Legislature(2007 - 2008)BELTZ 211
04/03/2008 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB379 | |
| HB295 | |
| SB113 | |
| SB280 | |
| HB331 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 331 | TELECONFERENCED | |
| + | SB 280 | TELECONFERENCED | |
| = | SB 113 | ||
| = | HB 295 | ||
| = | HB 379 | ||
SB 280-MEDICAID/ INS FOR CANCER CLINICAL TRIALS
CHAIR ELLIS announced SB 280 to be up for consideration. [CSSB
280(HES), 25-LS1464\M was before the committee.]
1:54:19 PM
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 280, said
this measure requires health care insurers to provide insurance
coverage for medical care received by a patient during certain
approved clinical trials designed to test and approve
prevention, diagnosis, treatment, or palliation of cancer. It
directs the Department of Health and Social Services (DHSS) to
provide Medicaid services to persons who participate in clinical
trials relating to experimental procedures and provides for an
effective date. He read the sponsor statement as follows:
Clinical trials are research studies that test how
well new medical approaches work in patients. Each
study answers scientific questions and tries to find
better ways to prevent, screen for, diagnose, or treat
disease. Patients who take part in cancer clinical
trials have an opportunity to contribute to the
knowledge of and progress against cancer. They also
receive state-of-the art treatment from experts in the
field.
The National Cancer Institute, as part of the U.S.
National Institutes of Health, reports 6,000 cancer
trials in the United States at any one time. They
include trials in prevention, screening, diagnosis,
treatment, quality-of-life, and genetic studies.
SB 280 removes important barriers to the participation
of patients in cancer clinical trials in Alaska. It
requires that all health care plans, including
Medicaid, cover routine patient care costs for
patients enrolled in all phases of clinical trials,
including prevention, detection, treatment, and
palliation (supportive care) of cancer. Currently
Alaska health plans can exclude coverage for routine
patient-care costs while a patient with cancer is
enrolled in a clinical trial. Providers of health care
plans often conclude that money is saved by excluding
care while patients participate in clinical trials.
But these patients, if not enrolled in clinical
trials, will continue to receive conventional therapy
at roughly the same or slightly increased costs in the
short-run.
National Conference of State Legislatures' studies
have shown that only 2-3 percent of eligible adult
patients enroll in clinical trials with a 6.5 percent
increase in costs for clinical trial participants
compared to nonparticipants. Without in-state
facilities and support of clinical trials,
participants in Alaska currently have to travel out of
state increasing the cost of non-emergency
transportation which is about 3 percent of total
Medicaid costs.
In FY 2007 an estimated 4,600 patients received cancer
treatments through Alaska's Medicaid program at a cost
of $21.5 million. The average payment per beneficiary
was about $4,675. The federal government reimburses
the state at about 50 percent of the total costs.
Based on an estimated 2.5 percent participation rate
per above, about 115 patients are expected to
participate in clinical trials each year. A 6.5
percent increase for 115 persons would add $35.00 per
year to Medicaid for cancer treatments. Non-emergency
transportation costs for the same group are estimated
to add another $15.00 per year. The fiscal note adds
an estimated $50,000 per year with the federal
government paying half of this.
Twenty-three states have passed legislation or
instituted special agreements requiring health plans
to pay the cost of routine medical care patients
receive while participating in clinical trials.
Passage of SB 280 will result in more successful
outcomes in cancer treatments in Alaska, increase
retention of patients in Alaska for their cancer care,
and also, after full implementation, result in cost
savings in the short and long term.
1:59:04 PM
MR. OBERMEYER concluded that this bill is trying to draw more
people into the trials because Alaskans have a high incidence of
cancer; patients who do participate are always at risk of not
being covered for routine care. This will encourage them to
participate at a greater rate in order to save lives and find
answers to treating cancer.
SENATOR STEVENS asked what clinical trials are and if they are
voluntary.
MR. OBERMEYER replied that clinical trials are always voluntary
and a patient can pull out at any time. Their expenses are
covered by the federal government, drug companies and private
organizations such as the American Association of Oncology. The
only way to improve the present state-of-the-art cancer
treatment is to present trials that can document results. He
said that all of the developments are followed immediately
through journals that are sent all around the world.
