ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 23, 2023 3:04 p.m. DRAFT MEMBERS PRESENT Representative Mike Prax, Chair Representative Justin Ruffridge, Vice Chair Representative Dan Saddler Representative Jesse Sumner Representative Zack Fields Representative Genevieve Mina MEMBERS ABSENT  Representative CJ McCormick COMMITTEE CALENDAR  CONFIRMATION HEARING(S): Commissioner, Department of Health Heidi Hedberg Anchorage - HEARD DEPARTMENT OF HEALTH HOUSE BILL NO. 112 "An Act relating to the Board of Pharmacy; relating to the practice of pharmacy; relating to pharmacies; relating to prescription drug manufacturers; relating to prescriptions for epinephrine; relating to the administration of epinephrine; and providing for an effective date." - HEARD & HELD HOUSE BILL NO. 60 "An Act relating to the licensing of runaway shelters; relating to advisors to the board of trustees of the Alaska Mental Health Trust Authority; relating to the sharing of confidential health information between the Department of Health and the Department of Family and Community Services; relating to the duties of the Department of Health and the Department of Family and Community Services; and providing for an effective date." - MOVED CSHB 60(HSS) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION  BILL: HB 112 SHORT TITLE: PROFESSION OF PHARMACY SPONSOR(s): REPRESENTATIVE(s) RUFFRIDGE 03/13/23 (H) READ THE FIRST TIME - REFERRALS 03/13/23 (H) HSS, L&C 03/23/23 (H) HSS AT 3:00 PM DAVIS 106 BILL: HB 60 SHORT TITLE: RUNAWAYS; DFCS/DOH: DUTIES/LICENSING/INFO SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR 02/03/23 (H) READ THE FIRST TIME - REFERRALS 02/03/23 (H) HSS, FIN 02/28/23 (H) HSS AT 3:00 PM DAVIS 106 02/28/23 (H) Heard & Held 02/28/23 (H) MINUTE(HSS) 03/07/23 (H) HSS AT 3:00 PM DAVIS 106 03/07/23 (H) Heard & Held 03/07/23 (H) MINUTE(HSS) 03/14/23 (H) HSS AT 3:00 PM DAVIS 106 03/14/23 (H) 03/23/23 (H) HSS AT 3:00 PM DAVIS 106 WITNESS REGISTER HEIDI HEDBERG, Commissioner Designee Department of Health Juneau, Alaska POSITION STATEMENT: Testified as commissioner designee of the Department of Health. JEANNIE MONK, MPH, Senior Vice President Alaska Hospital and Healthcare Association Anchorage, Alaska POSITION STATEMENT: Testified in support of Commissioner Designee Hedberg. ELLEN HODGES, MD, Chief of Staff Yukon Kuskokwim Health Corporation Bethel, Alaska POSITION STATEMENT: Testified in support of Commissioner Designee Hedberg. RON MEEHAN, Policy and Advocacy Manager Food Bank of Alaska Anchorage, Alaska POSITION STATEMENT: Testified in support of the commissioner designee. NANCY MERRIMEN, CEO Alaska Primary Care Association Anchorage, Alaska POSITION STATEMENT: Testified in support of the commissioner designee. ELIZABETH RIPLEY, CEO Mat-Su Health Foundation Wasilla, Alaska POSITION STATEMENT: Testified in support of the commissioner designee. VERNE BOERNER, representing self Anchorage, Alaska POSITION STATEMENT: Testified in support of the commissioner designee. BRAEDAN GARRET, staff Representative Ruffridge Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Read the sectional analysis of HB 112 on behalf of Representative Ruffridge, prime sponsor. ASHLEY SCHABER, Chair Board of Pharmacy Anchorage, Alaska POSITION STATEMENT: Provided a PowerPoint presentation on HB 112. SYLVAN ROB, Director Division of Corporations, Business, and Professional Licensing Department of Commerce, Community, and Economic Development Anchorage, Alaska POSITION STATEMENT: Answered questions during the hearing on HB 112. RILEY NYE, Staff Representative Mike Prax Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented the explanation of changes for HB 60, on behalf of the bill sponsor, House Rules by request of the governor. HEATHER CARPENTER, Deputy Director Department of Health Juneau, Alaska POSITION STATEMENT: Provided the explanation of changes in a proposed committee substitute for HB 60. STACIE KRALY, Director Civil Division Department of Law Anchorage, Alaska POSITION STATEMENT: Answered questions relating to HB 60. ACTION NARRATIVE 3:04:08 PM CHAIR MIKE PRAX called the House Health and Social Services Standing Committee meeting to order at 3:04 p.m. Representatives Ruffridge, Sumner, Fields, Mina and Prax were present at the call to order. Representative Saddler arrived as the meeting was in progress. ^CONFIRMATION HEARING(S): Department of Health, Commissioner   3:05:26 PM CHAIR PRAX announced that the first order of business would be a confirmation hearing for the governor's appointee for commissioner of the Department of Health. 3:06:48 PM HEIDI HEDBERG, Commissioner Designee, Department of Health, stated that she was born in Utah and raised in Seattle. She said she had moved to Alaska in 1995 to attended Alaska Pacific University and graduated with an outdoor studies degree. She shared that her husband is from Alaska, and that they have two boys. She explained that, prior to her state service, she worked 13 years in the non-profit sector, which provided the opportunities to travel to rural communities in the state and showed the different perspectives around the healthcare system. She said that she has worked for the Division of Public Health for the past 13 years and was the director for the last four years. She explained that, during her time as director and during the COVID-19 pandemic, she represented the department in unified command along with the federal Division of Homeland Security, Emergency Management and Alaska's Department of Public Safety for the pandemic response. She shared that being director and leading the pandemic response was one of the most fulfilling jobs. She said that she is thankful for staff and partners that positioned Alaska to fare better compared to other rural states, with fewer hospitalizations and fewer deaths; through partnerships with tribal health organizations, Alaska was ranked number one for vaccinations per capita when the COVID-19 vaccine became available in December 2020. She stated that her vision for the next four years is to help the wellbeing and self-sufficiency of Alaskans, which will be achieved through leveraging public health. She said that, as the chief health strategist, she will address insufficient systems in public assistance, addressing the gaps in the behavioral health continuum of care, caring for the ability to age in place, and focusing on timely reimbursement of Medicaid; her vision is that, through these outcomes, Alaskans will be healthier, the economy more vibrant, and healthcare will be more accessible and affordable. 