Legislature(2015 - 2016)HOUSE FINANCE 519
04/16/2015 01:30 PM House FINANCE
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE BILL NO. 71 "An Act relating to the practice of pharmacy; and relating to the administration of vaccines and related emergency medications." 2:50:38 PM SENATOR CATHY GIESSEL, SPONSOR, discussed the legislation. She explained that SB 71 allowed pharmacists in Alaska to administer vaccines without a collaborative practice agreement. She detailed that a collaborative practice agreement, established in 2001, was a contract between the pharmacist and a medical provider which allowed the pharmacist to administer vaccines. The contracts cost between $50 and $500 and often proved difficult for the pharmacist, especially those in rural areas, to find a provider who will oversee the vaccine administration which involved paperwork. The legislation authorized certified pharmacists to administer the vaccinations without the oversight agreements in place. She relayed that pharmacists had been educated in vaccine administration since 2005 as part of their curriculum and were entering the profession with a doctorate degree in pharmacology. The bill mandated that pharmacists educated prior to 2005 would have to take a specific course approved by the Board of Pharmacy. She described the training that the pharmacists already received in the administration of vaccinations including adverse reactions response and interactions with other medications. She shared that as a nurse practitioner herself, she relied on the pharmacist's specialized knowledge when prescribing. The bill would particularly help rural pharmacies by removing the collaborative agreement mandate. She shared that in states where pharmacists possessed the independent authority to administer vaccines immunization rates rise. She informed the committee that Alaska had a low vaccination rate. Currently, all vaccinations were recorded in a system called Vactracks and all healthcare providers had access to the information. Alaskan pharmacists administered over 13 thousand flu vaccines in the previous year. She believed that the bill would improve access to immunizations in the state. 2:55:14 PM Vice-Chair Saddler wondered if the system of recording immunizations needed to be improved or strengthened. Senator Giessel answered that the VacTracks system had been in place for a number of years and all healthcare providers used the system. She elaborated that the system "vastly" improved the tracking of vaccines and she was not aware of any flaws. Representative Kawasaki asked for details on how pharmacists currently administered vaccinations. Senator Giessel answered that the healthcare provider must fill out paperwork and review records; they were not required to be physically present. She added that the system for pharmacist administered immunizations was already in place. The bill merely removed the paperwork requirements and allowed highly trained professionals "administer medication." Representative Kawasaki asked whether the State Medical Board or the Medical Association had an opinion about the legislation. Senator Giessel replied that she had not received any opposition from the medical community. Representative Guttenberg asked whether the bill required pharmacists to administer an expanded list of vaccines that were currently not administered by pharmacists. Senator Giessel responded that she was not sure and deferred to pharmacists to answer the question. She noted that pharmacist routinely administered flu vaccines, which required needles, syringes, refrigeration, and other relevant supplies therefore, were already equipped. Representative Guttenberg wondered about logistics and how things would change for the pharmacist and the pharmacy space with passage of the bill, particularly for rural pharmacies. DIRK WHITE, PHARMACIST AND FORMER PRESIDENT, BOARD OF PHARMACY, SITKA (via teleconference), answered that internally and procedurally the pharmacy would not change. He revealed that a limitation of the collaborative practice agreement was that the agreement was specific to a location and the pharmacist could not leave the pharmacy to administer vaccinations. He highlighted pharmacists' inability to travel to community health fairs as an example. The bill would enable pharmacists to go to other locations and travel to rural areas to administer immunizations. 3:03:52 PM Representative Gara asked whether there were any safety issues with the bill. DR. JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, communicated that pharmacists currently delivered a large number of vaccines throughout the state and therefore, did not have any safety concerns or reservations with allowing pharmacists to administer vaccines. Representative Gara asked whether his answer extended to the ability of the pharmacist to administer emergency medications due to an adverse reaction. Dr. Butler answered that allergic reactions to a vaccine was a rare occurrence and that under the collaborative agreement the pharmacist was currently allowed to administer emergency medications. Representative Kawasaki stated that currently under a collaborative physician agreement reports were written and reviewed. He asked whether, absent an agreement reporting would still be required. Dr. Butler replied that completion of the vaccine adverse event reporting system was mandatory. He explained that the system was a tool available to pharmacists and patients and was monitored by the federal Food and Drug Administration and Centers for Disease Control. Vice-Chair Saddler noted that the bill included administration of emergency medications and asked for an example of emergency medications. Dr. Butler