Legislature(2015 - 2016)HOUSE FINANCE 519

04/16/2015 01:30 PM House FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 3:00 p.m. Today --
Heard & Held
Moved SB 71 Out of Committee
Scheduled but Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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).                                                                                                         

Document Name Date/Time Subjects
SB 26 CS WORKDRAFT FIN 041615 F version.pdf HFIN 4/16/2015 1:30:00 PM
SB 26