3:12:48 PM COMMISSIONER DESIGNEE HEDBERG explained that public health has strategies to better the health of Alaskans, which is the "Healthy Alaskans 2030" Department of Education and Early Development (DEED) health improvement plan. She further explained that prevention is cheaper than treatment and is a cost containment tool over time. She stated that the Division of Public Assistance is a low point - not a reflection of the dedicated staff that are trying their hardest - but rather a reflection of the inefficient systems. She said that she knows information technology (IT) systems need to be implemented, and that they have a workflow management tool that is being leveraged so that it can be more efficient for staff; through the department reorganization, things like this are affordable. She said that, looking back at the state's behavioral health continuum of care, there has been a lot of progress, but there's still more to go as gaps are still present. She said that last year's passage of House Bill 172 [passed during the Thirty- Second Alaska State Legislature] addressed one of the gaps, and now over the next four years, behavioral health services need to be implemented across the state. She spoke on aging in place for elders and the disabled using local resources, as it is another key to healthy families. She shared that, in November, she had heard from advocacy groups calling for an update to rate setting methodologies, increasing the workforce and allowing individuals with disabilities to choose their direct services. She recognized healthcare services, which she said touch all parts of the Medicaid program. 3:16:23 PM COMMISSIONER DESIGNEE HEDBERG stated that she has a great team, who has been able to save $370 million in general funds over past six years through tribal reclaiming. She said that her vision is to see the governor's initiative on healthy families realized, and that strong families are the foundation for a vibrant economy and community. She concluded that she brings organizational leadership, stability, innovation, and a team approach to the role. 3:18:31 PM REPRESENTATIVE MINA said she appreciates her speaking on issues relating to the department, and that with the department split, there is much opportunity to examine workplace culture and rebuild relationships. She asked her to speak about the importance of transparency in the department. COMMISSIONER DESIGNEE HEDBERG answered that transparency means building relationships with staff, as they need to know what her own vision and leadership style is. She said that department has 1,500 employees, and that she has held town hall meetings with the Division of Public Assistance, which she is working on making a regular occurrence. In regard to department partners, she explained that the department cannot reform healthcare on its own, so it needs to partner with tribal health, tribes, hospitals, health centers, and businesses. 3:21:04 PM REPRESENTATIVE SADDLER commented that the former Department of Health and Social Services was massive and had many responsibilities. He asked, even with the department organization, whether the new department's mission is still too big. COMMISSIONER HEDBERG answered that the mission is health, wellbeing, and self-sufficiency, and in looking at the divisions within the department, the mission is rightly matched. She reiterated that the department cannot do this alone; like healthcare providers licensed with the Department of Commerce, Community, and Economic Development or partnering with the DEED to ensure school age children wellness. She stated that partnerships with the business sector are critical towards making changes in the workforce environment. She added that the mission is set for the department, and that other state agencies and stakeholders need to be leveraged in order to move forward in creating a healthy workforce, economy, and people. 3:23:20 PM REPRESENTATIVE RUFFRIDGE said he can personally attest to Commissioner Designee Hedberg's work during the pandemic, and that he appreciates the long hours and weekends worked during an ever-changing situation. He asked about reports regarding staff morale and what plan there would be to help improve the working environment. COMMISSIONER HEDBERG commented that the pandemic showed that many staff in the department are exhausted. She shared that she met with staff, and that it'd be important to hear from them since they may just want to share their concerns and know leadership supports them. She said there are three areas she thinks of when it comes to staff; culture, work environment, and compensation all create an environment where one wants to work and fulfill their duties. She said her focus on addressing morale and retention is being done by having a connection with staff, examining compensation, and providing tuition reimbursement. 3:27:44 PM REPRESENTATIVE FIELDS thanked Commissioner Designee Hedberg, the department, and the governor for advancing the healthy family initiative as an organizing principal, which should guide policy and budget decisions because it will drive preparedness to read and reduce adverse childhood experiences. He further thanked her for engaging with stakeholders, in that, the department had listened, responded, and worked on solutions with them. He shared that he cares about early care learning, which is something her staff has been proactive about. He stated that she has his unequivocal support based on her record, and asked that she be honest with the legislature when there is a crisis, like Supplemental Nutrition Assistance Program (SNAP) benefits, so that the legislature can fund the department adequately. 