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Senate Health Committee California State Senate
Follow its sittingsSpeaker 3
American Lung Cancer Screening Initiative, or ALZIE. We're a student led organization that is dedicated to raising awareness for lung cancer screening. And this issue is deeply important to us because many of the family members and community members that we see are usually diagnosed with lung cancer at a later stage where it's already too late for effective treatment. And through ALZIE, I was able to speak directly to Californians at health fairs and also community outreach events across the state. And in these conversations, I have seen that many people have never heard of lung cancer screening, and even when they may be eligible for the USPSTF guidelines.
Now, to other recommended cancer screenings, lung cancer screening rates remain far lower, and I've seen that's about fourfold. And one major reason is low public awareness. Now, many people who qualify for screening either not know that screening exists or do not realize that they may be eligible or unaware that the screening itself may be at no cost to them through Medi Cal. And under current USPSTF guidelines, eligible individuals include adults that are between the ages
Speaker 3
have a significant smoking history, who are currently smoking, or have smoked within the past fifteen years. And yet people have never heard of these criterias, and so therefore they don't realize to ask for these screenings. There's also confusion for lung cancer screening on what it entails. It's basically a screening that's done through a low dose CT scan, which is non invasive. It's quick and has very low dose of radiation.
Speaker 24
And providing just clear information at the point of sale with the SB eleven twenty four, I think it would help reach individuals with higher risk by providing just like clear, potentially life saving knowledge about early detection and also cessation resources. So this bill is simple, but a meaningful step towards closing that awareness gap about lung cancer and helping more Californians learn about screening before it is too late. So, respectfully ask for your support. Thank you.
Speaker 5
Madam Chair, Weber Pearson, and the members of the committee, thank you so much for the opportunity to speak in support of SB eleven twenty four. Thank you to Senator Archuleta for and the co authors of this bill for introducing this bill. We think this bill is extremely important. My name is Alex Zu. I'm a general surgery resident physician at UC San Diego.
I'm also a research fellow at the Massachusetts General Hospital and currently help lead a clinical trial looking at lung cancer screening in high risk populations. One of the things that we found in our study so far is that we go out to the community and we try to recruit patients. And one of the things that we found is a lot of patients don't understand or don't know what lung cancer screening is. And from the patients that we found, we've been able to identify cancers that were found at an early stage, which is treatable. Unfortunately, for the vast majority of Americans, only sixty two percent of Americans do not actually know that lung cancer screening exists.
And here in California, really only about one to some studies say up to ten percent or so actually undergo lung cancer screening. And as a comparison, nearly seventy percent of Californians or California women at risk of breast cancer actually get screened over the last couple of over the past two years. And this is especially striking when the plurality of patients are diagnosed with lung cancer at stage four, when it cannot be cured. When it's caught, early lung cancer is highly treatable and patients often go on to live long, healthy lives. After their surgeries, a lot of our patients tell us that they don't if it wasn't for lung cancer screening, they wouldn't be here.
Speaker 15
California already mandates notices about the legal age of purchasing tobacco products, but nothing about educational lung cancer screening. Adding a notice about lung cancer screening is a low cost, actionable addition that would reach millions of high risk citizens in the most underserved communities and undoubtedly save thousands of lives. Thank you to the committee for the opportunity to speak today and for considering SB eleven twenty four.
Speaker 1
Thank you. If there's anyone else in the audience that would like to speak in support of this bill, this is your time to come to the microphone. State your name, your organization, and your position.
Speaker 6
Afternoon. E. J. Eguaya on behalf of the California Academy of Family Physicians in support. Thank you.
Speaker 1
E. Thank you. All right. Seeing no one else who is coming forward, if there is anyone that would like to speak as a lead witness in opposition to the bill, this is your time to come forward to the table. You will have five minutes for your presentation.
Speaker 16
Appreciate it. Thank you so much, Madam Chair. Jackie Anas, on behalf of the California Fuels and Convenience Alliance, representing the majority of small mom and pop convenience stores and gas stations here in the state of California. I want to start off and first thank the committee and their staff for their tireless work on the bill. Really appreciate that, as well as the author's willingness and openness to engage.
Speaker 7
Reduction in the fine from 1,000 to $500 we do think is a definite improvement in the bill. We do still have a concerns position on the legislation at this stage, mainly for what I would say are implementation concerns. Those kind of fall into two buckets. One bucket is the size of the signage. Some of our folks have very small footprints, so just ensuring the signage is really appropriate for the smaller stores is really helpful.
And also ensuring that the CDPH is providing the signage to our stores so they can display it would go a long way in helping this bill. The second part, I would say, is also notification to our retailers. Right now, obviously, with the fine, there's no right to cure currently in the bill. So, giving our folks the opportunity to know what their obligations are under the bill so they can get the signs up and be in compliance with the law will go a long way to addressing their concerns. So, at this stage, we have a concern decision.
But, again, thank the author and the committee for their work.
Speaker 1
If there's anyone else in the audience that would like to register their opposition, they can come to the microphone now, state your name, your organization, and your position.
Speaker 21
Good afternoon. Leticia Garcia with the California Retailer Association. Also want to echo our concerns. And we do have a concerns position, appreciate working with the author and his staff and the committee. Thank you.
