HB 145-EXPAND PHARMACIST AUTHORITY  6:02:18 PM CHAIR COSTELLO reconvened the meeting and announced the consideration of CS FOR HOUSE BILL NO. 145(HSS) "An Act relating to the Board of Pharmacy; relating to health care services provided by pharmacists and pharmacy technicians; and relating to the practice of pharmacy." She noted that this was the first hearing and the intention was to hear the introduction, take public testimony, answer any questions, and look to the will of the committee. 6:02:51 PM REPRESENTATIVE LIZ SNYDER, Alaska State Legislature, Juneau, Alaska, sponsor of HB 145, described HB 145 as a health care access bill that provides long overdue updates to the statutes governing the practice of pharmacy in Alaska so the profession is able to continue providing the services long associated with pharmacy. HB 145: • defines patient care services that pharmacists and support staff are able to provide • allows pharmacy technicians to administer vaccines and emergency medications under the direct supervision of a licensed pharmacist • empowers the Board of pharmacy to regulate pharmacists, student pharmacists, and pharmacy support staff • updates the statutes consistent with current practices and training • updates the provider antidiscrimination statute to support insurance coverage of these patient care services when they are provided by a pharmacist REPRESENTATIVE SNYDER clarified that HB 145 does not expand pharmacists' prescriptive authority. She highlighted the extensive support for the bill from pharmacists and health care organizations throughout the state. 6:05:53 PM CHAIR COSTELLO asked Alliana Salanguit to walk through the sectional analysis for HB 145. 6:06:01 PM ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska State Legislature, Juneau, Alaska, presented the sectional analysis for HB 145 on behalf of the sponsor. It read as follows: Sec. 1: Adds language to AS 08.80.030(b) Powers and Duties of the Board, statute that outlines the Board of Pharmacy's powers, that allows the Board of Pharmacy to adopt rules to regulate the independent monitoring of drug therapy and independent pharmacist prescribing of vaccines and naloxone.   Sec. 2: Adds a new subsection to AS 08.80.045 Nonprescription Drugs that aligns statute with the current practice of pharmacists recommending non- prescription medications and devices for treating minor and self-limited conditions. Sec. 3: Amends AS 08.80.155 Emergency Permit to increase the Board of Pharmacy's flexibility to grant emergency licenses for all relevant licenses used in pharmacies. Sec. 4: Amends AS 08.80.168(a) Administration of Vaccines and Related Emergency Medications by adding "prescribe" to existing vaccine administration statute. 6:07:10 PM MS. SALANGUIT continued the sectional analysis for HB 145. Sec. 5: Amends AS 08.80.168(b) by replacing "dispense" with "prescribe and administer" in regards to administering an opioid overdose drug. Sec. 6: Adds a new subsection to AS 08.80.168 that allows a pharmacy technician to administer a vaccine or related emergency medication but only if they have been authorized by the Board of Pharmacy to do so AND if they are under the direct supervision of a licensed pharmacist who meets the requirements in AS 08.80.168 (a). Sec. 7: Adds language to AS 08.80.297(a) Prescription Prices Available to Consumer that allows personnel who are not licensed pharmacists to disclose the cost of filling a prescription when directed by a pharmacist working at the same institution. 6:07:57 PM Sec. 8: Amends AS 08.080 Pharmacists and Pharmacies by adding a new section, AS 08.80.337 Other Patient Care Services, that: • Allows a pharmacist to provide patient care services for a disease or condition with an existing diagnosis under an agreement made with and approved by a practitioner • Limits patient care services that pharmacists can provide to those that are minor, self-limiting, and have a CLIA-waived laboratory test which guides clinical decision making. • Provides language that allows pharmacists to be reimbursed for providing these services Sec. 9: Amends AS 08.80.480 Definitions by removing "dosage form" as a definition of "equivalent drug product". This allows pharmacists to make minor, non- therapeutic changes to prescriptions using clinical judgement and expertise without contacting the prescriber for verbal or written approval. This does not allow a pharmacist to substitute a dosage form that would negatively impact patient outcomes, safety, or cost effectiveness. Examples of appropriate substitutions under this section include changing from a tablet form of medication to a capsule form of the same medication and strength. 6:09:18 PM MS. SALANGUIT continued the sectional analysis for HB 145. Sec. 10: Amends AS 08.80.480(30) by adding "dispensing" and "independent prescribing" to the definition of the "Practice of Pharmacy" to align with the changes made in Section 4 & 5 (AS 08.80.168) of this bill. These additions better represent actual provision of naloxone and vaccine by pharmacists. Sec. 11: Amends AS 21.36.090(d) Unfair Discrimination to include "pharmacists" as protected health care providers in the provider anti-discrimination statute. This aligns the state statute with federal statute (CFR 438.12) and afford pharmacists the same protection as all other healthcare providers when engaging health plans for covered services such as ordering laboratory tests, point-of-care testing, vaccine prescribing and administration, preventative health services, managing minor self-limiting conditions, and participating in collaborative disease state management. Sec. 12: Amends AS 21.42 The Insurance Contract by adding language ensuring health insurance plans reimburse pharmacists for eligible health care services they provide. CHAIR COSTELLO asked if there were questions. 