SB 253 INSURANCE FOR PROSTATE CANCER TESTING CHAIRMAN KELLY brought up SB 253 as the next order of business before the Senate Labor & Commerce Committee. KRISTINE PELLET, Student Intern for Senator Duncan, prime sponsor of SB 253, read the sponsor's statement, which contained information on prostate cancer and how one is tested for the disease. Currently, insurance companies are not required by Alaska Law to cover prostate cancer tests; SB 253 would require coverage for testing on annual physical examinations, when appropriate. SENATOR DUNCAN said it was unfair for an individual to have to pay for a simple test that could alter his life with serious medical and personal ramifications. Four states already require insurance companies to cover these tests. She urged support for insurance coverage in Alaska of the PSA (prostate specific antigen) test, if deemed necessary by a physician. SENATOR DUNCAN offered an amendment for regarding discussions with the American Cancer Society. They felt SB 253, as it stands, is too broad. CHAIRMAN KELLY asked if the American Cancer Society has data that shows that African-Americans are at higher risk for prostate cancer. MS. PELLET responded that was correct. CHAIRMAN KELLY thought "a family history of prostate cancer" is pretty broad. He thinks "family history" should be clarified to be "immediate family history". He asked if there are further questions. Hearing none, he asked Ms. Pellet to remain in attendance. The chairman called Mr. Evans to testify. Number 175 GORDON EVANS, Lobbyist for the Health Insurance Association of America, stated that HIAA opposes any mandated benefits; a mandated offering would be a different thing. He stated that since he is a male, he has nothing else to say. CHAIRMAN KELLY asked what the difference is between mandated benefits and mandated offerings. MR. EVANS responded that mandated benefits are when an insurance company must cover something. Mandated offering is when an insurance company gives a person buying an insurance policy the option of paying a little extra to have that coverage in the policy. SENATOR MILLER asked how SB 253 would affect premium charges. MR. EVANS replied it would be considered in the underwriting process. Any mandated benefit usually leads to some sort of an increase in premiums. He noted that he is covered by state health insurance through his wife, and they have always paid for PSA tests for him. So he does not know why they say some companies aren't covering it now. CHAIRMAN KELLY asked if there is anyone who disagrees that the state health insurance policy pays mandated benefits. Number 207 CAROL EDWARDS, RN and nationally certified oncology nurse, stated her husband was turned down for his PSA screening. She believes that men deserve the same rights in PSA testing that women receive in mammogram testing. Mandating insurance companies to pay for mammogram screening is now common throughout the United States. She believes that mandating payment by insurance companies for PSA screening will follow. Prostate cancer is the most commonly occurring cancer in men in the United States: 41% of all cancers in men are prostate cancers. A lot of men die with prostate cancer, and not of it. If a man lives to be 90 years old, he will probably have prostate cancer, although it will probably not be the cause of death. Number 244 Ms. Edwards stated that the younger a man is, the more aggressive prostate cancer will be, and the more likely that it will be the cause of death. Early detection of prostate cancer is the best chance for a cure. Ms. Edwards stated that unfortunately, she mostly sees patients with cancer in more advanced stages. Ms. Edwards stated that Aetna refused to pay for a PSA test for her husband, even though his father died of prostate cancer. He has a State of Alaska health insurance policy, and he carries the rider for the annual physical. In a letter, Aetna stated they would not pay for the PSA test, even though he was considered high risk, because it was a questionable test. Ms. Edwards stated it is a debatable test. CHAIRMAN KELLY asked if that test that will be mandated by SB 253. MS. EDWARDS responded it is. CHAIRMAN KELLY asked if the state will, at this time, pay for prostate examinations. MS. EDWARDS replied they will pay for a digital rectal examination. They will pay for a cardiac risk profile: her husband has no risk of cardiac disease, but they will pay for that test. He does have a risk of prostate cancer, but they will not pay for a PSA test. They won't pay for this one particular test, which at Bartlett Memorial Hospital costs between $60.00 - $70.00. She stated that her family is personally willing to pay for that, because they are capable of doing so. But it is the individual who is less knowledgeable and would not know the value of the test who might not be so likely to pay out of pocket. Ms. Edwards stated that in the oncology world there is a phrase called "oncology family syndrome". This phrase means that if there are three generations of cancer in your family, and it does not have to be the same type of cancer, then you are considered to be at high risk for having cancer. CHAIRMAN KELLY asked how family is defined. MS. EDWARDS thinks it goes back through generations. She knows that mother, grandmother, and great-grandmother are considered to be in those studies. CHAIRMAN