BILL ANALYSIS
SB 158
Page 1
SENATE THIRD READING
SB 158 (Wiggins)
As Amended August 31, 2009
Majority vote
SENATE VOTE :23-13
HEALTH 13-5 APPROPRIATIONS 12-5
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|Ayes:|Jones, Fletcher, Ammiano, |Ayes:|De Leon, Ammiano, |
| |Block, De La Torre, De | |Charles Calderon, Coto, |
| |Leon, Hall, Hayashi, | |Davis, |
| |Hernandez, Bonnie | |Fuentes, Hall, John A. |
| |Lowenthal, Nava, V. | |Perez, |
| |Manuel Perez, Salas | |Skinner, Solorio, |
| | | |Torlakson, Hill |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Adams, Conway, Emmerson, |Nays:|Conway, Harkey, Miller, |
| |Gaines, Audra Strickland | |Nielsen, |
| | | |Audra Strickland |
| | | | |
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SUMMARY : Requires every health care service plan (health plan)
contract and every health insurance policy that includes
coverage for treatment or surgery of cervical cancer and is
issued, amended, or renewed on or after January 1, 2010, to also
provide coverage for a human papillomavirus (HPV) vaccination,
upon the referral of the patient's physician, nurse
practitioner, certified nurse midwife, or physician assistant,
acting within the scope of his or her license.
EXISTING LAW :
1)Provides for the regulation of health plans by the Department
of Managed Health Care (DMHC) and health insurers by the
California Department of Insurance (CDI).
2)Requires every health plan and every disability insurer which
offers health insurance (health insurer), on a group basis, to
cover comprehensive preventive care for children age 16 or
younger and to offer such coverage for children age 17 and 18.
Defines comprehensive preventive care to include
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immunizations recommended by the current federal Recommended
Childhood Immunization Schedule.
3)Requires health plans licensed under the Knox-Keene Health
Care Service Plan Act of 1975 to cover all medically necessary
basic health care services, including "preventive health care
services," defined in regulations to include childhood
immunizations, as specified.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)No direct General Fund costs for Medi-Cal, the Healthy
Families Program, or the California Public Employees
Retirement System, as these programs already comply with
national guidelines for vaccination, including HPV.
2)Additional costs of $1.4 million in premiums paid in the
private health insurance market for individual and group
coverage. About 25% of this increase is offset by reduced
out-of-pocket costs paid by families for HPV vaccination prior
to the mandate. Under existing law, health plans regulated by
DMHC provide coverage for the mandate established by this bill
in 100% of policies. For health insurers regulated by CDI,
coverage for this health mandate is between 88% and 100%,
depending on whether a policy is in the individual, small
group, or large group insurance market. Under private
insurance coverage, the cost of the three-dose HPV vaccine is
$468.
COMMENTS : The author states the combination of the HPV vaccine
and regular screening for cervical cancer should drastically
reduce the rate of cervical cancer and related deaths. The
author further asserts this bill will also prevent many cervical
cancer cellular changes that would require years of biopsies and
medical procedures, and result in significant insurance savings.
According to a 2008 report by the California Cancer Registry
(CCR), cervical cancer is the 11th most frequently diagnosed
cancer among California women, with approximately 1,500 cases,
including 400 deaths, per year. Nearly all cervical cancer is
caused by HPV infection, with two types of HPV accounting for
approximately 70% of cervical cancer. HPV also causes 90% of
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anal cancers; 40% of vulvar, vaginal, and penile cancers, and
smaller proportions of oral and throat cancers.
According to the U.S. Centers for Disease Control and Prevention
(CDC), sexually transmitted HPV infections are the most common
sexually transmitted infection in the U.S. CDC states over 80%
of women will have been infected with HPV by age 50. Infections
with some types of HPV result in genital warts, cellular changes
that cause abnormal Papanicolau (Pap) test results, and, rarely,
cervical cancer.
In 2006, the federal Food and Drug Administration (FDA) approved
Gardasil, a vaccine which prevents four types of HPV and is
manufactured by Merck, for use in females nine through 26 years
of age. The vaccine is injected in three separate doses at
specified intervals within 6 months.
The California Health Benefits Review Program (CHBRP) reports
that all of the HPV vaccine trials that have been published were
sponsored by the vaccine manufacturers and have not evaluated
long-term efficacy in females under age 15. Interim results
from the largest clinical trial indicate that among females who
complete all three doses of the quadrivalent vaccine and who
were not previously exposed to HPV 16 or HPV 18 (which account
for 70% of all cervical cancers), indicate that the vaccine
reduces by 98% precancerous cervical lesions associated with HPV
types 16 and 18. A single dose of the vaccine appears to result
in a 17% reduction in precancerous lesions associated with any
type of HPV. Clinical trial analyses suggest that the vaccine
might be expected to prevent less than one-fifth of all cervical
cancers when administered to females age 15 to 26 years (but
might be more effective when administered to younger girls who
are less likely to have been exposed to HPV).
The American Academy of Family Physicians, American Academy of
Pediatrics, American College of Obstetricians and Gynecologists,
American Cancer Society, and the CDC Advisory Committee on
Immunization Practices recommend HPV vaccinations for females
age 11 to 12 years. Because HPV vaccines do not protect against
all types of HPV associated with cervical cancer, these
organizations also recommend that women and their health care
providers continue to follow current cancer screening
guidelines, including the Pap test.
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Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0002586