Legislature(2017 - 2018)BUTROVICH 205

03/13/2017 01:30 PM HEALTH & SOCIAL SERVICES

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Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
          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                                                                    
     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                                                               
     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                                                               
     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                                                                    
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                                                               
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                                                                    
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                                                               
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).                                                                   

Document Name Date/Time Subjects
SB053 verA.PDF SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Sponsor Statement.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Guttmacher Institute Alaska Specific.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Guttmacher Institute Cost of Unintended Pregnacies.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Contraceptives Dispensed and Unintended Pregnancies.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Opposition - NFIB.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - AK Pharmacists Association.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - Alaska Nurses Association.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - Planned Parenthood.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 1.PDF SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Sectional Analysis.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 91 Version A.pdf SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Transmittal Letter and Declaration.PDF SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Fiscal Note.PDF SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Sectional Analysis Version A.pdf SHSS 3/13/2017 1:30:00 PM
SB 91
SB 53 FNs.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 2.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 3.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 91 Public 1.pdf SHSS 3/13/2017 1:30:00 PM
SB 91