Alaska Legislature: House Finance, 4/7/26, 1:30pm

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Okay, I'll call this meeting of the House Finance Committee to order. Let the record reflect that the time is currently 1:38 PM. On Tuesday, April 7th, 2026. And present today we have Representative Allard, Representative Moore, Representative Stapp, Representative Bynum, Co-Chair Josephson, Representative Allard— or I'm sorry, Representative Galvin, Representative Tomaszewski, Representative Hannon, myself, Co-Chair Foster. When Representative Schrag does come in here a little— in a little while, I see there's a bag on his chair, so I think this affirms what I know, and that is that it may or may not be his birthday. So give him a wink and a nod when he comes in. We've also got here with us Representative Jimmy. And before we start, just a reminder, folks can mute their cell phones. We have two items on the agenda today, and that is House Bill 195. That's the Pharmacist Prescription Authority by Representative Mena. It's the first time we're hearing this bill, and then we'll take public testimony and set an amendment deadline for House Bill 262, and that is the number of Superior Court judges. So with that, looks like we have with us here Representative Mena as well as her staff, Ms. Katie Giorgio. And we also have, it looks like, Ms. Brandy St. Martin, the executive director of the Alaska Pharmacy Association. And so if you could all please come up and I'm guessing Ms. St. Martin is in the room. Oh, there you are. If you'd like to also come up and thanks for being here. If you could go ahead and introduce the bill.

Thank you, Co-Chair Foster and members of the House Finance Committee. For the record, my name is Genevieve Mena. I represent House District 19 in the Alaska Legislature. Those are the Anchorage neighborhoods of Airport Heights, Mountain View, and Rushing Jack. Thank you for hearing House Bill 195 on pharmacist prescriptive authority. House Bill 195 is a collaborative effort with the Alaska Board of Pharmacy and the Alaska Pharmacy Association. Pharmacists are seeing an evolution in their role in our healthcare system. They can assist in providing direct patient care for minor and chronic ailments, particularly in rural areas. In 2022, the 32nd Alaska Legislature passed House Bill 145, which added the phrase "other patient services" to pharmacy services in state law. This created a path to allow pharmacists to practice at the top of their education, training, and experience. However, while pharmacists can provide care for conditions such as the flu, strep throat, UTIs, and more, they are not allowed to do so. House Bill 195 clarifies that the intent of this law— clarifies the intent of that law in regards to independent prescribing and provides in, in providing direct care services. Under this bill, pharmacists would be able to provide limited primary care services, expand access to treatment for opioid use disorder, and prescribe similarly to pharmacists in the Veterans Health Administration. Additionally, the Alaska Board of Pharmacy already regulates pharmacists under a standard of care which aligns with this legislation. Since the introduction of this bill last year, This legislation has now been included in Alaska's Rural Health Transformation Program as one of the policies that are tied to the state's $272 million award. And the deadline to enact these policies is on December 31st, 2027. Over the interim, the Alaska Pharmacy Association also had extensive meetings with the Alaska State Medical Association to address some of their concerns And many of those policy recommendations have been incorporated in the House Labor and Commerce Committee. And I am happy to offer a sectional analysis through my staff, Katie Giorgio, if it is the will of the committee.

Yes, Ms. Giorgio, go ahead. And if you could please do that.

Thank you, Chair Foster. For the record, Katie Giorgio, staff to Representative Genevieve Mena. Sectional for House Bill 195 is as follows. Section 1 on the regulation of collaborative practice agreements prohibits a requirement of fees for pharmacists to enter into a collaborative practice agreement. Section 2 on the powers and duties of the Board of Pharmacy updates those boards— the board's power to establish standards related to the new prescribing and administration of vaccine and overdose opioid overdose drugs and requires that any licensed pharmacist that does provide controlled substances register with the controlled substance prescription database, also known as the PDMP. Section 3, qualifications for licensure by examination, requires that an applicant for licensure would receive education in pain management and opioid use addiction unless they demonstrate they do not hold a DEA license and therefore they're, they're not planning on providing controlled substances. Section 4 is on license reciprocity. Again, that is just to ensure that a pharmacist who is applying for licensure meet those same opioid and pain management education requirements. Section 5 on continuing education requires at least 2 hours of education, and specifically in pain management and opioid use. Occurs in each licensing period. Section 6, other patient care services, clarifies that these collaborative practice agreements that the pharmacists would engage in would not be with another pharmacist but a different type of provider. Section 7, also other patient care services, so this is that a pharmacist may independently provide services under the CLIA-waived tests. Dr. Stiglmarten will explain more on CLIA-waived tests, I believe, in her presentation. Section 8 defines patient care services intended to achieve the outcomes related to cure, prevention, slowing of disease, et cetera. Section 9 requires that a pharmacist who is prescribing and administer a drug or device recognize the limits of their own education, training, and experience. And refer to other practitioners if appropriate. Section 10, this is definitions on the practice of pharmacy. So this would explicitly include independent prescribing and the provision of patient care services. Section 11 adds a definition for opioids to include opium and opiate substances and derivatives. Section 12 repeals other patient care services to align with the updated independent practice and diagnosis— diagnostic testing provisions. And Section 13 provides for an effective date. Additionally, there were some changes that occurred between versions A and version I, and these were the results of many meetings with the State Medical Association as well as the department. And so just to highlight section couple sections that were changed. Section— this is now in Section I, or Version I. Section 1, we just added some clarity around the collaborative practice agreements. Section 5, we did a small adjustment to the way that we do the continuing education timing, just to align with how pharmacists do other types of continuing education. So it just aligned those timeframes. Section 7, this is something that came out of our discussions with the State Medical Association, that pharmacists under the new version cannot make a new diagnosis unless it's under one of these CLIA waived tests. Section 8 is amended to exclude specific Schedule Ia and Iia controlled substances, clarifying that there is a subset of opioids that are used

medication-assisted treatment for substance use disorder, and that would be allowed. And yeah, Section 13, we updated the effective date.

Okay, thank you very much. I would also like to recognize that we have with us Representative Kocher-Schraggi in the audience. We also have Representative Ruffridge. Thank you for joining us. And so we are not doing fiscal notes or public testimony today. We're going to be focusing on questions today. And so we're going to go to a question from Representative Josephson. Rep. Josephson, and then we'll also, I think, come back to the presentation from Ms. St. Martin. So with that, Rep. Josephson.

Thank you, Mr. Chairman. Representative Mena, thanks for your work on this. It probably doesn't come as a huge surprise. I don't know if you were— I don't think you may have been on the staff at the time, but when, for example, the optometrists wanted to expand their coverage, I was a leading opponent of that. I viewed it very— with real concern and caution. And so that's how I come to these bills. And I guess one question I have for you is you said in your opening statement that there were many concerns with ASMA, State Medical Association, that were incorporated. Were there some that were not incorporated?

Representative Mena?

For the record, Genevieve Mena, House District 19 representative. To Co-Chair Josephson. There were some areas, as discussed between the Alaska Pharmacy Association, that was discussed with the State Medical Association. And I would love to defer that question to Dr. Signa Martin to talk about those changes that were included in the bill and some that were not.

Dr. Martin, if you can put yourself on the record.

Yes. For the record, Dr. Brandy Signa Martin. To co-chair Josephson, we met a total, I think, of about 6 hours and had some pretty in-depth conversations between the Board of Pharmacy, the Pharmacy Association, and the Medical Association. Those conversations were very, very productive. And so what the significant changes that you'll see in the bill from those conversations is that we added in other patient care services where we're— that's the really the The fundamental change in law is adding prescribe and administer to that section of law. We added a section that says no new diagnosis, and we did that. We heard a lot of concerns around the diagnosis piece. So that was one of the big changes. We also took out, or we prohibited the prescribing of opioids unless it is methadone in the setting of an outpatient treatment facility for opioid use disorder. We also added Section 1, which is around collaborative practice agreements. That was a place where we really were very well aligned, was around the fact that we currently— our collaborative practice agreements right now, which I was going to talk about in my presentation as well, they're not really functional. So that was an area that we very much aligned on in the conversation. You know, one of the questions or the requests that they had asked us is, can we put lists into statute of, you know, very specific— getting very specific and granular, that really doesn't achieve the goal of the legislation. Also, you know, healthcare is on a wide spectrum. It's really hard when you get that specific, then we're going to be coming back to you guys, you know, every year saying, oh, well, there's this new other thing we want to do, essentially, right? So this legislation, we really feel like it puts us in a place where we can do a very limited number of things, but it also gives us the flexibility that as, you know, healthcare, the healthcare environment changes, that we're able to not have to come back and try to make statutory changes every time, as it would be if there were something in a list. So that was really the main thing that did not make it into this bill, because it didn't— we wouldn't have been able to achieve the spirit of what we're really trying to go for if we would have made that change.

Follow-up.

Is it Dr. Sig Martin?

Signa Martin.

Signa Martin.

Thank you.

Representative Josephson.

Um, follow-up, uh, Dr. Signa Martin. The one question, and I looked at this really thoroughly and carefully, um, and I saw a discussion of the collaborative agreements. Um, I'm going to guess that in a town as small as Juneau with only X number of providers one collaborative agreement could go a long way toward covering a lot of Juneauites. But in Anchorage, you might have 100 customers at the pharmacy and you might have 98 different providers. So is the plan to have 98 different collaborative agreements so that there's an expansive coverage? How would that work?

