HB 58-CONTRACEPTIVES COVERAGE: INSURE; MED ASSIST  4:14:18 PM CO-CHAIR SPOHNHOLZ announced that the next order of business would be HOUSE BILL NO. 58, "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date." 4:14:51 PM REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, as prime sponsor, introduced HB 58. He said that HB 58 would bring Alaska's statutes into consistency with the federal contraceptive coverage guarantee, and mandate coverage for dispensing up to 12 months of contraceptives at a time. He said Alaskans often face challenges in trying to access contraceptives; for women in rural areas, multiple trips to a pharmacy can be an insurmountable barrier to consistent contraception, and a one-year's supply would help balance health with work and family life. He said that research shows that women who are allowed a 12-month supply of contraceptives have a 30 percent drop in unplanned pregnancy and a 46 percent drop in the likelihood of abortion, compared to women who are allowed only a one- or three-month supply. He pointed out that HB 58 would also save money for the state, due to a reduction in unplanned pregnancies. He said that improved access to contraception improves health for women and families, and he pointed out that HB 58 would support victims of reproductive coercion, or "contraceptive coercion," by providing long-acting reversible contraceptives (LARCs) or a 12-month supply of birth control. He said that a strong, longstanding body of evidence recognizes contraceptives as vital components of public health care that help women avoid unintended pregnancy and improve birth spacing, which have positive consequences for women, families, and society. The evidence strongly suggests that insurance coverage of contraceptive services, he said, is a low- cost or even cost-saving means of helping women. 4:20:49 PM LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State Legislature, detailed the sectional analysis for HB 59 on behalf of Representative Claman, prime sponsor. She read the sectional analysis, which read as follows [original punctuation provided]: Section 1  AS 21.42.427. Coverage for contraceptives. Amends AS 21.42 by adding a new section which (1) requires a health care insurer to provide coverage for prescription contraceptives and medical services necessary for those products or devices (including over-the-counter emergency contraception that was obtained without a prescription); (2) requires reimbursement to a health care provider or dispensing entity for dispensing prescription contraceptives intended to last for a 12-month period for subsequent dispensing; (3) prevents an insurer from offsetting the costs of compliance; (4) prevents an insurer from restricting or delaying coverage for contraceptives; (5) if the provider recommends a particular service or FDA-approved item based on a determination of medical necessity, the plan or issuer must cover that service or item without cost sharing; and (6) exempts religious employers if certain criteria are met. Section 2  AS 29.10.200. Limitation of home rule powers. Amends AS 29.10.200 by adding a provision applying to home rule municipalities. Section 3  AS 29.20.420. Health insurance policies. Amends AS 29.20 by adding a new section clarifying that municipal health care insurance plans that are self-insured are subject to the requirements of sec. 1. Section 4  AS 39.30.090. Procurement of group insurance. Clarifies that a group health insurance policy covering employees of a participating governmental unit is subject to the requirements of sec. 1. Section 5  AS 39.30.091. Authorization for self-insurance and excess loss insurance. Clarifies that a self-insured group medical plan covering active state employees provided under this section is subject to the requirements of sec. 1. Section 6  AS 47.07.065. Payment for prescribed drugs. Requires the Department of Health and Social Services to pay for prescription contraceptives intended to last for a 12-month period for subsequent dispensing for eligible recipients of medical assistance, if prescribed to and requested by the recipient, as well as medical services necessary for those products or devices. The Department of Health and Social Services must also provide coverage for over-the-counter emergency contraception that was obtained without a prescription. Section 7  Uncodified law - applicability Requires the Department of Health and Social Services to immediately amend and submit for federal approval a state plan for medical assistance coverage consistent with sec. 6 of this Act. Section 8  Uncodified law - applicability Makes sec. 6 of the Act conditional on the approval required under sec. 7 of the Act. Section 9  If sec. 6 of this Act takes effect, it takes effect on the day after the date the revisor of statutes receives notice from the commissioner of health and social services under sec. 8 of this Act. 4:24:15 PM REPRESENTATIVE MCCARTY asked whether insurance companies would be required to pay for 12 months of contraceptives. He expressed the concern that a person may receive the full prescription and then no longer be covered by insurance, and he asked whether there exists a requirement for other medications to be covered in a similar manner. REPRESENTATIVE CLAMAN responded that a person would be able to continue taking their prescribed medication in such a scenario. He pointed out that if someone receives 12 months of birth control, then changes jobs after six months, the new employer's insurance wouldn't have to pay for the birth control the person was previously prescribed. REPRESENTATIVE MCCARTY asked what concerns have been expressed by representatives in the insurance industry. REPRESENTATIVE CLAMAN replied that the insurance industry has expressed no concerns. 