3:30:31 PM REPRESENTATIVE MINA said she echoes Representative Field's comments. She asked if Commissioner Designee Hedberg had thoughts about how the department could partner with the Office of Health Savings. COMMISSIONER DESIGNEE HEDBERG responded that the Office of Health Savings is an "ask" within department's budget. She said there are a lot of ideas around healthcare reform and cost savings; it ultimately boils down to bandwidth, in that, the office request is for positions that can investigate ideas and demonstrate how they work and how to expand them. 3:31:44 PM REPRESENTATIVE SADDLER asked whether, given the recent revenue shortfall forecast, Commissioner Designee Hedberg had any thoughts about how she might help the department run more efficiently and at less cost. COMMISSIONER DESIGNEE HEDBERG explained that it starts with having a discussion with division directors regarding what stays in the budget, operating efficiencies, and how to leverage partnerships. She provided examples, like increased obesity and hypertension, and said the cost of preventing those conditions are cheaper than the treatment and can serve as a cost containment tool over time. She shared that the fresh start program is focused on treating adults with the aforementioned conditions, as well as helping reduce smoking; there were over 1,000 people that registered with the program with a total reduced weight of 5,000 pounds. 3:34:31 PM REPRESENTATIVE SUMNER asked how much in federal funds is being spent on the fresh start program. COMMISSIONER DESIGNEE HEDBERG answered that she doesn't know. 3:34:50 PM REPRESENTATIVE SADDLER asked, regarding commissioner compensation, if Commissioner Designee Hedberg can work with the current pay for the next four years. COMMISSIONER HEDBERG answered yes. In response to another question from Representative Saddler, she answered that the healthy families initiative has three pillars: healthy beginnings, improving access, and healthy communities. She explained that the department needs to complete its studies around childcare in order to make recommendations on how to support and sustain childcare in the state, as having such care will allow parents to enter the workforce. 3:36:51 PM CHAIR PRAX recounted when the economy in Alaska was shut down due to the COVID-19 pandemic, and stated that he was impressed with the department's response. He asked her what she learned from the experience. COMMISSIONER DESIGNEE HEDBERG shared that she had received a call regarding a repatriation flight from Wuhan in January, and then later in March, the public health emergency continued to escalate; from March to May, the science behind the virus's transmission was unknown. She recounted that the governor and others wanted to ensure the economy opened as quickly as possible, so there was much effort in getting personal protective equipment and pandemic guidance. She relayed that many communities took the measures and did what was best for them at the community level while the state focused on getting the economy going. She said that Commissioner Adam Crum, Dr. Anne Zink, and herself worked with the governor and their partners to assess what is known so far about the virus. CHAIR PRAX commented that there was, and still is, lingering skepticism of public health and the health system in general. He inquired as to how trust could be restored. COMMISSIONER DESIGNEE HEDBERG responded that it is about meeting people and communities where they are at and understanding what their concerns are around public health. She explained that many listening sessions were held during the pandemic where updates were shared and questions were fielded, and that such sessions might be needed over the coming months. 3:42:32 PM CHAIR PRAX opened public testimony on the confirmation hearing. 3:43:03 PM JEANNIE MONK, MPH, Senior Vice President, Alaska Hospital and Healthcare Association, stated that she is testifying in support of the appointment of the Commissioner Designee Hedberg. She shared that she worked with her for the past 12 years and has seen her commitment to the health of Alaskans. She said she appreciates her willingness to step forward to the new role, and that she has a strong team; further, although she is new to the role, she is taking ownership of the problems and is focused on solving them. She said her success is her willingness to build relationships, and that she will be fair and inform stakeholders. 3:45:01 PM REPRESENTATIVE SADDLER asked what Ms. Monk thinks the department could improve in. MS. MONK answered that she supports the three pillars that Ms. Hedberg discussed. She said the association is interested in having a strong healthcare system, but also examining upstream, in that, what needs to be done to ensure Alaskans can be as healthy as possible. She added that the association is also interested in innovation around the healthcare system so it works better; this has been a challenge during the pandemic as the focus was keeping the health system functional, but now post-pandemic, the focus is finding ways to improve. 3:46:32 PM ELLEN HODGES, MD, Chief of Staff, Yukon Kuskokwim Health Corporation, shared that she has been a family medicine physician in rural Western Alaska for 20 years, and that she is speaking in support of the appointment of Commissioner Designee Hedberg. She said the appointee was able to find ways to promote development of community healthcare aide programs. She stated that, during the pandemic, she had been a steadfast ally and advocate for rural Alaska, and that her enthusiasm never waivered. She said there is still crisis in the state, with a large tuberculosis (TB) outbreak, substance misuse, and other health conditions, all of which impact rural Alaska uniquely. 3:49:16 PM RON MEEHAN, Policy and Advocacy Manager, Food Bank of Alaska, testified in support of the Commissioner Designee Hedberg. He said that she has kept constant communication with Food Bank of Alaska and the Anti-Hunger network throughout the food security crisis, playing an instrumental role in securing funds for the bank's immediate relief efforts to those suffering from the supplemental nutrition assistance program (SNAP) backlog. He said that, under her purview, the Department of Health has taken positive steps to reduce the backlog, reduce the Division of Public Assistance workload, and streamline the process for clients. He said that she and her team have been working around the clock to address the backlog. 