KELLY asked Ms. Edwards what word is used to describe family relationship and degrees of family relationships. MS. EDWARDS stated she would be willing to find that information for the committee. CHAIRMAN KELLY stated the committee would appreciate that. He asked if there were any questions. Hearing none, he asked if anyone knew the word used to define that whole phrase. MS. EDWARDS asked if the chairman was thinking of "immediate family". CHAIRMAN KELLY responded that is not the word. He came across it when he was working for the Nevada Legislature. He called Mr. Chisholm to testify. Number 299 BILL CHISHOLM stated he works in the claims field for the State of Alaska, and is covered by Aetna for almost everything. He stated he spends a great deal of time reviewing insurance provisions and supports SB 253. Mr. Chisholm stated that in 1991 during his annual physical, his physician recommended he take the exam. He did, and Aetna paid for it. Aetna also paid for the PSA exam for his 1992 physical. In 1993, Aetna would not pay for the test, and they have not paid for it since then. When he called Aetna to inquire why they did not pay for the test, he was told that the test was not an acceptable diagnostic tool. He believes that a test of this type is probably more accurate than the examination which involves a physician facing a somewhat squirming subject and trying to determine size and hardness or softness of a particular part of the body. In looking at the 1994 denial, it states that, "Services must be broadly accepted, professionally as effective, appropriate and essential treatment of disease or injury. Based on that, this is not covered." Mr. Chisholm pointed out that whether it's a PSA screening or a digital rectal exam, they are both for detection, not for treatment. He believes that men should be entitled to have the best screening possible for a potential disease of this type. CHAIRMAN KELLY asked Dr. Palmer to testify. Number 348 DR. PALMER, a Juneau physician, explained family genetics are such that certain problems can skip generations in people who are genetically interconnected (not family members by marriage). The fact that a first degree relative (a parent or sibling) does not have a specific disease does not dilute the fact that family relationships where other members of the bloodline have had the disease predisposes one to the disease. He believes the best medical procedures are preventive, especially to help patients stop smoking. Regarding the PSA, it will detect malignancy and is more specific than mammography. The positive predictive value of mammography is 20 percent, and around 35 to 50 percent with PSA. SENATOR KELLY asked Janet Parker from the Division of Retirement and Benefits why a zero fiscal note was submitted. MS. PARKER replied the state's major medical plan only pays for the PSA test if objective evidence exists throughout patient history and after a digital rectal exam. The PSA test is not automatically paid for as part of a routine physical exam. The state's plan does not cover a routine physical exam unless employees select SBS Option 1. The employee pays the premium for that option, and although there will be an increase in the cost to the state, most of the cost will be paid by the employee. The premium for Option 1 is expected to increase in future years. SENATOR KELLY questioned whether Option 1 coverage includes a PSA test. MS. PARKER answered it will if SB 253 passes, it does not now. SENATOR KELLY asked if employees who do not choose Option 1 are entitled to a full physical exam every year. MS. PARKER stated they are not, but a male employee would still be able to go in and have a PSA test without a full physical exam. SENATOR KELLY asked what the added cost to the state is. MS. PARKER assumed most people will not have the test done. SENATOR KELLY asked why she would make that assumption if the test was free. MS. PARKER responded the current plan pays for a pap smear test for a woman, but does not cover the office visit, therefore the employee still has to pay some cost. SENATOR KELLY commented he is surprised by the zero fiscal note. PHILLIP GRAY, a Juneau resident, stated he was diagnosed with prostate cancer in 1992, through a PSA test paid by Aetna. He is not required to have a PSA blood test every three months which is important to his treatment. He expressed his support for SB 253. He discussed his treatment for prostate cancer since 1992. Aetna has refused to pay for any of the treatment including blood tests, x-rays, bone scans, a second opinion or prescribed medicines, even though these things are covered in the manual. He noted Washington State has recently passed a law requiring insurance payment to any licensed practitioner. His last concern was that Juneau has no cancer registry which could be computerized and analyzed to pinpoint correlations. SENATOR KELLY asked Ms. Parker if she could comment on Mr. Gray's lack of coverage. MS. PARKER could not do so without looking at the specifics of his case, but offered to review his file. She noted that naturopathic services are generally not covered by insurance companies. SENATOR KELLY repeated his concern with the zero fiscal note, as it is unlikely the state could mandate another medical test without associated costs. He announced SB 253 would be held in committee until next week.