SENATE BILL NO. 71 "An Act relating to the practice of pharmacy; and relating to the administration of vaccines and related emergency medications." 2:06:27 PM Co-Chair MacKinnon discussed housekeeping. 2:06:51 PM SENATOR CATHY GIESSEL, SPONSOR, provided a sponsor statement: Currently, Alaska pharmacists require oversight by a medical doctor or nurse practitioner to oversee their immunization authority. SB 71 will give already- trained and certified pharmacists authority to immunize Alaska adults and children without having to contract with often hard-to-find doctors/nurse practitioners to oversee their immunization programs. This bill will particularly help rural pharmacies increase their reach to populations who often see their pharmacist more often than a medical professional. Consumers would enjoy more flexibility with their schedules and cost savings by being able to access their local pharmacist for crucial immunizations. SB 71 expands authority for Alaska pharmacists to independently administer all vaccines and would reduce burdensome collaborative practice agreements. Studies have shown that states in which pharmacists are granted broad authority to administer vaccines have higher immunization rates. In 2013 Alaskan pharmacists administered over 13,000 flu vaccines and this legislation would significantly improve access to additional vaccinations and public health as a result. I ask for your support to expand the authority of pharmacists to independently administer vaccinations. Senator Giessel added that SB 71 would provide already trained, and certified, pharmacists the authority to immunize Alaska adults and children, without having to contract with physicians or nurse practitioners to oversee their programs. She said that since 2005, all pharmacists had been trained in immunization procedures as part of their education program, pharmacists who attended school before 2005, would be required to take an immunization training program approved by the Board of Pharmacy. She highlighted the details of the training. She believed that the bill would be particularly helpful in rural areas where the populations encountered their pharmacists more often that their medical providers. She opined that Alaska had the lowest immunization rates in the country; studies had shown that in states where pharmacists had the authority to administer medications immunization rates were higher. She stated that all of the vaccinations that would be administered by a pharmacist would be reported to the statewide data program, VacTrack. 2:09:50 PM Co-Chair MacKinnon OPENED public testimony. 2:10:29 PM SCOTT WATTS, ALASKA PHARMACY ASSOCIATION, JUNEAU, testified in support of SB 71. He related that Alaska was rated below the national level for immunizations. He reiterated that pharmacists were trained in immunizations and were acting as a resource for the public concerning immunization accessibility and travel schedules. He commented that increased vaccination rates would help to lower health care costs in the state. He commented on the fiscal note and observed that it was a one-time cost, which would be easily off-set by the lower health care costs. 2:12:18 PM Senator Olson expressed concern about adequate training for adverse reactions to vaccinations, such as anaphylactic shock. 2:14:18 PM Mr. Watts replied that protocol existed for epinephrine injections to halt anaphylactic reactions. He added that the pharmacists that administered the vaccinations were CPR certified. Senator Olson clarified that pharmacists did not receive the same training as physicians. He said that pharmacists were not trained in intubation. 2:15:26 PM AT EASE 2:15:59 PM RECONVENED Senator Olson reiterated that most pharmacists did not have the same training as physicians and were not trained on intubation. Mr. Watts responded that he had not meant to imply that the two had the same training. Senator Olson spoke to the state's lagging vaccination numbers. He said that there existed the perception that vaccines delivered in multiple sequences over a short period of time could result in adverse reactions, like Sudden Infant Death Syndrome and Autism, but noted that those theories had largely been debunked. 2:17:51 PM MARGARET SODEN, SELF, FAIRBANKS (via teleconference), testified in support of the bill. She related that pharmacies in her community were open evenings and weekends, unlike medical offices; additionally, pharmacists interacted with patients more often than other practitioners because they returned to the pharmacy on a regular basis. She felt that the legislation would result in more pharmacies offering vaccinations, which would lead to more Alaskans being immunized. 2:19:46 PM AMBER BRIGGS, SELF, SOLDOTNA (via teleconference), testified in support of the legislation. She related that she was a pharmacist and had administered many vaccinations. She believed that not providing immunizations would result in adverse economic impacts to the state. She opined that the rates of emergency room visits due to the H1N1 flu virus increased when people did not vaccinate against the flu. She concluded the allowing pharmacists to independently administer vaccinations would help to decrease healthcare costs in the state. 