Legislature(2003 - 2004)

05/07/2003 03:38 PM House L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 32 - UNIFORM PRESCRIPTION DRUG CARD                                                                                        
Number 1754                                                                                                                     
CHAIR ANDERSON announced  that the final order  of business would                                                               
be HOUSE  BILL NO.  32, "An  Act relating  to a  health insurance                                                               
uniform prescription drug information  card; and providing for an                                                               
effective date."                                                                                                                
The committee took an at-ease from 4:10 p.m. to 4:11.                                                                           
[Not on tape, but taken from  the Gavel to Gavel recording on the                                                               
Internet, was:                                                                                                                  
REPRESENTATIVE JOHN  COGHILL, Alaska State  Legislature, sponsor,                                                               
paraphrased  from his  sponsor  statement,  which, with  original                                                               
punctuation provided, read:                                                                                                     
     The intent  of HB32 is  to have a  uniform prescription                                                                    
     card  implemented  to expedite  the  amount  of time  a                                                                    
     pharmacy   technician    spends   gathering   necessary                                                                    
     information   from  the insurance  company in  order to                                                                    
     process the insurance claim.   Pharmacists are spending                                                                    
     a  disproportionate amount  of time  trying to  address                                                                    
     reimbursement  issues rather  than  serving the  health                                                                    
     care needs of their customers.   HB 32 would allow form                                                                    
     more   face-to-face   care  between   pharmacists   and                                                                    
     patients.  It would  also minimize confusion, eliminate                                                                    
     unnecessary    paperwork,    decrease    administrative                                                                    
     burdens, and streamline  the dispension of prescription                                                                    
     products paid for by third party payors.                                                                                   
REPRESENTATIVE COGHILL  indicated that he'd  originally attempted                                                               
to  outline  in  statute  all  the things  that  would  be  on  a                                                               
prescription  card, but  because there  were many  things he  was                                                               
reluctant to  have on the  card, he'd  instead decided to  have a                                                               
bill that  simply said the  director shall adopt,  by regulation,                                                               
uniform prescription drug information cards.]                                                                                   
Number 1790                                                                                                                     
REPRESENTATIVE  ROKEBERG  made a  motion  to  adopt the  proposed                                                               
committee substitute  (CS) for HB 32,  Version 23-LS0203\D, Ford,                                                               
3/5/03, as the  work draft.  There being no  objection, Version D                                                               
was before the committee.                                                                                                       
Number 1814                                                                                                                     
BARRY CHRISTENSEN,  R.Ph., Legislative Chair,  Alaska Pharmacists                                                               
Association (AkPhA), said  that the AkPhA supports  passage of HB
32.  He  added that although the AkPhA would  be more comfortable                                                               
if certain  items were listed  in statute, it realizes  that such                                                               
is not  possible at  this time,  and so it  is trusting  that the                                                               
director will adopt suitable regulations.                                                                                       
REPRESENTATIVE ROKEBERG asked whether  the original version of HB
32  is   similar  to  legislation  sponsored   during  the  prior                                                               
REPRESENTATIVE COGHILL said it is essentially the same.                                                                         
REPRESENTATIVE  ROKEBERG  recalled   that  that  legislation  was                                                               
REPRESENTATIVE CRAWFORD concurred.                                                                                              
REPRESENTATIVE COGHILL indicated  that those controversial issues                                                               
are  resolved via  Version  D.   In response  to  a question,  he                                                               
relayed that "Aetna" is amenable to Version D.                                                                                  
REPRESENTATIVE  ROKEBERG  noted that  one  of  the problems  with                                                               
listing in statute  the specific things that a card  must have on                                                               
it is that it  would be difficult to make it  be both uniform and                                                               
REPRESENTATIVE COGHILL  concurred, and  indicated that  Version D                                                               
resolves that issue as well.                                                                                                    
REPRESENTATIVE GUTTENBERG  asked why  all the  interested parties                                                               
had not  simply sat  down with each  other and  created something                                                               
that resolved their concerns.                                                                                                   
REPRESENTATIVE  COGHILL suggested  that everyone's  past attempts                                                               
to list and  define, in statute, all the necessary  terms had met                                                               
with failure.  He opined that  "lining up" all the information in                                                               
statute is  the wrong approach;  thus Version D simply  gives the                                                               
division  the   authority  to,   by  regulation,   adopt  uniform                                                               
prescription drug cards, and mandates that it shall do so.                                                                      
REPRESENTATIVE GUTTENBERG noted that  the legislature has heard a                                                               
lot of  complaints over the  years about the  problems associated                                                               
with creating, adopting, and changing regulations.                                                                              
Number 2163                                                                                                                     
REPRESENTATIVE   COGHILL  pointed   out  that   having  something                                                               
implemented via  regulation instead  of via  statute is  a policy                                                               
call the  legislature can  make.   He added  that if  they really                                                               
wanted  to wrestle  with getting  the necessary  items listed  in                                                               
statute  to  everybody's satisfaction,  he  would  be willing  to                                                               
