27 Jun Komen Succeeds: No More Treatment Caps
We know that real change comes from changing the system. And we’re not afraid to speak up for the women and men we serve. Susan G. Komen has a rich history of more than 30 years in public policy and advocacy. When there is a need for improvement with our current laws, Komen San Diego stands before the assembly and the senate and advocates for change. As a long-time leader in policy change, Komen San Diego co-chairs the Komen California Collaborative Public Policy Committee (KCCPPC), a state-wide group focusing on breast health protection laws.
This year we’ve had a huge win. The KCCPPC broke ground on removing the 18 and 24-month treatment caps in the state-funded Breast and Cervical Cancer Treatment Program (BCCTP), with the leadership of Senator Toni Atkins. Breast cancer patients whose lives depend on this program will no longer ask, “Why can’t I continue my treatment?” Now uninsured and underinsured Californians will be able to complete their full prescribed treatment plans without an arbitrary time limit. This is an important step the San Diego Affiliate has taken to save lives and support our bold goal to cut the number of breast cancer deaths in half by 2026.
“Komen plays a great part in orchestrating major changes to legislation that are meant to elevate the lives of those affected by breast cancer. It starts from uncovering the need, rallying support from key leadership in our community and then advocating for equal and quality access to healthcare.” said Lizzie Wittig, Susan G. Komen San Diego’s Director of Mission Initiatives and Public Policy.
With government action, broad, systemic, lasting change can be made in the fight against breast cancer. We wouldn’t be able to do this without the help of our constituents who raise their voices and the support and leadership of Senators and Assemblymembers.
Susan G. Komen’s Timeline of Legislative Accomplishments in California
Click on each year for more details.
This year, the Susan G. Komen California Collaborative is sponsored SB 945 (Atkins), legislation that will remove the 18 and 24-month caps for breast and cervical treatment through the State funded program Every Woman Counts. The Collaborative is also sponsoring AB 1860, legislation that permanently caps the cost of oral anticancer drugs.
Access to Affordable Anti-Cancer Medications
AB 1860 (Limon) Komen, along with the American Cancer Society and the Association of Northern California Oncologists, is introduced legislation to eliminate the sunset in AB 219 (Perea, 2013). AB 219 was sponsored by Susan G. Komen and capped patient co-pays for orally administered anticancer medications to $200. This bill is set to sunset on January 1, 2019.
Breast Cancer Treatment through the Breast and Cervical Cancer Treatment Program
SB 945 (Atkins) Current law limits the period of coverage for breast cancer treatment to 18 months and cervical cancer treatment to 24 months through California’s BCCTP, Every Woman Counts. Komen is introducing legislation to remove those treatment caps so that services will be covered for the duration of the treatment period. Senator Atkins, leader of the Senate authored this bill with co-authors Assemblymember Christina Garcia, Assemblymember Autumn Burke, Assemblymember Blanca Rubio, Senator Dr. Richard Pan and Assemblymember Joaquin Arambula.
Circle of Promise Initiative
The California Affiliates also continue working with the Legislative Black Caucus on the Circle of Promise Initiative. Since 2014, Komen has been conducting intensive peer-to-peer education where African American women live, work, shop, pray or play. African-American women have higher breast cancer mortality rates as compared to their Caucasian counterparts. The Circle of Promise is helping to bring breast health education and screening services to thousands of women across California to achieve health equity.
Health Care Coverage for Fertility Preservation
SB 172 required health plan contracts and health insurance policies to cover the cost for all medical expenses for standard fertility preservation services for patients who will undergo chemotherapy treatments. Currently, fertility preservation is the only wide-spread long-term side effect of chemotherapy treatment not required to be covered.
Status: Held on Senate Appropriations suspense file
Breast Cancer Genetic Risk Testing
AB 1386 required the Department of Public Health to establish a program to promote and encourage screening for breast cancer susceptibility gene mutations for individuals who are newly diagnosed with breast and ovarian cancer.
