Legislature(2015 - 2016)BARNES 124
04/06/2016 03:15 PM House LABOR & COMMERCE
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SB 142-INSURANCE FOR ANTI-CANCER MEDICATION 4:36:36 PM CHAIR OLSON announced that the final order of business would be CS FOR SENATE BILL NO. 142(L&C) am, "An Act relating to insurance coverage for anti-cancer medications." 4:37:09 PM REPRESENTATIVE HUGHES moved to adopt Amendment 1, labeled 29- LS1133\W.A.1, Wallace, 4/5/16, which read: Page 1, line 1, following "medications": Insert "; and providing for an effective date" Page 2, following line 14: Insert a new bill section to read: "* Sec. 3. This Act takes effect January 1, 2017." CHAIR OLSON objected for discussion purposes. 4:37:21 PM KARI NORE, Staff, Senator Cathy Giessel, Alaska State Legislature, advised that Amendment 1 changes the effective date of the bill, as requested by the PREMERA health insurance company, in order to ensure it can completely implement this change and not affect premiums or accrue additional costs. 4:38:02 PM CHAIR OLSON removed his objection to Amendment 1. 4:38:18 PM REPRESENTATIVE LEDOUX objected to Amendment 1 for discussion purposes. She said she was aware there are certain times a cancer patient is prescribed medication, which is paid for, but then receives it in another form and it is not paid for. She expressed her preference for the legislation to be effective immediately instead of January 1, 2017. MS. NORE advised that PREMERA's fiscal year 2016 filing must be submitted by May 6, 2015. There is concern that the proposed legislation, as written, would cause PREMERA to amend its filings, causing a fiscal impact to consumers. CHAIR OLSON commented that initially all of the contracts come up on January 1; therefore, there are already contracts in place that are good until December 31. MS. NORE added that the bill only applies to new and renewed plans, and would not affect plans currently in place. REPRESENTATIVE LEDOUX surmised that if the bill were passed in April , PREMERA would have three weeks to respond. MS. NORE pointed out that the sponsor wishes to avoid putting any additional burden on consumers, especially since the bill only applies to renewed plans. Ms. Nore further explained that SB 142 seeks to ensure that both intravenously and orally administered cancer treatments are treated fairly and are equally available to consumers. She said currently, there is a disparity between what patients pay for intravenous cancer treatments versus oral, because oral treatments are billed as prescriptions, and there is no deductible to meet. However, intravenous treatments are often billed as medical benefits, of which there is a deductible to reach, and after which the consumer no longer pays. Thus, although oral cancer treatment is much cheaper for administration costs, it ends up being more expensive. Also, certain cancer treatments are only available in the oral option; therefore, patients should not be forced to pay higher premiums simply because treatment is only available in the oral form. In addition, the bill also prevents the re- classification of benefits or increasing costs, with respect to both intravenous and oral cancer treatments. 4:43:05 PM REPRESENTATIVE LEDOUX relayed her personal experience with typhoid oral and inoculation vaccines: inoculations are reimbursed by insurance and oral vaccines are not. She questioned why the bill is limited to cancer treatments as there are probably many drugs that can be taken orally or intravenously. MS. NORE answered that the sponsor chose to focus on cancer medications, and deferred to the director of the Division of Insurance at DCCED. CHAIR OLSON opened public testimony. 4:44:56 PM EMILY NENON, Alaska Government Relations Director, American Cancer Society/Cancer Action Network, advised that 40 states have adopted this measure. She described it as a modernization of Alaska's insurance statutes due to the tremendous changes in cancer research making many options available in an oral form as opposed to infusion. Ms. Nenon stated that the issue is not just about whether a physician prescribed chemo in the pill or the infusion form, but that some chemo treatments are only available in the oral form; in fact, approximately 25 percent of the new treatments in the research pipeline for cancer are oral. She pointed out that oral medications often have fewer side effects and the ease of administration is a huge issue, particularly with the geographic challenges of Alaska. Ms. Nenon expressed her organization's support for the bill. 4:46:39 PM ERIC HANSEN, International Myeloma Foundation, advised he is an advocate for patients - and is also a patient - as four years ago he was diagnosed with Multiple Myeloma caused by exposure to Agent Orange. Multiple Myeloma is incurable, but treatable by chemo, and he noted that research breakthroughs have made some insurance procedures obsolete; for example, the pharmacy benefit for many conditions is insufficient, when applied to cancer medications. He opined that the issue for most patients is not so much the needles and the toxicity of chemo, but rather [medical] access, especially in Alaska. For example, in Juneau there is only one nurse who can administer chemo, as it is a highly specialized procedure. There are few places in the entire state where a person can be infused with chemo and some patients need to be infused twice per week. The pills that are now available target cancers, unlike chemo fluids, which "just kill everything." Mr. Hansen characterized cancer treatment pills as "a godsend," because patients do not have to adhere to the administrator's availability or spend four hours to receive an infusion. Further, a patient's veins can collapse. Mr. Hansen said he has been taking one pill per day for three years to treat his cancer, although he may have to eventually return to infusion chemo pending further research. He noted the difficulties for those who live far from infusion treatment facilities and urged for this "insurance glitch" to be resolved, and restated his support for the bill. REPRESENTATIVE LEDOUX asked Mr. Hansen's view of changing the effective date from immediately to January 1. MR. HANSEN, speaking as a patient, said he would like to make the effective date tomorrow because someone who cannot afford the copay will have to go somewhere for treatment. He acknowledged that the insurance companies have to establish paperwork, but sooner is better for patients. REPRESENTATIVE COLVER described Mr. Hansen's testimony as compelling, and inquired about the cost for Mr. Hansen's copay. MR. HANSEN replied that he qualifies for Medicare; however, if he were younger, his copay would be $2,000 per month. He said he would have had to go back to the hospital and the chemo fluids, although now all cancer medications cost about the same because they are all unique and targeted. 4:54:33 PM KIMBERLY THEIS, Advocacy Manager, Leukemia & Lymphoma Society, echoed the sentiments that have been shared, and said that the Leukemia & Lymphoma Society believes this is a vital solution intended to ensure that patients can reliably and consistently expect fair coverage for cancer treatments even when the treatments come in the form of a pill. She said the society is hopeful that the lawmakers in Alaska will embrace this bill because it helps to offer meaningful improvements in access to care. CHAIR OLSON announced public testimony would remain open. [SB 142 was held over.]