BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 961|
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VETO
Bill No: SB 961
Author: Wright (D), et al
Amended: 6/10/10
Vote: 21
SENATE HEALTH COMMITTEE : 5-0, 4/21/10
AYES: Alquist, Leno, Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Strickland, Aanestad, Cedillo, Cox
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 26-6, 5/24/10
AYES: Aanestad, Alquist, Calderon, Cedillo, Corbett,
Correa, Cox, Denham, DeSaulnier, Ducheny, Florez,
Hancock, Kehoe, Leno, Liu, Lowenthal, Negrete McLeod,
Padilla, Pavley, Romero, Simitian, Strickland, Wolk,
Wright, Wyland, Yee
NOES: Ashburn, Dutton, Hollingsworth, Huff, Runner,
Walters
NO VOTE RECORDED: Cogdill, Harman, Oropeza, Price,
Steinberg, Wiggins, Vacancy, Vacancy
ASSEMBLY FLOOR : 54-20, 8/23/10 - See last page for vote
SENATE FLOOR : 29-5, 8/25/10
AYES: Aanestad, Alquist, Ashburn, Calderon, Cedillo,
Cogdill, Corbett, Correa, DeSaulnier, Ducheny, Emmerson,
Florez, Hancock, Kehoe, Leno, Liu, Lowenthal, Negrete
McLeod, Padilla, Pavley, Price, Romero, Simitian,
Steinberg, Strickland, Wolk, Wright, Wyland, Yee
NOES: Blakeslee, Dutton, Huff, Runner, Walters
NO VOTE RECORDED: Denham, Harman, Hollingsworth, Oropeza,
CONTINUED
SB 961
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Wiggins, Vacancy
SUBJECT : Health care coverage: cancer treatment
SOURCE : Author
DIGEST : This bill requires a health care service plan
contract or health insurance policy (collectively carrier
contract or policy) that provides coverage for cancer
chemotherapy treatment to establish limits on enrollee
out-of-pocket costs for prescribed, orally administered,
nongeneric cancer medication.
Assembly Amendments require the carrier contract or policy
to review the percentage cost share for oral nongeneric
cancer medication and intravenous (IV) or injected
nongeneric cancer medications and apply the lower of the
two as the cost-sharing provision for oral nongeneric
cancer medications, and require the provisions of the bill
to remain in effect only until January 1, 2015, and as of
that date are repealed, unless a later enacted statute
deletes or extends that date.
ANALYSIS : Existing law provides for the regulation of
health care service plans by the Department of Managed
Health Care (DMHC) and regulation of disability insurers
who sell health insurance by the California Department of
Insurance (CDI).
Existing law 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.
Existing law imposes various requirements on contracts and
policies that cover prescription drug benefits, such as a
requirement to cover "off-label" uses and a requirement to
cover previously prescribed drugs, as specified.
Existing law authorizes DMHC to regulate the provision of
medically necessary prescription drug benefits by a health
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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
1)Requires a carrier contract or policy issued, amended, or
renewed on or after January 1, 2011, that provides
coverage for cancer chemotherapy treatment, to provide
coverage for prescribed, orally administered, nongeneric
cancer medication, used to kill or slow the growth of
cancerous cells.
2)Requires the carrier contract or policy referenced in 1)
above, to review the percentage cost share for oral
nongeneric cancer medication and intravenous (IV) or
injected nongeneric cancer medications and apply the
lower of the two as the cost-sharing provision for oral
nongeneric cancer medications.
3)Prohibits a carrier contract or policy from providing an
increase in enrollee cost sharing for nongeneric cancer
medications to any greater extent than the contract or
policy provides for an increase in enrollee cost sharing
for other nongeneric covered medications.
4)Defines "cost share" as copayment, coinsurance, or
deductible provisions applicable to coverage for oral,
IV, or injected nongeneric cancer medications.
5)Prohibits the provisions of this bill from being
construed to require a carrier contract or policy to
provide coverage for any additional medication not
otherwise required by law.
6)Clarifies that provisions of this bill do not prohibit a
carrier contract or policy from removing a prescription
drug from its formulary of covered prescription drugs.
7)Prohibits the provisions of this bill from applying to a
carrier contract or policy that does not provide coverage
for prescription drugs.
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8)Prohibits the provision of this bill from applying to a
health care benefit plan or contract entered into with
the Board of Administration of the Public Employees'
Retirement System (CalPERS) pursuant to the Public
Employees' Medical and Hospital Care Act.
9) Requires the provisions of this bill to remain in effect
only until January 1, 2015, and as of that date are
repealed, unless a later enacted statute deletes or
extends that date.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee, (1) no
fiscal impacts to CalPERS, Medi-Cal, or the Healthy
Families Program. CalPERS is specifically exempted from
the mandate established by this bill and Medi-Cal and the
Healthy Families Program already provide oral chemotherapy
treatment under current law, and (2) increased premium
costs in the employer-based and individual insurance
markets of $18 million, largely offset by a reduction in
out-of-pocket costs paid under current law by individuals
for oral chemotherapy treatments that are not a covered
benefit or with less favorable cost sharing requirements.