In 2016, the Susan G. Komen California Collaborative sponsored AB 1795 (Atkins), legislation that expanded eligibility for breast cancer screening and diagnostic services for symptomatic women, and provide more comprehensive treatment coverage for breast and cervical cancer. In addition, the Collaborative was actively engaged in supporting two pieces of legislation pertaining to cancer clinical trials and specialized breast cancer awareness license plates.
Health Care Programs: Cancer
AB 1795 (Atkins) provided that an individual of any age who is symptomatic, whose age is within the range for routine breast cancer screening, and meets all other requirements, is eligible for breast cancer screening and diagnostic services. The bill also provided that if an individual is diagnosed with a recurrence of breast or cervical cancer, whether at the original cancer site or a different cancer site, the individual would be eligible for an additional period of treatment coverage.
California Cancer Clinical Trails Program
AB 1823 (Bonilla) provided for the establishment of the California Cancer Clinical Trials Program and request that the University of California establish or designate an institute or office within the university to administer the program. It will also authorize the program administrator to solicit funds from various sources to increase patient access to eligible cancer clinical trials in underserved or disadvantaged communities and populations.
Specialized License Plates: Breast Cancer Awareness
AB 2469 (Frazier) would have extended the time the Department of Health Care Services (DHCS) has to collect the required 7,500 applications for the breast cancer awareness license plate. This bill was vetoed by the Governor. In his veto message, he noted that he believed the bill to be unnecessary and cited that the DHCS was already notifying applicants of their “option to request a refund.” However, current law would have required the DHCS to actually offer a refund, which they were not doing. Frazier’s office was not happy with the veto, because they believed the Governor’s office did not fully understood the need for the bill. The DHCS has until July 21, 2017 to collect the remaining applications.
This year, the California Affiliates of Susan G. Komen are actively engaged in supporting two pieces of legislation pertaining to health care provider network transparency and access to medically appropriate cancer medications.
SB 137, authored by Senate Health Committee Chair Ed Hernandez, would require health plans to regularly post and update provider directories to ensure greater transparency for patients. Currently, patients shopping for a health care plan often encounter unexpected hurdles when it comes time to determine if their providers are in network or out of network, resulting in frustration and unforeseen costs. Breast cancer patients already undergoing treatment will find the information very valuable in determining if their current provider is covered by the various plans, and help to ensure continuity in treatment.
The second priority bill is AB 374, authored by Assemblymember Adrin Nazarian, which proposes to limit the use of step therapy by health plans and health insurers and help ensure patients and their physicians are able to choose the most medically appropriate and effective course of treatment. Step therapy, sometimes called “fail first,” requires a patient to try a preferred drug prior to receiving coverage for the originally prescribed drug, and is a method of utilization management used by health plans to control costs. These protocols should optimize affordable, effective and appropriate access to care, not delayed treatments and poor patient outcomes.
Unfortunately, most step therapy protocols rely on generalized information regarding patients and their treatments as opposed to taking into account unique patient experiences and responses to different treatments. Further, physicians are faced with considerable challenges in identifying drugs subject to step therapy due to the varying formularies and protocols established by health plans and pharmacy benefit managers. As there is no standardization among health plans regarding the override process, it is difficult for physicians to prescribe the best option for the patient and creates barriers for accessing timely and appropriate treatments.
Both SB 137 and AB 374 are in the Appropriations Committees awaiting a fiscal analysis.
Circle of Promise Initiative
The California Affiliates have also been working closely with the Legislative Black Caucus on the Circle of Promise Initiative. In July, the Caucus agreed to author a resolution commemorating August 1 as Circle of Promise Day in California.
Circle of Promise Initiative
Komen received a two year $390,000 “Challenge” grant from Anthem Blue Cross Foundation to help launch the African American Initiative in order to serve diverse, disadvantaged communities with high mortality rates. Although incidence rates are lower, African American women suffer significantly higher mortality rates, 41 percent higher than their Caucasian counterparts. For women without health coverage, the burden is even higher – uninsured women have a 30 to 50 percent increased risk of dying from breast cancer than those with insurance. The grant’s elements are centered on community organizing, direct education, screening and navigation services, and targeted marketing.