2:01:26 PM
SENATOR STEVENS asked who pays for this. Me? Why isn't all of it
covered by the drug companies? Why ask insurance companies to
pick up the cost?
MR. OBERMEYER replied all this bill asks is for insurance to
cover routine patient care costs. It seeks to encourage patients
who would normally hesitate to participate in a trial because of
fear they will be dropped from routine coverage for doing it.
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community & Economic Development, echoed Mr.
Obermeyer's comments saying her enforcement concerns were
addressed in this CS and that it brought the bill in line with
other states' requirements.
MS. HALL, however, cautioned that this bill is mandating
coverage for only a small percentage of Alaskans and that
Alaskan plans are about 60 percent self-insured and those are
regulated by the feds under the Employee Retirement and Income
Security Act of 1974 (ERISA). She stated this measure would not
apply to Alaska state employees through the Select Benefits
Plan. It may or may not apply to some of the union health trusts
under Title 21, but she has chosen not to use her resources on
that litigation at this point. She said mandating this coverage
also has the potential of increasing the cost of health care
even though she agreed with the sponsor that it only looks at
routine health care that would be provided otherwise. Some
insurance contracts will exclude anything to do with someone who
is involved in an experimental type of process. This puts good
controls on that. This is not an attempt to have insurance
companies pay for clinical trials.
2:07:58 PM
SENATOR STEVENS asked if this could be applied to a test where
someone is accidentally given the flu, for instance.
MS. HALL replied no and that while she is not an expert, she
explained that it's when someone has been diagnosed with cancer
and various medications have already been developed and approved
to be used on human beings. There are different levels of
testing like tests with control groups and with therapies that
have been shown to have some reasonable expectation of a
beneficial effect.
SENATOR STEVENS asked if there would ever be more demand on the
insurance cost because the treatment made the disease worse.
Would it force insurance companies to pay for anything beyond
routine care?
MS. HALL answered that the patient would have gotten
progressively worse anyway. She didn't envision additional
charges other than possible additional testing.
2:11:36 PM
DR. MARY STEWART, President, Denali Oncology Group, Anchorage,
said last year their group found improving access and enrolling
more patients in clinical trials was its biggest priority. She
explained that there all different kinds of clinical trials, but
a typical cancer trial would take a standard treatment,
Treatment A, and take another treatment, Treatment B, which
might be better; usually there is a good deal of preliminary
evidence. So patients enroll and doctors find out which one is
better. Generally, using placebos is considered unethical for
cancer treatment because it's such a serious disease. Everyone
gets the standard of care treatment, but this is how doctors
further their knowledge about the diagnosis and treatment of
cancer.
She stated that 2,650 Alaskans will be diagnosed with cancer
this year and having good treatment options is essential for
them. Knowing what doesn't work is just as important as knowing
what does. She said that cancer is a costly disease no matter
how you cut it.
DR. STEWART related that many of the tests and medicines are
better than before. For example, when clinical trials were
completed for treating breast cancer with chemotherapy in the
90s; it was found that it didn't help. At the time chemotherapy
was a $100,000-procedure and it's more now; money was saved by
having accurate information.
2:16:37 PM
SENATOR STEVENS asked what routine care is included with
clinical trials.
DR. STEWART replied CAT scans, blood tests and things that would
have to be done any way. Clinical trials don't add much to
cancer care.
SENATOR STEVENS asked if she was saying there are no additional
costs for a person who is in the clinical trial.
DR. STEWART answered not exactly. The added cost would be small,
maybe less than 1 percent, for an extra X-ray or a blood test
monitoring tumor marker levels. But these things have to be done
anyway.
2:18:39 PM
DR. JEANNE ANDERSON, Katmai Oncology Group, agreed and added
that in the 1970s, only 50 percent of cancer patients lived five
years after diagnosis. In 2008, 66 percent are predicted to
survive five years.
She said cancer physicians in Alaska are committed to providing
the best care possible to their patients to relieve suffering
and reduce death from cancer. They often turn to clinical trials
for providing the best treatment. She explained, "A clinical
trial is a formal scientific way to test whether a new treatment
is safe, effective and superior to existing treatments."
DR. ANDERSON said Alaskan doctors support the clinical trials
and have more than 50 open currently for cancer patients.
