BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1823 (Bonilla) - California Cancer Clinical Trials Program
          
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          |Version: June 23, 2016          |Policy Vote: HEALTH 9 - 0, ED.  |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 8, 2016    |Consultant: Jillian Kissee      |
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          This bill meets the criteria for referral to the Suspense File.




          


          Bill  
          Summary:  This bill requests the University of California (UC)  
          to establish a board to solicit and receive funds from federal  
          or private sources for the California Cancer Clinical Program  
          (Program) to provide grants to increase patient access to  
          eligible cancer clinical trials in underserved or disadvantaged  
          communities.


          Fiscal  
          Impact:  
           Start-up: Unknown one-time General Fund cost pressure for the  
            UC to provide oversight and administration of the Program  
            related to initial start-up activities.   These costs are  







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            required to be reimbursed by moneys donated to the fund  
            (federal or private funds) prior to awarding grants, thereby  
            offsetting the use of state funds.  This bill also provides  
            that if the UC determines at any time that the moneys in the  
            fund are insufficient to establish or sustain the Program, it  
            may be terminated.  

           Unknown federal or private funds to administer the Program and  
            award grants.  In order to have a viable Program and offer  
            services as described in this bill, UC indicates that funding  
            would likely need to be in the millions.  The scope of the  
            Program, including the number of grantees, grant amounts, and  
            administrative support to operate the Program would depend  
            upon future donations.


          Background:  Clinical trials are conducted by pharmaceutical companies  
          seeking approval to market new drugs or existing drugs for  
          additional conditions.  In addition, the federal government  
          provides financial support for clinical trials designed to study  
          medical effectiveness or other characteristics of new or  
          existing drugs. 

          In recent years, concerns have been raised that participants in  
          clinical trials tend not to reflect the larger society, which  
          may bias the results of those trials.  Research findings  
          indicate that participants in clinical trials are more likely to  
          be male and to be Caucasian than the general population.   
          Clinical trials tend to be conducted at academic medical  
          centers, often requiring patients to receive their care from a  
          new doctor participating in the trial and often requiring  
          substantial paperwork for patients to enroll.  These factors and  
          others have tended to limit participation in clinical trials.

          According to the author, barriers to participation include a  
          lack of awareness, mistrust of research and the medical system,  
          loss of income, and transportation and lodging costs.  These  
          ancillary costs of participation fall onto the clinical trial  
          participant who may be unable to pay, and therefore unable to  
          enroll in the trial.  The intent of this bill is to assist  
          patients in in paying for the ancillary costs associated with  
          participation in these trials.










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          Proposed Law:  
            This bill requests the UC to establish a board to solicit and  
          receive funds from federal or private sources for the California  
          Cancer Clinical Program (Program) to provide grants to increase  
          patient access to eligible cancer clinical trials in underserved  
          or disadvantaged communities.

          Key provisions of the bill include:
                 Prior to establishing the Program, the UC may pursue any  
               federal, state, or internal approvals, authorizations, or  
               advice it deems necessary.
                 The UC is authorized to use its own state funds for  
               oversight and administration of the Program relating to the  
               initial start-up costs only.  
                 Any resources provided by the UC to establish and  
               operate the Program are required to be reimbursed from  
               moneys donated in the fund prior to distribution of any  
               grants.  
                 Only federal or private funds may be used to administer  
               the Program.   
                 Funds may be provided to research institutions and  
               hospitals that conduct eligible cancer clinical trials and  
               nonprofit organizations, as specified.  
                 Funds may be used for a number of activities, including  
               but not limited to, technical assistance tools to assist  
               patients in identifying available clinical trials, and  
               payment of ancillary costs related to participation in the  
               clinical trial, such as airfare, lodging, child care, and  
               meals.
                 If the UC determines at any time that the moneys in the  
               fund are insufficient to establish or sustain the Program,  
               the UC may terminate the Program.  
                 Similarly, if the fund does not receive at least  
               $500,000 by January 1, 2021 or if it is determined that the  
               administrative support allocation allowed by this bill is  
               insufficient, the Program administrator may elect to  
               dissolve the program.


          Related  
          Legislation:  AB 1060 (Bonilla, 2015) proposed establishment of  
          the Cancer Clinical Trials Foundation in the Health and Human  
          Services Agency to administer a grant program substantively  
          similar to that proposed by this bill.  AB 1060 was vetoed by  








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          the Governor whose message read, in part: "Numerous private  
          organizations already perform this fundraising function.  While  
          I support eliminating barriers to take part in clinical trials,  
          I am hesitant to place this new burden on the Health and Human  
          Services Agency which is managing a huge expansion of our health  
          care system."  This bill establishes the program in the UC  
          instead of within a state agency.


          Staff  
          Comments:  According to the UC, in order to operate this  
          Program, it must first receive approval from the federal Office  
          of Inspector General.  Once approval is received, the UC can  
          receive donations, of which at least $500,000 is required to  
          begin providing grants to increase patient access to eligible  
          cancer clinical trials.  According to the UC, this bill outlines  
          the structure of the program that would meet federal approval.

          The UC has already expended state funds for purposes of gaining  
          permission from federal regulators and engaging in other  
          administrative activities to establish the Program. This bill  
          specifies that any resources provided by the UC to establish and  
          operate the Program are required to be reimbursed from moneys  
          donated in the fund prior to distribution of any grants.  The  
          ongoing operation of the Program is intended to be supported  
          entirely by private and federal funds.


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