That's a great question. I think it would really be up to the individual practice site, but I can speak to my experience from working in community pharmacy that, you know, how we would do it in Washington State with our collaborative practice agreements is at the pharmacy level. And this is typically what you see. They kind of work with one specific provider on what extended services they would want to offer and then work that into one single agreement. And the place where we're really going to see the collaborative practice agreements is going to be in like primary care settings where typically you would have a pharmacist embedded in the clinic. So Anchorage Neighborhood Health Clinic is an excellent example. They have a clinical pharmacist there who sees patients all day long. She sees patients with diabetes and other chronic diseases. And so she has a collaborative agreement with the chief medical officer there who decides what, what is in that. They decide together what goes into that agreement. So more if we can do the independent piece of this legislation, I think Those are the really simple things that we'll probably see more in the community pharmacy setting versus having pharmacists who are embedded in health systems who are providing higher levels of care along, you know, shoulder to shoulder with an entire team.

Follow-up? As a practical matter, how would a pharmacist carve out time to have the kind of appointment that I might have with my general practitioner? I mean, you couldn't come down from what do you call your station that's always higher than the rest of us? You couldn't just repeatedly interrupt your work and come down. You'd have to block out time. And that would suggest you'd need new coverage with the pharmaceuticals. Am I just as to run the operation?

Yes. To the co-chair. So absolutely, you're correct. And part of what's in this legislation is that we have to have quality improvement programs and you have to be working within the standard of care. So, that being said, you have to have time set aside to do that patient assessment. So, I can tell you a little bit about what we're working on for the Rural Health Transformation Program that might help you like to see kind of the bigger picture of how this works. And so, it is having dedicated time for the pharmacy team members to spend directly with the patient on patient care essentially. So, as we look at offering additional services in the pharmacy, pharmacy, that's going to help to create the ability to have that sustainable time. I know we're not talking about pharmacy benefit managers today. However, they're a major part of the ecosystem in pharmacy that cause stress on the staffing and those kinds of things. So, we're really seeing that pharmacy model shift and change. So, in a lot of the states that already have this level of authority and even more levels of authority, we've seen that— so, Albertsons Company, for example, which owns Carr's Pharmacies in Alaska, which have the highest number of pharmacies in Alaska, I believe 21 or 22 pharmacies. They offer suites of services where they do set aside dedicated time to see patients and they have assessment rooms in the pharmacy as well. So they have a private space to be able to go in and meet and talk with patients in that private place.

Okay. Last question. I have many more, but I don't want to hog the dialogue. How does the record keeping work if I see I'm talking about you as a pharmacist and you treat a persistent throat ailment. How do we tell my GP what our plan of treatment was? Literally, how does he or she get the file?

Yes. Representative Josephson, to the co-chair. So, actually pharmacies, over the last 10 years, we've seen a tremendous shift in how this works in community pharmacies. So, there's a whole suite of technological solutions, electronic health records for pharmacies. And one of the things that we're actually working on for the Rural Health Transformation Program is building out health information exchange access into pharmacies so the pharmacists can see the information that's there and see the entire patient record, as well as building out solutions so that it pushes that to the health information exchange. So, but in the meantime, there's direct communication between pharmacies and providers' offices all the time. So, typically it's a best practice that if you saw a patient for, say, you know, a minor issue in the pharmacy, we would follow back up with that primary care provider. And there's already those pathways that go between even the dispensing software and the provider's offices back and forth.

Actually, if I could, Representative Josephson, I had something occur to me in the Fred Meyer pharmacy. I don't want it to sound like the most dramatic thing that ever happened. After all, it's a pharmacy. We hope that there isn't lots of drama in them, but I was prescribed something by a local physician. When I presented the prescription to the desk, the pharmacist said, I have no idea why she's prescribing this. I wouldn't do it. Now, that could

a one-off, but that creates sort of a state of anxiety for a patient because they're left wondering who's the wise person. What is your understanding now and then after this bill about the proper protocol in those situations?

Yes, Representative Josephson, to the co-chair. So I mean, those are difficult situations, and obviously I don't have all the details of, you know, maybe what was going on in that person's mind or why they would have said that, but always it's still You know, the pharmacist wouldn't— I mean, a pharmacist always actually has. So they have a corresponding responsibility that is federal responsibility from the DEA to ensure that every single prescription is the right medication for the right patient at the right time at the right dose. So they do have that responsibility. A pharmacist does maintain a professional responsibility to refuse filling a prescription if it's inappropriate or outside of those bounds in their professional opinion. So that's always the case. However, Currently, and once this bill is passed, if you come in with a prescription from your provider and the pharmacist doesn't believe that it's the right prescription for you at that time, the appropriate thing would be for them to reach out to your provider, and that would still be required under this and have that conversation with your provider. And always, you know, if there's the opportunity, if they don't feel comfortable filling a prescription for you, you always have the opportunity to take that to another pharmacy or another pharmacist. To get that prescription filled.

Okay. Thank you. I am going to swing back to the lineup, which is Representative Hannon and Representative Allard. But before I do, I'm thinking we should probably build up a good little base here by letting Ms. Dr. Sigmartin maybe go through the slide deck. It's only 6 slides. So maybe if you'd like to walk us through that, then we'll come back to questions. And again, once we do, it'll be Representative Hannon, then Allard. So with that, Dr. Sigmartin.

Yes, absolutely. And again, for the record, Brandy Signa-Martin. I am a pharmacist by training, and I'm the executive director of the Alaska Pharmacy Association. And I do hope to be able to answer a number of your questions as we go through these slides. So first, you know, to get us started, let's level set on the landscape of pharmacists' scope of practice across the country. So this map shows the current landscape of pharmacists' prescriptive authority. The green states are states where pharmacists have what's considered full practice authority, meaning they're able to independently assess, diagnose, and treat patients within their education training and without specific statutory limitations. And then the states in blue have some level of prescriptive authority, which varies from limited models to, to broad approaches. And the legislation before you today would really put Alaska kind of in the middle of the pack as far as that goes, essentially. So House Bill 195 authorizes limited independent prescriptive authority for pharmacists, and I want to be very clear about the guardrails. So like Representative Mena said, pharmacists may only prescribe within their education, training, and experience, the professional standard of care, and within those specific parameters that are already in law. AS 08.80.337, titled Other Patient Care Services, already states the pharmacist may independently provide services for general health and wellness, disease prevention, conditions that are minor and generally self-limiting, or have a CLIA wave test to guide diagnosis. And CLIA wave tests are those tests that are deemed by the FDA to be simple enough that anyone can do them. We all lived through COVID, so we've all done them, right? Those nose swabs or other things like that. So we're adding to that section of other patient care services that patient care services means medical care services, including the prescription and administration of a drug or device to a patient. And then again, adding no new diagnosis. So when you take a step back, these services are limited in nature, focused on routine low acuity conditions. And importantly, pharmacists are already providing care within these guardrails. What they cannot currently do is prescribe or administer the medications needed to fully resolve that care. So I think it's an important point of clarification for the committee to— as Representative Mena said, this is really building on House Bill 145 that was passed in 2022. So that language was intended to allow pharmacists to provide, you know, these services within those guardrails. And at the time, there was kind of a general understanding that that would, that would happen. But we weren't able to fully operationalize that when the Board of Pharmacy went to regulate the practice. So in many ways, this bill isn't really creating something totally new. It's clarifying and operationalizing what the legislature already intended in 2022. So less about expansion and more about really being able to operationalize that. Additionally, the idea of pharmacist-provided care is not new. So pharmacists in the federal system, including the Veterans Health Administration and Indian Health Services, have had full prescriptive authority since 1979. So it also aligns with broader federal policy, the, the Mainstreaming Addiction Treatment Act that was passed also in 2022 that specifically allows pharmacists to prescribe buprenorphine-containing products. For medication-assisted therapy for opioid use disorder as long as it's allowed within their state scope of practice. So, you know, one of the concerns that we've heard is whether pharmacists can do this safely. And it's a fair question, right? But we don't have to guess. We have real-world data. So in Idaho, they were the first state to pass this sort of policy. So since 2018, pharmacists there have been practicing at the top of their education and training. And as noted in the quote on the slide taken from a letter submitted to the legislature from the bureau chief Bureau Chief of Health Professions at the Idaho Division of Occupational and Professional Licenses. There have been zero patient safety incidents related to pharmacists practicing outside of their scope or related to their prescribing authority. So 8 years of experience and no issues there. As we move to our next slide, I want to address another question that has been raised and might be raised here today, which is that, are pharmacists trained to provide these services? The answer is unequivocally yes. And importantly, HB 195 does not allow pharmacists to do anything outside their scope of competency. And it requires that if a patient presents with something more complex or outside of their scope, that pharmacists must refer to another provider, just like we do today. So to briefly ground that, pharmacists earn a Doctor of Pharmacy degree, which includes 4 years of doctoral-level education, over 1,700 hours of hands-on clinical training, and the pharmacy accreditation standards, which are uniform across the entire North America, really. But in the United States, we all follow the same standards. They require in-depth training in topics including patient assessment, diagnosis, pharmacotherapy, dispensing, prescribing, and administration of medications. So again, this bill doesn't expand pharmacists' scope beyond their competency. It simply more closely aligns what they're already allowed— they're already trained and trusted to do with what they're allowed to do in law. So with that in mind, I actually want to take a minute to provide a brief workforce update actually about our local UAA Idaho State University Doctor of Pharmacy program. So many of you actually had the opportunity to meet with some of our amazing student pharmacists when they were here for our fly-in earlier in the session. So the program that we have here at UAA started in 2016. So in just over 3 weeks, we're going to be graduating our 6th class. Of Alaskan pharmacists. At that point, we will have graduated 60 pharmacists right here in Alaska, and that's really important. These are Alaskans. So at our fly-in, Representative Ruffridge asked a simple question to the group. We had 14 student pharmacists with us. He said, how many of you plan to stay in Alaska after graduation? Every single one of them raised their hands. So that is the workforce that we're building right here. Growing our own, and we're producing very high-quality clinicians. So across our 3 campuses, 2 in Idaho and 1 in Alaska, our class of 2025 was ranked in the top 5 for their first-time North American Pharmacist Licensure Examination pass rates, which is a major benchmark of success. And when you zoom in on just our Alaska campus, that was 100%. So we're very proud of that, very proud of our students. They really are the best and the brightest across the entire country. So when we talk about expanding access to care, we're not just talking about this in theory, and we're really actively building the workforce right here in Alaska. I want to now spend a couple minutes really kind of talking about the care delivery and the heart of this bill ultimately. So in addition to the independent authority we discussed earlier, this bill also meaningfully fully strengthens collaborative practice. And I want to highlight this because it was a place where we found alignment across stakeholders. Um, there was a shared recognition that Alaska could benefit from more functional, meaningful collaborative practice agreements. And right now, collaborative practice agreements in Alaska are truly not operational. We have the most restrictive framework in the country, and this framework makes it impossible to implement and sustain these long term. And as a result, they're really underutilized. Also, there's currently no pathway for pharmacists to participate in medication-assisted treatment for opioid use disorder. And so this, the Section 1 of this bill, really makes collaborative practice agreements workable in these real, real-life practice settings to strengthen team-based care. And that really matters because when we talk about opioid use disorder and the opioid epidemic

