BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 161|
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THIRD READING
Bill No: SB 161
Author: Wright (D), et al
Amended: 5/21/09
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 4/29/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 10-0, 5/26/09
AYES: Kehoe, Cox, Corbett, Denham, DeSaulnier, Leno,
Walters, Wolk, Wyland, Yee
NO VOTE RECORDED: Hancock, Oropeza, Runner
SUBJECT : Health care coverage: cancer treatment
SOURCE : American Cancer Society
Carries TOUCH
DIGEST : This bill requires a health care service plan
contract or health insurance policy issued, amended, or
renewed after January 1, 2010, that provides coverage for
cancer chemotherapy treatment to provide coverage for an
orally administered cancer medication no less favorably
than intravenously administered or injected cancer
medications covered under the contract or policy.
ANALYSIS : Existing law:
1. Provides for the regulation of health care service plans
CONTINUED
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by the Department of Managed Health Care (DMHC) and
regulation of disability insurers who sell health
insurance by the Department of Insurance.
2. Requires health care service plan contracts and health
insurance policies to provide coverage for all generally
medically accepted cancer screening tests and requires
those plans and policies to also provide coverage for
the treatment of breast cancer.
3. Imposes various requirements on contracts and policies
that cover prescription drug benefits, such as a
requirement to cover "off-label" uses, as specified, and
a requirement to cover previously prescribed drugs, as
specified.
4. Authorizes DMHC to regulate the provision of medically
necessary prescription drug benefits by a health care
service plan to the extent that the plan provides
coverage for those benefits. Existing regulation
requires health plans providing outpatient prescription
drugs to provide all medically necessary prescription
drugs, except as specified in that regulation.
This bill requires that health plans and insurers provide
coverage for orally administered anticancer medications no
less favorably than intravenously administered or injected
anticancer medications.
This bill requires health plans and insurers to review the
percentage cost share for oral medications and compare it
with that of intravenous or injected medications. This
bill requires the health plans and insurers to apply the
lower of the two numbers as the cost-sharing provision for
oral medications. There are currently 38 oral anticancer
medications approved by the Food and Drug Administration
(FDA) that are used to treat 52 different types of cancer
and there are approximately 100 new oral anticancer
medications under development. The most frequently
prescribed oral medications are used to treat breast,
ovarian, endometrial, and uterine cancers.
This bill defines "cost share" as copayment, coinsurance,
or deductible provisions applicable to coverage for oral,
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intravenous, or injected anticancer medications.
This bill provides that these provisions do not apply to a
health plan contract entered into or an insurance policy
purchased by the California Public Employees' Retirement
System (CalPERS).
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
DMHC regulations up to $50-150
$5-10$5-10 Special*
and oversight
*Managed Care Fund
SUPPORT : (Verified 5/27/09)
American Cancer Society (co-source)
Carrie's TOUCH (co-source)
AstraZeneca
California Cancer Registry
California Medical Association
California State Conference of the National Association for
the Advancement of Colored People
McKay Photography
National Coalition of 100 Black Women, Sacramento Chapter
National Patient Advocate Foundation
Northern California Cancer Center
Public Health Institute
Sacramento Breast Cancer Resource Center
Saint James African Methodist Episcopal Church
St. Andrews African Methodist Episcopal Church
Wright Chapel African Methodist Episcopal Church
OPPOSITION : (Verified 5/27/09)
Anthem Blue Cross
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Association of California Life and Health Insurance
Companies
California Association of Health Plans
California Chamber of Commerce
ARGUMENTS IN SUPPORT : The American Cancer Society (ACS),
a co-sponsor of this bill, writes that oral chemotherapy
improves the qualify of life for cancer patients, such as
producing milder side effects, and avoiding the need for
transportation back and forth from chemotherapy
appointments. ACS states that many insurance companies
categorize oral chemotherapy as a prescription drug, not a
cancer treatment, which subjects patients who opt to use
oral chemotherapy to exorbitant out-of-pocket costs. ACS
believes that this measure would protect cancer patients
from financial hardship or foregoing the treatment entirely
because of barriers erected by coverage under the pharmacy
benefit.
Carrie's TOUCH, an African American breast cancer
organization states that studies have shown that, although
African American women do not have the highest diagnosis of
breast cancer incidence, they have the highest death rate
of any group, and believes that several factors lead to an
increased death rate amongst African American women,
including barriers to treatment because of cost. It states
that intravenously administered chemotherapy has been the
standard cancer treatment for many years; however, with the
advancement of medical technology, oral chemotherapy has
become the standard of care for many types of cancer
diagnosis including certain types of metastatic breast
cancer. The group points out that oral chemotherapy also
offers an alternative for patients who have failed to
respond to other treatments, oral chemotherapy could
potentially reduce resource utilization and health care
system costs, while improving patient satisfaction.
ARGUMENTS IN OPPOSITION : The California Association of
Health Plans (CAHP) writes that new mandates increase the
cost of health care and hinder a plan's ability to offer a
wider range of affordable products, which results in higher
premiums for individuals and employers. CAHP believes
that, in some cases, mandates can lead to a reduction of
coverage, as individuals and employers drop their insurance
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due to premium increases.
The Association of California Life and Health Insurance
Companies writes that requiring all plans to include
specific benefits is counterproductive to efforts to make
health insurance more affordable and available to
Californians. The California Chamber of Commerce likewise
believes that the bill would further exacerbate the problem
of rising health care costs.
CTW:nl 5/27/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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