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A
A
Welcome
to
everyone
in
the
room.
Welcome
those
of
you
online,
we'll
just
go
over
the
brief
rules
again,
as
we've
gone
over
several
times
in
this
committee,
we're
getting
good
at
it.
Now,
if
you
have
a
cell
phone,
please
leave
it
on,
because
if
it
goes
off,
you
buy
donuts.
Although
those
that
were
here
last
week
will
remember,
somebody's
phone
went
off
in
this
committee
and
we
Face
the
problem.
Nobody
wanted
to
rat
them
out,
so
we
still
didn't
get
donuts.
So
if
your
phone
goes
off,
we
prefer
maple
glazed
and
chocolate
glazed.
A
With
that
in
mind,
we
got
a
couple
of
issues
this
morning
that
perhaps
will
generate
some
some
emotional
responses.
So
I
would
ask
everybody
testifying
and
the
committee
to
be
respectful,
be
ethical,
Etc,
et
cetera.
You
know
it
seems
like
we're
in
the
going
into
the
fifth
week
now.
I'm,
just
I
need
a
recording,
we'll
just
play
these
things
over
and
over,
but
everybody's
done
very
well
so
far
and
I
I
appreciate
that
continuing
for
another
four
weeks.
A
A
B
Thank
you
for
having
me
here,
it's
good
to
see
you
all
this
bill
was
is
the
result
of
the
constituent-driven
incident
that
happened
with
someone
in
in
my
area
r.
I
was
a
friend
of
our
children's
that
kind
of
disappeared
from
from.
B
B
and
the
the
perpetrator
or
the
the
person
she
was
with
was
15
years
older
than
she
was.
He
went
to
to
jail
for
child
pornography
and
then
got
out
of
jail.
She
married
him.
This
is
a
kind
of
a
sad
story,
but
she
married
him
and
and
had
more
children.
She
had
one
before
he
was
in
prison
and
then
three
afterwards,
three
girls
and
then
here
we
are
years
later
she's
trying
to
dissolve
the
marriage
and
the
relationship
and
she's
in
a
custody
battle.
B
With
with
these
three
daughters
over
that,
as
well
as
the
divorce
that's
going
on,
and
it's
got
to
be
15
or
so
years
later.
I
haven't
really
figured
the
numbers
out.
B
So
in
that
custody
battle
she
found
that
the
the
evidence,
basically
a
rape
kit
had
been
disposed
of,
and
apparently
it
happens
at
five
to
seven
years.
It
just
goes
away
and
so
that
the
bill
seeks
to
just
require
that
the
evidence
be
kept
for
a
longer
period
of
time
and
I'm
I'm
looking
through
the
bill.
The
meat
of
this
bill
is
begins
on
page
one
and
then
page
two.
B
It
says
a
minimum.
The
evidence
will
be
kept
for
a
minimum
of
10
years,
whereupon
the
death
of
the
victim.
So
it
would
be
ten
years
past
that
eight,
when
the
victim
would
die
and
then
kept
for
50
years
if
if
they
remain
alive,
so
something
that's
unclear
to
me-
and
this
is
we
reinserted
some
stricken
language
when
it
was
when
we
were
in
Judiciary
Committee,
and
that
was
the
part
that
a
court
order
could
be
could
be
changed.
This
evidence
could
be
changed
by
a
court
order.
B
I
wasn't
sure
I
liked
that,
and
so
it
it
doesn't
show
in
here,
we'd
have
to
clarify
that
I
would
like
for
that
to
be
kept
in
members
of
the
Judiciary
Committee
said
that
it
would
probably
be
to
the
benefit
of
the
public
if,
if
the
court
is
able
to
rule
at
some
point
in
time
on
on
this
evidence,
I
didn't
like
it
at
the
time
I
mulled
it
over
and
then
thought
about
other
cases
and
I
think
for
the
protection
of
everybody
involved.
B
In
matters
like
like
this,
that
are
kind
of
sticky-
and
you
know
one
of
the
things
I
left
out
in
that
story
is
after
she
married
and
I
think
it's
part
of
why
the
evidence
went
away
after
she
married.
She
recanted
on
all
of
everything
and
just
said
no
I
I
just
lied
about
lied
about
it
all,
but
she
was
under
control
of
this
man.
B
So
that's
kind
of
kind
of
what
brought
the
bill
and
my
big
concern
with
it.
After
I
started
researching.
It
was
how
much
evidence
the
that
law
enforcement
would
have
to
keep,
how
biggest,
how
how
much
storage
can
you
have,
because
50
years
is
a
long
time
and
I'd
be
open
to
maybe
reducing
that,
but
what
we're
talking
about
is
probably
not
all
of
the
the
evidence,
but
especially
the
rape
kit
in
in
this
case,
so
that
is
a
bill
and
I
could
stand
for
questions.
C
Thank
you,
representative
life
is
sometimes
times
complicated.
Isn't
it
let's?
Let's
look
at
your
10-year
Mark?
How
did
you
settle
on
that
and
were
there
any
concerns
from
law
enforcement?
Some
places
are
small.
May
struggle
with
storage.
Other
places
are
well
organized.
Any
feedback
on
that
representative.
B
Yes,
Mr
chairman
I,
the
feedback
I
got
was
kind
of
the
opposite
of
that
the
the
smaller
Department
said.
We
always
keep
this
evidence.
It
just
isn't
something
we
would
ever
throw
out
the
larger
ones
who
have
considerably
more
evident
to
store,
or
probably
the
areas
of
great
concern.
I
think
we
might
have
some
testimony
from
them
and
they
can
speak
for
themselves
at
some
point.
Thank
you.
D
D
When,
when
someone
gets
it
put
in
prison,
you
know
they
often
find
wait
a
minute.
This
person
was,
you
know,
did
a
rape
over
here
in
a
different
in
another
state,
because
they
have
collaborative
databases
now
that
go
across
the
nation.
So
I
am
concerned
that
so
where
the
bill
says
no
evidence
record
report
or
other
examination
results
or
analysis
collected
or
created
under
subsection.
A
of
this
section
shall
be
destroyed.
Period
is
where
it
ought
to
be.
D
F
B
Baffles
me
too,
and
you
have
such
a
wide
disparity
of
wealth
discretion
by
the
police
departments,
because
some
say
it's
five
to
seven
years
they
could
get
rid
of
it.
Others
say
no,
we
policy
is.
We
will
keep
that
evidenced.
B
B
It
fell
through
the
cracks
and
there
was
evidence
disappeared.
That
would
have
helped
her
at
a
later
date.
A
Further
questions,
committee,
Senator,
Barlow
and
I
would
add
in
here
I
remember.
Perhaps
Senator
Barlow
remembers
as
well.
This
Committee
in
in
a
previous
life
and
previous
makeups
has
heard
about
back
or
a
backlog
of
sexual
evidence
kits,
which
is
a
totally
different.
It's
the
same
topic,
but
it's
a
different
topic
about
kids
that
have
been
kept
and
never
been
been
processed,
but
go
ahead.
Sandra
Barlow.
G
Thank
you
Mr
chairman,
so
I
I
kind
of
like
the
I
guess
the
leanings
of
the
or
what
up
here
is
the
liens
committee
that
maybe
we
should
look
at
a
longer
timeline
or
something,
but
I
also
want
to
point
out
that
a
pursuant
to
a
court
order,
if
someone
there
are
there,
are
cases
and
I'm
not
suggesting
I'm,
hoping
our
criminal
justice
system
does
it
correctly
where
someone
is
accused
and
convicted,
and
then
there
is
subsequent
DNA
evidence
that
rules
them
out,
maybe
as
the
perpetrator
for
that
crime.
G
For
that
particular
crime,
maybe
they've.
So
the
court
order.
G
D
Ahead
and
follow
so
I,
let
me
throw
this
scenario
at
you,
because
this
is
what
I
think
happened.
Typically,
what
happens
when
you
have
a
case
that
starts
and
then
someone
says
well,
I,
didn't
it
didn't
it
wasn't
that
way
or
they
changed
their
story.
They
recanted
and
the
courts
actually
take
all
the
evidence
and
toss
it
because
and
you'll
see
it
on
the
docket
somewhere.
D
But
everything
is
gone,
I
mean
the
files
and
everything
are
thrown
away
so
and
that's
not
necessarily
a
bad
thing,
because
there
there
could
be
a
frivolous
case
that
gets
thrown
out
and
all
the
evidence
gets
thrown
away.
So
so
I
think
we're
kind
of
crossing
over
those
two
things
that
are
happened
on
one
side.
That
doesn't
necessarily
mean
we
should
do
something
on
this
side,
although
I
liked
it.
You
know
the
first
part
of
the
feel
here.
Does
that
make
sense
to
you,
representative.
B
Mr
chairman,
it
does
as
I
mulled
over
what
we
do
with
the
court
order,
which
could
reverse
what
I'm
trying
to
do.
It
seems
like
I,
had
to
think
of
a
case
that
that
representative,
Barlow
and
I
dealt
with
on
the
house
floor
in
which
there
was
there
was
DNA
evidence
that
exonerated
should
have
exonerated
a
man.
B
I
also
had
to
think
about
a
a
jury
trial
that
a
close
family
member
was
on,
in
which
a
bunch
of
kids,
kids
conjured
up
a
story
that
could
easily
be
proven
false
and
the
court
sorted
that
out
and
in
both
cases
in
in
part
of
the
case,
I
have
to
trust
law
enforcement
will
by
law,
will
do
what
needs
to
be
done
to
protect
victims,
and
the
court
will
also
protect
victims.
That
may
be
perceived
to
be
perfect.
B
Traders
I
just
think
that
that
I
have
to
trust
that
the
court
will
sort
that
out
and
I
think
they
do
so.
I
would
agree
and
I
if
there
is
discrepancy
on
this,
the
stricken
language
was
put
back
in,
and
we've
been
in
a
flurry
of
paperwork
and
I.
This
is
the
first
time
I've
seen
this
in
Gross
Senate
version,
and
this
stricken
language
it
was.
H
My
question
to
you,
because
I'm
in
agreement
here
I
think
this
is
too
short
a
period.
I
think
it
should
be
kept
in
Forever
because
we
don't
know
what
will
happen
so
with
the
Court's
order.
Do
we
find
that
elsewhere
in
statute
about
a
court
ordering
evidence
to
be
tossed
out?