arguably this is one of the biggest public health crisis of our lifetimes, and this bill creates an opportunity for pharmacists to participate in care in that space, and not independently, but that would be coordinated team-based care. So stepping back, one of the most important aspects of House Bill 195 is that it improves access to safe, timely care. Pharmacists are everywhere in Alaska. Pharmacies are everywhere in Alaska— small towns, on the road system, off the road system, and in communities where often Oftentimes other providers may not always be available. Pharmacies oftentimes have extended hours, do not require appointments, and are often the most accessible healthcare touchpoint in a community. In many cases, they're the only consistent healthcare access point. So, when pharmacists are able to provide care for minor ailments, preventative services, chronic disease support, patients are able to get care faster, closer to home, and without unnecessary delays or travel. And importantly, this helps reduce delayed care and unnecessary emergency utilization for non-emergent issues. I want to give two quick examples, um, of things that I had heard from pharmacists who I, who I know was working here actually at the fly-in meeting with some of the— our legislators. So the director of pharmacy at Yukon-Kuskokwim Health Corporation was here. She had shared that if we'd had this policy in place when former Typhoon Halong, um, happened, they would have been better, more efficiently able to triage patients as they were getting evacuated into Bethel and then later to Anchorage and make sure that they had the medications that they needed when they're getting transported and moved around because that is a critical component of making sure that they have the health and safety that they needed. I also heard an example from the district manager, Fred Meyer. He had shared a common situation that he has. A parent comes in with a prescription for a nebulizer solution for their very sick child, but not the prescription for the device that is needed to administer that medication. In the current state of things, this can cause days of delays and administrative burdens on the provider's office and the pharmacy going back and forth and trying to get that prescription, really harming the patient. And you have this stressed-out parent right in front of you. If we have this legislation, he said, I could easily just resolve that issue in real time, get the parent what they need, on their way so that they can go home and take care of their child, which is what they should be focusing on, not on all of these administrative barriers, essentially. So what else does this look like in real life? So we could be seeing pharmacists providing care for test and treat services for strep throat or influenza, preventative services like smoking cessation or HIV pre-exposure prophylaxis, treatment for minor conditions such as seasonal allergies, cold sores, pink eye, insect bites, supporting teams managing chronic diseases like hypertension, asthma, diabetes. Supporting medication-assisted treatment for opioid use disorder, and overall improving efficiency within the healthcare system by ensuring that patients are being seen by the right provider at the right time. So, I also want to speak directly to what I think is a Finance Committee perspective, which is that it's not just about access, it's also about value. An economic evaluation of pharmacist-provided care found that for every $1 invested in pharmacists services return— brings a return of $4.81 in healthcare savings that comes from fewer hospitalizations, fewer complications, and more efficient care delivery. And then also in a more recent study from Washington State that looked at community pharmacist-provided care for minor ailments compared to traditional care settings found that $277 less cost per episode with no difference in outcomes or return visits. So, in short, better access, lower cost, same quality. I'll share that I was personally involved in that study, and what really stuck out to me was hearing from the patients how grateful they were that they didn't have to take time off of work, that they didn't have to wait days for an appointment or navigate unnecessary barriers to get something simple taken care of. So that really is the kind of smart, high-value investment that Alaska needs, and House Bill 195 helps unlock the value that pharmacists are already bringing to the system. So when paired with this once-in-a-generation funding opportunity with the Rural Health Transformation Program, it becomes even more powerful. So this bill really positions us to expand access, strengthen team-based care, improve outcomes, and deliver care in a way that actually works for Alaskans. And, you know, we at the Pharmacy Association are committed to working alongside the Department of Health and partners across the the state to implement innovative and sustainable models of care. So next, and kind of lastly, I want to address a point of confusion on the bill. House Bill 195 does not authorize pharmacists to prescribe or dispense abortion medications. The Department of Law addressed this directly with our bill sponsors. One on the screen, and we have a written statement from Senior Assistant Attorney General Parker Patterson confirming this fact. House Bill 195 does not amend Alaska's abortion statutes, does not alter the existing legal requirements governing medication abortion, and does not create a new pathway for pharmacists to provide that care. So to be clear, this bill does not change abortion policy or abortion medication law in Alaska, but rather, as the assistant AG says, this bill would simply provide pharmacists the ability to provide limited patient care services within their training and experience. So in closing, I want to share that this bill is formally supported by the Alaska State Board of Pharmacy, the Alaska Hospital and Health Care Association, the Alaska Native Health Board, the Alaska Doctor of Pharmacy Program, and the chief medical officers at many of our tribal health organizations, including Southcentral Foundation and Tanana Chiefs Conference, who we've heard from them in previous bill hearings. So That is my presentation and I would be happy to take the rest of your questions at this time.

Great. Thank you very much for that. We do have 4 people on the list here and I've got Representative Hannan, Representative Allard, Representative Stapp, Representative Galvin. So we'll go to Representative Hannan.

Thank you, Co-Chair Foster. My question was for the sponsor and I was wondering if Representative Mena selected April 7th as the hearing date because she wanted to lead us in a round of birthday celebration, or whether that was being reserved for Representative Stapp to do a solo performance, who's out of the room at the moment, or whether we were just going to let Representative Schrag be embarrassed at caucus later.

That sounds best. Representative Mena, would you like to address the question?

For the record, Representative Genevieve Mena to the chair, to Representative Hannon, no comment. Fair enough.

Thank you.

Sounds like we're all in for a surprise, especially Representative Sharagi later. Happy birthday, Representative Sharagi. So next up we have Representative Ballard.

Thank you. So I have a lot of questions. I think I have 10 pages of questions, but I'm not going to ask them all. So I do have concern, and I will disagree with the Attorney General Patterson— Assistant Attorney General, that's who it was— through the chair. So I'm going to hit up on Section 8 if we can. First, my first question through the chair is to Ms. Signe-Martin. Did I say it right?

Close. Signe-Martin.

Okay. This bill actually is going to bring in a lot of money. Are we—

is this bill—

lobbyists are jumping on board, big pharma lobbyists jumping on board, and are pharmacists going to make a lot of money off this bill once it passes?

Dr. Signa Morton.

Yes, Representative Allard, through the chair. So pharmaceutical companies will not be involved in this at all. That's more on the medication-specific side. I mean, pharmacists will have a pathway. So in House Bill 145, one of the provisions of that bill added pharmacists to the list of all the many other types of providers that are in Alaska to the nondiscrimination statute in insurance that does require pay insurance payers, including Medicaid, to pay pharmacists for their clinical services, just like we see with everybody else who's in the healthcare system. So, yes, pharmacists will be able to create these. These will be sustainable because they'll be able to get reimbursed, just like we see our other providers doing. Are they going to make a lot of money? I doubt that, but they're going to be able to offset their time, right, so that they can spend time doing it, certainly.

I just want to make sure that everybody knows this is on the record.

Representative Ballard, thank you.

And then just a couple of follow-ups.

Representative Ballard.

Okay. So we are working with big pharma lobbyists to get this bill passed. Is that a correct statement?

Dr. Signa Martin.

Through the chair, Representative Ballard, no, we're not working with any pharma lobbyists that I don't know of, any pharma lobbyists that we're working— that are working on this bill at all.

Okay. The other question is if we go to Section 8, page 6, line 5, it's amended to read patient care services. So one of the questions I would have for you, Doctor, is are pregnancy tests CLIA waived?

Dr. Signa Martin?

Through the chair, since they are over-the-counter, anyone can do that, yes, they would be considered CLIA waived tests. Anything that you see that you could purchase, like in a store over the counter would be a ClearWave test. Okay.

And then I just have a couple more questions. So pharmacists can diagnose a pregnancy, correct?

Under this bill.

Dr. Signa Martin.

