SB 142-INSURANCE FOR ANTI-CANCER MEDICATION  1:54:14 PM CHAIR COSTELLO announced the consideration of SB 142. KARI NORE, Staff, Senator Cathy Giessel, Alaska State Legislature, introduced SB 142 on behalf of the sponsor, speaking to the following sponsor statement: SB 142 would ensure that both intravenous and orally administered cancer treatments are treated fairly and are equally available to consumers. Patients should not be prohibited from receiving cancer treatment due to high insurance costs. Currently intravenous cancer treatment co-pays are much less expensive than the oral cancer treatments, and are not always the easiest option for patients. This bill also prevents increasing costs for intravenous or injected chemotherapy that is covered under the policy or plan or by reclassifying benefits with respect to anti-cancer medications. This bill asks for parity, or fairness, to the consumer, as they choose the treatment option that is right for them. I urge you to support this bill that will require equal insurance coverage for anti-cancer medications, both those administered intravenously and those administered orally. 1:56:05 PM JEANNE MUNGLE, Deputy Director, Division of Insurance, Department of Commerce, Community and Economic Development (DCCED), stated that SB 142 seeks to reduce out-of-pocket expenses for consumers utilizing healthcare insurance plans that provide coverage for anti-cancer medications. Section 1 would level the playing field in terms of cost. Currently, 40 states have enacted similar legislation. She related that the division is working with the sponsor to add language that would not prohibit cost-sharing rates that could occur between network and out-of-network providers. The bill would have zero fiscal impact on the Division of Insurance and would be a good measure from the standpoint of eliminating surprise billings for consumers. 1:57:42 PM SENATOR MEYER asked if there was any opposition to the bill. MS. MUNGLE answered the division is not aware of any opposition. MS. NORE added that Premera Blue Cross Blue Shield supports the bill and she is not aware of any opposition. CHAIR COSTELLO asked if the administration has a position on the bill. MS. MUNGLE offered her belief that the general opinion is that it is a good bill. CHAIR COSTELLO asked if the administration is in support of the bill. MS. MUNGLE replied "generally I believe we would support that measure." CHAIR COSTELLO opened public testimony on SB 142. 1:59:13 PM ERIC HANSEN, representing himself, Juneau, Alaska, testified in support of SB 142. He related that four years ago he was diagnosed with multiple myeloma, as a result of exposure to Agent Orange. It is incurable but treatable. He said this bill seems trivial in light of the budget crisis, but it can make a life-changing difference for many patients. The pill he takes now costs $10,000 per month, and the 20 percent co-pay is beyond his reach. A less effective drug that has to be infused has a $30 co-pay. But not only does it not work as well, it also has more side effects. He discussed the different options for cancer treatment and described SB 142 as a way to get everybody on the same page, working for the benefit of the patient to make treatments equally available and affordable. This would take one huge problem off the table, he said. SENATOR STEVENS asked if he was exposed to Agent Orange when he was in the military. MR. HANSON answered yes; he received significant exposure in the highlands of Vietnam. The first symptoms appeared about 20 years ago and became full blown about four years ago. SENATOR STEVENS asked if the Veterans Administration has been of assistance. MR. HANSON replied yes and they're good when they've finally lined up, but it's a slow, cumbersome process. SENATOR STEVENS thanked Mr. Hansen for his service. CHAIR COSTELLO thanked Mr. Hansen for his service and Senator Giessel for introducing the legislation. 2:07:49 PM DR. LATHA SUBRAMANIAN, MD, Denali Oncology Group, Anchorage, Alaska, testified in strong support of SB 142. She explained that Denali Oncology Group represents all the medical and radiation oncologists in Alaska and the nurse practitioners. They are the Alaska chapter for the American Society of Clinical Oncology. Their mission is to advocate for their patients and ensure that any Alaskan that has cancer will have equal access to the most effective therapy for his/her cancer in Alaska. DR. SUBRAMANIAN said she couldn't say it any better than the previous testifier. In the last several years tremendous progress has been made in the care of cancer and there are several new drugs for many kinds of cancer, including multiple myeloma. Sometimes the most effective treatment is taken by mouth and there isn't an intravenous substitute. The problem is that even if a patient has health insurance, they often can't afford the prescribed oral drug because their policy includes deductibles, co-pays, co-insurance and various formularies. Patients that can't afford a drug, simply don't take it. DR. SUBRAMANIAN urged the committee to pass SB 142 to ensure equal, affordable access for cancer patients so they can get the best treatment available regardless of the method of delivery. 