Maybe
we
can
just
refer
to
that
instead
of
just
I,
don't
know
it's
kind
of
a
tricky
little
question
here.
B
Representative
Mr
chairman
I
I,
don't
know
that
either
this
is
out
of
my
wheelhouse,
but
there
may
be
people
here
that
do
know
how
often
I
I
think
that
it
is
because
it
was
attorneys
on
the
on
the
house
Judiciary
Committee
that
brought
that
back
to
the
that
stricken
language
back
to
the
bill
and
so
I
think
it's
done.
But
there
may
be
other
people
in
the
room
that
would
know
the
answer
to
that
I.
Don't.
A
We'll
save
that
question
if
somebody
may
come
forward
any
other
questions
for
representative
none.
Thank
you
very
much
stand
by
okay.
Let's
go
to
the
room
first!
Is
there
anybody
from
any
of
the
Departments
or
agencies
who
wish
to
testify
I?
Don't
see
anybody
hear
from
well
I,
see
one
Department
I,
don't
think
he's
here
for
that
one,
okay.
Anyone
else
in
the
room
wish
to
testify
to
this
bill
come
on
come
forward,
come
on
up
and
fill
one
of
the
seats.
We
have
four
empty
seats,
all
warm
all
comfortable,
Mike's
mics
that
work
great.
I
Thank
you
chairman
Baldwin,
and
represent
our
Senators
here.
I
just
wanted
to
share
a
little
bit
on
evidence.
I
was
I
used
to
I
was
a
deputy
in
Park
County
Colorado
I
worked
in
evidence.
There
can.
I
Susan
loan
I'm
in
a
house
district
for
11.,
so
you
know,
I
was
a
deputy
up
there
and
I
did
evidence
and
I
worked
in
a
lot
of
cases
that
you
know
we
find
that
we'd
have
to
get
rid
of
evidence
after
the
court
order
came,
but
also
that
we
based
it
on
statute
of
limitations,
and
so
there
were
certain
crimes.
I
You
know
that
we
had
to
get
rid
of
the
evidence
in
that
and
the
Judges
usually
were
the
ones
who
made
the
decision
on
when
a
court
was
finished
and
that's
when
we
had
to.
We
had
a
certain
time
we
had
a
clear
out
our
evidence.
Room
and
I
also
worked
as
evidence
here
in
in
Laramie
County
and
I
participated
in
a
time
when
we
had
to
get
rid
of
the
evidence
and
a
lot
of
those
were
drug
related
things,
and
so
a
lot
of
it.
I
I
We
had,
we
had
to
you,
know,
methods
of
how
we
had
to
destroy
things.
You
know
it's
hard
in
a
drug
situation,
we
had
to
burn
them
and
and
in
different
situations
we
had
to
destroy
them
correctly.
It
wasn't
just
tossing
it
in
the
trash
can
so.
A
D
Question
Senator
Bouchard,
thank
you
Mr
chairman,
so
how
long
ago
was
that?
Because
I
know
that
Colorado
also
has
a
DNA
database
for
you
know
for
I,
don't
know,
I,
don't
know
how
that
works,
but
I
know
that
they
have
caught
people
that
were
rapists
and
then
you
know
traveled
through
the
system
even
outside
of.
D
I
Chairman,
Baldwin
and
and
Senator
Bouchard.
Yes,
that
is
correct
when
I
was
in
there,
that
was
back
in
the
90s,
and
so
we
kept
the
rape
kits
were
kept.
But
and
at
that
point
I
don't
know
when
it
was
destroyed.
They
were
kept
in
our
possession
at
that
time.
But
at
some
point
you
know,
with
these
small
at
least
I
learned
with
small
places
we
had
to
do
something
to
get
rid
of
evidence
and
it
was
based
on
the
courts.
H
Mr
Sloane,
so
you're
saying
you
have
a
problem
with
this
bill
or
you
like
the
fact
that
we
want
to
keep
the
DNA
for
as
long
as
possible,
because
we
know
that
in
the
future
there
may
be
a
case
similar
and
then
they
check
the
database
and
they
wow.
This
person
raped
someone
back
here
same
DNA,
blah
blah
blah.
So
what
exactly
was
it?
You
were
saying.
I
I
This
is
a
I
would
think
this
is
kind
of
a
complicated
case
that
happened
especially
with
the
marriage
and
things
like
that,
and
the
fact
that
this
man
had
surged
some
time
for
that
the
rape
I
it
would
just
I
would
just
question
things
like
that.
It's
such
an
individual
situation.
J
Good
morning,
chairman
Baldwin
committee
members,
my
name
is
Tara
Muir
public
policy
director
with
the
domestic
violence,
sexual
assault,
Coalition
here
in
Wyoming,
just
to
be
helpful
for
the
committee
and
I
I,
with
the
pace
of
the
session,
I
haven't
been
able
to
check
in
with
representative
Eklund.
The
statute
that
he's
amending
is
a
new
statute
that
was
just
created
back
in
2019
by
another
good
senator
to
address
backlog
of
rape
kits
at
the
time
testimonials.
We
really
didn't
have
a
deep
backlog
at
all
in
our
state,
even
though
other
states
had
a
significant
backlog.
J
What
Senator,
Ellis
was
able
to
do
is
is
say
clearly
we
don't
destroy
the
evidence
until
the
statute
of
limitations
has
run,
and
the
question
then
was
well:
when
does
the
statute
of
limitations
run?
It's
like
it
doesn't
on
sexual
assault.
There
is
none
so
back
in
2019
the
bill
that
passed
said.
There's
no
reason
to
get
rid
of
this
evidence
unless
there
is
a
court
order
and
individual
circumstances
in
a
particular
case,
and
the
court
would
order
it.
J
What
at
the
time,
if
we
wanted
to
be
ideal,
we're
like
well,
let's
test
all
the
kits,
so
we
put
that
DNA
into
a
database,
but
we
weren't
ready
to
do
that,
then.
So,
storing
the
evidence
until
the
statute
of
limitations
runs
is
what
the
current
law
says
and
I
think
it
should
stay
that
way,
because
it
I
agree
with
Senator
Richard,
which
I
rarely
do
but
I
agree.
This
is
this
complicates.
It
throws
out
some
arbitrary
deadlines
which
we
didn't
have
before.
H
J
A
A
J
Departments
here
to
talk
about
their
process,
which
I
wish
they
were
I,
think
you
just.
You
should
go
back
to
what
it
was
previously
that
kept
the
until
all
applicable
statutes
and
limitations
have
expired,
because
then
departments
can
say
hey.
You
know
the
statute
of
limitations
just
run,
there's
no
way
to
even
bring
charges.
D
L
D
It
so
when
it
says
no
evidence
and
then
it
says
record
reporter
there
could
be
cases
where
they
they,
for
instance,
they
have
a
case
that
they
heard
and
they've
decided
to
destroy
the
evidence,
because
the
case
was
bad,
it
didn't
they
couldn't
prosecute
and
it
was
a.
It
was
the
rights
of
the
person
that
was
being
charged
so
by
US
changing
any
of
this
here
we
could
disrupt
all
of
that
and
they've
already
figured
that
out.
So
that's
does
that
so
am
I
correct
in
that
thinking.
Miss
mirror.
G
Thank
you,
Mr
chairman,
so
I
want
to
dig
into
the
statute
of
limitations
a
little
more
because
the
way,
the
way
this
statute
is
structured
n,
which
is
the
language
we're
talking
about,
309,
refers
to
a
and
a
report
of
sexual
assault
and
then
the
second
in
the
last
sentence
of
a
it
says
upon
consent
of
the
victim.
They
can
release
this
to
law
enforcement.
So
actually,
what
we're
talking
about
is
whether
we
Gathering
the
evidence
and
subsequently
the
victim
has
the
authority
to
release
it
to
law
enforcement.
G
G
J
That
is
what
I
have
learned
while
being
in
Wyoming.
Yes,.
C
J
J
Thank
you,
I'm
the
public
policy
director
of
the
Wyoming
Coalition
against
domestic
violence
and
sexual
assault,
we're
a
Statewide
organization,
23
programs,
every
County
reservation,
your.
J
J
It
can
take
your
whole
life,
sometimes
so
having
no
statute
of
limitations,
which
we've
never
had
in
Wyoming,
coupled
with
don't
destroy
the
evidence.
Sometimes
it's
just
you
know
the
size
of
a
cereal
box,
the
evidence,
so
it
can
be
stored
for
that
long.
So
we
would
support
no
amount
of
years
at
all.
Just
when
the
statute
of
limitations
runs.
A
J
Hesitated
to
come
up
here
because
I
didn't
study
every
single
change,
I
think
when
it's
this
bill,
or
these
set
of
laws
were
done
in
2019,
it
was
very
thorough,
I
mean
they
are
adding
a
couple
of
extra
words
around
no
evidence
and
being
clearer
about
record
report
or
other
examination
results
or
analysis.
That's
helpful
if
we
do
test
the
kit
and
run
the
DNA
against
other
DNA,
which
is
always
the
most
helpful
thing
to
do.
J
That
is
a
good
addition
that
would
be
like
page
one
line:
14
and
15.
D
D
J
You
I
I,
don't
see
that
any
of
the
other
changes
really
impact.
What
we're
talking
about,
because
it
does
reference
back
to
this
Con.
This
paragraph,
we're
focused
on
page
one
top
of
page
two
I
would
Advocate,
though,
keeping
in
all
that
language
online
16
of
page
one
line,
one
and
two
of
page
two
that's
been
struck.
I
would
keep
that
and
put
the
period
after
page
two
line,
two
destruction.
A
B
Yeah
this
Mr
chairman
this
becomes
more
and
more
interesting
because
we
still
don't
know
where
the
statute
of
limitations
would
take
us
and
how
long
that
period
of
time
might
be,
and
I
don't
have
a
problem
with
reinserting
that
that
would
be
fine.
I
think
there
are
reasons
why
you
want
to
keep
this
evidence
and
it
isn't
Justice
in
years
forward,
trying
to
figure
out.
B
If,
if
there
is
this
alleged
perpetrator
is
that
or
if
that
person
is
innocent,
the
evidence
could
could
help
everybody
in
this
having
that
evidence
around
maybe
years
later
so,
I'm
I
still
but
I
still
question
the
statute
of
limitations
there.
There
are,
let
me
correct
a
couple
things.
