 4, "Polio," and explained that it attacked the nervous system, causing muscle weakness, paralysis, or death. She reported that the last case of polio in the United States had been in 1979, although polio was still endemic in other parts of the world and could be brought into the country. She moved on to slide 5, "Diphtheria," and shared an anecdote of an epidemic in Nome, which was today highlighted by the Iditarod Race. She relayed that diphtheria was also a disease of the past in the U.S. because of vaccines. Discussing slide 7, Hepatitis A and B in Alaska," she relayed that there had been almost total control of Hepatitis A in Alaska since the vaccine. She pointed to slide 6, "Hib disease," and explained that it had decreased. She concluded with slide 8, "Measles," and stated that Alaska had not had measles since 2000. She emphasized that since 2009, providers had fronted the cost of vaccine for insured patients, while separately stocking private and state purchased vaccines. She relayed that SB 169 would re-establish universal access to vaccines through the self-sustaining, cost effective private- public partnership. REPRESENTATIVE REINBOLD opined that this was leveraging the state's buying power to reduce the cost and increase access for vaccines. She asked if there were any adverse reactions or concerns for vaccinations and immunizations on a larger scale. DR. SINGLETON replied that all vaccines could have adverse side- effects. She stated that vaccines were the most tested and regulated health care benefit that we have. She said there was not any evidence for significant side effects from the newer vaccines, as they had been extensively tested with post vaccine testing and evaluation. 4:50:50 PM DR. SINGLETON, in response to Representative Reinbold, stated that there was not any link between vaccines and autism. There had been a 1998 paper published in Britain, based on research of 12 children, claiming a link between vaccines and autism, which had ultimately been found to be fraudulent. The paper was disavowed by the British Medical Journal, and the data had not been replicated in subsequent studies. She declared that this report had sparked unwarranted concerns, and she expressed her confidence that there was not any link between vaccines and autism. REPRESENTATIVE REINBOLD said that the proposed bill could have "a long term, very positive effect on our state budget." CHAIR HIGGINS expressed his agreement with evidence that vaccines were good. He declared that the proposed bill raised the question for how to pay for this. He stated his concern with third party payers and Tricare making these payments. He stated that he wanted to make the program work. CHAIR HIGGINS asked for more information about the third party payer, specifically Tricare, as the focus of the proposed bill was for adult immunizations. He stated that federal money paid for child immunizations. He opined that the "donut hole" was for adult immunizations, as Medicare did not offer coverage. He asked how the proposed program would work for adults. He stated that only one other state included adults in vaccine coverage. He offered his belief that Vermont most closely mirrored the proposed bill. 4:56:14 PM JILL LEWIS, Deputy Director - Juneau, Central Office, Division of Public Health, Department of Health and Social Services, expressed agreement that Vermont had included adult vaccines in its universal program since 2009. She declared that, without the proposed bill, when the temporary funding for vaccines was depleted at the end of 2015, the state would not have a state supply for all children. She clarified that the only state supplied vaccine would be for the 50 percent of children covered by a federal program, Vaccines for Children. She reported that this would only include Medicaid, Alaska Native, American Indian, and uninsured children. She stated that anyone with private pay insurance would not receive any state supplied vaccine, as the burden would be on the providers to purchase and pay up front for vaccines, and then seek reimbursement from the payers. She explained that there was no safety net program for adults, and each payer would need to be assessed funding for its patients. She noted that Tricare had not participated and paid the reimbursement in other states. She reported that the proposed bill had reviewed the programs in other states and decided that, should Tricare not participate, then the state would not supply the vaccine and other payers would not have to pay, so the providers would continue to purchase the vaccine on the open market and continue to seek reimbursement from Tricare, as was the current practice. She said that the provider could continue to purchase vaccines privately when there was not an accessible payer. REPRESENTATIVE NAGEAK asked that the vaccine for shingles be made available for people. REPRESENTATIVE KELLER reflected that the proposed bill was "a big issue and lots of pitfalls in it." He requested that the questions be answered before the bill was moved from the committee, that any unintended consequences be addressed, and that the costs be closely reviewed. CHAIR HIGGINS said that [SB 169] would be held over.