4:27:12 PM The committee took a brief at-ease. 4:27:35 PM LORI WING-HEIR, Director, Division of Insurance, Department of Commerce, Community, and Economic Development, said that insurance companies are aware of the existence of the proposed legislation, but that they have not contacted the Division of Insurance with any comments. 4:28:44 PM CO-CHAIR SPOHNHOLZ noted that this is the third time that the sponsor has introduced the proposed legislation. She commented that other medications are available for longer periods of time. MS. WING-HEIR said, "That is a very good point." She pointed out that most prescriptions have a 90-day or even a six-month supply, and she said that the Division of Insurance encouraged health care providers to allow longer supplies of medication during the pandemic. 4:29:42 PM REPRESENTATIVE MCCARTY expressed concerns about setting a precedent for longer supplies of medications. MS. WING-HEIR explained that insurance plans operate on either a fiscal year or calendar year. If a patient has an appointment in November and receives a three-month supply of medication, she said, the patient may have a new insurer or plan on January 1. She stressed that it's quite common for insurance coverage to change midway through a prescription supply. 4:31:10 PM REPRESENTATIVE NELSON asked for information on receiving medications via mail. REPRESENTATIVE CLAMAN replied that his understanding is that insurers prefer mail order plans due to lower costs, but that mail order plans are optional. REPRESENTATIVE NELSON expressed that mail order would be a better way to receive medications. REPRESENTATIVE CLAMAN responded that he always has been a supporter of mail order, but that many patients want a consultation with a pharmacist, and he wouldn't want to stand in the way of consumer choice. 4:34:06 PM CO-CHAIR FIELDS interjected that he contacted a representative from Aetna, and he said the company expressed that it was "neutral" on HB 58. CO-CHAIR SPOHNHOLZ pointed out that the insurance industry is well-represented, and the committee and sponsor would be aware of any concerns. 4:34:26 PM REPRESENTATIVE SNYDER added that the provisions under HB 58 would result in fewer visits to the doctor, which would help recover any costs to the insurance company. She pointed out that several states allow contraceptive coverage for periods of between 15 and 22 months. CO-CHAIR SPOHNHOLZ added that reducing unintended pregnancies would also save money for insurance companies. 4:35:31 PM REPRESENTATIVE KAUFMAN referred to page 1, line 11, of the text of the proposed legislation and asked Representative Claman about the inclusion of emergency contraception. MS. KUBITZ responded that the inclusion of emergency contraception was made during the hearings of HB 58 in the House Health and Social Services Standing Committee. She said the intent of the inclusion was to allow someone who needs emergency contraception to purchase it over-the-counter and then submit to the insurance company for reimbursement. REPRESENTATIVE KAUFMAN asked about being covered by insurance with which a patient is "philosophically aligned." MS. KUBITZ referenced the religious exemption discussed in the sectional analysis, and she pointed out that employers that object to emergency contraception have the option to choose a certain plan. 4:37:47 PM REPRESENTATIVE CLAMAN suggested a discussion with Ms. Wing-Heir on religious exemptions for contraceptive coverage. 4:38:18 PM MS. WING-HEIR stated that an employer does not have to offer employees a plan that includes contraception. REPRESENTATIVE KAUFMAN asked for clarification. MS. WING-HEIR responded that an employer chooses an insurance plan for a group. 4:40:13 PM REPRESENTATIVE KAUFMAN referred to the text of the proposed legislation, page 2, lines 28-30, which read as follows: In this subsection, "cost containment" means incentivizing the use of generic or lower cost medications or the use of health care providers or pharmacies that offer services or prescriptions at a lower negotiated rate. REPRESENTATIVE KAUFMAN asked whether the language "avoids" other opportunities for cost containment. MS. KUBITZ responded that the inclusion of that language was a compromise. She said that the sponsor wanted the option to encourage the use of generic medications. REPRESENTATIVE KAUFMAN expressed the opinion that, as written, it looks like it is defining cost containment. 4:41:53 PM CO-CHAIR SPOHNHOLZ shared her understanding that this provision relates directly to contraception, so that cost containment measures could exist without interfering in the doctor-patient relationship. She pointed out that birth control has uses other than simply preventing pregnancy, and generic options sometimes don't meet the therapeutic need. [HB 58 was held over.]