Legislature(2017 - 2018)BUTROVICH 205
03/13/2017 01:30 PM HEALTH & SOCIAL SERVICES
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SB 53-INSURANCE COVERAGE FOR CONTRACEPTIVES 1:32:37 PM CHAIR WILSON announced the consideration of SB 53. 1:32:43 PM SENATOR BERTA GARDNER, Alaska State Legislature, Juneau, Alaska, provided a sponsor's statement on SB 53 as follows: SB 53 is, we believe, a cost-saving measure that will help improve the lives of women in families. What it does simply is it requires that health-care insurers in the state of Alaska allow for coverage of a 12- month supply of contraceptives, self-administered hormonal-contraceptive patches at one time. Some of you may be aware that prescription contraceptives require that a woman return to her provider or to a pharmacy for refills sometimes in one month, sometimes in three-month increments. Contraceptives have been used for a long time and are known to be safe we think should be available in 12- month increments. Many women in Alaska don't have the ability to consistently get to their providers for appointments either because of work, location, or school. One-in- four women report missing a pill because they couldn't get the refill pack in time. Ensuring consistent access to birth control gives individuals better ability to control when and whether they have children, it gives them more career and educational opportunities and reduces the likelihood that they end up needing government assistance. With perfect use, hormonal birth control has a success rate of about 95 percent. The data that we have that we are relying on comes from 2010 that says, "In Alaska 48 percent of all pregnancies were unintended; of those pregnancies, 60 percent resulted in birth, 26 percent in abortion, and the remainder were miscarriages. Unintended pregnancies have a drastic impact on the wellbeing of Alaskan women and families, and are associated with adverse maternal and child health outcomes, and along with health concerns, unintended pregnancies are major cost drivers to Alaska's public-health programs. In 2010, public-funded unintended pregnancies cost Alaska almost $43 million. When contraceptives are more readily available, Alaska will see a reduction in the number of unintended pregnancies and abortions which will ultimately result in a cost savings to the state. 1:35:39 PM JONATHON CHURCH, Staff, Senator Gardner, Alaska State Legislature, Juneau, Alaska, provided supportive data on SB 53 as follows: One of the studies in your packet followed 84,000 women in California who were given various supplies of contraceptives: one-month supply, three months, and one year. Researches of that study found that women given a one-year supply saw a 30-percent reduction in the odds of having conceived a pregnancy as well as a 46-percent reduction in the odds of having an abortion. Had the remainder of the women in the study been given a one-year supply, an estimated 1300 publicly funded births and 300 abortions would have been avoided. We have heard some concerns about the issue of pill waste due to improper storage or possible illegal selling. According to the CDC, oral contraceptives have a shelf life of three to five years depending on the manufacturer; this timeline can be diminished due to humidity or temperature, but we believe that women that opt for a 12-month supply of birth control and who are regular users of oral contraceptives know how to store their medications. The study from California also found that women who were dispensed the one-year supply of oral contraceptives wasted on average one cycle. Wasting one cycle is rather insignificant compared to the cost of clinic and pharmacy visits as well as the cost of unintended pregnancies. In the unlikely event that women do start selling-off hormonal birth control, there are already criminal statutes in place to deal with that behavior. Senate Bill 53 would also make birth control more readily available therefore decreasing the need for any sort of black market. MR. CHURCH provided a sectional analysis on SB 53 as follows: Section 1: Amends AS 21.42 by adding a new section, AS 21.42.427. AS 21.42.427 requires a health care insurer, in the group or individual market, that provides coverage for prescription contraceptives to provide reimbursement for dispensing prescription contraceptives for a 12- month period. AS 21.42.427(b)-(g) contains other related compliances and coverage provisions. Also provides provision for allowing for a religious organization that is not required to provide contraceptives under the Affordable Care Act would also be exempt from having to provide contraceptives. Section 2: Amends AS 47.07.065 by adding new subsections (b)-(d), which require the Department of Health and Social Services to pay for prescription contraceptives intended to last for a 12-month period for eligible recipients of medical assistance, if prescribed to and requested by the recipient, as well as pay for specified related services. Section 3: Requires the Department of Health and Social Services to amend and submit for federal approval a state plan for medical assistance coverage consistent with sec. 2 of this act. Section 4: Provides that sec. 2 of this Act takes effect only if the provisions of sec. 2 of this Act receive federal approval. Section 5: Provides that if sec. 2 of the Act takes effect, it takes effect the day after the commissioner of the Department of Health and Social Services makes certification of federal approval under secs. 3 and 4 of the act. Section 6: Except for sec. 5 of this act, provides for a January 1, 2018 effective date. 1:39:09 PM MR. CHURCH addressed fiscal notes and an issue on coverage as follows: There are three-fiscal notes currently attached to the bill. Two-fiscal notes noted from the Department of Health and Social Services, and one zero-fiscal note from the Division of Insurance. One issue that came up recently is that the bill as written would not cover the Alaska Care Plan which covers 45 percent of state employees; this is due to the location of the definition of health-care insurer in Title 21. Since the Division of Insurance does not regulate self-insured employers such as the state, we would need to place the definition outside of Title 21 and at that time the Division of Administration will have a fiscal note associated with the bill, but we do not know what