3:50:55 PM NANCY MERRIMEN, CEO, Alaska Primary Care Association, testified in support of Commissioner Designee Hedberg. She said the appointee has a wealth of knowledge and experience that leads to strong collaboration that is result oriented. She relayed that primary care that meets patients where they are at is the sort of health that federally qualified health centers (FQHC) are committed to. She said that she has deep awareness and the ability to improve health and wellness through affecting economic status, housing, education, and food security. She stated that she is a strong public health leader in Alaska. 3:53:19 PM REPRESENTATIVE MINA noted that, when she was working at Alaska Primary Care Association, she had worked on COVID-19 pandemic communications and had interfaced a lot with Commissioner Designee Hedberg. She thanked her for working with community health centers during the pandemic. 3:53:54 PM ELIZABETH RIPLEY, CEO, Mat-Su Health Foundation, stated that the foundation worked with Ms. Hedberg before and supports her confirmation. She explained that her work during the pandemic showed she is a proven leader, and that she is a high-energy, experienced, and dedicated public servant, who built a solid team around her. She said that she is also an excellent communicator, which is a key strength a commissioner needs in order to work with the many constituencies. She pointed out that, upon her taking up her role of commissioner designee, she had walked into a difficult situation around SNAP and Medicaid payments, recognized that those were priority areas, and brought resources to improve the situation. 3:55:47 PM VERNE BOERNER, PhD, representing self, stated that she is honored to speak in support of Commissioner Designee Hedberg's appointment to the Department of Health. She shared that she is a second-year PhD student in epidemiology and had previously worked with her during her time as president and CEO of the Alaska Native Health Board, which was also during the COVID-19 pandemic. She stated that she had demonstrated exceptional strategic thinking, honed collaborations, and effectively deployed scarce resources. She said that, during a time of great scarcity, Commissioners Designee Hedberg had acted quickly and decisively and worked countless hours; the collective result was putting Alaska at the top of the nation in protecting its people. 3:58:29 PM CHAIR PRAX, after ascertaining that no else one wished to testify, closed public testimony. 3:59:53 PM CHAIR PRAX stated that the House Health and Social Services Standing Committee has reviewed the qualifications of the governor's appointees and recommends that the following names be forwarded to a joint session for consideration: Heidi Hedberg, Commissioner of the Department of Health. He said that signing the report regarding appointments to boards and commissions in no way reflects an individual member's approval or disapproval of the appointee, and the nomination is merely forwarded to the full legislature for confirmation or rejection. 4:00:19 PM The committee took an at-ease from 4:00 p.m. to 4:03 p.m. HB 112-PROFESSION OF PHARMACY  4:03:06 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 112, "An Act relating to the Board of Pharmacy; relating to the practice of pharmacy; relating to pharmacies; relating to prescription drug manufacturers; relating to prescriptions for epinephrine; relating to the administration of epinephrine; and providing for an effective date." 4:03:34 PM REPRESENTATIVE RUFFRIDGE, as prime sponsor, paraphrased the sponsor statement [included in committee packet], which read as follows [original punctuation provided]: Pharmacists and pharmacies are an integral part of Alaska' healthcare system. It is important that the Alaska statutes that guide them are updated and reflect the services provided by modern-day pharmacies. House Bill 112 clarifies the Alaska Board of Pharmacy's powers and duties to align with the federal Drug Supply Chain and Security Act (DSCSA) related to licensing and oversight of manufacturers, out-of-state pharmacies, outsourcing facilities, and internet pharmacies who conduct business in Alaska. In doing so, these out-of-state entities will be held to the same high standard as those operating in the state of Alaska, helping to ensure Alaskans have access to medications that are safe, no matter where they originate. HB 112 aligns Alaska's pharmacy board statutes with similar boards in other states. It allows for it to meaningfully recognize retired pharmacists and their contributions. Stressing the importance of public safety, HB 112 would allow the board to institute a national criminal background check for Alaska pharmacists and pharmacy technicians. This would align the Alaska Board of Pharmacy with the National Association of Boards and Pharmacy Model State Pharmacy Act. The Executive Administrator plays a critical role in the smooth functioning of the board and requires a high degree of competency and understanding of the complexities of pharmacy-related regulations and issues. This bill gives Alaska's Division of Professional Licensing flexibility to hire a qualified pharmacist for this administrative role should one apply. The changes proposed in House Bill 112 reflect a dedicated collaboration between the Alaska Board of Pharmacy and the Alaska Pharmacists Association (AKPhA) to modernize pharmacy practice statutes. 