undertake that  project next  year, but  adopting Version  D this                                                               
year  will enable  [the  division] to  develop  something in  the                                                               
meantime.   He surmised that without  the pressure of HB  32, the                                                               
division might not  even bother with the process  of developing a                                                               
prescription  drug card.   On  the  issue of  whether there  even                                                               
ought  to  be  such  a   card  developed,  he  relayed  that  his                                                               
constituency is in favor of it.                                                                                                 
REPRESENTATIVE GATTO asked whether  the information that would be                                                               
on a  uniform prescription  drug card  would be  his information,                                                               
the   insurance   company's   information,  or   the   pharmacy's                                                               
REPRESENTATIVE  COGHILL  replied:    "It would  have  your  name,                                                               
insurance information, and prescription  information.  And that's                                                               
actually  what  we  were  trying to  describe  in  [the  original                                                               
version of the bill]."                                                                                                          
REPRESENTATIVE  CRAWFORD  opined  that  Version D  of  HB  32  is                                                               
heading  down the  right track,  and that  the quicker  a uniform                                                               
prescription drug card is developed, the better.                                                                                
REPRESENTATIVE ROKEBERG  asked Katie  Campbell whether  she would                                                               
be the one writing the regulations proposed by Version D.                                                                       
Number 2290                                                                                                                     
KATIE  CAMPBELL,   Actuary  L/H,  Central  Office,   Division  of                                                               
Insurance,  Department   of  Community  &   Economic  Development                                                               
(DCED),  confirmed  that  she  would be  the  one  writing  those                                                               
proposed regulations.                                                                                                           
REPRESENTATIVE   ROKEBERG   asked   Ms.  Campbell   whether   she                                                               
anticipates  any problems  doing  so or  requires any  additional                                                               
direction from the legislature.                                                                                                 
MS. CAMPBELL replied:                                                                                                           
     I think that  it's something the division  can take on,                                                                    
     and  it is  not going  to  be easy.   I  think ...  the                                                                    
     reason  why  it's  been controversial  is  because  the                                                                    
     insurance  companies think  they  have everything  they                                                                    
     need on there and the  pharmacists are saying, "No, you                                                                    
     don't have everything  we need on there."   And I think                                                                    
     that the goal  is really to sit down at  the table with                                                                    
     both  of them  and figure  out what  it is  that really                                                                    
     needs to  be on the cards,  and I guess that's  what we                                                                    
     would do through the regulatory process.                                                                                   
REPRESENTATIVE  GUTTENBERG  asked  whether any  other  states  or                                                               
jurisdictions have a standard.                                                                                                  
MS. CAMPBELL replied:                                                                                                           
     As I understand  it, there are a number  of states that                                                                    
     have   adopted    uniform   prescription    drug   card                                                                    
     legislation; I  don't know how  many, or what  they ...                                                                    
     look like.  From what  I've heard, they vary from state                                                                    
     to state,  and the  goal of the  pharmacy organizations                                                                    
     has  been that  it be  a national  standard so  that it                                                                    
     doesn't  vary  across states.    And  that just  simply                                                                    
     hasn't happened, as I understand it.                                                                                       
REPRESENTATIVE   GUTTENBERG  asked   Ms.  Campbell   whether  she                                                               
envisions that  the cards  will have  a magnetic  strip or  a bar                                                               
code on  the back  so that  the information can  be read  in that                                                               
fashion as opposed to having everything printed on the card.                                                                    
MS. CAMPBELL replied:  "I don't  think that was part of the plan;                                                               
it was  more ...  like the  Aetna card  that has  the information                                                               
printed  on it,  [but]  it wouldn't  preclude the  use  of a  bar                                                               
REPRESENTATIVE  ROKEBERG again  asked  Ms.  Campbell whether  she                                                               
needs any additional direction from the legislature.                                                                            
MS. CAMPBELL replied:                                                                                                           
     I think one really critical  piece that would be useful                                                                    
     would  be to  get  your  direction on  the  use of  the                                                                    
     actual national  standard that was referenced  [in] the                                                                    
     prior versions  of the bill,  and how close we  need to                                                                    
     be there.                                                                                                                  
TAPE 03-48, SIDE B                                                                                                            
Number 2388                                                                                                                     
MS. CAMPBELL continued:                                                                                                         
     I think  ... some of the  issue has been that  a lot of                                                                    
     the claim  processing is done  electronically.   And so                                                                    
     even if you  don't have it on the card,  ... [when] you                                                                    
     go in and  you get a prescription filled,  ... you have                                                                    
     a social security  number ... [to] put  [on] the screen                                                                    
     and ... all  the information comes up that  you need to                                                                    
     process to  a claim -  ... you  don't need to  have all                                                                    