answered that epinephrine administered for rare allergic reactions to immunizations called "anaphylactic reactions" was an example of emergency medication. Vice-Chair Saddler asked whether pharmacists received specialized emergency medication response training. Dr. Butler responded that the critical issue was the ability to recognize the adverse reaction. DANIEL NELSON, PRESIDENT, ALASKA PHARMACISTS ASSOCIATION, FAIRBANKS (via teleconference), stated his strong support of the legislation. RYAN RUGGLES, PHARMACIST AND DISTRICT PHARMACY MANAGER, ALBERTSON-SAFEWAY, ANCHORAGE (via teleconference), testified in support of the bill. He shared that Alaskan pharmacist currently administered many types of vaccines. The legislation would remove the collaborative physician agreement mandate which was "difficult to obtain" and limited the pharmacists' ability to serve their patients. He believed that passage of SB 71 would strengthen the continuity of care that pharmacists endeavored to provide patients. 3:11:31 PM LIS HOUCHEN, NORTHWEST REGIONAL DIRECTOR, STATE GOVERNMENT AFFAIRS, NATIONAL ASSOCIATION CHAIN AND DRUG STORES, OLYMPIA, WASHINGTON (via teleconference), spoke in favor of the bill. She listed the organization's members. She shared that in 2012 only 1.2 percent of Alaskans had received the flu immunization. The association believed that the legislation would increase access to vaccinations in rural areas. BARRY CHRISTENSEN, CO-CHAIR, ALASKA PHARMACIST ASSOCIATION LEGISLATIVE COMMITTEE, KETCHIKAN (via teleconference), testified in support of the legislation. He thought that the bill would help reduce the cost of healthcare. He relayed that the association had met with other medical providers prior to the bills introduction to inform them about the legislation. Co-Chair Thompson CLOSED public testimony. Representative Kawasaki spoke to the fiscal notes. He pointed to Fiscal Note 1 (CED) and wondered why it cost $2.5 thousand to amend the regulation. He previously had not seen a fiscal note accompany a bill changing a regulation. Co-Chair Thompson assumed it was a one-time cost. Senator Giessel deferred the question to the Department of Commerce, Community and Economic Development. SARA CHAMBERS, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, answered that the Department of Commerce, Community and Economic Development (DCCED) was implementing the practice of requesting receipt authority for the average cost of a division "regulation project" in an effort "to best and conservatively manage licensing fees" that were charged to the licensees. She elaborated that the division handled "competing interests" between the division and the various board's mission related and statutory authority. In situations when the division had other bills related to regulations and were managing tens of thousands of dollars dealing with regulation changes, the fiscal note added transparency to the process and alerted the boards that their funds were being spent in case funding for their other mission purposes was curtailed. Representative Kawasaki supported adding the receipt authority in the fiscal note as long as the practice would continue into the future. Representative Wilson wondered how many hours it would take to amend the regulation and how the department calculated the $2.5 thousand expenditure. 3:17:14 PM Ms. Chambers replied that the expense was calculated based upon a variety of expenses including the charges from the Department of Law (DOL) review and DCCED regulation specialist time. She added that the bulk of the cost came from printing and postage for sending copies of the new regulations to the licensees'; mandated by statute. She shared that $2.5 thousand was an average board expense. Representative Wilson asked whether there was an option to send the regulations by email. Ms. Chambers answered that the department was exploring the option with DOL. The current legal interpretation required the paper option. Representative Wilson believed the email option should be pursued. Representative Pruitt voiced that previously the division spread the cost among all boards. He thought that the division was attempting to shift to using the receipt authority to charge the actual costs on to the specific board affected. He hoped it would be the direction the department would take on any future adjustments or regulation projects for any licensee group. He asked for confirmation on his comments. Ms. Chambers agreed with his comments and related that the division was ensuring that "the expenses were directly correlated to the licensing fees of the particular licensed profession that incurred the costs." Representative Kawasaki cited Fiscal Note 3 (DHS) and relayed that the analysis noted that the Medicaid program would be expected to incur costs resulting from changes needed to the claims processing system. He wondered what the total costs amounted to. Dr. Butler replied that the original fiscal note had included a one-time capital request of $50 thousand for the claims processing without the collaborative agreement. Subsequently, it was discovered that the bonus performance money from the Children's Health Insurance Program (CHIP) could be used to implement the changes to the claims processing system. Therefore, the fiscal note had been zeroed out. 3:22:15 PM Vice-Chair Saddler MOVED to REPORT SB 71 out of committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. SB 71 was REPORTED out of committee with a "do pass" recommendation and with one previously published fiscal impact note: FN1 (CED); and one previously published zero fiscal note: FN3 (DHS).
|SB 26 CS WORKDRAFT FIN 041615 F version.pdf||
HFIN 4/16/2015 1:30:00 PM