4:05:33 PM BRAEDAN GARRET, Staff, Representative Justin Ruffridge, Alaska State Legislature, on behalf of Representative Ruffridge, prime sponsor, read the sectional analysis for HB 112, which read as follows [original punctuation provided]: Section 1. Amends AS 08.08.010(a) Creation and membership of board; officers Alters composition of the seven-member Board of Pharmacy by designating one member to be a licensed pharmacy technician, and one being an individual with no financial interest in the healthcare industry Section 2. Amends AS 08.80.030 Powers and Duties of Board (b)(10) Separates out the licensing/regulating entities relating to manufacturing and distributing of drugs and devices by use of the word "or" (b)(12) adds an epinephrine auto-injector training program (b)(14) Clarifies that only pharmacists who dispense federally scheduled controlled substances be required to register with the Prescription Drug Monitoring Program (PDMP) (b)(16) Adds pharmacies and manufacturers from out-of- state to the list of entities to be licensed and inspected (b)(17) Adds internet-based pharmacies to the list of entities to be licensed if they are servicing Alaskans (b)(18) adds language adopting regulations pertaining to retired pharmacist status Section 3. Amends 08.80.145 Reciprocity; license transfer 2 (3) removes character requirement - "of good moral character" (4) removes internship details this is a national standard among schools of pharmacy Renumbering of statute items Section 4. Amends AS 08.80.157 Licensing of facilities (k) this adds out-of-state pharmacies and manufacturers to the list of entities that must be licensed and inspected Section 5. Amends AS 08.80.159 Licensing and inspection of facilities outside the state (a) Adds "distributor, pharmacy, manufacturer" to those out-of-state entities that must be licensed and inspected, under the Drug Supply Chain and Security Act Section 6. Amends AS 08.80.159 Licensing and inspection of facilities outside the state (c) adds "pharmacy and manufacturer" to list that may be inspected if located outside the state Section 7. Amends AS 08.80.160 Fees (10) Removes the word "registration" since the bill mandates licensure of a facility Section 8. Amends 08.80.168 and adds a new subsection Administration of vaccines and related emergencies (e) Allows a pharmacist to administer epinephrine to a person or prescribe epinephrine auto-injectors to someone who has completed the epinephrine auto- injector training program Section 9. Amends AS 08.80.270 Executive administrator of the board (a) Adds an additional salary range option for the executive administrator, allowing flexibility for the Division to select a pharmacist for the role Section 10. Amends AS 08.80.420 Certain advertising prohibited 3 (a) adds the term "apothecary" to list of those that cannot be used in media or advertising unless the store employs a licensed pharmacist with regular hours Section 11. Amends AS 12.62.400 National criminal history record check (a)(23) adds pharmacist and pharmacy technician to list of professions where a background check is required. Aligns with State of Alaska's nursing requirements and pharmacy requirements typical in other states. This adds a national level background check Section 12. Amends AS 17.22.010 Prescription, purchase, administration of epinephrine by a trained individual Allows anyone over 18 to purchase or be prescribed an epinephrine auto-injector, and to administer epinephrine in an emergency to another person if they have completed an epinephrine auto-injector training program approved by the board. It removes very outdated language from this section Section 13. Amends AS 17.22.020(a) Approval of training programs (a) Allows the board, rather than the department, to adopt standards for the epinephrine auto-injector training program and deletes outdated language Section 14. Amends AS 17.22.020(b) Approval of training programs (b) Allows the board, rather than the department, to approve an epinephrine auto-injector training program that meets the board's standards Section 15. Amends AS 17.22.030 Applicability States that this chapter does not apply to someone currently authorized under another law to administer epinephrine, such as a nurse or doctor, or some other authorized professional Section 16. Amends AS 17.22.040 Liability of certified individual Outlines that a person may not be sued who administers epinephrine to another in an emergency, and in good faith, if he or she has completed the epinephrine auto-injector training program approved by the board Section 17. Amends AS 17.22.090 Definitions (3) defines the "board" as the Board of Pharmacy 4 Section 18. Repeals AS 08.80.110(2) Qualifications for licensure by examination • Repeals (2) furnish the board with at least two affidavits from reputable citizens that the applicant has known for at least one year attesting to the applicant's good moral character. This is not required in medical board, dental or nursing statutes. • Repeals 08.80.158 Registration of pharmacies located outside the state since this bill would now require licensure • Repeals AS 17.22.020(c) which is the Department's epinephrine auto-injector training program • Repeals AS 17.22.090(1) that defines the department as the Dept of Health, since it will no longer be the approving entity of the epinephrine auto-injector training program Section 19. TRANSITION LANGUAGE for currently registered pharmacies A new section that would allow pharmacies previously registered to continue to ship, mail or deliver prescription drugs to its customers in Alaska until their registration expires. At that time, they will then have to apply for licensure. Section 20. TRANSITION: REGULATIONS Allows the Board of Pharmacy and DCCED to adopt regulations to carry out the changes laid out in this legislation. Section 21. Section 20 has an immediate effective date under AS 01.10.070(c) Section 22: Effective date is set to coincide with the Drug Supply Chain and Security Act that will go into effect on November 26, 2023. 