the fiscal impact will be at this time. SENATOR BEGICH asked him to verify that the bill simply extends the time period for contraceptives. MR. CHURCH answered correct, 12 months instead of monthly or 3- month visits. SENATOR BEGICH assumed that the negative-fiscal notes are due to data in the bill's report that the bill should lead to a drop in unintended pregnancies and unintended abortions. MR. CHURCH concurred with Senator Begich. SENATOR GIESSEL noted that the bill contained more than contraceptives and asked for an elaboration. MR. CHURCH replied that the first portion of the bill addresses the coverage for contraceptives that is required by the Affordable Care Act and puts the requirements in statute, so the coverage continues if changes occur. SENATOR GIESSEL stated that she thought the bill strictly addressed prescriptive contraceptives. MR. CHURCH replied as follows: Ultimately with the current requirements these are already required by the federal government so there would be no, I would say, practical change minus the ability to prescribe the hormonal birth controls beyond the one or three months. 1:42:26 PM SENATOR VON IMHOF quoted section 1 in SB 53, lines 12-14 as follows: Provide coverage for prescription contraceptives; voluntary sterilization procedures; and consultations, examinations, procedures, and medical services that are necessary to prescribe, dispense, insert, deliver, distribute, administer, or remove the drugs, devices, and other products or services provided under this paragraph. She asked if voluntary sterilization procedures were already in the bill or being added in a new section. MR. CHURCH explained that voluntary sterilization procedures would be added to state statute. He assumed that the procedure was covered by the Affordable Care Act. He noted that Megan Wallace with Legislative Legal was available to speak more accurately to the bill. SENATOR VON IMHOF asked to confirm that the bill is not necessarily about just adding 12 months of contraceptives. She opined that voluntary sterilization gets into surgery and is very expensive. SENATOR GARDNER noted that the bill's intention is not to increase coverage, but to simply say for the hormonal contraceptives that people should be able to get them in a 12- month supply. SENATOR VON IMHOF asked to confirm that SB 53 is saying that voluntary sterilization is included. SENATOR GARDNER reiterated that her intention is for the 12- month supply and asked that the bill's drafter address the committee. 1:44:42 PM At ease. 1:45:40 PM CHAIR WILSON called the committee back to order. SENATOR VON IMHOF repeated her inquiry regarding voluntary sterilization procedures versus the sponsor's intent of just covering 12 months of oral contraceptives. 1:46:15 PM MEGAN WALLACE, Attorney, Legislative Affairs Agency, Alaska State Legislature, Juneau, Alaska, addressed bill-drafting questions regarding SB 53 as follows: Section 1 starting on page 1, line 9, requires that any insurance plan offered in the state have to provide coverage for a, b and c, which is prescription contraceptives, the voluntary sterilization procedures, and the consultation, examination, procedures, and medical services that are necessary for those services; in addition to that, the bill requires that a health-care insurer reimburse for 12 months of birth control. Yes, the bill does two things: it requires the sterilization and consultation and procedures and other services necessary to have birth control or other contraceptives prescribed and those procedures necessary to carry out those prescriptions covered and then in addition requires essentially a 12-month supply of contraceptives where requested. SENATOR VON IMHOF asked to clarify if the verbiage being added is new or is already covered by the Alaska Care Plan. MS. WALLACE replied as follows: I cannot speak to what the plan already covers, I don't possess that information, so that would be a question for the administration in terms of whether they can confirm that these coverages are already available under this specific plan. All I can advise is that the bill requires that all health-insurance plans provide the coverage in both item-1 on page 1, [lines 10-14], and then item-2 which is on page 2, line 2-6; it requires both 1 and 2 being included in all plans offered in the state if this bill becomes law. 1:48:58 PM SENATOR MICCICHE noted that AS 21.42.420 has coverage for prescription drugs and asked why a separate section under AS 21.42.420 was not considered that simply says, "Birth control pills and hormonal contraceptive patches will be extended for 360 days versus the 90 days that is currently allowed under the section." He asked why an entire subsection was created that included other services. MS. WALLACE replied as follows: The bill does more than provide prescription drug coverage, so it was essentially a drafting decision to set this requirement out in their own subsection because as I was just articulating the bill requires coverage for certain procedures, consultations, examinations, and then in addition to that there's restrictions on the coverage provided under this section that don't apply to the prescription drug coverage under AS 21.42.420. SENATOR GARDNER specified as follows: Our intent is not to add any new coverage as not to change co-pays, but simply to have prescription, hormonal, self-administered contraceptives to be available at a 12-month plan and why it was drafted differently I don't know. I should know, but I don't. SENATOR BEGICH asked Ms. Wallace why the bill was drafted in a way that was not what the sponsor of the legislation requested. 1:51:44 PM MS. WALLACE replied as follows: I was directed to draft the bill that is in front of us and if there was a miss communication between our office and Senator Gardner, the sponsor, I'd be happy to provide her with a new version that clarified that intent, but essentially it was my understanding that we provided the bill that was requested. SENATOR BEGICH asked Senator Gardner if the bill does what she intended it to do. SENATOR GARDNER replied apparently not and conceded that the bill goes further. 1:52:40 PM CHAIR WILSON announced that the committee will hear public testimony. 1:52:57 PM At ease. 1:54:52 PM CHAIR WILSON called the committee back to order. He announced that SB 53 will be held awaiting a committee substitute (CS).