However, she said, only a small number of patients enroll in
these trials, about 40 patients per year. The reasons are varied
and include lack of knowledge or interest by either the patient
or the doctor, lack of availability of an appropriate trial or
lack of insurance or just because of fear of losing insurance
coverage. Passing this bill will remove an important barrier to
access to clinical trials and will result in improved care for
patients and facilitate their stay in Alaska for state-of-the-
art care.
2:20:44 PM
DENNY DEWITT, Alaska Director, National Federation of
Independent Business, opposed SB 280. While he appreciated the
intent of this bill, he said to begin with, state employees are
not covered by it. And it seems ironic that they would mandate
this kind of coverage on small businesses in Alaska and not on
employees of the state. ERISA plans and union welfare benefit
plans are not covered; about 60 percent of the state's coverage
is not included in this bill. So those expenses that do incur
will fall heavily on small businesses.
MR. DEWITT said they know the uninsured group is growing and
that small employers are more hesitant now to offer employee-
based health insurance than they have been historically and many
that have been providing health care coverage are finding ways
to get out of it because of the cost. This is one more straw on
the camel's back. Even though this measure would add less than 1
percent to the cost of coverage, that number would be borne by
the small employers and would encourage them to not be in the
employer-based market at all.
2:23:48 PM
KRISTA RANGITSH, Cancer Research Nurse, Providence Alaska
Medical Center, said she is speaking on her own behalf today.
She explained when a clinical trial is recommended to a patient
by a physician as a best treatment option, they are referred to
her office. Part of her discussion about the study with the
patient includes informing them that their insurance company
many not cover some or all of the costs associated with their
cancer while on the study. She strongly encourages all patients
to find out what their policy says about clinical trial
coverage. This is where the road blocks appear.
She related that being diagnosed with cancer is already a
difficult time for patients and the last thing they should have
to worry about is finding out if their insurance covers a
clinical trial their physician thinks is in their best interest.
One of her ever-increasing reasons for patients not going on a
clinical trial is because of lack of or fear of lack of
insurance coverage. In many instances, treatments for cancer
must be started right away and insurance companies take too long
to determine if they will cover it or not. She concluded that
she was confident more people would enroll in trials if
insurance coverage was mandated for them. This would hopefully
lead to finding more cures for cancer.
SENATOR STEVENS asked if this bill passed, would her insurance
company offer her this coverage.
MS. RANGITSH replied she wasn't sure, but she would find out.
CHAIR ELLIS thought she might be covered under ERISA.
2:26:33 PM
EMILY NENON, Alaska Government Relations Director, American
Cancer Society, said just because the state regulates only 40
percent of insurance coverage doesn't mean that the other 60
percent are not providing this coverage; a lot of them do. When
Medicare decided to add this coverage years ago, three-quarters
of the federal employee plans were already making that coverage.
Having the language in statute would be important even for the
plans that are not regulated by the state.
2:28:13 PM
DONNA CARROL, representing herself, Juneau, said she was
diagnosed with cancer 10 years ago. She was so bad that she was
shipped immediately to Seattle where she took part in a phase-3
clinical trial and was told the treatment was no different than
what she would get if she weren't in the clinical trial. They
wanted to test two drugs to find out if it was better to
administer them together rather than one after the other. This
clinical trial found that it was good to give them together.
2:30:14 PM
BEVERLY WOOLEY, Director, Division of Public Health, Department
of Health and Social Services (DHSS), said she was testifying as
a private citizen and a cancer survivor. She supported SB 280.
She expressed the emotional turmoil that comes when diagnosed
with cancer. She was eligible for a clinical trial and spent
days on the Internet looking at the options and decided it was
the best course of action for her. She also hoped that at the
very least she would be contributing to research. She panicked
when she found her insurance might not cover the cost of the
trial. This brought her back to the time when she was 17 and her
father died of cancer and depleted all his family's resources
because he didn't have insurance. Fortunately, her insurance
company eventually determined it would cover the cost of the
clinical trial, which was demonstrated to not be significant.
She received the care needed while research and new important
information vital to improving future cancer care was gained.
CHAIR ELLIS thanked everyone for their testimony and said SB 280
would be held for consideration in the near future.
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