4:13:37 PM ASHLEY SCHABER, Chair, Board of Pharmacy, began the PowerPoint presentation titled, "House bill 112: Profession of Pharmacy" [hardcover included in committee packet] on slide. She explained the mission of the Board of Pharmacy, and that HB 112 touches on goal 4.1 [shown under "strategies on slide 2] relating to regulation and enforcement, which read as follows [original punctuation provided]: Routinely review effectiveness of regulations that reduce barriers to licensure without compromising patient health and safety. MS. SCHABER also pointed to 4.4, which read as follows [original punctuation provided]: Advocate for legislation as the pharmacy profession evolves and new opportunities for improvement patient safety arise. MS. SCHABER further referenced the goal list, pointing to 4.5, which read as follows [original punctuation provided]: Anticipate changes to the Drug Supply Chain Security Act and respond proactively. MS. SCHABER read slide 3, which read as follows [original punctuation provided]: Background of HB 112 •Result of multi year, multi chair review of statutes and regulations to ensure the Alaska Board of Pharmacy can continue to meet its mission •HB 112 addresses changes by: •Streamlining licensure process while improving public safety •Compliance with the Drug Supply Chain and Security Act •Alignment with other professional boards in Alaska and pharmacy boards in other states •Clarification of pharmacists' roles in epinephrine access •Collaborative effort between the Alaska Board of Pharmacy and the Alaska Pharmacists Association 4:15:53 PM MS. SCHABER moved to slide 4, which read as follows [original punctuation provided]: Goal: Streamline licensure process while improving public safety •Eliminates unnecessary forms currently required in statute •Clarifies that only pharmacists who dispense controlled substances are required to register with the Prescription Drug Monitoring Program (PDMP) •Adds national criminal background check MS. SCHABER read slide 5, which read as follows [original punctuation provided]: Goal: Compliance with Drug Supply Chain and Security Act •The federal Drug Supply Chain and Security Act (DSCSA) further secures the U.S. drug supply through a system to prevent harmful drugs from entering the supply chain, detect harmful drugs if they do enter, and enable rapid response when such drugs are found •Boards of Pharmacy play a key role in this process through appropriate licensing of drug distributors and pharmacies •HB 112 ensures the AK Board of Pharmacy powers and duties support the DSCSA related to manufacturers, out of state pharmacies, and internet pharmacies to ensure Alaskans receive safe medications 4:18:53 PM MS. SCHABER directed attention to slide 6, which read as follows [original punctuation provided]: Goal: Alignment •Replaces one of the two public member seats with a pharmacy technician seat •Allows the board to adopt language for retired pharmacist status •Clarifies the board executive administrator's salary, allowing flexibility for a pharmacist to serve in this role in the future MS. SCHABER showed slide 7, which read as follows [original punctuation provided]: Goal: Epinephrine Access •Adds epinephrine training program under Board of Pharmacy Oversight •Clarifies that a pharmacist can administer epinephrine to a person or prescribe epinephrine auto injectors to someone who has completed the training program •Increases epinephrine access for Alaskans with anaphylactic emergencies 4:22:18 PM MS. SCHABER concluded the presentation on slide 8, which read as follows [original punctuation provided]: Support •The Board of Pharmacy respectfully requests your support of HB 112, allowing us to further promote , preserve, and protect the public health, safety, and welfare of Alaskans by and through the effective control and regulation of the practice of pharmacy. •Thank you for your time! 4:22:34 PM REPRESENTATIVE FIELDS inquired as to what type of person is considered as someone that has a financial interest in the healthcare industry. MS. SCHABER answered that it is in statute, which is that it is a person that is a public member that has no financial interest in the healthcare industry. She said that such a person brings a public consumer interest to the board. REPRESENTATIVE FIELDS asked what the current board member requirements are, other than just being a member of the public. MS. SCHABER deferred the question to the division. She mentioned statute and said that no financial interest is the biggest change. She said that a willingness to attend quarterly meetings and a commitment to the work involved is required. 4:24:14 PM REPRESENTATIVE RUFFRIDGE added that there are currently two public member positions on the board with only one recently filled. He stated that it has been difficult to get public members to serve due to the time commitment requirement, as well as low willingness from a member of the public to serve on a board for a profession they may not know much about; therefore, HB 112 would change one of the public seats to a technician position. 4:25:06 PM REPRESENTATIVE FIELDS commented that he likes the idea. He asked what Representative Ruffridge sees as the role of the board in supporting training for pharmacy technicians. REPRESENTATIVE RUFFRIDGE responded that, during his time serving on the Board of Pharmacy, that was an item of interest, and that regulations were passed to add a certified pharmacy technician as a specific individual recognized in regulatory practice. He explained that certified pharmacy technicians in Alaska currently have the ability to do final checks on prescriptions, if the prescription had a drug utilization review done by a pharmacist, and administer vaccinations, as examples. He stressed that there is an effort in the industry to promote pharmacy technicians as being a "middle step." 4:26:54 PM REPRESENTATIVE SADDLER observed that, if there are four pharmacists on the board right now, it wouldn't seem necessary to have the executive director be a pharmacist. He asked why the executive director is required to be a pharmacist. REPRESENTATIVE RUFFRIDGE responded that, in his time as previous member of the Board of Pharmacy, as well as a pharmacist, there is a lot of work to be an executive administrator of the Board of Pharmacy, and members are expected to have a deep-level understanding of what the department does for licensing. He said that many licensing and professional questions are directed to the executive administrator, and there would be a disconnect if they had knowledge of the pharmacy profession since they would have to go to the board to answer every question. He added that a pharmacist serving in the role is current practice in many states. 