B
This
man
was
in
prison
for
child
pornography.
He
wasn't
in
prison
for
for
rape
and
a
couple
years
later,
when
the
girl
was
18
is
when
she
married
him
and
that
becomes
a
real
complicated
situation.
B
B
It
was
collected
at
the
hospital,
but
it
was
disposed
up
by
the
sheriff's
department
as
what
her
understanding
was
in
the
deal
so,
but
as
far
as
reinserting
that
language
I
don't
have
a
problem
with
that.
But
if
we
don't
really
have
an
idea
of
how
many
years
evidence
might
be
kept,
then
I
think
we
probably
need
at
least
some
kind
of
an
idea.
What
the
time
period
should
be.
M
M
You
thank
you
I'm
here
on
behalf
of
the
Wyoming
Association
of
sheriffs
and
Chiefs
of
police.
I
want
to
tell
you
first
off
in
a
general
pro
in
a
general
way.
We
have
no
objection
to
this
bill.
There
are
a
couple
things
I
want
to
tell
you
to
help
you
make
some
decisions
and
then
one
observation
about
something:
I'd
like
you
to
consider.
M
First
of
all
in
Wyoming
there
is
no
statute
of
limitations
on
any
criminal
case,
so
the
use
of
the
term
statute
of
limitations
in
one
of
our
statutes
is
kind
of
oxymoronic,
but
secondly,
DNA
is
collected
already
by
by
ordering
a
judgment
and
sentence
from
all
convicted
felons
and
that's
maintained
at
the
state
level.
Now
that
I,
don't
believe,
would
have
helped
the
case
that
the
that
the
sponsor
of
the
bill
is
speaking
to
and-
and
so
I
want
to
address
this
as
well
and
I.
M
Think
Karen
will
support
me
on
this
right
now.
If
a
rape
kit
is
done
and
I'm
using
that
as
an
example,
but
if
a
rape
kit
is
is
done
at
the
hospital,
whether
or
not
charges
are
ever
brought
and
and
the
language
that
refers
to
the
idea
that
unless
the
victim
consents
or
if
the
victim
consents
to
the
release
of
this
to
law
enforcement,
it's
actually
a
little
different
than
that.
It's
the
consent
to
the
use
of
that
in
a
prosecution,
and
sometimes
people
don't
in
in
Ms
Muir-
is
absolutely
correct.
M
When
she
speaks
to
the
idea
that
victims
of
sexual
assault
are
affected
in
a
myriad
of
different
ways,
some
are
become
angry
and
very
proactive
and
some
it
destroys
them
and
they
don't
have.
They
can't
work
themselves
up
to
the
to
the
idea
that
they
would
have
to
face
their
their
rapist
or
the
person
that
sexually
assaulted
them
again.
So
these
kits
are
I
think
the
National
Standard
is
50
years.
M
Okay,
so
10
seems
a
little
limited,
but
but
it
may
be
better
to
stick
with
the
National
Standard
on
that
or
use
or
take
out
the
word
statute
of
limitations
or
leave
them
in
because
we
have
none
would
be
fine
with
us,
so
but
these
kids
still,
whether
rape
kits,
for
example,
if.
M
Have
to
be
kept
until
the
victim,
whether
or
not
there's
ever
been
a
criminal
charge
filed,
consents
to
their
destruction,
which
brings
me
to
my
point,
and
that
is
I
when
I
was
considering
what
I
might
say
about
this
bill
this
morning,
I
was
a
little
puzzled
by
this
particular
bill,
which
governs
evidence
in
criminal
cases
was
coming
to
revenue,
but
then
it
struck
me:
it's
a
perfect
place
for
it,
because
I
read
the
fiscal
notes.
They
are
no
impact
state
level
and
otherwise
indeterminable
due
to
unknown
cases.
L
M
Such
things,
but
they'll
reach
a
point
in
time
if
even
if
you've
got
10
years,
but
especially
if
you
go
out
to
50,
where
the
ability
to
store
that
stuff
would
require
a
warehouse
even
in
a
even
an
accounting
to
store
the
the
evidence
that
is
collecting.
That
is
a
considerable
expense
that
the
counties
would
then
have
to
bear,
or
the
cities,
as
the
case
may
be.
A
M
A
H
A
H
M
You're
not
but
a
rape
kit
is
substantially
Greater
by
the
way.
I'm
sorry
Mr,
chairman,
Senator,
Hutchings
Senator
Hutchings,
is
not
incorrect.
It
can
be
a
minute
amount,
but
a
rape
kit
is
a
substantial
amount
of
material,
sometimes
clothing,
a
whole
series
of
swabs.
It
is
not
just
a
I'm
a
minute
particle,
it
could
be,
but
it
isn't
necessarily
so
and
then
more
more
often
than
not
it's
a
bag
full
of
evidence.
G
A
M
Apologies,
thank
you.
Mr
chairman
Senator,
Barlow
I
can
only
speak
to
the
place
where
I
was
recently
the
county
attorney
and
that's
Washington
County,
and
even
there,
former
sheriff
ragnes
and
I,
who
retired
on
the
same
day,
met
on
this
subject
on
a
number
of
occasions.
When
the
bill
came
up
in
2019,
we
met
on
it
and
he
had
concerns
because
he
already
had
a
lot
of
those
kits
stored.
I
mean
we're
talking.
M
I
think
he
has
had
because
he's
not
the
sheriff
anymore,
but
I
believe
they
still
have
between
50
and
70
in
Washington
County.
D
M
To
keep
it
whether
or
not
there's
been
a
charge
and
I
have
no
problem
with
that,
but
when
that
has
to
happen,
that
means
there's
a
lot
of
things
that
we
don't
know
because
they've
never
seen
the
light
of
day
other
than
with
the
victim
and
with
the
people
that
helped
with
the
storage
kit
and
with
the
storage
of
Satan.
Thank
you.
C
Yeah
I:
do
you
want
to
speak
before
I?
Ask
you
a
question:
okay,
Mr,
chairman
representative,
your
thoughts
on
the
10-year
eliminating
the
10-year
minimum
I
wish
the
folks
from
sexual
assault.
They
do
a
good
job,
but
I
wish
they
would
have
been
with
you
earlier
on
that
in
the
process,
but
your
thoughts
on
eliminating
that
and
any
solutions
you
have
for
that
storage
issue.
Thank
you,
representative,
representative,
Eckland.
B
Yes,
Mr
chairman
and
Senator
doc,
statter
the
we're
getting
to
the
heart
of
my
biggest
concerns,
and
that
was
evidence,
storage
and
the
cost
when
I
started,
because
I
did
this
and
then
I
started
researching,
which
you
shouldn't
do
but
I
that's
just
how
it
works.
When
you're
in
a
hurry,
the
10-year
deal
could
go
away.
I
think
it
confuses
it's
confusing
to
me.
It's
been
explained
as
at
least
10
years
after
the
the
victim
would
have
died
in
either
case.
Evidence
would
go
away.
B
I'm
starting
to
understand
the
statute
of
limitations
is
probably
just
a
moving
Target,
depending
on
on
what
the
policy
would
be
in
in
whatever
law
enforcement
and
the
circumstances
too
I.
Don't
I
still
think
you
kind
of
need
the
the
court
to
be
able
to
to
rule
in
the
deal
and
the.
B
B
B
She
was
groomed
at
age,
16
married
at
18,
and
it's
just
one
of
those
cases
that
the
DNA
evidence
would
have
been
beneficial
to
have
been
kept,
but
I
still
think
it
I
I,
don't
know
how
we
sort
this
out
without
muddying
up
laws.
It
is,
but
this
happened
previous
to
2019..
B
D
Senator
Bouchard,
thank
you
Mr
chairman.
Well,
that's
where
I'm
at
is
the
2019.
The
change
that
happened
in
our
statute
would
have
would
have
probably
fixed
this
if,
in
that
case,
so
I
don't
know
if
we
are
going
for
just
muddying
the
waters
here,
since
the
courts
already
have
decided.
This
is
the
way
we
handle
it.
We
know
now
that
there's
no
on
sexual
assault.
There
is
no
statute
of
limitations,
so
I'm
trying
to
figure
out
where
we're
going
I
mean
you
do
understand
that
there
is
no
we've.
B
Mr
chairman
I
do
and
been
through
a
set
of
attorneys
that
seemed
very
unclear
on
what
the
new
law
does,
apparently,
because
we
are
trying
to
sort
that
out
and
finally
get
someone
in
who
starts
talking
about
what
the
new
statute
says,
and
this
is
my
first
day
of
news
on
what
that
news.
How
that
new
statute
applies
and
the
language
is
just
oh,
getting
back
to
statute
law,
the
language
and
it
just
isn't
clear
to
most
of
the
public
myself
included.
N
Hello,
Mr,
chairman
and
members
of
the
committee,
my
name
is
Laura
Pearson
I
wasn't
going
to
testify
on
this
bill,
so
I
realize
that
you're
saying
that
there
is
the
statute
of
limitations
on
on
rape
or
rape
kids.
But
what
about
the
statute
of
limitations
on
say?
A
murder
say
that
there
is
a
crime
scene,
a
murder
scene
and
there's
DNA
evidence
there,
but
but
they
can't
find
that
in
their
database
and
later
on,
that
person
comes
into
the
database.
N
So
I
don't
think
that
this
bill
is
necessarily
only
focusing
on
on
rape
kits,
and
so
that
would
just
be
my
question:
what
is
the
statute
of
limitations
on
somebody
that
is
murdered
that
maybe
hasn't
been
raped,
but
there
is
DNA
DNA
evidence
there,
but
that
person
that
perpetrator
hasn't
been
brought
into
the
database
yet
but
later
on,
say
20
years
later,
all
of
a
sudden
they
they
get
a
hit.
C
Hey,
thank
you.
Ms
Pearson,
there's!
No
there's!
No
one
here
left
at
the
front
table
to
answer
your
question
so
I'll.
Let
you
pose
those
questions
as
a
testimony:
okay,
okay,
James.
Thank
you.
Thank.
N
C
C
Okay,
consideration,
Bill's
been
moved
past
German
or
the
current
chairman
has
not
asked
for
a
second
Bill's
been
moved
for
sake
of
discussion.
Go
ahead.
Mr,
Senator,
Barlow.
G
Thank
you
Mr
chairman,
so
I
think.