I mean, sorry, Representative Ellard, to the chair, it's not. So the rest, if you read the rest of it, I wouldn't consider pregnancy to be minor or any of those other things. So I would say no. I mean, I don't think that it fits within that whole bigger broad picture of that, especially in like a community pharmacy setting where I wouldn't— I wouldn't believe that you would see that. No. Okay.

So this bill does state that a pharmacist can diagnose a pregnancy under this bill. So then my next question would be, can a pharmacist prescribe the drug for an abortion? I can't remember how to say it. Misoprostol, I think it's called.

Okay. Dr. Signa Martin.

Yes, Representative Eller, through the chair. No, they would not be able to. This would be So because of the— as the Attorney General said, in a community pharmacy setting, you wouldn't be able to do that. You also wouldn't be able to prescribe that within those independent confines. That wouldn't be something that would be possible. And currently, so after the Supreme Court decision that put the question of abortion policy back onto the states and the state legislatures in 2022, Attorney General Taylor had come come out at that point in time to clarify that pharmacies in Alaska cannot dispense that medication and also that outside pharmacies cannot do mail order to send it into the state either.

Okay, I'm gonna— if I can, I need to clarify some things on here. According to this bill, and I'm disagreeing with the Attorney General on this because he's given the wrong statement, I've contacted him, gave me the same statement, he's completely incorrect on it. So under Section 8, it clearly states that including the prescription or administrative of a drug or device to a patient that are given in exchange for compensation and. But then you go down to number 2, which is line 12, does not include the prescription or administration of a Schedule I or IIA controlled substance under state law. But under this right here, it is saying that a pharmacist can give a pregnancy test and then based on that can administer the medicine. I'm trying to pronounce the drug. Are you 486 or is that 480G? 6. So I'm totally disagreeing with that and I have all proofs of documentation here that say different than that and I'm very concerned about it. And are you concerned that it violates the Hyde amendment by any chance?

Dr. Signa-Martin.

Representative Ellard, through the chair, I'm not sure what that is exactly that you're referencing, so I wouldn't want to speak on something that I'm not entirely certain of. And again, I'm a pharmacist, not an attorney, so I have to just go with what the Attorney General says. I don't— I don't— I don't have the legal training to be able to interpret that in any other way.

Okay. All right, I'm going to hold off based on some of her answers and then I'm going to come back, but I want to let others go ahead. If you can just put me back in queue. Okay, thank you.

Okay, so next up I have Representative Stepp, Galvin, then back to Allard. Representative Stepp. Yeah, I think, Co-Chair Foster, I guess through the chair, I guess the bill sponsor or testifier. First question is, I looked through all the public test— I looked through all the supporting documents in the packet, right? All the all the letters and pro and some of the opposition letters. And I do not see the letter from the State Medical Board in opposition that is on BASIS. And I'm curious why it's not included in your bill presentation, because the letter from the State Medical Board that's not in this packet that's on BASIS regarding the bill clearly says that they're in opposition because this bill would— and I'll read it, and hopefully we can get it added to the bill packet because it is actually part of the public testimony that was submitted. It says HB 195 and SB 147, which is Senate companion, would effectively expand the prescription authority for pharmacists to provide and administer any medications including controlled substances and abortion medication. So that's in the State Medical Board's opposition letter to this bill that's conveniently not in this packet. So 2 questions. Why did you not include that letter when you presented this bill? Because it's on basis. And 2, what is the counterargument to the state medical board's claim? Representative Mena or Ms. Giorgio? Representative Mena.

For the record, Genevieve Mena, House District 19 representative, through the co-chair to Representative Stepp. I know that was from the State Medical Board from last year. And I know that there's been some discussions from the Board of Pharmacy and the Alaska Pharmacy Association about that letter. But you're correct, it's not currently in the bill packet. And your second question, which— excuse me, could you restate your second question?

Yeah, just through the chair. Thank you, Representative Mena. Yeah, they say it does. I mean, the state medical board's opposition letter says it does allow for pharmacists to prescribe abortion medicine. So I don't— I'm just curious what the rebuttal is because again, and also just for the record, it's kind of like I can't— I don't know why you wouldn't include that in the bill packet when you include everything else. It's kind of— it makes me really question what's happening right here. Ms. Georgiou, thank you.

Through the chair to Representative Stapp. Yes, we were well aware of the medical board letter, hence why we went to the Attorney General's office to clarify, because we believed that they were incorrect in their letter. And so we went to the, the people who, who are in charge and who can answer that question, because that's what they do at the Attorney General's office. So we included this information here because we believed that this was factually correct.

Your fault, Mr. Co-chair. Representative Scott. Yeah, but I'm— and again, I want to be as polite as possible about this, but you can kind of see where I'm hesitant to believe you because I have a document that's on basis from the state medical board that says they can't do this. So I appreciate that you went to the AG. You might very well be right. But I mean, the fact that you didn't include it in this packet when you include everything else makes me really hesitant to, like, think that everything's above board here. Through the chair, Ms. Georgiou.

Through the chair to Representative Stepp, as you noted, it is on basis and publicly available for view.

Representative Stepp. I mean, it's insufficient answer, co-chair. Sorry. Right. Okay. Next up, we have Representative Galvin, Representative Allard, then Representative Bynum. So we've got Representative Galvin. Galvin.

I thank you, co-chair Foster. Through the chair, I think this is a question. Well, first of all, a comment. Thank you for being here. Thank you for presenting this. We need more care in Alaska. We need more care and accessibility. And I, in hearing from the folks who came to visit, I really appreciated that, knowing how many smaller communities truly have access issues. And I think that especially after experiencing COVID, we've seen a need to expand. And I do have a couple of questions, probably because I've just learned some new things. One of them is you referred to, I think you really calmed everything, every fear I had after hearing about the pharmacists just staying in their lane, essentially, that that's written in there, that we're not going to go beyond their field. I appreciate that that's in the bill. I appreciated that they're going to stay within the scope of their education, training, and experience. And I believe that's maybe why AHHA, or the Alaska Hospital and Healthcare Association, wrote a very supportive letter. I appreciate that. Generally, I kind of lean on them since I'm in finance and I'm not in healthcare, and kind of like to hear from those who are doing that. What I didn't hear from that I'm gonna ask you about is a group that's related to the behavioral health organization. Because I think you mentioned methadone being used, and this is where I don't know much about it, but I had a daughter-in-law who was associated with caring for those who were being prescribed Suboxone. I think that they're maybe along the same thing related to opioid overdose. And it seemed to me that that would need a lot of oversight, a lot of oversight before any treatment. And so if you could just explain that piece. And then I have one more piece, a follow-up question.

Dr. Signa Martin.

Yes, Representative Galvin, through the chair. So methadone is an opioid product that is used in the setting of opioid use disorder treatment. And so both that and Suboxone, the buprenorphine-containing products, pharmacists would be able to prescribe those or participate in care around that in a collaborative practice agreement. And so the specific where it prohibits opioids or that schedule of drugs other

than methadone, I do believe it says in the setting of an outpatient treatment facility. So we have pharmacists who do work around the state in tangential to some of those settings, but they're not able to actually prescribe. And really managing the medications is what pharmacists are the experts at. And so we want them to be able to work in those settings. And I've heard Dr. Sarah Spencer— I don't know if you're familiar with her. She is a physician out of Nanilchuk who has a mobile opioid use treatment. And she has actually testified. I've heard her testify to the Board of Medicine that she would like to be able to collaborate with pharmacists in that setting to be able to expand access to those services as well.

Thank you. Through the chair, I appreciate that. And I— hearing the words that that would be part of a collaborative practice agreement makes a lot of sense to me. And that kind of resolves everything I was wondering about, just thinking about how much intensity of oversight that would require. Thank you. And then my final question, if I may.

Representative Galvin.

Thank you. It relates to hearing that pharmacists and those who are in that area of work are under a lot of stress. I guess that there is a study recently that shows they were— the U.S. Pharmacists says they are at 61.2% highest burnout, partly attributed to taking on more responsibilities through COVID and all of that. And I just wondered, I imagine that the answer is going to be, well, now they're going to be allotted time and paid for this, and it would be a different scenario. But if you could just please speak to this concept of adding more stress. I worry about how we will be adding more if we're going to grow their scope if you will. And so I'd appreciate hearing about that.

Dr. Signa-Martin.

Yes, Representative Galvin, through the chair. So the pharmacy ecosystem is really— I think we're at this time of change. And so let's take actually a step back, I think, and look at the system as a whole. And so I can't talk about pharmacy without talking about pharmacy benefit managers and the pressure that they've put on pharmacies by having at least 30% of claims that are being paid to pharmacies are paid under the wholesale cost of the medication. That is what's putting this tremendous amount of stress on our pharmacies. It's closing our community pharmacies. We saw a 30% loss of independent community pharmacies between 2018 and 2024, really, really diminishing that access. And so, what we're trying to do here, I think big picture, is really shift the model of care. We really, we're seeing more and more PBMs, even though this body did pass a bill that says no patients get to choose their pharmacy, that law only applies to 15% of covered lives in Alaska. So, there are still a ton of lives, including all of you who are state employees and have OptumRx as your PBM. They're oftentimes steering you to use out-of-state pharmacies. They don't just steer you to use those pharmacies all the time, but oftentimes when it's on the most— the medications that have the most profitability. So, the problem with that, you can see, is diminishing returns to our local pharmacies. Really harming that ecosystem. So, instead of seeing pharmacies close as they have less and less prescriptions, we would really like to shift the model of care so that pharmacies can become healthcare hubs in our communities and places where community members and people can go in and ask questions and get care for these minor things. And the pharmacies can get reimbursed for those and create the sustainability that we need so that you still have that open door. And you know what, when your kid is sick and they need an antibiotic, you can't wait for mail order to send you that. That's why we need to have pharmacies in our communities. We need them to be open. This is one piece of like that bigger picture and that ecosystem. We've also seen that in other states where they've advanced pharmacist scope of practice, there is professional satisfaction increases significantly because now pharmacists are actually able to do what they were trained to do. In pharmacy education, they've been telling us for over 20 years that you're going to graduate and you're going to go and actually do patient care. But oftentimes our state laws are actually not keeping up with that. And so that's— that would be my answer. It's really like, let's take a step back and look at the bigger picture of the ecosystem and how we can really change it. And this bill is a big part of that.