4:29:23 PM MS. SCHABER added that the five pharmacists on the board are all volunteers and work full time, so they don't have the time to address the questions. 4:30:21 PM REPRESENTATIVE MINA asked how out-of-state entities are being regulated currently. REPRESENTATIVE RUFFRIDGE answered that they are not. He explained that they are required to register in the state, but the Board of Pharmacy if the entity is dispensing or providing services into the state has no option to protect or promote the safety and wellbeing of Alaska patients because the entities are not licensed. 4:31:17 PM MS. SCHABER elaborated that the change in HB 112 gives the board oversight. She explained that currently it is only a registration that acknowledges that they are providing services. She explained that if there was a safety concern regarding the out of state pharmacy, the board has no oversight. 4:32:11 PM REPRESENTATIVE MINA asked how prevalent out-of-state entities are and what kinds of businesses they are. MS. SCHABER pointed to mail-order pharmacies as an example, and that some of the out-of-state pharmacies are considered compounding pharmacies that provide either sterile or non- sterile compounds, medications, eye drops, and injections to patients in Alaska. 4:33:01 PM REPRESENTATIVE FIELDS asked about fentanyl being present in adulterated drugs, and how pharmacies are adapting to this. REPRESENTATIVE RUFFRIDGE answered that it is a very large concern and has always been a concern since fentanyl is one type of the adulterated/counterfeit medications that's been seen. He explained that getting a clearer picture of what the drug supply chain looks like was one of the reasons why the Drug Supply Chain Act is at the federal level, as adulterated medications are being sent to Alaska often through Internet pharmacies. He said the bill contains changes to comply with requirements within federal regulation. 4:35:00 PM MS. SCHABER added that the bill does address giving the board oversight of Internet pharmacies, and that access to naloxone is important. 4:35:33 PM REPRESENTATIVE FIELDS shared that he is a parent, and that when his kids get sick, it makes him think about how gaps in primary care could lead to expensive care. He asked if there are opportunities for the board to work with other primary healthcare providers in an effort to reduce such gaps. 4:36:22 PM REPRESENTATIVE RUFFRIDGE responded that there will be a more detailed answer from him later; there is an extensive number of opportunities for pharmacists to fill gaps in care. During the pandemic, pharmacies across the state filled in roles that they did not historically provide. He relayed that there is a nationwide push for pharmacists to be given provider status, something HB 112 does not do, but the state has taken steps to promote the ability of pharmacists to take such steps. He said there is a barrier in the fact that pharmacies are a difficult business to be in, with many across the state and country closing because there are many challenges. 4:38:53 PM REPRESENTATIVE SADDLER asked for the number of licensed pharmacists in Alaska. MS. SCHABER deferred the question to the division. She shared that there has been a challenge in ensuring that licenses are processed quickly. 4:40:42 PM SYLVAN ROB, Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community, and Economic Development, answered that, as of today, there are 1,049 licensed pharmacists and 1,206 licensed pharmacy technicians. 4:41:10 PM REPRESENTATIVE SUMNER asked how many registered pharmacies there are. 4:41:33 PM MS. ROB answered that she doesn't know how many but would get that information to the committee. 4:42:18 PM REPRESENTATIVE RUFFRIDGE thanked members for hearing the bill. He said the hearing has been a good start in promoting changes that have been worked on for a long time. He shared that the chair before him would be proud that members are finally bringing to bear a process they started a number of years ago. 4:43:26 PM REPRESENTATIVE FIELDS shared that Representative Ruffridge had previously shared that some regulatory reforms around staffing could help address "pharmacy deserts" in the state. He asked if there are other reforms to be thinking about to help bring more pharmacies to places that are unserved. REPRESENTATIVE RUFFRIDGE responded that pharmacies closing is due to the high barrier entry, namely in payroll costs. He pointed out that some corporate pharmacies are going through staff reduction, even while the numbers of prescriptions being dispensed go up. He elaborated that a lot of pharmacies operate as a net loss to large corporations because there is a small margin; a big component in altering that is the role of pharmacy technicians becoming more of a manager while pharmacists act more as clinical oversight for a pharmacy. He explained that tele-pharmacies allow a pharmacy to operate in an urban setting; downtown Anchorage, as an example, has three pharmacy technicians with the pharmacists being more centrally located in a larger facility and using technology to remotely access the prescriptions that are being dispensed. He explained that this is an option that already has statute to govern it, and a barrier to it was changing regulations related to the pharmacy technician's capacity, something the board has changed, which opens the option now for pharmacy deserts. 4:46:35 PM CHAIR PRAX announced HB 112 was held over. 4:46:51 PM The committee took an at-ease from 4:46 p.m. to 4:49 p.m. HB 60-RUNAWAYS; DFCS/DOH: DUTIES/LICENSING/INFO  4:49:07 PM CHAIR PRAX announced that the final order of business would be HOUSE BILL NO. 60, "An Act relating to the licensing of runaway shelters; relating to advisors to the board of trustees of the Alaska Mental Health Trust Authority; relating to the sharing of confidential health information between the Department of Health and the Department of Family and Community Services; relating to the duties of the Department of Health and the Department of Family and Community Services; and providing for an effective date." 4:49:54 PM REPRESENTATIVE RUFFRIDGE moved to adopt the proposed committee substitute (CS) for HB 60, 33-GH1343\S, Bergerud, 3/21/23, as the working document. 