Actually
there
I
think
that
the
new
language
or
the
stricken
language
in
new
language,
bottom
of
page,
one
I.E
until
all
applicable
and
then
one
through
six
I,
would
actually
get
rid
of
I
mean
I
would
go
back
to
the
original
language,
but
I
do
think.
There's
some
value
in
in
the
edition
of
online
14
and
15
of
record
report,
other
examination
results
or
analysis,
because
that
may
be
something
that
there
can
be
some
discretion.
G
L
G
Rep
Senator
Ellis,
hasn't
hasn't
I
mean
maybe
taken
a
look
at
this
and
giving
us
some
feedback.
Since
this
was
new
statute
just
three
years
ago
that
so
I
don't
know,
I
I
guess
I'm
I'm
hesitant
to
move
it
forward.
I
did
it
for
the
sake
of
discussion,
so
I
could
actually
outline
this.
C
C
D
Burchard,
thank
you
Mr
chairman,
so
here's
where
I'm
at
on
this
I've
looked
at
the
courts
books
when
they
when
they
decide
how
they're
going
to
run
procedures
I've
seen
on
different
cases
how
they
handle
things.
Well,
when
we
start
making
statute,
we
change
those
things
that
they've
already
been
doing.
The
change
that
happened
in
2019
looks
like
it's
fixed
things,
so
I,
don't
I
think
we
may
be
breaking
things.
So
that's
where
I'm
having
a
problem
and
and
I
think
there's
a
much
bigger
conversation
has.
K
D
Had
we
should
have
a
DNA
database,
that's
in
DCI
and
take
it
off
the
backs
of
the
of
all
the
individual
departments.
C
D
C
Senator
any
further,
yes,
all
right,
Senator
Barlow!
What's
your
wish
on.
G
That
Amendment,
Mr
chairman
so
I
think
one
of
the
things
to
point
out
in
this
is
the
the
there
were,
certainly
potentially
a
crime,
grooming,
etc,
etc,
but
the
evidence
is
actually
being
sought
in
a
civil
manner
in
a
civil
matter.
So
this
is
not
a
using
evidence.
This
is
actually
at
least
the
evidence
it
was
that
generated.
This
interest
by
a
very
respected
colleague
of
mine
is
actually
was
going
to
be
used
in
a
civil
matter:
I.E
a
divorce
and
a
custody
battle,
not
in
a
subsequent
or
other
criminal
matter.
G
At
least
that
would
be
at
least
that's
how
it
was
presented
unless
there
is,
of
course,
a
complaint
that
the
first
child
was
the
result
of
rape
and
that
maybe
that
throws
that
all
out,
but
I
don't
I
did
not
get
that
from
the
from
the
testimony,
so
I
think
there's
also
that
just
modest
complication
but
yeah.
C
D
Right,
Mr,
chairman,
just
to
add
in
a
little
commentary
there
people
make
bad
choices.
C
Okay,
thank
you.
Bill's
been
moved,
no,
no
amendments
ready
for
the
Roll
Call.
E
C
C
O
Thank
you
Mr
chairman,
and
thank
you
labor
and
health
senate
committee
for
allowing
me
the
opportunity
to
present
this
bill
before
you
this
morning.
So
we
have
House
Bill,
119
medical
prescriptions
for
off-label
purposes,
which
passed
the
house
with
very
favorable
favorable
support.
If
I
may
I'd
like
to
give
a
little
bit
of
background
on
how
this
originates
and
where
this
comes
from
so
20
to
30
percent
of
all
prescribed
medications
are
actually
done
so
for
off-label
purposes.
Currently,
what
does
off-label
mean
so
off
label?
O
The
definition
of
that
simply
is
that
the
drug
wasn't
FDA,
tested
and
approved
for
that
specific
use,
but
it
or
that
it
isn't
listed
on
the
label,
but
it
has
gone
through
the
FDA
process
of
approval,
so
the
FDA.
What
do
they
do?
They?
They
focus
on
Market
entry
of
drugs.
They
consistently
maintain
that
they
do
not
regulate
or
interfere
in
the
practice
of
medicine
between
a
patient
and
a
physician.
O
Fda
clearance
means
that
a
medic,
FDA
clearance
of
a
medication
ensures
that
a
physician
understands
that
a
drug
effectively
produces
certain
physiologic
actions
that
are
proven
to
treat
an
illness.
But
it's
the
physician,
not
the
FDA,
that
determines
whether
these
specific
physiologic
effects
will
be
useful
or
beneficial
with
respect
to
their
particular
patients.
O
So
we
have
a
need
to
protect
and
preserve
the
Integrity
of
the
practice
of
medicine
and
allow
providers
to
retain
their
autonomy,
to
use
their
clinical
judgment
and
and
benefit
their
patients.
Patients
need
providers
to
have
the
latitude
to
make
the
best
choices
for
them
individually
and
specifically
so
what
what
drugs
are
we
potentially
discussing
here?
Let
me
just
go
through
a
list
of
several
of
the
most
commonly
prescribed
medications
for
off-label
purposes.
O
O
We
commonly
use
that
for
treatment
of
headaches
and
migraines
and
insomnia
drug
classes,
oftentimes
are
very
commonly
prescribed,
cardiac
medications,
anticoagulants
or
you
know.
Blood
thinners
medications
to
treat
arrhythmias,
antipsychotic
or
psychiatric
medications
are
once
again
very
commonly
used
for
this.
This
purpose
and
other
specific
individual
things
Albuterol
inhalers.
O
We
know
that
that
how
that
works
because
of
the
FDA
approval
process,
it
works
as
a
bronchodilator.
So
it's
a
proof
for
the
use
of
asthma.
We
understand
that
the
disease
process
that
it
treats
is
also
present
in
other
diseases
as
well
and
therefore
may
have
beneficial
use
in
things
like
COPD,
reactive,
airway,
disease,
other
other
disease
processes,
and
so
we
commonly
use
those
things
for
those
purposes.
O
This
right
was
taken
away
from
patients
and
providers
who
were
warned
sometimes
threatened
about
prescribing
for
off-label
purposes
that
created
a
situation
where
providers
may
have
been
uncomfortable
or
unwilling
to
provide
those
medications
because
they
were
concerned
about
their
risk
of
loss
of
license
or
loss
of
livelihood
and
we'll
hear
testimony
today.
I
am
confident
that
in
Wyoming
there
have
been
providers
who
did
lose
their
their
livelihoods
because
they
continued
to
practice
and
and
do
what
they
felt
like
was
best
for
their
patients
But.
O
Ultimately,
what
happened
is
many
people
lost
access
to
those
potentially
life-saving
medications
and
lost
their
us,
their
confidence
in
the
in
in
the
system
as
a
as
a
whole,
so
the
the
boards
will
say
it,
and-
and
it
is
true
to
my
understanding
that
no
providers
actually
lost
their
licenses
in
Wyoming
for
these
per
for
these.
For
continuing
these
practices,
providers
were
fired
from
their
facilities
or
from
their
clinics,
but
no
one
actually
lost
their
license.
O
However,
there
were
there
were
warnings
issued
that
encouraged.
O
To
put
it
nicely,
these
providers
to
refrain
from
these
practices
I
have
a
an
article
here
from
a
Wyoming
publication
dated
March
of
2020,
the
title
of
or
the
headline
of
which
says.
Wyoming
Medical
Board
warns
about
using
malaria
drugs
for
covid
and
in
there
they,
the
board
says
that,
if
you're
inappropriately
prescribing
these
medications,
that
would
be
a
violation
of
the
Medical
Practice
Act
and
that
they
would
take
action,
and
so
those
those
things
were
certainly
put
out
there.
O
The
Federation
of
State
Medical,
State,
Medical
Boards,
of
which
Wyoming
is
a
member,
issued
a
statement
in
July
of
2021
that
so
that
any
spread
of
misinformation
or
disinformation
would
put
an
individual,
a
prescriber
at
risk
of
disciplinary
action
by
State
Medical
boards,
including
the
suspension
or
revocation
of
their
medical
license.
O
O
So
what
we
have
here,
in
my
opinion,
is,
is
a
situation
where
the
threat
of
discipline
was
in
many
cases
as
effective
as
the
discipline
itself.
O
People
lost
that
ended
up,
losing
access
to
the
cares
that
they
they
desired
and
they
wanted
and
I
truly
believe
that
lives
were
lost
and
and
in
these
situations
we
have
medications
that
were
the
excuse
was
used
that
we
can't
do
this,
because
it's
off
label
and
because
it
hasn't
been
studied
for
these
specific
uses
and
therefore
we're
not
going
to
allow
it
when
these
medications
have
actually
been
around
for
35
years
and
been
in
in
fact
they're
over
the
counter
in
a
lot
of
countries,
while
at
the
same
time
other
medications
that
you
know
I
guess
I'll
put
out
there
that
when
we're
talking
about
the
treatment
of
covid,
all
medications
were
off
label.
O
We
had
nothing
that
was
had
gone
through
the
FDA
process
and
approval
for
treatment
of
covid,
and
so
some
some
medications
were
villainized
and
other
medications
were
lifted
up
as
being
acceptable
But.
Ultimately,
the
patients
were
the
ones
that
that
suffered
and
lost
access
to
their
to
their
options,
foreign.
So
again,
why
do
we
need
this?
Now?
Because
we
have
an
opportunity
to
learn
from
the
events
of
the
last
couple
of
years
and
we
need
to
be
prepared
for
what
may
come
next.
C
O
Right,
thank
you
page
one.
There
isn't
too
much
there.
We
mostly
things
start
on
page
two
with
me
start
with
this
with
definitions.
So
the
definition
of
disciplinary
action
includes
any
action
taken
by
Boards
or
facilities.
We've
already
discussed
their
definition
of
off
what
off-label
indication
means.
O
We
know
what
pharmacists
are
hopefully
and
in
this
bill,
the
list
of
prescribers
on
page
three
that
are
included
or
would
be
Physicians,
Physicians,
assistants,
dentists,
optometrists,
Nerf
and
nurse
practitioners
so
statute,
three
thirty,
three
one
402
and
paragraph
a
on
page
three
says
that
prescribers
may
lawfully
prescribe
and
pharmacists
are
authorized
to
dispense,
off-label
medications
with
a
valid
prescription
order,
these
things
in
section
B
indicate
or
that
this
bill
does
not
apply
to
schedule
one
and
schedule
true
Two
drugs,
which
would
be
things
like
narcotics
or
marijuana
and
schedule.