2:22:09 PM RYAN RUGGLES, DISTRICT PHARMACY MANAGER, CARRS SAFEWAY, ANCHORAGE (via teleconference), testified in support of the legislation. He echoed the comments of the previous testifiers. He believed that the bill offered convent and economical access to vaccinations. He noted that pharmacies across the state already administered vaccinations. 2:24:48 PM Co-Chair MacKinnon whether shots were administered on site at Carrs Safeway. Mr. Ruggles indicated that all immunizations were available except for Yellow Fever. Co-Chair MacKinnon asked whether the store contracted with a doctor. Mr. Ruggles replied that the store contracted with a nurse practitioner through a collaborative practice agreement. Co-Chair MacKinnon queried the cost of the contract. Mr. Ruggles responded that contract agreements with providers varied. He could not provide the specific cost offhand, but noted that the price could vary drastically between providers. 2:25:51 PM Co-Chair MacKinnon informed the committee that a representative of the Department of Health and Social Services was available online for questions. 2:26:08 PM BARRY CHRISTENSEN, CO-CHAIR, ALASKA PHARMACISTS ASSOCIATION LEGISLATIVE COMMITTEE, KETCHIKAN (via teleconference), spoke in favor of the legislation. He believed that the bill would provide improved access to vaccinations and improve public health. He felt that the fiscal note could be justified by the healthcare savings that would be realized by the lesser number of hospitalizations due to the flu virus. He related that, according to the Center for Disease Control (CDC), for every $1 spent on vaccinations - $10 in healthcare costs were saved. He noted the letter of support from the National Association of Trade Drugstores in member packets (copy on file). 2:28:26 PM JASON TAPLEY, SELF, JUNEAU, testified in support of the bill. He felt that the legislation would increase access to vaccinations for those with disabilities or other travel constraints. 2:29:39 PM Senator Olson asked Mr. Tapley what kind of resources and equipment were available to the pharmacists where he worked that addressed adverse reactions to vaccinations. Mr. Tapley replied that most pharmacists were train in basic life support; most pharmacies were stocked with epi- pens and Benadryl, which could be used in the short-term until an ambulance arrived. 2:31:05 PM Co-Chair MacKinnon CLOSED public testimony. 2:31:22 PM Senator Giessel commented that the collaborative agreements that were in place currently had been in place since 1989. She asserted that healthcare education had evolved, pharmacists were now required to earn PHD degrees and were highly educated. She contended that intubation was a highly refined skill requiring repeated practice and was a rare necessity. 2:32:45 PM Senator Dunleavy queried the fiscal note. Senator Giessel spoke to the fiscal note 1, from the Department of Commerce, Community, and Economic Development. She stated that the regulatory costs would be covered by the licensing fees. She continued to fiscal note 2, from the Department of Health and Social Services, which reflected a capital budget cost of $50 thousand. She referred to the audit that had been completed for the department which documented the system deficits and known non-compliance instances for many sections of the state's Medicaid management information services. She argued that the system used for enrollment in and payment for Medicaid needed a complete renovation. 2:34:31 PM Senator Olson agreed with Senator Giessel assessment of the immunizations needs of the state. 2:35:03 PM Senator Bishop asked whether there was data which reflected the number of cases of adverse reactions to vaccinations in the state. Senator Giessel commented that the data would need to be gathered. 2:36:01 PM Senator Olson asked whether the sponsor had heard from any of the Native Health organizations in rural Alaska. Senator Giessel responded in the negative. Senator Olson asked whether the administration supported the legislation. Senator Giessel replied that she did not know. Senator Olson asked whether the sponsor had heard from the Alaska State Medical Association of the Alaska State Medical Board. Senator Giessel said that she had not received any negative feedback from either organization. 2:37:10 PM Co-Chair MacKinnon commented that there was representation from the state of Alaska available to answer questions. 2:37:45 PM ERIN NARUS, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, ANCHORAGE (via teleconference), stated that the department did not have a position on the legislation. Senator Olson asked whether the fiscal notes seemed accurate. Ms. Narus replied that the request in fiscal note 2 was necessary in order to comply with federal requirements. SB 71 was HEARD and HELD in committee for further consideration. 2:39:19 PM AT EASE 3:30:56 PM RECONVENED Co-Chair MacKinnon handed the gavel over to Co-Chair Kelly.