4:50:14 PM CHAIR PRAX objected for purpose of discussion. 4:50:37 PM RILEY NYE, Staff, Representative Mike Prax, Alaska State Legislature, on behalf of the bill sponsor, House Rules, by request of the governor, explained that HB 60 was introduced to support the reorganization of the Department of Health and Social Services in to the Department of Family and Community Services and the Department of Health under Executive Order 121. Version S amends the original version to reflect new fixes and missions to support the reorganization, which include adding the Department of Family and Community Services to the definition of "department" in A.S. 18.65 Section 2, giving clarification of the role of each department as it relates to shelters for runaways. He requested the invited speakers to testify. 4:52:32 PM HEATHER CARPENTER, Deputy Director, Office of the Commissioner, Department of Health, paraphrased the explanation of changes to HB 60 proposed in Version S [included in committee packet], which read as follows [original punctuation provided]: Section 1 This language is unchanged from section 1 of version A. Section 2 Version S includes the newly identified need to include the Department of Family and Community Services in the definition of department. Section 3 This language is unchanged from section 2 of version A. Section 4 This language is unchanged from section 3 of version A. Sections 5-9 and 11-14 Version S updates these sections to further clarify the duties of each department related to programs for runaways. Section 10 Version S updates the bill to include a necessary clarification related to the confidentiality of records related to shelters for runaways. Section 15 This language is unchanged from section 10 of version A. Section 16 Version S amends this section to replace the term "authorizing" with "applicable" from section 11 of version A. This change reflects the removal of the definition for the term "authorizing" in section 20 below. Sections 17-18 This language is unchanged from sections 12-13 of version A. Section 19 This language is unchanged from section 14 of version A. Section 20 Version S amends Section 15 from version A to remove the new definition for "authorizing department" to avoid potential confusion with the duplicate definition of "applicable department." Section 21 Version S moves the repeal of this language related to the licensure of shelters for runaways from Section 9 in version A. AS 47.32.010 was repealed and reenacted under Executive Order 121, section 79. Section 22 This language is unchanged from section 16 of version A. 4:55:50 PM REPRESENTATIVE SADDLER pointed out that the date of the CS is labeled March 21, and that there is a legal opinion by Margaret Bergerud, Legislative Legal Counsel, about potential single subject law violations, which is also dated March 21. He asked if the legal opinion applies to the CS before the committee. 4:56:18 PM STACIE KRALY, Director, Civil Division, Department of Law, answered yes, in that, the memo relates to the CS and the overall framework of HB 60. REPRESENTATIVE SADDLER asked Ms. Kraly to comment on the validity of the allegation that the bill may likely violate the single subject provisions of the state constitution. MS. KRALY answered that she disagrees with Legislative Legal Service's assessment that there is a single subject issue with the CS. She pointed to the title, which shows there are a number of different issues being addressed, and looking at the underlying theme, the bill deals with all of the powers and duties for the Department of Health and the Department of Family and Community Services. She relayed that a concern raised was in regard to the mental health trust authority; the change in the CS articulates that there was an issue with who was going to be on the advisory council for the trust authority. She explained that, at the advice of Legislative Legal Services last year, the department had picked a particular commissioner because it said a member cannot be added to the advisory board because that would be a subject change in nature, which is not allowed under executive order rule; further, the commissioner was picked for that purpose, with an understanding that they would need to come back this year and introduce a bill to articulate how the two departments interact with the mental health trust authority. She explained that there are no substantive changes to trust statutes in the bill, rather, it articulates that both departments need to be involved as advisory members to the board. She elaborated that every provision in the bill relates to the operations of the two departments and how they meet their statutory duties. She stressed that she does not see any problems with the bill as it is drafted. REPRESENTATIVE SADDLER advised that it'd be better to get these issues resolved on the front-end, and that he hopes there will be a meeting to hash out the legal issues. 5:00:20 PM REPRESENTATIVE SUMNER read from Section 13 of the Alaska State Constitution, which read as follows: Every bill shall be confined to one subject unless it is an appropriation bill or one codifying, revising, or rearranging existing laws. REPRESENTATIVE SUMNER offered his understanding that, through the executive order, the two departments are separated and now the legislature is codifying that. 5:01:18 PM MS. KRALY stated that the power to split the department is authorized by the constitution. She explained that it was conveyed last year that there would some minor technical changes this year because one cannot amend an executive order during the process, and that HB 60 is a clean-up bill. 5:02:23 PM CHAIR PRAX withdrew his objection. There being no further objection, the CS, Version S, was before the committee as a working document. 5:03:05 PM REPRESENTATIVE RUFFRIDGE moved to report CSHB 60, Version 33- GH1343\S, Bergerud, 3/21/23, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 60(HSS) was reported out of the House Health and Social Services Standing Committee. 5:03:40 PM The committee took an at-ease from 5:03 p.m. to 5:05 p.m. 5:05:56 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 5:06 p.m.