O
One
drugs
are
typically
not
prescribed
at
all
page
four
paragraph
a
basically
says
that
no
adverse
action
will
be
taken
solely
and
I
draw
your
attention
to
that.
So
page
four
line,
eight
solely
on
the
basis
for
off-label
indication,
so
adverse
action
won't
be
taken
solely
on
the
basis
that
this
was
an
off-label
prescription
and
lower.
O
In
that
paragraph,
it's
not
considered
a
professional
conduct
if
the
prescriber
has
obtained
the
informed
consent
of
the
patient,
specifically
acknowledging
the
off-label
indication
and
use
paragraph
B,
which,
at
the
bottom
of
line
of
page
four,
which
moves
into
pain,
page
five
and
is
the
final
paragraph
in
this
bill,
says
that
also
it's
not
considered
it
wouldn't
be
considered
unprofessional
for
a
doctor
to
recommend
prescriber
Give
opinions
on
the
treatment
of
covid
I.
Might
if
it's
considered
friendly
by
the
committee,
suggest
a
possibility
of
some
amendments
as
I.
O
Look
through
the
young
girls
copy
and
and
saw
some
of
the
Amendments
that
had
made
on
line
six
page
five
I
might
suggest
putting
a
period
after
the
word
patient
and
striking
the
remainder
of
that
line
and
line
seven.
That
exact
language
is
found
in
the
previous
paragraph
as
well,
and
it
does
seem
a
little
bit
out
of
place
here.
But
if
that's
not
considered
friendly
I'm,
you
know
it's
fine
to
say,
as
is
I
also
might
make
a
suggestion
that
the
effective
date
be
moved
up
to
immediately.
C
Representative
give
us
that
one
more
time-
and
somebody
may
do
that,
then,
as
we
both
of
those
yes.
So
we
got
the
effective
date.
But
what
was.
O
P
G
G
Just
like
a
dentist
would
within
them
that's
the
first
one
and
and
then
the
schedule
two
actually
interests
me
and
and
I'm
I've
got
scheduled
to
in
front
of
me,
and
it
includes
a
lot
of
commonly
used
drugs,
including
fentanyl,
so
it's
fentanyl
used
in
ways
that
are
not
on
the
label
right
because
it
shares
any
pin
and
any
other
drug
under
schedule
too,
because
this
would
seem
to
limit
any
obvious
label
of
schedule
two
which
are
commonly
used
in
our
drugs,
some
of
them.
Thank
you,
representative.
O
Thank
you,
Mr
chairman
Senator
Barlow,
so
your
first
question
about
prescribers,
so
it
does
include
Physicians
and
podiatrists
and
psychiatrists
are
MDS,
and
so
that
should
include
them.
If
you
feel
like
there's
an
amendment
that
needs
to
be
made
to
include
others,
I
would
I
would
be
agreeable
to
that
and
the
second
question
on
the
schedule
two
so
fentanyl
is
a
is
a
pain,
medication
and
and
would
be
considered
unlabel
to
treat
pain
and
so
I'm,
not
certain
what
other
off-label
indications
you
might
be
referring
to.
C
G
Borrow
follow
up
Mr
chairman,
so
thank
you
so
because
this
is
actually
by
practice
and
by
practice,
board
podiatrists
have
their
own
board
and
so
do
psychiatrists.
So
that's
that's
what
I'm
asking
do
granted.
They
may
be
MDS,
but
they
have
their
own
licensing
Authority.
At
least
that's
my
understanding
and
there's
other
folks
in
the
audience
speak
that
the
second
one
is
I
use
fentanyl
as
an
example
there's
an
entire
list
of
schedule,
two
in
title
35.
Maybe
it
would
be.
G
O
Sure,
thank
you.
Thank
you,
chairman
I
I
think
that
that's
a
appropriate
thing
and
I
I
can
certainly
look
into
that.
I
think
that
the
reason
that
this
the
schedule,
one
and
two
drugs
were
included
in
this
bill
is
because
they
are
higher
level
higher
risk
medications.
O
As
I
said
at
this
point,
this
is
this
practice
is
not
considered
illegal.
I.
Don't
think
that
this
bill
would
make
the
practice
illegal.
If
it's
not
specifically
listed
here.
C
Okay
committee
further's
questions
representative
I've
got
one
before
we
cut,
you
lose
sight
since
we've
spoke
and
I've
received
lengthy
correspondence
from
one
of
my
providers
who
speaks
for
many
of
his
colleagues
and
providers
here
and
her
colleagues.
They
note
that
they
prescribe
these
medications
for
off-label
use
regularly
within
our
practices.
C
O
I
would
agree
with
that.
Like
I
said
20
20
to
30
percent,
depending
on
which
studies
you
look
at
of
all
prescribed
medications
are
done
so
far
off
label
purposes,
and
so
we
currently
do
that.
As
I
said.
The
reason
for
this
bill
is
to
to
ensure
that
that's
a
statement
that
that
it
is
okay
as
the
practice
or
the
prescribing
of
off-label
medications
that
was
used
as
an
excuse
for
entities
to
block
the
prescription
of
certain
medications.
C
So
represent,
pin
you've
kind
of
already
touched
on
it.
Then
you,
if
we're
doing
this,
the
necessity
of
your
bill.
Why
do
you
think
we
really.
O
C
O
Thank
you
Mr
chairman,
so
the
the
reason
that
we
need
this
is
to
allow
that
can
that
that
relationship
to
continue,
allow
the
practice
of
medicine
to
continue,
because
I
foresee,
with
the
events
that
happened
in
the
last
couple
of
years
and
seeing
how
other
states
have
handled
this,
we
have.
We
have
States
who
have
actually
enacted
laws
that
simply
say
the
that
the
spread
of
misinformation
is
is
now
subject
to
Legal
review
and
their
definitions.
In
fact,
I
have
the
bill
in
front
of
me.
They're
definitions
for
misinformation.
O
O
Their
job
is
to
to
go
through
the
go
through
the
data
go
through,
and
especially
in
situations
like
emergencies,
and
things
like
that
to
be
able
to
reap
purpose
medications
and
and
look
at
what's
available,
look
at
how
they
work
and
see
if
that
might
have
applicability,
to
address
the
issue
that
they
see
before
them,
and
so
because
we
saw
an
effort.
O
What
appears
to
be
a
concerted
effort
to
to
hamper
that
practice
in
some
situations,
I
think
we
need
to
step
up
in
Wyoming
needs
to
to
be
one
of
one
of
the
first.
So
this
isn't.
This
is
model.
This
bill
is
modeled
after
legislation
that
has
passed
into
other
states,
and
so
we
aren't
the
one
of
We
aren't
the
very
first,
but
we
we
need
to
be
leading
that
charge
to
say
that
that
we
will.
We
will
protect
this
right
in
this
practice.
O
I
think
that
oftentimes,
the
entities
in
discussion
here
put
out
that
the
reason
that
this
was
done
was
to
protect
patient
safety
and-
and
we
want
to
believe
that,
but
I've
I've
been
approached
by
many
who
have
said
if
this
is
what
what
protection
means.
We
don't
want
that
protection,
because
if
that
protection
means
that
we've
lost
the
ability
to
have
all
the
options,
then
it's
no
longer
protecting,
and
so
this
bill
aims
at
truly
protecting
the
patients.
Thank.
C
You
all
right,
one
fell
off,
go
ahead.
H
O
O
We
want
to
protect
providers,
ability
to
stand
up
for
their
patients
and
so
again
preventing
action
taken
solely
on
the
basis
that
a
medication
was
prescribed
off
label,
so
this
doesn't
prevent
a
board
from
if,
if
negligence
occurs
or
if
there's
harm
done
because
of
negligence,
that
that
doesn't
it's
not
involved
here.
This
is
to
prevent
discipline
strictly
because
it
was
off
label.
Thank.
H
You
all
right,
yes,
Mr,
chair!
Thank
you.
So
what
I
also
gather
from
this
piece
of
legislation
is
that
the
physician
knows
what
they're
doing
they're.
Not
just
hey.
Do
this.
They
understand
what
the
the
drugs
gonna
do
to
this
person
go
ahead.
Is
that
correct.
O
Thank
you,
chairman
Senator
Hutchings,
yes,
Physicians
and
prescribers
have
have
gone
through
the
proper
levels
of
training
to
understand
the
things
that
they're
that
they're
prescribing
and
so
yes,
I,
would
agree
that
the
education
is
there
to
make
informed
clinical
judgments.
C
P
I,
just
I
just
wanted
to
reinforce
the
statement
that
representative
Penn
presented
about
providers
receiving
a
letter
from
the
medical
board's
threading
net
that
they
would
take
away
their
license
and
really
pursue
that
Avenue
and
I.
Don't
I,
don't
think
that's
right,
and
it's
just
because
of
the
this
use
of
off
labeled
drugs
that
they
were.
They
were
wanting
to
do
that
with
that,
I
will
stand
for
questions,
questions
for.
L
Q
We'll
we'll
be
brief.
I
wanted
to
keep
our
comments
focused
on
the
Medicaid
Program.
As
the
committee
is
probably
aware,
we
operate
under
under
some
pretty
strict
guidelines
when
it
comes
to
authorizing
payment
for
services,
in
this
case
for
prescriptions
under
medical
necessity.
I'll.
Let
Corey
describe
some
of
that
Nuance
as
it
pertains
to
the
Medicaid
Program,
but
first
just
wanted
to
inform
the
committee
that,
as
I
read
this
bill
and
certainly
don't
have
to
get
into
the
weeds
conceptually
here,
but
as
I
read
the
bill.
Q
We
could
be
essentially
again
on
the
administrative
side
I
put
at
risk
for
non-compliance.
If
we
don't
have
procedures
in
place
to
Prior
authorize
some
of
those
things
not
to
say
they
wouldn't
ultimately
be
allowed,
and
many
of
you
have
been
on
this
committee
for
a
long
time
know
that
we
prior
authorize
a
lot
of
different
treatment
and
services,
costly
things
Etc
that
annoys
our
providers.
I'll
I'll
put
it
that
way
and
can
sometimes
delay
that
that
access
to
care
is.
Is
it
necessary?
Yes,
for
different
purposes
and
Medicaid
plans?