2:11:43 PM ROD GORDON, Pharmacist, Great Land Infusion Pharmacy, Anchorage, Alaska, testified in support of SB 142. He said this is a specialty pharmacy that focuses on infusion therapy, but also provides support for patients who need oral medications. In addition to what has already been said about barriers to access, an unforeseen consequence of high co-pays is that it forces patients to resort to an out-of-state specialty pharmacy to get a competitive co-pay. This prevents immediate access and a personal face-to-face interaction with a specialty oncology pharmacy provider. 2:13:50 PM THEA ZAJAC, Director, Government Affairs, Leukemia and Lymphoma Society, California, testified in support of SB 142. She thanked the sponsor for introducing the bill and stressed its importance for people living with blood cancers in Alaska. She said cancer treatment is changing rapidly and this legislation is about catching up the insurance industry with the modernization of treatments. She said she has worked on this issue in several states and has seen the positive impact it has on patients' lives. 2:15:09 PM LINDSEY TRISCHLER, Advocate Associate, International Myeloma Foundation (IMF), Washington, D.C., testified in support of SB 142. IMF is the largest and oldest foundation dedicated to improving the quality of life of myeloma patients. They work collaboratively with organizations and individuals representing patients in Alaska to focus on equal access to treatments regardless of how it's administered. Treatment decisions should be based on what is the most effective, not what the patient is able to afford. She echoed Mr. Hansen's testimony about the difficulty and complication of myeloma cancer treatments and emphasized that it is highly treatable given the advancements in drug development. The different treatment options have enabled patients to live longer, but remissions are not always permanent so additional treatment options are essential. Thus, it is critical that all cancer patients have equal access to all treatments, not just the ones covered on an affordable rate. 2:18:24 PM SHEILA STICKEL, West Coast Field Director, National Patient Advocate Foundation (NPAF), Seattle, Washington, testified in support of SB 142. She said SB 142 would ensure coverage for all oral cancer medications that are equal to the traditional IV therapies. Nearly 30 percent of the new cancer therapies are oral but insurance doesn't always cover them at the same rate as intravenous drugs. There are a host of very good reasons for patients to have access to oral therapies but those in critical need of oral cancer medication often have prescription policies that cost thousands of dollars each month. This can exhaust financial resources and force difficult decisions. By ensuring there is parity between the types of cancer treatments, Alaska will take the needed step of ensuring patients have access to the treatment that their physician prescribed. Forty states and the District of Columbia have already passed oral parity laws. SB 142 would make it easier for patients in Alaska to afford oral cancer medications. 2:21:52 PM DR. MARY STEWART, Oncologist, Alaska Oncology & Hematology, Anchorage, Alaska, testified in support of SB 142. She said she has practiced in Alaska since 1985 and is amazed at the options for cancer treatment that are available today. "Oral drugs are simply amazing" but they're all expensive. It's clear that something has to be done nationally to affect pharmaceutical pricing, but "you and I can't do anything about that," she said. However, it is possible to positively affect people in Alaska by giving them access to medications. 2:23:22 PM EMILY NENON, Director, Government Relations, American Cancer Society, Anchorage, Alaska, testified in support of SB 142. She said she works on cancer research funding issues at the federal level and at the American Cancer Society. She said there have been tremendous strides in the area of cancer treatments and over one-quarter of the anti-cancer treatments in the research pipeline are in oral form. This bill is about modernizing statutes and getting equitable coverage between oral and intravenous anti-cancer medications. 2:24:50 PM SENATOR COSTELLO closed public testimony. CHAIR GIESSEL offered a conceptual amendment on page 2, line 4. Insert: "Nothing in this section shall prohibit a plan from requiring different cost sharing rates for in network and out- of-network pharmacies." The language was recommended by the Division of Insurance. Renumber the subsequent subsection. She said she would have a committee substitute prepared. CHAIR COSTELLO held SB 142 in committee awaiting the CS.