6:09:34 PM SENATOR MICCICHE asked for an explanation of "unfair discrimination" because it seems as though it's related to providers. MS. SALANGUIT confirmed that the statute addresses unfair discrimination by providers; it lists all the health care providers with the exception of pharmacists. SENATOR MICCICHE asked what that statute covered and how it was associated with pharmacists. 6:10:24 PM REPRESENTATIVE SNYDER explained that Alaska statute and federal statute CFR 438.12 provide protections for other types of providers who deliver covered services. Pharmacists have federal protection and Section 11 of the bill extends that protection to pharmacists practicing in Alaska. She deferred further explanation to the chair of the Board of Pharmacy. SENATOR MICCICHE requested Board of Pharmacy Chair Ruffridge describe the type of discrimination this protects against. 6:11:37 PM JUSTIN RUFFRIDGE, Chair, State Board of Pharmacy, Soldotna, Alaska, explained that the change to the anti-discrimination statute allows pharmacists to bill for health care services through Medicare, Medicaid, and private insurance. Pharmacists often are unable to bill for certain testing and other limited patient care services because they are not recognized as a provider. The amendment addresses this issue by specifically mentioning pharmacists in the anti-discrimination statute. SENATOR MICCICHE expressed appreciation for the answer. 6:13:08 PM CHAIR COSTELLO opened public testimony on HB 145. 6:13:13 PM TOM WADSWORTH, representing self, Wasilla, Alaska, stated that he is a pharmacist licensed in Alaska and the administrator of UAAs ISU Doctor of Pharmacy program. He clarified that he was not representing the university. Rather, he was speaking as a practicing pharmacist and Doctor of Pharmacy educator in support of HB 145. He conveyed that HB 145 represents two years of close collaboration between the Alaska Pharmacists Association, the Board of Pharmacy, and the School of Pharmacy. The updates are long overdue and more accurately reflect the contemporary practices of pharmacy and pharmacists. The public is aware of pharmacists working in retail settings such as Walmart or Safeway but 60 percent of pharmacists actually work in health systems, primary care systems, and tribal systems. MR. WADSWORTH explained that a pharmacist is behind ever medication order and they also provide a variety of health care services unrelated to dispensing medication. This has been the case for over 30 years in Alaska, primarily in the VA system, tribal organizations, and private sector. He said this simply contemporizes the statute so the Board of Pharmacy is able to promulgate regulations around those practices. He highlighted that the Doctor of Pharmacy program in Alaska was growing its own pharmacists. Over 40 pharmacists had graduated and they were all practicing in Alaska communities. He said they are competent health care providers who should be able to practice at the highest level of their education. 6:15:53 PM LIV SWONGER, Doctor of Pharmacy Student, UAA/ISU Doctor of Pharmacy Program, Anchorage, Alaska, stated that she was a fourth year Doctor of Pharmacy student on the University of Alaska Anchorage campus, speaking in support of HB 145. She conveyed her belief that HB 145 will allow her to practice to the full extent of her education and training when she receives her Doctor of Pharmacy degree next year. Provisions in HB 145 will increase accessibility for pharmacists to provide critical health care services such as independently monitoring drug therapies for high blood pressure and diabetes. Additionally, HB 145 will help give pharmacists the ability to prescribe and be reimbursed for the life-saving overdose reverse medication such as Naloxone. This will help combat Alaska's high overdose deaths involving opioids. Passage of HB 145 will also mitigate barriers to care by allowing people experiencing illness such as strep throat or influenza to access testing and treatment through community pharmacists. Finally, adding pharmacists to the insurance anti-discrimination statute will ensure the sustainability of and access to services that pharmacists can provide. CHAIR COSTELLO asked Renee Robinson if she wanted to provide testimony on HB 145. 6:18:35 PM RENEE ROBINSON, President, Alaska Pharmacists Association (APA), Anchorage, Alaska, stated that she was available for questions and had not prepared specific testimony, but as president of the Alaska Pharmacists Association she was supportive of the legislation. This has been a collaborative effort among stakeholders over the past two years, she said. 6:19:00 PM CHAIR COSTELLO closed public testimony on HB 145. 6:19:20 PM At ease 6:19:43 PM CHAIR COSTELLO reconvened the meeting and solicited a motion. 6:19:49 PM SENATOR REVAK moved to report the committee substitute (CS) for HB 145, work order 32-LS0720\B, from committee with individual recommendations and attached fiscal note(s). CHAIR COSTELLO found no objection, and CSHB 145(HSS) was reported from the Senate Labor and Commerce Standing Committee. 6:20:19 PM REPRESENTATIVE SNYDER thanked the committee.