SUPPORT : (Verified 8/24/10)
American Cancer Society
BayBio
California Communities United Institute
California Healthcare Institute
California Medical Association
Cancer Legal Resource Center
Carrie's Touch
Disability Rights Legal Center
International Myeloma Foundation
Leukemia & Lymphoma Society
Oncology Nursing Society
Susan G. Komen for the Cure
Central Valley
Inland Empire
Los Angeles County
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Orange County
Sacramento Valley
San Diego
San Francisco Bay Area
OPPOSITION : (Verified 8/24/10)
Association of California Life and Health Insurance
Companies
Blue Shield of California
California Association of Health Plans
California Chamber of Commerce
Health Net
Medco Health Solutions, Inc.
ARGUMENTS IN SUPPORT : The American Cancer Society
supports this bill because patients using oral chemotherapy
generally experience milder side effects. Many of these
oral chemotherapy treatments do not have intravenous
counterparts, making the need to ensure access to them
critical.
The California Healthcare Institute (CHI), an advocacy
organization of biotechnology companies and academic
research institutions, supports this bill, stating that CHI
member companies are at the heart of biomedical research
that has lead to discoveries to treat diabetic neuropathy
and other complications from diabetes. These treatments,
when administered after early detection, can prevent
amputations. CHI further points out that these treatments
are only effective when patients have access to them.
The California Medical Association (CMA) supports the bill,
stating that oral chemotherapy improves the quality of life
for cancer patients, such as producing milder side effects,
and avoiding the need for transportation back and forth
from chemotherapy appointments. CMA further states that,
because chemotherapy is administered in different ways and
the choice of delivery depends on many factors, this bill
would ease some of the difficult choices cancer patients
face by protecting patient choice when making treatment
decisions.
The Disability Rights Legal Center and the Susan G. Komen
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Foundation both support the bill, stating that there is a
significant difference in the amount cancer patients must
pay out of pocket for an oral drug instead of an
intravenous drug. This is echoed by the International
Myeloma Foundation, which argues that insurance policies
discourage the use of oral drugs when they are medically
appropriate. The Oncology Nursing Society writes in
support, stating that many oral anti-cancer drugs have
fewer side effects than infused therapies.
ARGUMENTS IN OPPOSITION : Opponents argue that "SB 961
does not do anything to stem the increase of prescription
drugs. Rather it sets the rate for one class of drugs,
thereby creating an unequal benefit category that
artificially sets rates for oral chemotherapy medications
lower without requiring manufacturers to charge less for
these high cost drugs. Anthem Blue Cross further states
that these costs must be borne somewhere, with the most
likely result being higher overall premium costs for
employers and consumers. This legislation could also set a
precedent to limit insurers' ability to manage care and
provide best value to members."
The Association of California Life and Health Insurance
Companies opposes this bill and points out that, with
health insurers poised to implement federal health reform,
one of the most expansive pieces of health care legislation
at the federal level, this bill is unnecessary and
untimely.
Blue Shield of California opposes the bill, arguing that
carving out one type of medication from the rest of a
health plan's pharmacy benefits is not good public policy.
If enacted, Blue Shield believes that pharmaceutical
companies will continue to pursue legislation that
guarantees government set retail rates for their most
expensive drugs.
GOVERNOR'S VETO MESSAGE:
"I am returning Senate Bill 961 without my signature.
This measure is almost identical to a bill that I vetoed
last year. My concern about adding costs to our
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increasingly expensive health insurance premiums have not
been addressed. This bill is also unnecessary in light
of the provisions of the federal health reform act that
will take effect on January 1, 2014 and cap out-of-pocket
costs for both individuals and families. For these
reasons, I am unable to sign this bill."
ASSEMBLY FLOOR
AYES: Ammiano, Arambula, Bass, Beall, Block, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Carter, Chesbro, Cook, Coto, Davis, De La
Torre, De Leon, Eng, Evans, Feuer, Fong, Fuentes,
Galgiani, Gatto, Hall, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Lieu, Bonnie Lowenthal, Ma,
Mendoza, Monning, Nava, V. Manuel Perez, Portantino,
Ruskin, Salas, Saldana, Skinner, Solorio, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NOES: Adams, Anderson, Tom Berryhill, Conway, DeVore,
Fletcher, Fuller, Gaines, Garrick, Gilmore, Hagman,
Harkey, Knight, Logue, Miller, Niello, Nielsen, Silva,
Smyth, Audra Strickland
NO VOTE RECORDED: Bill Berryhill, Furutani, Nestande,
Norby, Vacancy, Vacancy
CTW:do 10/5/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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