BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1000|
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THIRD READING
Bill No: AB 1000
Author: Perea (D)
Amended: 8/6/12 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/27/12
AYES: Harman, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
NOES: Anderson, Blakeslee
NO VOTE RECORDED: Hernandez
SENATE APPROPRIATIONS COMMITTEE : 5-1, 8/6/12
AYES: Kehoe, Alquist, Lieu, Price, Steinberg
NOES: Walters
NO VOTE RECORDED: Dutton
ASSEMBLY FLOOR : 52-17, 1/26/12 - See last page for vote
SUBJECT : Health care coverage: cancer treatment
SOURCE : Author
DIGEST : This bill prohibits health plans and health
insurers that cover prescription drugs and chemotherapy
treatment from imposing higher copayments, deductibles, or
coinsurance for oral anticancer drugs than would be imposed
for intravenous anticancer drugs.
ANALYSIS :
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Existing law:
1. Provides for the regulation of health care service
plans (health plans) by the Department of Managed Health
Care (DMHC) and regulation of disability insurers who
sell health insurance (health insurers) by the
Department of Insurance.
2. Requires health 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 plan to
the extent that the plan provides coverage for those
benefits. Requires, under regulation, health plans
providing outpatient prescription drugs to provide all
medically necessary prescription drugs, except as
specified.
This bill:
1. Prohibit health plans and health insurers that cover
prescription drugs and chemotherapy treatment from
imposing higher copayments, deductibles, or coinsurance
for oral anticancer drugs than would be imposed for
intravenous anticancer drugs.
2. Exempts the California Public Employees' Retirement
System (CalPERS) plans or policies.
3. Prohibits this bill from being interpreted to prevent a
plan or policy from requiring prior approval or
authorization for the use of oral cancer medications.
4. Prohibits a health plan or insurer that increases the
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copayment, deductible, or coinsurance amount for an IV
administered or injected cancer chemotherapy agent
covered by the plan or insurer from being deemed to be
in compliance with this bill.
5. Prohibits any benefits that exceed the essential health
benefits (EHBs) that all health plans will be required
to provide under the federal Patient Protection and
Affordable Care Act (ACA) from being provided under this
bill.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Minor costs to the DMHC and the Department of Insurance
to review plan filings.
No state costs to state health care programs. Medi-Cal,
Healthy Families, and Access for Infants and Mothers
have no or limited cost sharing for anticancer drugs.
This bill specifically exempts CalPERS contracted health
plans and insurance policies.
It is unlikely that this bill requires the state to
provide coverage subsidies through the California Health
Benefit Exchange due to any coverage mandate in the
bill. This bill will only apply to plans that already
cover anticancer drugs and specifies that no benefits
that exceed essential health benefits are required to be
provided under this bill.
SUPPORT : (Verified 8/7/12)
AIM at Melanoma
American Cancer Society
Association of Northern California Oncologists
BayBio
BIOCOM
California Affiliates of Susan G. Komen for the Cure
California Healthcare Institute
California Medical Association
Cancer Legal Resource Center
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International Myeloma Foundation
Leukemia & Lymphoma Society
Medical Oncology Association of Southern California, Inc.
Padres Contra El C�ncer
The Parker and Friends Fund
OPPOSITION : (Verified 8/7/12)
Association of California Life and Health Insurance
Companies
America's Health Insurance Plans
Blue Shield of California
California Association of Health Plans
California Chamber of Commerce
Health Net
Kaiser Permanente
Southwest California Legislative Council
ARGUMENTS IN SUPPORT : The California Coalition for
Cancer Treatment Access (Coalition), consisting of the
International Myeloma Foundation, American Cancer Society,
Susan G. Komen for the Cure, Leukemia & Lymphoma Society,
California Healthcare Institute, BIOCOM, BayBio,
Association of Northern California Oncologists, California
Medical Association, Aim at Melanoma, Cancer Legal Resource
Center, Padres Contra el Cancer, and Parker and Friends,
supports this bill because they believe it will eliminate
the cost disparity between oral and IV chemotherapy
treatment, decreasing the out-of-pocket costs to patients
and increasing access to life-saving treatments. The
Coalition claims that the emergence of safe, clinically
effective, orally administered anticancer medication has
increased the treatment options for cancer patients, but
the disparity between medical and pharmacy benefit designs
creates a significant barrier. The Coalition claims there
are significantly greater patient out-of-pocket costs for
oral anticancer therapies covered under the pharmacy
benefit than IV therapies covered under the medical
benefit, which become a de facto denial of access,
resulting in one out of six patients not receiving
treatment solely due to high cost. The Coalition notes
that this bill does not mandate health contracts and
policies to provide coverage for anticancer medications.
Instead, this bill requires that, if contracts and policies
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already provide this coverage, that they provide it on an
equal basis for oral and IV medications.
ARGUMENTS IN OPPOSITION : America's Health Insurance
Plans (AHIP), the Association of Life and Health Insurance
Companies (ACLHIC), and the California Association of
Health Plans (CAHP) all oppose this bill because it is a
benefit mandate. AHIP claims benefit mandates increase
costs to consumers and may expose California fiscally if
the mandates conflict with federal requirements. AHIP
claims that health insurance plans have taken important
steps over the last decade to address the critical issues
of increasing access to innovative, quality health care
products and cost control mechanisms that would better
allow individuals and small businesses to obtain coverage
in the private market, but this bill threatens the efforts
of all health care stakeholders to provide consumers with
meaningful health care choices and affordable coverage
options. ACLHIC is concerned that this additional mandate,
added to the 87 mandates that are already in statute, will
further erode affordable health insurance options for
insureds. CAHP points out that the best evidence of the
high cost of mandates is that many of them, by design,
completely exempt public employers and programs. This
spares the government from the cost of these bills but
means that private employers will be expected to shoulder
that cost instead. This concern is echoed by the
California Chamber of Commerce, California Manufacturers
and Technology Association, and the National Federation of
Independent Businesses, who all cite concerns about the
cumulative impact of benefit mandates on premiums for
employers, particularly at a time when employers are
struggling in an uncertain economic environment.
ASSEMBLY FLOOR : 52-17, 1/26/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Cook, Dickinson, Eng, Feuer, Fong, Fuentes,
Furutani, Gatto, Gordon, Hall, Hayashi, Roger Hern�ndez,
Hill, Huber, Hueso, Huffman, Jeffries, Lara, Bonnie
Lowenthal, Ma, Mendoza, Mitchell, Olsen, Pan, Perea, V.
Manuel P�rez, Portantino, Skinner, Solorio, Swanson,
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Torres, Wieckowski, Williams, Yamada, John A. P�rez
NOES: Achadjian, Conway, Donnelly, Fletcher, Beth Gaines,
Garrick, Grove, Hagman, Jones, Knight, Logue, Mansoor,
Miller, Morrell, Nielsen, Silva, Wagner
NO VOTE RECORDED: Bill Berryhill, Davis, Galgiani, Gorell,
Halderman, Harkey, Monning, Nestande, Norby, Smyth,
Valadao
CTW:d 8/8/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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