To help launch this exciting initiative, the Affiliates engaged the California Legislative Women’s Caucus, which is comprised of Senators and Assemblymembers throughout the state. We held a press conference, followed by a legislative briefing for key staff and Brown Administration officials, to share an in-depth look at treatment and detection disparities in breast cancer.
Our legislative efforts centered on AB 49, the “Pink Plate,” by Assemblymember Joan Buchanan. AB 49 created a specialty license plate to promote and support breast cancer awareness, early detection, and treatment. We successfully advocated to have the proceeds from each plate sold go directly to benefit the Every Woman Counts (EWC) Program, which provides services to the under and uninsured. AB 49 was ultimately signed by Governor Brown in the fall of 2014, and we have been actively working with the Department of Health Care Services to design the slogan and format of the plate.
Governor Brown signed AB 49 into law during this legislative session.
Every Woman Counts (EWC)
Since 2009, Komen has been extremely engaged in protecting and promoting the Every Woman Counts program, which provides free clinical breast exams and mammograms, along with other services, to California’s underserved women. The mission of the EWC is to save lives by preventing and reducing the devastating effects of cancer for Californians through education, early detection, diagnosis and treatment, and integrated preventive services, with special emphasis on the underserved. EWC is part of the Department of Health Care Service’s Cancer Detection and Treatment Branch (CDTB).
During 2014, California Affiliates of Susan G. Komen continued their efforts to maintain sustainable funding to maintain EWC. Advocacy efforts focused on the Brown Administration and included regular quarterly meetings with the Department of Health Care Services.
In 2013, California Affiliates of Susan G. Komen sponsored and ultimately passed into law AB 219 (Perea), which ensures that cancer patients can afford oral anticancer medications that are covered by their health plan or insurance.
Oral chemotherapy has quickly emerged as an essential option for patients who can take oral anticancer medications as prescribed by their doctors rather than receive chemotherapy treatment intravenously at a medical facility. Oral chemotherapy drugs can be extremely expensive and patients may face thousands of dollars a month in out-of-pocket costs. Approximately 70% of the prescriptions and 31% of the total cost for non-generic oral anticancer medications are for drugs used to treat breast cancer.
AB 219 limits the total amount of copayments and coinsurance a patient is required to pay to $200 for a prescription of oral anticancer medications. The bill was signed into law by Governor Brown in October, 2013, following extensive lobbying and negotiations with Governor Brown’s Administration, Health and Human Services Agency and the legislature.
Governor Brown signed AB 219 into law during this legislative session.
Public Access to State Funded Research
California Affiliates of Susan G. Komen supported AB 609 (Nestande), which requires state-funded research to be made available to the public, thus maximizing the impact of these works. California has a strong reputation for being a hub of innovation and ingenuity, and while there is an abundance of thought provoking research happening in our state, the work and outcomes of these studies are greatly diminished if they are tough to access. Requiring state-funded research to be made publicly available will eliminate barriers to knowledge and make important findings more accessible to breast cancer researchers, clinicians, students, and advocates just to name a few who would benefit from the passing of this bill.
Governor Brown signed AB 609 into law during this legislative session.
The California Affiliates of Susan G. Komen also supported AB 912 (Quirk-Silva), which would have required health care insurers to cover standard fertility preservation services for Californians who have received medical treatments that may compromise fertility.
While treatment options continue to advance and increase survivorship rates for breast cancer patients, chemotherapy and radiation also present difficult side effects, including compromising a patient’s fertility. Unfortunately, most health care plans do not currently provide for fertility preservation services for these patients, and the often quick timeframe between diagnosis and treatment of breast cancer can make it difficult to submit an insurance appeal in time to begin these services.