Commercial
plans
do
prior
authorizations.
Q
I
just
want
the
committee
to
be
aware
of
as
I
read
it
right
now,
what
might
be
required
of
your
Department
of
Health
and
your
your
Medicaid
Program
in
order
to
try
to
comply
with
both
what
would
be
articulated
in
the
legislation
and
with
our
with
our
Medicaid
requirements.
Mr
chairman,
with
your
permission,
I'll,
ask
Corey
Cooper
Dr
Cooper
too,
to
speak
to
those
issues.
C
H
Q
Mr,
chairman
Senator
Hutchings,
let
me
ask
Dr
Cooper
to
answer
that.
It
I
think
it
depends
on
if
we're
talking
about
prescriptions
that
need
prior
authorization
or
or
not,
but
I
think
Corey
could
address
that
and.
H
F
Social
Security,
Act,
section
1927,
is
really
where
most
of
the
the
federal
rules
are
that
we
have
to
follow
in
Medicaid
in
terms
of
drug
coverage,
reimbursement
that
sort
of
thing
and
basically
1927
states
that
we
are
are
only
allowed
to
to
collect
federal
financial
participation
or
fmap
in
Medicaid
for
prescriptions
that
are
prescribed
and
dispensed
for
a
medically
accepted
indication.
So
the
definition
of
medically
accepted
indication
is
a
little
bit
broader
than
what
is
on
label.
F
So
there's
there's
two
ways
to
get
to
medically
accepted
indication.
One
is
going
through
the
FDA
process.
The
manufacturer
goes
through
that
process
establishes
that
a
drug
is
safe
and
effective
for
a
particular
disease
state.
That
is
what
put
is
put
on
the
label.
The
manufacturers
spent
the
time
and
money
invested
in
getting
that
particular
indication
on
label.
F
Once
a
drug
is
on
the
market,
as
has
been
testified
to
it,
can
be
prescribed
for
anything
by
any
prescriber
so,
and
we,
of
course,
in
the
scope
of
practice,
we
assume
that
that's
happening
as
well
as
experience
is
gained
with
that
drug
in
the
open
market,
then
situations
arise
where
Physicians
and
prescribers
want
to
try
that
drug
for
an
off-label
purpose
for
something
other
than
what
it
was
approved
for,
and
so
those
studies
are
done
outside
of
the
manufacturer
they're
done
out
in
the
real
world,
but
in
a
research
setting.
F
So
those
studies
are
done
with
an
Institutional
review
board
approving
the
study
design,
protecting
the
patients
setting
out
parameters
ahead
of
time
that
you
know
if,
if
we
reach
a
certain
endpoint
we're
going
to
stop
this
study
if
it's
clearly
not
safe
for
the
patients
involved
in
the
study,
and
so
through
that
process
repeated
multiple
times,
we
reach
a
preponderance
of
evidence
that
then
allows
the
medication
to
be
medically
accepted
for
an
indication
that
is
not
on
label,
and
that
happens
when
that
medication
and
indication
is
then
labeled
in
or
it
is
then
listed
in
a
compendia.
F
F
Okay,
so
that's
where
we
get
to
prior
authorization
and
answer
the
answer
to
your
question:
Senator
Hutchings,
regarding
how
do
we
know
and
do
we
keep
track
of
every
prescription?
Every
doctor
writes
for
every
patient.
F
We
certainly
do
keep
track
of
the
ones
that
we
pay
for
and
that's
something
that
we
have
to
do
or
we're
obligated
to
do,
particularly
if
we
want
to
collect
the
federal
share
on
those
prescriptions
if
it
is
an
off-label
use
or
something
that
we
have
on
prior
authorization
requiring
that
the
labeled
indication
be
confirmed
before
we
can
cover
that
medication,
then
we
have
a
prior
authorization
in
place
and
we
do
keep
those
prior
authorizations.
F
So
we
can
go
back
and
look
I
want
to
give
you
a
bit
of
an
illustrated
example
to
hopefully
help
clear
this
up.
Representative
Penn
was
completely
transparent
in
that
this
is
a
practice
that
is
conducted
now.
Off-Label
prescribing
is
done.
F
Off-Label
prescribing
is
generally
within
the
medically
accepted
indications,
as
just
described
to
you
the
example
that
I
have
real
world
example,
as
you
can
imagine,
because
there
are
51
State
Medicaid
agencies,
since
Washington
DC
has
their
own.
F
That
means
there's
51
Pharmacy
programs
and
we're
a
pretty
tight-knit
community,
and
so
when
we
see
practices
in
one
state
that
are
concerning
in
terms
of
off-label
and
not
for
a
medically
accepted
indication,
we're
not
worked
in
with
each
other
and
we
might
give
each
other
a
heads
up
that
that's
happening,
which
is
how
this
situation
came
about.
We
heard
from
another
state
that
they
were
seeing
a
lot
of
Naltrexone
use
in
children
with
autism
spectrum
disorder.
F
Naltrexone
is
a
medication
used
for
alcohol
use,
disorder
and
opioid
use
disorder,
although
almost
exclusively
alcohol
use
disorder.
At
this
point
in
time,
there
is
scant
evidence
that
Naltrexone
would
help
with
the
behavior
complications
of
autism
spectrum
disorder
in
a
couple.
A
couple
of
parts
of
Behavioral
complications,
but
not
necessarily
broad
use.
F
And
if
there
wasn't
you
bet,
we
were
calling
the
providers
who
prescribed
it
and
asking
what
it
had
been
prescribed
for
because
we
are
under
not
we're
not
under
a
permissive
law
with
the
federal
law
we're
under
a
law
that
says
you
cannot
cover
this,
so
we
needed
to
make
sure
that
we
weren't
I
use
that
as
an
example,
because
that
particular
use,
if
it's
not
unlabel
and
it's
not
medically
accepted,
is
considered
experimental
and
the
last
thing
anyone
wants
is
for
the
Medicaid
population
to
become
open
season
for
experimental
treatment.
H
Thank
you,
Mr
chair
two
questions
in
another
bill
we
just
put
except
for
Medicaid
and
Medicare.
Will
that
help
number
one
and
number
two
did
we
did
Medicaid
Medicare
pay
for
covet
vaccine
vaccines.
F
F
Senator
Hutchings
I
do
not
believe
that
the
exception
for
Medicaid
or
Medicare
would
would
help
okay
in
this
bill,
the
off-label
prescribing
is
is
widely
accepted.
It
is
legal
we
we
don't
want
to
make
it
illegal
if
it's
not
on
label,
because
there's
the
medically
accepted
indication
piece
of
it.
There's
there's
a
label
and
there's
medically
accepted
and
then
there's
completely
off
label
and
we
can
cover
on
label
and
medically
accepted
and
I.
Don't
you
know
medically
accepted
is
not
language
used
in
this
bill
and
so
I?
F
That's
why
that
exception
wouldn't
help
us
out
here:
gotcha,
okay
and
yes,
because
we
are
aesthetically
federally
funded
program.
Wyoming
Medicaid
did
Cover
coveted
vaccines.
F
H
Thank
you,
Mr
chairman
follow-up,
one,
quick
follow-up,
the
exceptions
for
Medicaid
Medicaid
care
you're,
just
telling
us
about
it.
It's
not
going
to
help
or
not
help.
This
was
just
for
our
information
that
you
brought
this
up.
F
Mr,
chairman
Senator
Hutchings.
Yes,
we're
giving
you
that
information,
because
there
are
financial
implications
in
terms
of
federal
audit
and
if,
if
the
federal
government
or
specifically,
the
office
of
the
Inspector
General,
were
to
audit
our
records
and
find
a
medication
that
we
had
covered
for
a
non-medically,
accepted
medication
or
off-label.
That
finding
would
be
extrapolated
and
we
would
be
expected
to
pay
the
federal
government
back
potentially
a
large
amount
of
money.
Thank.
D
Thank
you
Mr
chairman,
so
I'm
I'm,
having
a
hard
time
with
what
you're
talking
about,
because
I
know,
doctors
that
have
lists,
and
it
says
this
will
be
covered
by
insurance
or
this
won't
be
covered
and
the
same
with
Medicaid.
So
I'm
I'm
of
the
belief
that
doctors
are
smart
enough
to
know
when
to
prescribe
something
and
when
it
can
be
paid
for
so
I.
D
Don't
so
I'm
just
having
a
hard
time
with
everything
all
your
testimony,
because
that's
the
way
I
see
it,
doctors
don't
prescribe
things
knowing
that
they're
going
to
put
their
patient
at
some
kind
of
Financial
Risk.
There
are
lists.
There
are
codes.
All
those
things
are
already
have
been
set
forth.
We
would
you
not
agree
that
they
they
have
an
ability
to
know
what
is
covered
and
what
isn't
Dr
Cooper.
F
Mr
chairman
Senator
Bouchard
I,
do
agree
with
a
caveat,
so
I
agree
that
yes,
Physicians
have
lists.
They
know
what
various
insurance
agencies
cover
and
what
they
don't.
I
think
what
I
didn't
make
clear
in
my
testimony.
F
So
hopefully
this
will
clarify
is
that
if
this
bill
were
to
pass
because
of
the
federal
limitations
that
the
Medicaid
agency
is
under,
there
would
be
a
much
larger
list
of
drugs
that
we
would
have
to
put
on
prior
authorization
to
or
in
to
ensure
that
they
were
being
prescribed
for
a
labeled
or
medically
accepted
indication,
because.
F
As
representative
Penn
observed,
the
threat
of
action
on
someone's
license
is
as
good
as
actual
action
on
someone's
license.
We
all
live
with
that
every
day.
The
threat
of
being
stopped
for
speeding
or
running
a
red
light
is
what
keeps
us
from
doing
those
things,
and
so,
with
this
bill,
taking
away
any
accountability
for
off-label
prescribing
the
accountability
then
would
have
to
come
for
us
from
the
agency
itself,
which
would
mean
a
larger
number
of
Prior
authorizations.
F
We
have
two
prior
authorization:
pharmacists
who
reviewed
over
15
000
prior
authorizations,
and
that
was
before.
Obviously,
before
this
bill
existed
in
one
year,
we
would
have
to
expand
the
list
of
drugs
on
prior
authorization.
The
list
for
the
Physicians
would
get
longer,
their
administrative
burden
would
get
larger
and
we
would
have
to
hire
additional
staff
to
evaluate
the
prior
authorizations
that
were
coming
in.