     kinds of information on the  card. ... That's their one                                                                    
     side.  And I think  the pharmacists are saying, "No, we                                                                    
     really  want to  have  a card  that  has more  complete                                                                    
     information;  that's  consistent   with  this  national                                                                    
     standard."  That's my understanding  of the issue.  And                                                                    
     so, to the  extent that you would want  the division to                                                                    
     draft  a  regulation  that  references  those  national                                                                    
     standards, that would be useful.                                                                                           
REPRESENTATIVE GATTO, noting  that he already has  two cards from                                                               
different  insurance   companies,  asked  whether  it   would  be                                                               
possible  to create  one card  that  could replace  those he  now                                                               
carries in  his wallet.   Or would the uniform  prescription drug                                                               
card they've been  discussing be in addition to the  cards he now                                                               
carries?    Is there  a  standard  that  says it  doesn't  matter                                                               
because  the information  is the  same?   But then  the companies                                                               
would  be different,  he remarked,  and the  pharmacist needs  to                                                               
know the company.                                                                                                               
MS.  CAMPBELL replied,  "I think  if  we move  to a  single-payor                                                               
system, that might  work, but each insurance company  is going to                                                               
have their own information."                                                                                                    
REPRESENTATIVE GUTTENBERG  asked what  the process would  be when                                                               
someone  is traveling.   He  noted  that it  would be  good if  a                                                               
pharmacist  could   also  use   the  card   to  see   what  other                                                               
prescriptions  a person  is using  so as  to be  able to  prevent                                                               
conflicts in medication usage.                                                                                                  
Number 2289                                                                                                                     
REPRESENTATIVE COGHILL said  he is not sure  whether this vehicle                                                               
can solve  the problem of  having numerous cards.   He suggested,                                                               
though,  that perhaps  the cards  could be  made similar  to each                                                               
other.   He reiterated that  the goal of  HB 32 is  to streamline                                                               
the  prescription  process, and  that  he  is reluctant  to  list                                                               
specific things  in statute.   He again indicated that  Version D                                                               
offers a good  way to go about the process  of creating a uniform                                                               
prescription drug card.                                                                                                         
REPRESENTATIVE ROKEBERG  posited that the division  might welcome                                                               
more legislative direction.                                                                                                     
REPRESENTATIVE COGHILL said he would  not mind adding some intent                                                               
language  to the  bill  or  perhaps even  attaching  a letter  of                                                               
REPRESENTATIVE  ROKEBERG asked  Ms. Campbell  whether there  is a                                                               
"turf war"  going on and, if  so, wouldn't it be  better to avoid                                                               
it  by  perhaps making  a  legislative  decision with  regard  to                                                               
certain items.                                                                                                                  
MS. CAMPBELL replied:                                                                                                           
     I  think there  is  somewhat  of a  turf  war, but  any                                                                    
     direction you  that can give [regarding]  how you would                                                                    
     [like] ... to handle that  would be helpful when we sit                                                                    
     down ...  [at] the  table to  talk about  the card.   I                                                                    
     think it's  been a very  controversial issue,  no doubt                                                                    
     about  it, between  the pharmacists  and the  insurance                                                                    
     companies [regarding]  what should be on  that card and                                                                    
     how it  should be structured.   So I think some  of the                                                                    
     insurance   companies'  concern   has  been   with  the                                                                    
     reference to  those national standards,  and so  to the                                                                    
     extent  that we  can get  some direction  on where  you                                                                    
     want  to go,  whether it's  in statute  or just  intent                                                                    
     language, something so  that we know where  you want to                                                                    
     go with that would be helpful.                                                                                             
REPRESENTATIVE  COGHILL  surmised  that  he  could  probably  get                                                               
something  drafted  to that  effect  for  the next  committee  of                                                               
referral, adding  that he  favors the standard  set forth  by the                                                               
National Council for Prescription Drug Programs (NCPDP).                                                                        
REPRESENTATIVE DAHLSTROM  mentioned that  it would  probably also                                                               
be  helpful to  get input  from the  drug companies  that provide                                                               
computerized information.                                                                                                       
REPRESENTATIVE COGHILL concurred.                                                                                               
REPRESENTATIVE ROKEBERG relayed that  having the legislature make                                                               
the decision  regarding standards gives him  greater comfort than                                                               
just  leaving  that burden  with  the  department to  decide  via                                                               
Number 2037                                                                                                                     
REPRESENTATIVE ROKEBERG  moved to report  the proposed CS  for HB
32,  Version 23-LS0203\D,  Ford,  3/5/03, out  of committee  with                                                               
individual  recommendations  and  the  forthcoming  fiscal  note.                                                               
There  being no  objection, CSHB  32(L&C) was  reported from  the                                                               
House Labor and Commerce Standing Committee.                                                                                    

Document Name Date/Time Subjects