Thank you.

Okay, in line I've got Representative Allard, Bynum, and Josephson. Representative Allard.

Thank you. And through the chair, so this is going to go to the sponsor of the bill, and this is— this is the reason why I say the Assistant Attorney General is absolutely incorrect. I know it seems weird that I would be able to challenge the Attorney General. But here's the facts. The fact is that in the bill it clearly states— let's look here— collaborative practice agreement with a written protocol approved by a practitioner who is not the pharmacist. Now, if that happens, a pharmacist can take the collaborative deal that you have in the bill and and that physician can then prescribe an abortion pill and give that authority to the pharmacist, and then the pharmacist then is prescribing that medication to the individual. So my question would be, if there's no such thing— and the other bill that was heard in the other body, the sponsor of that bill, the staff clearly stated yes, you're allowed to have an abortion based on the bill that they were carrying, 147, and this is the sister bill. So my question then would be, if there's no abortion allowed, and that's what we're saying in this bill, then why is it so difficult just to write that into the bill?

Representative Mina, for the record, Genevieve Mina, House District 19 representative. Through the co-chair to Representative Allard, we want to make sure that This bill is specific to pharmacists prescribing authority, and we are looking at the direction of the Attorney General's office in terms of what is allowed and for prescribing abortions, etc. And under the senior assistant attorney general's memo and the note that we have here, that's what we have been following. And so we don't want to add more unnecessary unnecessary language in the bill that would detract from the central focus, which is related to increasing access to primary care and making sure that pharmacists can practice to the scope of their expertise and training. And additionally, with the collaborative agreement with the provider, that collaborative, collaborative agreement wouldn't allow a physician to change that scope of the pharmacist and their ability to do more prescriptions or practice what's outside of their training.

A quick follow-up. Thank you. A couple of things. I'll hit on the Idaho law in a second, but I would disagree with you because I have a legal memo stating differently, and I have— my staff is going to be able to hand that legal memo out. The legal memo clearly states that if a written protocol included prescribing and administering an abortion drug from the collaborative practicing agreement for one of the reasons described above, then the pharmacist would be able to prescribe or administer a drug that induces an abortion on a patient. That came from our legal department. So I have grave concerns, not only that, in my opinion— well, I'm not going to say that. I'm shocked that the medical exam— the medical board's findings We are not in this. I feel that was deliberate in a sense that— nope, I'm not going to say that either. Just surprised it wasn't in here. The other thing is I wanted to ask one question in regard to the Idaho law. Thank you. Through the chair, Dr. Sine-Martin. Sing-Martin? Close. I'm getting there. I'm getting there. Can you explain to me again a little bit the connection of why you feel this bill aligns with the Idaho law? Because you had mentioned it earlier. Could you remind— just refresh? Because then I have a question for you.

Dr. Signa Martin?

Yes, Representative Allard, through the chair. So Idaho in 2018, so almost 8 years ago, they had started down this path where now they have full practice authority. So they practice fully independently in Idaho, like the same level as an independent nurse practitioner. But they, when they first started kind of down that path, this was the language that they had passed in their state legislature was very similar to the language that's in front of you in this bill. That's, that's actually part of actually what was already passed in 2022 is that section, other patient care services, that pharmacists may independently provide patient care services in those instances of general health and wellness, preventative services, or for minor and generally self-limiting. So things that would go away eventually on their own anyways, like pink eye or something like that, or when there's a CLIA wave test to guide decision making. So that was like the same language that they had passed originally, which is why we kind of reference that as being similar. But since they've gone much far beyond that, I appreciate it.

So I'm just going to go with a couple of follow-up things that you had said. So if you look at the map on page 2 of your slide

presentation, you said most of these states that are in green have full statutes of full authority. I did a little bit of research. Montana, North Dakota, and Wyoming do not. And I'm not really caring about what other states do, but those three states don't have full authority. And then the second thing is that when you reference the abortion law for the Idaho abortion or the Idaho bill, they actually say that they put it in their bill that it's a felony to prescribe anything that would lead to an abortion, meaning an abortion pill. So I'm concerned that you're referencing that because it's not actually accurate, because Idaho actually has it in their bill, or yeah, in their bill, in their statute, that says that it's a felony and punishable by imprisonment up to 2 years to give any type of abortion drug to a woman. So my concern is, again, I'm going to go back to raise the question, Why not just say any type of abortion? This is to the sponsor chair. Through the chair, Representative Mena, if, if we want this passed, why is it so difficult to just say that the pharmacist, even through collaborative agreement as the legal document from Ledge Legal has given and provided, and I will give everybody a copy, why not just say you cannot prescribe an abortion drug?

Representative Mena, through the chair to Representative Allard, for the record, Genevieve Mena, House District 19 representative. What we want to do is make sure that this bill focuses on primary care access, and what we don't want to do is add additional language that detracts from the bill's goal to help make sure that pharmacists are able to provide limited primary care services. And once again, we're deferring to the Attorney General's office and how they are currently enforcing the law, particularly as it relates to AS 1816.010, that subsection A.1 is specific that the provider— the— it's— it prohibits pharmacists from being able to dispense abortions. And so we just see that as unnecessary language that detracts from the bill's goal.

Representative Ballard.

Yeah, just one last closing statement. So Ledge Legal wrote the bill. And they said, based on the wording in the bill, the collaborative agreement, that the pharmacist then would be able to prescribe the abortion pill. The reasoning you're giving is not good enough for me, and I don't think it's going to be good enough for a lot of the public. Some of the things that can happen when you have an abortion that is not monitored— you can die, you can bleed out, you're killing a baby. I have a whole list of things that we can do, and nobody is monitoring that female. So if you give which they say in here, you can give a urinalysis test. The woman can be pregnant. They can just say, hey, I'm pregnant. The pharmacist can say, you're pregnant, here it is. Then that female can then say, can I have an abortion pill? Then walk away. Could be further along than the pharmacist knows. She could be 4 months, 6 months. We don't know. And then deliver a baby and both her and the baby could die. So I have really big concerns about this bill. And that's all I'm going to say right now.

Thank you.

Okay.

Thank you. In line, I have Representative Bynum, Josephson, Tomaszewski, and Stapp. Representative Bynum.

Oh boy. Thank you, Co-Chair Foster. Through the chair. I mean, that's a big conversation that's just brought up here. I don't even know where to begin with it, but it does bring some questions to mind. I guess when I look at the bill, I see that there's an opinion from our attorney general or assistant attorney general. I'm assuming that I can trust our attorney general to follow the law. And prescribe application of the law. And if we can, I guess that we have some real issues at hand and maybe we got to ask some different questions. But we're not here today to do that. When I look through the statutes and I look through the bill specifically on the topic that we were just talking about, and this is about abortion-inducing drugs being prescribed by a pharmacist, I look on page 6 of the bill, Section 8, and it talks about medical care services, and it talks about what, talks about what can be prescribed or administered. And when I read this, it basically tells me that they can prescribe things to prevent disease, they can eliminate or reduce a patient's symptoms, or arresting or slowing the progression of a disease. Are there any other things that the pharmacist can prescribe medication for that's not listed here?

Dr. Signa Martin?

Yes, Representative Bynum, through the chair. So I would say that's actually the most broad of the language. And then if you go back to the whole section 08.80.337, which that's going to sit in, that's where it gets even more restrictive, where it's though for those things, but only in instances of general health and wellness. Preventative care, minor and generally self-limiting. So that's— that would be the context, I believe.

Follow-up. So when I went back and I looked at this section, I didn't see abortion being listed or providing abortion. Is abortion listed in that section?

Representative Bynum, through the chair. No, it is not. And I think that that's a key component, is the— that piece in the place of therapy.

Representative Bynum. And then a quick follow-up on that is when I look at these definitions and I read them, is diagnosis of pregnancy— I'm assuming that that would happen in a clinical setting. Can pharmacists currently, or are they able to diagnose pregnancy in the clinical setting of a pharmacy?

Dr. Signa-Martin.

Representative Bynum, through the chair, not that I have heard of. No, I don't know about that.

Okay. And then my last question is under that section that we just talked about, broad provisions, determination of a pregnancy. Would that fall under the definition of preventing a disease, elimination or reduction of a patient's symptoms, or arresting or slowing a disease?

Dr. Signa-Martin.

Representative Bynum, through the chair, no, it would not.

Thank you.

Okay. In line, I have Representative Josephson, Tomaszewski, Stepp, Moore, Galvin, and Allard. Representative Josephson. Yeah. One thing I wanted to say, Mr. Chairman, is that in this packet, and I've just quickly read the legal opinion provided by Representative Allard, But in this packet, there are 22 anti-bill, opposition to the bill letters. And they all concern, except for one, by a Dr. Dante Conley, who addresses the issues I addressed in my questions. The other 21 all concern the issues Representative Ballard made. So I want to be clear, accusations that the sponsor is hiding this debate, if she is, she's doing a miserable job at it, assuming that she prepared this packet, and I suspect she did. So you've got to do better at prohibiting us from seeing these opposition letters, I say sarcastically.