D
Follow
up
with
thank
you,
Mr
chairman,
so
CMS
has
all
these
lists
and,
and
they
probably
have
them
in
electronic
format.
So
I'm,
just
trying
to
I
mean
grasp
what
you're
saying
here.
I
mean
I.
Just
don't
see
doctors
running
out
there
saying
hey.
Let
me
let
me
give
rat
poison
to
cure
a
disease.
I
I
mean
that's
what
you're
making
it
sound
like.
Doctors
are
very
careful
when
they
use
off
label.
I've
I've
talked
to
them
about
this
very
subject.
D
In
fact,
my
daughter
would
be
dead
if
they
didn't
use
something
off
label
and
it
was
to
treat
a
virus,
and
it
was
this
because
of
a
cytokine
storm
and
they
gave
her
something
that
was
to
treat
malaria
long
before
covid
came
along,
but
then,
when
covid
came
along,
nobody
would
even
listen
to
to
what
I
mean
there
are
professionals
that
work
in
the
field
that
don't
even
know
what
a
cytokine
storm
is,
and
they
don't
know
how
to
treat
it.
Yet
there
were.
D
There
are
various
doctors
around
the
state
that
were
treating
that
and
I
have
recordings
from
a
pharmacy
that
would
not
give
out
the
the
prescription.
I
mean
I,
thought
I
almost
brought
it
in
today
and
I
should
have
it
I
see
a
reporter
out
there
I
think
I'll
make
sure
he
has
it.
But
when
you
have
a
a
pharmacy,
even
saying
well
we're
not
gonna
We're,
not
gonna
give
it,
because
we
have
a
a
letter
from
somebody.
I
can't
remember
who
they
had
it
from
where
they
said.
They
saw
a
study.
D
D
So
how
do
we
balance
that
access
to
care,
if
we're
not
willing
to
say
hey
CMS,
has
all
this
this
on
records,
and
we
can
gather
that
without
a
lot
of
money,
put
that
out
there
and
put
a
memo
out
to
doctors
and
say
hey?
These
are
the
things
you
can't
prescribe
because
we
can't
get
it
paid
for
I
mean,
don't
you
think,
that's
a
much
simpler
issue.
Q
Mr,
chairman
director,
and
knowing
that
you
all
sure,
are
short
on
time.
I'll
try
to
be
brief.
I
think
that's
the
the
issue
here.
I
think
you're
articulating
the
issue
where
one
of
the
unintended
consequences
here
is
that
kind
of
administrative
growth
that
that
you're,
mentioning
where
absolutely
we
can
put
that
out
and-
and
we
will
because
we'll
have
to
have
longer
lists
to
your
point
of
Prior,
authorized
drugs
and
have
that
administrative
burden
on
the
docks
on
the
providers.
Q
Q
What
I
worry
about
is
given
the
Nuance
of
of
our
programs
and
I'm
sure,
there's
others
out
there
that
we
create
an
access
to
care
issue,
because
we're
going
to
put
administrative
hurdles
by
requirement
in
place
that
are
going
to
that
are
going
to
put
more
steps
in
place
than
I
think
would
be
necessary,
absent,
absent
the
bill.
If
that
makes
sense,.
A
Hold
on
for
one
second
Senator
I
just
want
to
put
this
out
there
publicly.
So
everybody
knows
this:
it's
905
right
now
we're
clearly
not
going
to
finish
this
bill
today,
which
means
the
bill
behind
us
is
probably
not
going
to
get
hurt
today.
Well,
it
won't
be
heard
today,
so
this
one
will
be
continue.
We're
going
to
go
ahead
and
finish
out.
We
have
to
leave
at
9
30.,
we'll
do
more
testimony
anybody
that
wants
to
testify,
but
this
will
be
continued
into
Friday
morning.
A
So
just
that
that's
up
front
for
anybody
out
there
waiting
to
testify.
That's
that's!
What's
going
to
happen,
we
will
take
more
testimony,
but
we
won't
be
moving
or
working
this
bill
today.
So
you
had
to
have
follow-up
just.
D
Chairman,
what
about
the
people
who
aren't
on
Medicaid
aren't
on
any
kind
of
even
Insurance?
What
about
people
just
want
to
pay
and
have
access?
I
mean
we're
putting
a
roadblock
on
one
side,
but
then
what
about
the
people
that
don't
have
those
roadblocks.
Q
Q
That
I'm
sure
will
testify
here
from
the
non-departmentof
world,
but
in
terms
of
the
the
broader
area
again,
I
think
what
we're
all
wrestling
with
here
is
a
is
a
concern
that
removing
accountability
to
promote
something
that
that
we're
prescribing
and
pharmace
pharmacological
use
could
be
beneficial.
We
want
to
strike
that
right
balance
where
there's
accountability
in
patient
safety
and
also
access
so
for
the
again
for
the
broader
population.
My
department
certainly
has
an
interest
there
and
a
concern
and
I
want
to
do
what
we
can
to
ensure
we
get
that
balance
right.
A
Very
good
I
think
I
speak
for
all
the
prescribers.
Maybe
I
shouldn't
speak
for
all
the
prescribers.
Every
insurance
company
has
long
list
of
pre-approved
and
medically
approved
drugs.
As
for
those
who
pay
individually,
that's
another
topic
all
all
together,
but
all
insurance
companies
have
long
lists
and
I'm
sure.
The
good
representative
will
tell
you
horror
stories
of
having
to
do
prior
authorizations
and
we
talk
about
that.
K
Mr,
chairman
members
of
the
committee,
my
name
is
Matt
Martin
I'm,
the
executive
director
for
the
Wyoming
State
Board
of
Pharmacy,
wanted
to
be
here
to
try
to
answer
the
committee's
questions
and
and
do
what
I
could
to
speak
or
answer.
Some
of
the
things
that
have
come
up.
K
K
The
concern
was
about
the
inappropriate
use
of
the
medications
and,
as
chairman
Baldwin
knows,
as
a
provider
there
are
of
and
Senator
Barlow
as
well
as
a
as
a
veterinarian.
There
are
many
many
many
many
many
elements
that
are
part
of
the
consideration
for
what
is
appropriate
and
inappropriate.
Prescribing
and
I
I
understand
the
concern
that
they've
to
codify
this,
to
make
it
to
where
this
is
without
a
shadow
of
a
doubt
and
a
loud
practice.
K
As
has
been
said,
it
has
allowed,
it
happens
all
the
time
in
Wyoming
already
and
across
the
country,
but
when
we're
talking
about
affecting
prescribing
and
the
practice
of
Medicine
and
Pharmacy,
and
all
these
things,
a
pendulum
is
often
brought
up
and
very
small
touches
to
that.
Pendulum
can
have
really
wild
swings
to
what
ends
up
happening
with
things
and
as
this
committee
has
heard,
and
some
of
the
members
of
the
committee
sat
on
the
opioid
task
force.
P
K
K
K
The
reports
that
we
were
getting
at
the
board
was
that
there
were
not
legitimate
patient
provider
relationships
for
prescriptions
that
were
being
called
in
by
practitioners
who
were
not
licensed
to
practice
in
this
state
who
were
looking
to
hoard
medications
for
themselves
and
at
the
time
this
one
of
these
medications,
the
hydroxychloroquine
is
an
anti-malarial,
is
usually
used
for
now
that
I'm
in
the
hot
seat,
I'm
going
to
forget
Lucas
and
Ms
I
want
to
say,
and
when
I
was
a
practicing
pharmacist,
those
met
that
was
a
medication
that
I
routinely
ran
out
of
stock
on
it
was.
K
It
was
very
difficult
for
me
to
have
on
hand,
and
so
when
that
suddenly
became
the
target
of
hey.
This
could
be
something
that
could
help,
and
there
was
this
rush
on
it.
Pharmacy
suddenly
were
unable
to
obtain
it
and
that
put
patients
who
were
stable
on
these
medications
for
legitimate
medical
purposes
at
risk
of
relapse
or
worsening
of
their
conditions,
because
the
pharmacy
wasn't
able
to
obtain
it.
K
And
so
the
communications
that
we
had
sent
out
was
to
say
that
the
pharmacists
have
a
corresponding
responsibility
and
they
need
to
use
their
professional
judgment
to
evaluate
the
medications
and
determine
what
they
were
going
to
be
doing
in
dispensing
the
medications.
Nothing
that
we
ever
said
or
did
was
to
look
at
and
say
we're
going
to
discipline
anybody,
because
you
dispensed
X
number
of
prescriptions
for
hydroxychloroquine
or
anything
like
that.
K
I
I
guess
with
that
I'd
I'd
like
to
still
emphasize
too
that
the
boards
we
we
exist
to
protect
the
public
and
one
of
the
things
that
this
does
from
a
practice.
A
pharmacy
perspective
by
making
a
lot
of
things
off
label
practice
of
Pharmacy
and
and
kind
of
what
Dr
Cooper
was
talking
about.
A
lot
of
things
from
the
pharmacy
perspective
is
a
game
of
probabilities.
K
Pharmacists
are
trained
to
know
what
the
drugs
are.
What
they're
used
for
what
the
proper
dosage
is,
all
those
sorts
of
things
and
when
you
get
into
off-label
uses
you
start
to
get
into
grayer
areas
where
you
don't.
You
may
not
know
what
exactly
is
being
treated.
You
may
not
know
exactly
whether
or
not
that
dose
is
or
isn't
appropriate
and
that
can
put
the
pharmacist
in
a
difficult
position,
because
on
the
one
hand
they
do
have
to
verify
the
legitimacy
of
a
prescription.
K
They
have
a
duty
to
do
a
drug
utilization
review
and
make
sure
that
it's
appropriate
that
it's
safe,
that
they're
not
going
to
cause
harm,
and
some
medications
have
what's
called
a
wide
therapeutic
window,
meaning
the
the
the
range
of
dose
between
too
little
and
too
much
is,
is
really
really
big.
So
it's
really
hard
to
hurt
people
on
some
of
these
medications,
because
that
window
is
so
big.
K
But
again,
when
you
get
into
these
off-label
uses,
the
pharmacist
playing
a
game
of
probability
gets
into
those
kind
of
gray
areas
where
they
don't
know.