Despite successful efforts to move the bill through the legislative process, Governor Brown ultimately vetoed it because the provisions exceeded the essential health benefits as outlined under the Affordable Care Act.
Governor Brown vetoed AB 912 during this legislative session.
Breast Cancer Screening
The California Affiliates of Susan G. Komen supported Assemblymember Portantino on AB 137 which requires health plans and insurers to provide patients with information regarding recommended timelines for the screening and diagnosis of breast cancer.
Governor Brown signed AB 137 into law during this legislative session.
Hospital Stay for Lumpectomy and Partial Mastectomy
The California Affiliates of Susan G. Komen also supported Senator Pavley on SB 255 which allows patients undergoing partial mastectomies and lumpectomies to determine the length of their hospital stay in consultation with their physician or surgeon without prior approval from the patient’s insurance company.
Governor Brown signed AB 255 into law during this legislative session.
Tax Check Off for Cancer Research
The California Affiliates of Susan G. Komen supported Senator Simitian on SB 1359 which extends until 2018 the ability for taxpayers to designate on their tax returns a specific contribution to the California Cancer Research Fund.
Governor Brown signed SB 1359 into law during this legislative session.
The California Affiliates of Susan G. Komen supported Senator Simitian on SB 1538 which requires health care providers to inform women if they have breast dense tissue and encourages further conversation between the patient and her doctor.
Governor Brown signed SB 1538 into law during this legislative session.
California Access to Cancer Treatment Act
The California Affiliates of Susan G. Komen also supported and worked closely with Assemblymember Perea on AB 1000 and will join him again in support of the bill in the 2013 legislative session. This bill would have fixed the disparity that currently exists in insurance coverage for oral anti-cancer drugs.
Governor Brown vetoed AB 1000 during this legislative session.
Every Women Counts
In December 2009, the California Department of Public Health (CDPH) announced significant changes to Every Woman Counts, including changing the minimum screening eligibility age from 40 to 50 and freezing enrollment for the first six months of 2010. The Collaborative worked to restore funds to the program through press outreach, relationship building with key members of the Legislature and Administration, collaboration with other stakeholder groups, visibility events, and education and mobilization of the public. In October 2010, funds were restored to the Every Woman Counts program and it was reopened to new enrollees for the first time in nearly a year, benefiting approximately 300,000 California women.
Health Care Coverage: Mammograms
The Susan G. Komen Affiliates of California supported AB 113 by Assemblymember Portantino which would have required health plans to provide coverage for mammography services upon referral, regardless of patient’s age.
Governor Schwarzenegger vetoed AB 113 during this legislative session.
Breast and Cervical Cancer Screening
The Susan G. Komen Affiliates of California also supported AB 1640 by Assemblymembers Evans and Nava that would have required the Department of Public Health, when making changes to the EWC Program, send written notice outlining the changes to contractors and notify the Legislature if these changes would restrict access or reduce services.
Governor Schwarzenegger vetoed AB 1640 during this legislative session.
Health Care Coverage: Cancer Treatment
The Susan G. Komen Affiliates of California supported SB 961 by Senator Wright which would have required a health policy that provides coverage for cancer chemotherapy treatment to establish limits on enrollee out-of-pocket costs for oral, nongeneric cancer medication.
Governor Schwarzenegger vetoed SB 961 during this legislative session.
Digital Mammography Reimbursement Rates
The Susan G. Komen Affiliates of California supported AB 359 by Assemblymember Nava which required that the Every Woman Counts Program reimburse digital mammograms at the Medi-Cal reimbursements rate for analog mammograms, as well as allowed that an EWC provider use digital mammography when analog mammography services were not available.
Governor Schwarzenegger signed AB 359 into law during this legislative session.
Health Care Coverage: Mammograms
The Susan G. Komen Affiliates of California also supported AB 56 by Assemblymember Portantino which would have required health plans to provide coverage for mammograms upon provider referral and notify policyholders of recommended timelines for testing.
Governor Schwarzenegger vetoed AB 56 during this legislative session.