The—

there was also a claim about slide 2 and about what Montana does or doesn't do. That slide doesn't purport to be about abortion. It's about the broader prescription authority. And as a green state, it has full authority. That's, that's all it purports to say. I just want to be clear, Mr. Chairman, that my concerns with this are asthma's concerns, if any, the State Medical Association, not the State Board. I got to make that super clear on the record. The— I don't think I have a whole lot more I wanted to add. It does seem that Deputy Attorney General or Assistant Attorney General Patterson I mean, I do know that when a board, an authorized board, seeks guidance, they seek it from people like Mr. Patterson. That's what they do. They are required to do that. And his statement, Parker Patterson's, is pretty unequivocal. But there are those who want something more prophylactic in the bill. So I don't really have a question. I just wanted to make those statements. I don't find— if this were— if this were a trial about presenting alternative opinions, the sponsor would be fully acquitted.

Okay.

Representative Tomaszewski. Thank you, Co-Chair Foster. So I have a few questions. It looks like what I want to start with is Section 9, actually. And Section 9 simply reads, a pharmacist prescribing or administering a drug or device under this section shall recognize the limits of the pharmacist's education, training, and experience and consult with and refer to other practitioners as appropriate. Is this a pharmacist talking about themselves in like— is that what this is? This is a pharmacist

Dr. Signa Martin.

Yes, Representative Tomaszewski, through the chair. So this is based in what's called the standard of care model that we use in healthcare, that all, all of our other healthcare colleagues use this model to ensure that they're providing care within their education, training, and experience. So for example, a— while, you know, maybe two physicians, one who is an oncologist and one who's a family practice physician, wouldn't wouldn't have separate types of licensure, but they would be required to recognize the limits of their education, training, and experience. So if your family, you know, went to your family practice physician and did have cancer, then the standard of care would be for them to refer that— refer you on to an oncologist or somebody who has the more specialized education. So that's what that language is rooted in is something that's throughout healthcare that all of our other nurse practitioners, our PAs, our physician colleagues are all governed under that same model.

Okay, follow-up, Representative Tomczewski. Okay, to me that just sounds like the fox guarding the henhouse. And maybe that's the way they do it. It's just to me, looking at that, I'm like, I have to recognize my own And it's kind of left up to me too, which is kind of, kind of strange. So I was looking through the letters of support and oppositions. Looks like we had a doctor, I think, that had a concern, and that was in regards to education. They said that pharmacists should only practice up to their education. And then we had a lot of pro-life opposition, and they're specifically talking about abortion drugs. And it looks like we've had a pretty good discussion on that. And there was also an oppositional letter from the Human Rights Commission, the Citizen Commission of Human Rights, and they're talking about psychiatric diagnosis. Was there a discussion on that in committee? And can you kind of kind of talk me through that opposition of the bill and what their problems were and if they were addressed.

Representative Mena.

Through the co-chair, through to Representative Tomaszewski, for the record, Genevieve Mena, House District 19 representative. I don't believe we had discussed the Citizens Commission on Human Rights letter. I know that they're a Seattle-based organization that generally has been consistently opposed to anything related to psychiatry and any legislation that we have here. But that was not brought up in committee.

Okay. Follow-up, Representative Tomaszewski. So then I just received the letter that I guess is on basis from the Alaska State Medical Board, and the diagnosis and treatment of medical conditions is the practice of medicine, they state, and the State Medical Board opposes pharmacist being granted the ability to practice medicine in Alaska. And that takes me to this— I think it was a mistake to not include that, probably feeling that way. But I want to go to this memorandum that says, "To interested stakeholders," and this is from the Alaska Pharmacy Association. Is this actually what the Senior Assistant Attorney General. I don't know what that position is. I guess is that, is that the number 2? But is this actually what they sent? Is just a copy and paste, or is this a summary of what they said? What Parker Patterson, Senior Assistant Attorney General, is this actually his? This isn't exactly what he sent you, is it? Or is it? Rep. Ms. Georgiou.

Katie Georgiou for the record. Through the chair, Representative Tomaszewski, I can answer that for you. In the packet, there is a copy of the actual email from Assistant Attorney General Parker Patterson, and I do believe what you're holding in your hand is a summary for interested stakeholders. So the language in that summary was pulled directly from the email.

Okay. Thank you. I will look at that again. And so back to the abortion. So specifically, was there an amendment offered in committee prior to getting to finance that specifically asked for the abortion pill exemptions to be made clear, like put it into the legislation? Was that amendment offered? Representative Mena.

For the record, Genevieve Mena through the chair to Representative Tomaszewski. No.

Okay. Thank you. Okay. In line, I have Representative Stepp, Moore, Galvin, Ellard, and Bynum. Representative Stepp.

Yeah, thank you, good chair. Through the chair to Rep Mena. So just really quickly, I know you said that— or excuse me, maybe it wasn't you, maybe it was our wonderful folks from the pharmacy— talked about how you felt that language clarifying that would be kind of unnecessary to be put in the statute. So the crux of the issue I see here for me is I have a relatively kind of benign legal memo regarding this collaborative practice agreement. And of course I got a letter from the state medical board and I have relatively contradiction from the state Assistant, I guess, AG. So if there is no harm in putting language into the bill regarding the collaborative practices agreement and just clarifying that, hey, nothing in this says that we want you to be able to prescribe abortion medication, is that a big of an issue with the bill if you think it already doesn't allow that?

Through the chair, Representative Mina.

For the record, Genevieve Mina, House District 19, Representative. Through the chair to Representative Stapp, our goal is to not add any language pertaining to abortion in the bill because the bill is not about abortions. It's not about pharmacists being able to prescribe, dispense, administer abortions or abortifacients at all. It's a bill about primary care access.

Yeah, follow, Mr. Kocher.

Representative Stapp?

Yeah, well, I mean, just clarify, so I I thought I heard you guys say that nothing in the bill allows for that type of prescription, that it's already covered in state law and that adding language would be relatively unnecessary, right? And I want the— I mean, I want the bill to pass because I want pharmacists to have a scope of practice. I said, but from my perspective, it's like we clearly have a bit of a disagreement here over kind of an ideological thing. And if you're saying that, hey, the bill doesn't do that already and it's fine how it is. I don't see any harm in putting any language in there just to say that's kind of their intention there in that collaborative agreement. I mean, if it's already not going to happen, then us putting some language in there doesn't have any effect. Is that correct? Through the chair, Ms. Georgiou.

Thank you. Katie Georgiou for the record. Through the chair to Representative Stapp, we talked long and hard about that exact question. About whether or not including the language would be benign or not. And one of the things that we've come to understand, if you say, quote, abortion-inducing drugs, well, what does that mean? Which exact drugs are we talking about? I mean, that could be out. I mean, I don't— I'm not a pharmacist, so I feel like more and more of one each day. But I think there is a little bit of uncertainty about what exactly an abortion-inducing drug might be. Now, if you want to name mifepristone specifically, Again, I'm not a pharmacist or a physician, but my understanding is that mifepristone is not exclusively used for abortions. It's, I think, stomach ulcers. There's a couple other uses for that specific drug. So in our conversations, we thought it would actually do more harm than good because it would create more uncertainty around what is an abortion-inducing drug. And we think there would be some unintended consequences to including the language. And again, just resting back on our Attorney General's office, we felt that this was ironclad enough language where it was very much unnecessary to include problematic language in our bill.

Follow-up, Representative Staff. Yeah, thank you, Chair Foster. My bad, you're the chair. I'm used to a lot of hours saying Coach Jefferson last week, you know. So looking at slide 6 though, right, I mean, it's— to me, this is I mean, it makes me uncomfortable because I have conflicting opinions, right? So this AG's slide deck 6 said the short answer is no and has a statute. And you mentioned a little bit ago, Ms. Gorgio, that it depends on your definition of what an abortion pill is. Obviously, if you codify a drug, right, drugs can be used for multiple purposes. So obviously you wouldn't want to do that. But I mean, what's the harm in saying, hey, we don't want to Nothing in this collaborative agreement is going to be to allow pharmacists to diagnose and dispense abortion medication that they can't otherwise already do. Like, what's the harm in doing that? Because I think that probably solves this controversy. If your testimony is correct and it's already— they already can't do it, then it seems relatively

relatively simple to me, at least through the chair.

Representative Mena, through the chair to representative staff, for the record, Genevieve Mena, House District 19 representative. Once again, I think that if you create a collaborative agreement where you have a physician that is trying to allow a pharmacist to be able to prescribe or dispense an abortion, it would go against what's currently in statute. As it relates to AS 18-1610 subsection A-1.

Representative Stap.

Yeah, thank you, Co-Chair Foster, through the Chair. I mean, you might be— I mean, maybe Representative Bailey would be right, but why not just say that in the bill here? Right? I mean, just say, hey, we don't want to do anything that conflicts with this statute. Because the intention is not to have pharmacists diagnose and prescribe abortion medicine. To be sure.

Representative Mena.

Through the chair to Representative Stapp, it's redundant language.

All right. Thanks. Okay. In the lineup, I've got— let's see, we'll come back to Representative Moore. She's at the top. Representative Galvin, Allard, and Bynum. So Representative Galvin.