If
what
they're
doing
is
or
isn't
going
to
be,
causing
harm
and
again
from
the
board's
perspective,
it's
not
that
we
would
look
at
a
pharmacist
and
say
well.
K
You
definitely
did
something
wrong
here,
because
there's
a
lot
of
things
that
go
into
evaluating
whether
or
not
there
was
a
violation
of
the
rules
and
if
there
was
a
violation
of
the
rules,
what
sort
of
discipline
is
is
necessary
in
in
in
a
given
case,
so
it
from
the
board's
perspective
to
make
it
not
unprofessional.
Conduct
to
just
be
able
to
fill
prescriptions
off
label
makes
the
practice
of
Pharmacy
much
more
difficult
because
you
end
up
having
a
lot
of
competing
Masters
to
to
serve
so
to
speak.
K
I
guess
with
that
I'd
try
to
answer
the
committee's
questions
when
I
was
before
the
the
opposite
chamber,
I
was
told:
I
was
causing
more
questions
to
be
thought
of
than
I
was
answering
so
I'll
I'll
stand
for
questions
and
let
my
colleague
from
the
Board
of
Medicine
step
in
if
you'd
like
questions
from
Mr
Martin
Senator.
G
Barton,
thank
you.
Mr
chairman,
so
remind
me,
the
relationship
that
the
pharmacist
Pharmacy
board
has
with
other
prescribers
I.E.
Besides
your
size,
pharmacists
I
used
to
have
a
pharmacist
a
license
with
a
pharmacy
board
and
I
can't
remember
what
the
you
know.
What
level
I
was
it
Controlled
Substances?
Was
it
all
prescribing?
Would
you
just
inform
remind
me
and
informed
the
committee?
Thank
you.
Mr
chairman
Mr
marnell.
K
G
Under
title,
35
I
wanted
to
control
the
substances
at
any.
All
prescribers
are
under
the
has
a
has
a
subsequent
license
under
the
pharmacy
board.
Is
that
accurate?
Thank
you.
K
K
This
committee
famously
heard
a
bill
for
a
number
of
years
for
optometrists
to
be
able
to
prescribe
a
certain
schedule,
two
medication
that
before
it
had
been
scheduled
as
a
schedule
to
was
a
schedule
three
and
they
had
been
able
to
prescribe
it.
While
it
was
a
schedule
three
and
as
soon
as
it
became
a
schedule
too,
they
were
no
longer
able
to
do
that
and
it
took
many
years
for
them
to
be
able
to
get
that
back
into
their
tool.
Kit.
D
Thank
you
Mr
chairman,
so
rolling
back
and
looking
at
what
happened.
I
I
was
told
that
doctors
can
prescribe
these
other
drugs
for
during
covet,
but
in
the
reality
was
in
reality
the
situation
was,
doctors
were
calling
me
and
I
was
calling
the
pharmacies
and
finding
out
that
that
was
not
the
case.
The
pharmacy
was
saying:
well
we're
not
going
to
prescribe
it,
because
it's
not
for
that
for
for
use
for
the
what
they're.
P
D
K
See
if
I
can
say
this
clearly
right
now,
the
practice
of
pharmacy,
at
least
from
a
retail
perspective,
because
we're
talking
about
a
at
an
outpatient
setting,
it's
geared
largely
around
reimbursement
for
dispensing
the
prescriptions
and
so
a
lot
of
the
behavior
that
you
see
a
pharmacy
do
in
terms
of
I
will
or
that
the
chain
or
the
individual,
pharmacist
or
whatever
if
they
will,
or
they
will
not
dispense
a
particular
medication
that
there's
a
ton
of
factors
that
go
into
that,
like
I
mentioned
before,
as
soon
as
a
drug
becomes
difficult
to
obtain
or
on
the
shortage
list,
there's
very
little
that
they
can
do
because
there's
only
so
much
available
in
the
country
and
you
get
on
lists
to
try
to
get
it
or
you
have
to
find
Alternatives
things
like
that
again
because
of
outcomes
from
like
the
multi-state,
opioid
litigation
that
came
out.
K
Certain
criteria
have
been
developed
by
not
just
pharmacies,
but
by
payers
and
lots
of
other
entities
in
terms
of
what
they
will
consider
something
to
be
appropriate
or
not,
and
whether
or
not
there's
a
risk
to
them.
In
dispensing
these
medications.
K
Hence
why
there's
settlements
in
the
usually
tens
of
millions,
if
not
hundreds
of
millions
of
dollars
when
a
pharmacy
is
filling
it,
when
it's
determined
that
a
pharmacy
was
filling
illegitimate
prescriptions
for
controlled
substances
and
as
Dr
Cooper
was
mentioning
the
financial
costs
and
concerns
with
those
things
shift
the
practice
in
ways
that
isn't
always
intended
necessarily
and
like
I,
say
it
it
it's
a
pendulum
and
a
small
touch
here,
you
may
think,
is
only
going
to
have
a
small
swing,
but
because
there's
a
bunch
of
dominoes
that
hit
before
it
hits
the
pendulum,
it
can
end
up
really
sending
the
thing
flying.
K
It
does
get
to
be
difficult
too,
because
you're
talking
about
the
practice
of
multiple
Health
Care
Professionals,
and
so
you
might
have
a
a
prescriber
who
says
in
my
professional
judgment.
This
is
an
appropriate
thing
to
do,
but
a
pharmacy
is
not
obligated
to
fill
every
prescription
that
is
presented
to
them
and
the
pharmacist
may
have
information
or
they
just
may
not
agree
with
the
information.
That's
out
there,
and
so
we've
had
for
pharmacies
that
would
not
fill
medications.
K
Access
to
care
in
Wyoming
is
difficult
on
the
best
of
days,
and
when
you
have
some
some
communities
that
only
have
a
single
Pharmacy
and
if
especially,
if
it's
only
a
single
mom-and-pop
sort
of
Pharmacy,
they
won't
have
the
sort
of
buying
power
in
the
contract.
Sorts
of
deals
that
chain
pharmacies
will
have
so
they
won't
necessarily
have
access
to
the
medications
and
be
able
to
stalk
them
the
way
that
other
pharmacies
may
be
able
to
do
so.
It
becomes
a
very
multifaceted
answer
and
I.
Don't
know.
A
Let's,
let's
hold
up
for
one.
Second,
let
me
let
me
make
a
statement
here
is
that
we've
got
Mr
bloodbust
up
here,
ready
to
testify
and
I
would
give
this.
His
preference
we've
got
roughly
five
minutes
left
to
testify.
Would
you
prefer
testified
now
or
continuing
to
questioning
and
you
come
back
on
Friday?
What's
your
preference
Mr
Columbus
thank.
L
D
Mr
chairman,
my
my
question
was
specific
to
sort
of
conditions
that
happened,
so
you
have
you
some
of
the
things
that
were
that
you
missed
for
Alopecia,
rheumatoid
arthritis,
autoimmune
diseases
and
when
I
was
in
a
world
in
the
crazy
world
where
we
were
in.
You
have
a
pharmacist
talking
to
someone
like
me:
who's,
not
even
a
medical
professional
that
I
knew
more
about
what
they've
used
hydroxychloroquine
for
than
he
did,
and
he
was
mentioning
a
study
where
they
used
four
times
as
much.
D
K
Chairman
Baldwin
Senator,
Bouchard,
I
I,
don't
know
that
there
is
necessarily
a
satisfactory
answer
to
that
because,
on
the
one
hand,
to
put
Pharmacy
in
a
position
where
they
have
to
fill
every
prescription,
every
prescription
that's
presented
to
them,
reduces
the
profession
to
literally
a
dispensing
function
only
to
where
you
could
have
like
red
boxes
or
something
similar
where
you
just
go
in
and
you
get
whatever
medication
and
Medicaid
prescription
medications
are
dangerous
substances.
K
They
can
do
harm,
they
can
hurt
people
and
there's
there's
a
reason.
Why
there's
a
lot
of
different
people
involved
in
in
the
process
with
with
it
the
other
thing
again
with
the
pendulum,
there's
a
lot
of
unintended
consequences.
If
you
say
that
you
have
to
fill
every
prescription,
that's
presented
before
you
in
terms
of
other
Controlled
Substances,
this
build
doesn't
go
into
schedule,
one
and
schedule
twos.
K
But
again,
if,
if
the
pharmacist
again,
it's
a
it's
a
game
of
probabilities,
if
they
don't
have
enough
information
to
make
a
proper
intervention
as
a
practicing
pharmacist
that
that
leaves
me
with
what
what's
what
information
am
I
using
to
try
to
to
help
and
take
care
of.
My
patient,
because
the
pharmacist
is
always
doing
their
best
to
put
the
patient
first
and
foremost
in
in
their
practice.
K
But
again,
as
I
mentioned,
there's
there's
a
number
of
different
reasons
for
why
a
pharmacist
may
choose
to
dispense
or
to
not
dispense
a
medication.
Sometimes
it's
their
professional
judgment.
Sometimes
it's
the
direction
from
their
their
corporate
leadership
if
they
work
for
a
chain,
but.
G
You
so
Mr
chairman
to
be
clear:
I,
don't
think
this
legislation
has
any
impact
on
requiring
dispense.
Dispensation
at
least
I,
don't
read
it
that
it
would
require
any
pharmacist
to
dispense
based
on
receiving
a
a
prescription.
Second
thing,
I'd
say
is:
any
prescriber
can
also
be
a
dispenser.
A
Okay
with
that
being
said,
here's
the
plan.
Oh
yeah,
we
have
a
plan,
we're
going
to
come
back
on
Friday
and
continue
this
topic.
Second
topic:
good
question:
we
will
be
doing
the
I
already
forgot
the
UPL
program.
First,
it's
live
on
Friday
and
then
we
will
follow
with
this
one,
and
then
we
will
follow
with
the
third
topic
and
I'll
decide
that
here
in
a
minute,
so
probably
988,
well
also
the
one
we
put
off
today.
A
So
that's
the
plan
we'll
be
back
here
at
7
30
on
Friday
morning
and
those
who
online
didn't
get
testifier
had
something
to
say
to
this
bill
or
988,
we'll
see
you
on
Friday
and
we'll
Emma
go
from
there.
Thank
you
very
much.
Everyone
at
testified.
Thank
you.
Committee
I,
apologize
for
skipping
out,
I,
went
across
the
hall
and
filled
the
seat
up.