Thank you, Co-Chair Foster. I think that my questions are becoming redundant, and so I don't want to add to that, but I agree with your language about redundancy. Now that we know, I've just now had my staff look into whether or not pharmacists can administer mifepristone, and knowing that that's not something that is allowed to happen in clinical setting, and it can't be prescribed in a pharmacy. And so I really just think we— I'm ready to drop that one. Thank you.

Okay. I've got Representative Allard.

Thank you. And through the chair, so I want to skip down to speaking about the CPA, the collaborative practice agreements. Through the chair to the sponsor, it says that it restricts the Department of Board's authority to approve or regulate a CPA. That's concerning to me. And then it goes on to say that this does not restrict abortion pills like the metoprostol. I'm just going to call it the abortion pill in any way. What I'm getting at is if you have a collaborative practice agreement, we are the boards that have anything to do with this are just outed. Meaning they're gone. They have no say in regards to anything that happens with being able to pick those CPAs. That's a concern in this bill as well. So they have no input, no oversight, and that is why we have boards to have that oversight. Do you— obviously you believe it's okay, but do you have any concerns with the pharmacy board or any boards having any oversight?

Representative Mena.

Through the chair to Representative Foster— through the chair to Representative Allard, we have a lot of different collaborative practice agreements already as it relates to physician assistants and other providers, and boards and departments do still have the ability to regulate the standard practice of care as it relates to pharmacists, and that applies to these collaborative practice agreements. And I believe Dr. Signa Martin also has some commentary to add.

Dr. Signa-Martin?

Yes, Representative Allard, through the chair, I would say the Board of Pharmacy was in agreement on that language and it doesn't say that they cannot regulate. It just takes away the approval process. So when I said we're the most restrictive state in the country around collaborative practice agreements, it's because right now they must— each one individually must be approved. This is incredibly onerous. Like the the Board of Medicine gets really into the details of these things. And oftentimes, they might not have even worked with a pharmacist before. The challenge we've had is that currently, a lot of those don't get approved for reasons that we don't understand when they're things that are, are pretty run-of-the-mill. And there are even times when we've seen it in a clinic setting where because these agreements currently have to be approved every 2 years, where we've been at risk of actually losing access to care because those boards change over time. And so, there was a situation out of Fairbanks where they have a pharmacist embedded in a clinic who sees patients all day every day. And then they just resubmitted their same agreement that they had, and the board was really close to not approving it until their executive administrator actually had to tell them this is something that this person's already been doing for years, but they weren't privy to that because they cycle in and out. And so really trying to just change the dynamic of that so that we're on par with most other states where they would still have to be, like, they still have to be filed and seen into, and they could still be regulated. We just don't want them to have to specifically say what can and cannot be a part of those. Right now, that's one of the restrictions that we have where the Board of Medicine actually says that controlled substances cannot be a part of the collaborative practice agreement, which is what creates the situation where we have no pathway currently for pharmacists to participate in medication-assisted therapy for opioid use disorder, which is one of actually the concerns I had when I first saw the State Medical Board's letter of opposition, is that it's incorrect in the fact that it says that pharmacists could prescribe any medications. Obviously, it's, it's limited to those certain conditions, so it wasn't unlimited as far as pieces go. So, that's why that section has been put in here. And that was really like through the conversations that we had with the medical association. We would like to see more collaborative practice agreements where we're having pharmacists embedded in primary care clinics to extend the amount of care they're able to provide and within the health system. But currently, the model just isn't really functional. So, that's kind of where that language came from and some of the background on those pieces.

Okay. So I'm having— thank you. And through the Chair, I'm having Board of Pharmacy individuals tell me absolutely different. They said this was pushed by one individual, that there has never been an issue with the CPA because they are allowed to be— you're allowed to put in— the pharmacists are allowed to put in reimbursement for Medicaid and Medicare. So I'm concerned of what's the language that's being used on public record. And I don't like it. The other concern that I have is that I asked earlier in regards to lobbyists, And one thing that happens a lot of times, and I think people are becoming aware, what goes on the internet stays on the internet. So lobbyists were supporting this bill, and it's the NAPSA, the APHA, and the Community Pharmacy Foundation. And in the flyer that was out last year, it said that they are supporting this 100%. So it's concerning that the narrative is changing depending on what questions are asked. So I have that document, and I will also pass it out to the committee. But lobbyists are supporting it. They were rounded up to do this. And it's alarming to me that the language and what's being said on public record right now is going to be countered by me. I am absolutely shocked on what is being said and what's on record with the Board of Pharmacy and all those conversations and minutes. But I don't want to accuse anybody of anything. I'm just saying there's a lot more information that's out there. And I think the public needs to know.

Dr. Signer-Martin.

Yes, Representative Ellard, to the Chair. I just want to clarify. So the American Pharmacists Association, the National Community Pharmacists Association, the American Pharmacy Foundation, those are actually national associations of pharmacists, not pharmaceutical companies. So just to make sure that that distinction is clear, those are pharmacists as in healthcare providers, not pharmaceutical manufacturers.

Lobbyist. Thank you.

Representative Mena, did you have a statement? No.

Through the chair to Representative Allard, for the record, Jennifer Mena, House District 19 representative. I was going to agree with Dr. Signa-Martin. Pharmaceutical companies are different from pharmacists.

Okay.

Yep.

Let's see. I think I'm going to— did you— Representative Schwaggy?

Yeah, thank you, Co-Chair Foster. I just wanted to clear— further clarify. What I heard earlier was, were any big pharma lobbyists working on this bill? And I haven't heard anything to the contrary, uh, from representatives or otherwise. So, uh, I, I don't hear any discrepancies in the information that you've provided. So thank you for that. And I guess to the extent that we're getting inside information from pharmacists or otherwise, it's in a Board of Pharmacy members or otherwise in conflict with the testimony we're receiving here today. I'd prefer— I would like to see that correspondence so that we can ask those same questions, because otherwise it's just, it's a bunch of hearsay and I don't find it very helpful. So I appreciate seeing some of that information.

I will give you the information from the Board of Pharmacy. Absolutely, no problem.

Thank you.

And that last comment was Representative Allard. We're going to go to the last comment question. That's Representative Bynum. And then after that, we'll come to our, our last item of the day, which is the court judge bill. We'll go to Representative Bynum, then Representative Hand, and then we'll close it out. Representative Bynum.

Thank you, Co-Chair Foster. Really quick, I know that there was mention of the, of the memo in BASIS that was not included in the packet.

possible if we could get a copy of that distributed into our packets, that would be very helpful. And then I had a question through the chair to Dr. Sien-Martin. I know I've heard it today. I'm sitting here thinking in my mind I'm going to get it right. I apologize if I got it wrong. Have you looked at the legal memo that was provided from legal services that was handed out to us? Have you seen this memo?

Dr. Signe Martin.

Representative Bynum, through the chair, I do not believe I have. No.

Follow-up through the chair. So this was just distributed to the committee from Representative Allard. It's a legal memo dated April 1st, 2026, and it's talking about prescription authority of pharmacists, specifically abortions. And it references the bill in here. It gives kind of a basic outline that basically revolves around the legal opinion based off of a very specific caveat, and that is, is that all— it says that all healthcare professionals must confine the care they provide to their scope of practice. In here, the attorney says he does not know if providing an abortion falls under the scope of practice of pharmacists. You seem to be well qualified to answer that question. Does providing abortions fall under the scope of practice for pharmacists?

Dr. Signa Martin.

Representative Bynum, through the chair, it is not a part of the education and training provided to pharmacists as part of our formal education. So generally, I would say no. Can any clinician, you know, go on to do additional trainings or other things outside of that original scope? I mean, possibly, but that is definitely not in the scope of what a pharmacist does, what we learn as a part of our education and training.

Follow-up, follow-up. I'm trying to relate this to my experience as an engineer and a licensed engineer having to provide engineering services under my scope of practice and how you can then go outside of that or not. I'm just trying to understand under what circumstances somebody that's licensed as a pharmacist would be able to go outside of their license to get that kind of an education, and then how it would technically apply to my licensure as a pharmacist. Could you help me try to understand that a little bit?

Dr. Signa Martin?

Yes, Representative Bynum, through the chair. Absolutely. In the state of Alaska, I would say that is— so speaking broadly of pharmacists, but then speaking in the state of Alaska, it would not be in the scope of the pharmacists, being that especially we see that their abortion is Specifically called out, it's— I believe it's the only healthcare procedure that is called out on its own in statute where it specifically says who can do it, where it can happen, and those kinds of things. And so specifically based on all of those pieces, I would say in Alaska specifically, it is outside of that scope and you would not be able to move into that realm at all.

Senator, final follow-up. Co-chair Foster, thank you for that. The section of statute that you referenced was 1816.010, abortions, A1, and that says abortions performed by a physician licensed by the state medical board under Alaska statute 0864-200. Do pharmacists fall under that particular statute as far as being physicians licensed under the state board?

Dr. Signa-Martin?

Representative Bynum, through the chair, no, they are not.

Thank you.

Okay, I've got Representative Hannan and then Jimmy, and then we're going to jump into the other bills. So Representative Hannan.

Thank you, Co-Chair Foster. My question is for Representative Mena, and in your view of having chaired the— our Health Committee, Health and Social Services, and I'm curious whether you've heard from the Board of Medicine. Another scope of practice issues. Have they written in opposition to scope of practice bills on any other areas besides pharmacists? Say naturopathy.

Representative Meena.

Through the chair to Representative Hannan. For the record, Genevieve Meena, House District 19 representative. I don't recall this particular opposition from the State Medical Board related to other bills? I, I don't know.

Representative Hannan, how about the, the Medical Association? Have you heard from the Medical Association in opposition to scope of practice bills that have come before the Health Committee?

Representative Mena, through the chair to Representative Hannan, yes, from the State Medical Association.

Okay. Can you tell us what those are? I'm thinking that naturopathy is one that I've heard from them in opposition to.

Ms. Georgiou.

Katie Georgiou for the record through the chair to Representative Hannon. Yes. The State Medical Association generally opposes scope of practice expansions for pharmacists. We've heard about naturopaths recently.

I'm not—

you know, another One that's out there being contemplated right now is on physician assistants. I don't— I don't— I can't speak to specifically all of the different scope of practice, but generally it takes a little bit of conversation and work with the state medical association to get them comfortable with pieces of legislation like we have done with HB 195.

Representative Mena.

Through the chair, to Representative Hannan, for the record, Genevieve Mena, House District 19 representative. And also, just to clarify, with physician assistants. I know that previously the State Medical Association was in opposition to a prior version of the physician assistant bill, and they had worked with that respective professional group for the physician assistants on a compromise, and they're in support of that. So they have been in support of other scope of practice bills in the past. Thank you.

Okay, Representative Jimmy.

We are not quite sure, Foster. I'm kind of bewildered or confused. Why are we trying to make this sound like it's an abortion bill more than a pharmacy bill to assist people who need medical care in the quickest fashion way, especially in Alaska where we have many challenges all throughout, whether you're in urban or rural? But isn't there other ways people seek out that's unprescriptive, that's available in stores for them to terminate their own pregnancy? Such as the Plan B?

Dr. Signer-Martin.

Representative Jimmy, through the chair, there— I mean, I'm not an expert on this area. I'm sure that there are ways that people do that. And Plan B is noted— is of note. It is over-the-counter. So anybody can walk into any store and purchase that. There's not not a restriction, not a prescription required since it is over-the-counter.

Well, okay, let's go ahead and move on to the next bill here. So with that very good, robust, thorough discussion, it's only the first of, I'm sure, maybe a number of discussions. This is our first hearing on the bill. So with that, Representative Mena, thank you very much for the introduction of that bill, and we'll set the bill aside for now. We do have about 16 more minutes, and I think we might be able to move through the next bill fairly quickly. We have House Bill 262. That's the number of Superior Court judges, and I'd like to invite up Ms. Nancy Mead, General Counsel to the Alaska Courts, to please come to the table, put yourself on the record. And if you could just give us a brief recap of the bill, my intent is to open up public testimony. Currently, I don't see anybody online for public testimony. We do have one new fiscal note from Office of Public Advocacy, and then we'll set the amendment deadline. So I think we can get through this relatively quickly. So with that, if you could give us a brief recap, put yourself on the record. Thanks for being here.

Thank you, Mr. Co-Chairman. For the record, Nancy Mead, General Counsel for the Alaska Court System. Very briefly, this bill would add one new Superior Court judge. The number of Superior Court judges is set in statute, which is why this is included with the typical budget request. The new Superior Court judge would be seated in Palmer. The reasons that the court is seeking this Superior Court judge is because Palmer is the busiest courthouse for Superior Court cases in the state. I think I talked about last time that they exceed the average about— by about 1.5 times. Their average was about 683 cases per year compared to the state average of 458. The The types of cases this new judge would handle include felony cases, all domestic relations cases, child in need of aid cases, probate cases, juvenile delinquency, and civil cases with an amount in controversy over $100,000. Palmer has not had a new Superior Court judge since 2007 when 2 were added. At that— since that time, the population of the Mat-Su has grown about 58%, and correspondingly, case filings has grown

58%, with no additional Superior Court judges to handle those. In addition, I described last hearing the ways that the workload has also increased so that cases are handled differently than they were 20 years ago, and in almost all instances, they take more time than they did 20 years ago and more work on the part of the judge. The court has tried to fill the gaps in Palmer by hiring back retired judges upon occasion to take trials, by moving judges from Anchorage temporarily for specific purposes or for specific time periods, and from Valdez and other locations, and from taking district court judges and temporarily assigning them to handle superior court cases. This has worked somewhat, but is unsustainable, and at this time, the Supreme Court has determined that a new superior court judge is necessary in order to provide the type of justice that the court system should be providing. That's my summary. I'm happy to take any questions.

Okay, actually, we're gonna jump, maybe let's go ahead with public testimony fiscal note, I'll come back to questions. So with that, I'm going to open public testimony on HB 262. And is there anyone in the room who would like to testify? Seeing none, is there anyone online who would like to testify? And we don't have anyone. If anyone's watching and they would like to submit written testimony, they can do so by emailing us at [email protected]. We do have one fiscal note, and that is from the Office of Public Advocacy. Mr. James Stinson, the director, if you could put yourself on the record and walk us through this fiscal note.

Yeah, thank you, Chair Foster. For the record, this is James Stinson, Director of the Office of Public Advocacy.

I'll try to be brief.

This fiscal note is requesting a single flex attorney position. It should be identical to the public defender's note. With another judge is going to come another calendar. We're going to have to be responsive to that court and to that calendar. And so if the current caseload is justifying another judge to help increase the processing, then inevitably you need parties to litigate those things that are in front of that judge. And so that's really the basis for this request. Thank you.

[Speaker] Great. Mr. Stinson, is the OMB component number that you have, 43, and also in the bottom right, the control code. Is that NVSUB?

That's correct, Chair Foster.

Okay, thank you. Okay, so with that, I'm going to close public testimony on HB 262, and we've also got the fiscal notes out of the way. So we're going to come back to questions, and we've got questions from Representative Bynum and then Galvin. Representative Bynum.

Thank you, Co-Chair Foster. Through the Chair, Ms. Mead, thank you for being here. In your memo and the sponsor statement that's being provided here, and this was a question that I had asked earlier when the last time you were here, was that we're going from 4 judges to 5, and then that brings the caseload of work down from 683 cases per judge to 546 cases per judge. And then hearing all the testimony on the fiscal notes, it sounds like all the other folks are getting really excited that there might be additional capacity for those judges to then continue to do more work. If we wanted to bring the caseloads down to the state average, we would actually need to add 2 judges. Other than fiscal constraints, is there a reason why we didn't ask for 2 judges instead of Just the one.

Ms. Mead.

Through the chair to Representative Bynum, two reasons in all likelihood that the Supreme Court did not ask for two judges. The first is fiscal responsibility and trying to be responsible and ask for the minimum need that will get us through. The second is space for an additional judge. And the building in Palmer is being retrofitted now to accommodate one additional judge in the hopes that this bill passes. Accommodating a second judge would take a bit more juggling and a bit more renovation that we haven't embarked upon yet.

Representative Bynum.

Thank you, Co-Chair Justin, through the chair. Thank you for that. If I had my opportunity to do so, I would provide you two judges or three to bring these caseloads down and be able to provide more expedited services. But with that explanation, I will be happily satisfied with one additional judge. Thank you.

Representative Gelvin.

Thank you, Co-Chair Foster. This is more a question about the fiscal notes that we went through. The fiscal note that we just heard from, from the Office of Public Advocacy, and that would be OMB component 43, he mentioned that they should be identical to the, the other the fiscal note that we heard from, from the Criminal Division, and I just wanted to comment that they are not identical, and I can see why. In fiscal note from the Department of Law Criminal Division, the range is 25 versus the other range from the Office of Advocacy is 24 Level C, and so there would be a difference, I think, in part because of that, but also it seems to be about about half of the amount of travel for the Office of Public Advocacy. So I just wanted to call that out so that we are familiar with why it is that they are not identical. And that is really all I had to share.

Thanks.

Thank you. Okay, Representative Hannon.

Thank you, Co-Chair Foster. I think the identicalness of two fiscal notes are the two from the Department of Administration. One, the Office of Public Advocacy, and the other, the Public Defender. I think Representative Galvin was comparing it to the Department of Law's Criminal Division, the prosecution office. But the two from the same department that has two legal branches, Public Defender and Public Advocacy, are identical to each other.

Any further questions or comments? My intent is to establish an amendment deadline. This bill is not terribly complicated, seems pretty straightforward and simple. I'll set the amendment deadline, but I wouldn't oppose anyone moving the bill if they wanted to move it. But I'm happy, happy to set the amendment deadline as well. So with that, If anyone is interested in moving the bill, I would entertain a motion.

I am sure.

Sure. Co-chair Foster, I— Representative Bynum, I don't see a lot of people clamoring to want to amend this bill, so I'm not opposed to moving it forward. But I think one of your co-chairs would gladly move.

Okay. Representative—

I don't have the script. Sure.

Representative Schrag. Grief it is.

Okay, that's why I'm just—

okay, House Finance back on record at 3:25, and again we are on House Bill 262. Representative Schrag.

Thank you, Chair Foster. I move House Bill 262, work order, work order 34-LS1312/alpha, from committee with individual recommendations and attached fiscal notes.

Okay, is there any objection? Seeing no objection, House Bill 262, which is version 34-LS1312/a, moves out of committee with individual recommendations and attached fiscal notes. And if folks could stick around to sign the committee report. Ms. Mead, thank you so very much for your thorough explanation. Were you wanting to say anything?

I would just like to thank the committee for its attention and consideration of this issue and for moving this bill. Thank you.

Okay, thank you very much. So with that, our next meeting is scheduled for tomorrow. That's April 8th at 9:00 AM. And at that meeting, we'll have our first hearing on House Bill 246. That is the special education service agency funding. And so if there's nothing else to come before the committee, we will be adjourned at 3:26 PM. Thank you.