Speaker 1
Thank you. Seeing no one else from the audience that would like to come and speak in opposition, Senator, I want to thank you so much for bringing this bill forward. You know, we have done a very good job in the area of tobacco on educating Californians, educating residents here in this country about the harms as far as the link to lung cancer. But we have fallen short in terms of educating them about the preventative screening. We talk about breast cancer screening, cervical cancer screening, colorectal screening, but we do not talk about lung cancer screening.
So, this is truly a gap. As we are seeing numbers fall for people who are smoking, it's not at zero. And we know that there are also other ways in which people can get lung cancer. And so, allowing for people to have that awareness that, one, there is such a thing as lung cancer screening and, two, what would qualify you to be eligible for that screening, I think, is extremely important. I understand the concerns of the opposition, and I think that they are things that you all can continue to work out.
I don't think that they are major, major obstacles that you can't come to an agreement or a resolution about. So, I really want to thank you for bringing this bill forward, for authoring this bill, and I would love to be a coauthor. And at this point, you may close.
Speaker 2
Well, thank you, Madam Chair. If anyone should be a coauthor, it's you. And I appreciate that. And I I truly acknowledge it, and I appreciate it. But I also wanna share something else with you.
When I was in the military, you can imagine a platoon of men standing, and there's a break for whatever reason. And they would say, light them up. If you don't have one, bum them because the one next to you probably has one. So let's share those cigarettes. And at 18 years of age, there it went.
18, 19. And next thing I know, my buddies are smoking in their twenties and thirties and forties. We've come home from deployments, and they're still smoking because of what picked up in the military. Because it was macho. It was the right thing to do and so on.
Speaker 31
And not knowing that we were tearing up our lungs. And so on behalf of my veterans that I've served and represent as the chair of the military and various committee, I asked them to please be aware of the cancer and not just themselves, but their friends and relatives and everyone else. And I think this bill will bring awareness to that issue. And, yes, we're gonna work out the size of the sign that might be in the in the store. But I will tell you this, if it's that small store, it's probably our neighborhood.
Speaker 2
Think about that. Read between the lines on that one. So we'll adapt the signs, but we wanna make sure that sign is up there. And we've already made the adjustment from a high dollar amount to $500 since we talked this morning. And but also more importantly, we also have the time to come back if they violated it, come back and say, please display this sign.
And then come back thirty days later and make sure it's still there. So we're not trying to be punitive. We just wanna be informative. And that's the key. And if we can stop one gas station or two or liquor store across California, imagine the lives we can save.
So with that, I ask for your aye vote.
Speaker 1
Thank you, senator. At the appropriate time, once we've established quorum, we will, get a motion and vote on that bill. Thank you.
Speaker 1
Alright. I see, senator Jones has come in. And, before he comes to the podium, I would strongly encourage any other authors who, have bills that they wanna present in health to come down and also strongly encourage any members of the committee to come down. So, Senator Jones, file item number three, SB eleven fifty. You may begin when you're ready.
Speaker 9
Thank you, Madam Chair. It's an honor to be with you today in presenting SB eleven fifty, which addresses the lack of consistent patient notice when cancer cases are reported to the California Cancer Registry. I want to thank the chair and the committee staff for their work on this bill, I will be accepting the committee amendments as suggested by the chair. Under the current law, specified entities are required to report cancer cases to the Department of Public Health. The registry collects identifying and clinical information for public health tracking and research purposes.
While a notification requirement exists in regulation, it is not being consistently followed in practice. Notification practices vary across providers, and evidence from practitioners across specialties indicates that many providers are unaware of the notification requirement or the associated materials. Many patients only become aware of their information has been reported after being contacted by third party researchers rather than at the time the report is made. In the era of HIPAA, it is widespread and reasonable assumption among patients that their medical information is being kept private. It is imperative that patients are made aware of the sharing of their medical data when it occurs.
SB eleven fifty helps increase patient awareness of the California Cancer Registry by requiring clear, accessible notice at the point of care. I don't believe we do. No.
Speaker 1
Thank you, senator. If there is anyone who would like to, either speak as a lead support witness, this is your time to come up. Not seeing anyone. If anyone would like to come and register their support as a me too, this is your time to come up to the mic. State your name, your organization, and your position.
Seeing none, if there's anyone that would like to speak in lead opposition, please, this is your time to come to the table. Not seeing anyone. If there's anyone that would like to register their opposition for this bill, please come to the mic, state your name, your organization, and your position.
Speaker 10
On behalf of the Public Health Institute and our colleagues at the Cancer Registry of Greater California, we want to thank the author and his staff for working with us on this. We want to thank the chair and your staff for working with us. We appreciate the amendments. We think it gets us a long way. We still have to share the language with our colleagues at the registries, but we really appreciate that, and we look to we look want to work with you moving forward Thank as the bill
Speaker 1
Afternoon, Madam Chair. John McClain, on behalf of Keck USC School of Medicine. We also had concerns with the bill that was in print, and we stand ready to continue working with the author and committee and other stakeholders as this moves forward. Thank you.
Speaker 13
Good afternoon. Jen Chase, on behalf of the University of California. We also had concern letter on the bill in print, look forward to continuing conversations moving forward.
Speaker 1
Seeing no one else in the audience that would like to come forward and speak, senator, thank you so much for bringing this bill forward. I know this is a bill that you have worked on multiple times, and it's an important issue. People who have been diagnosed with cancer, if their name is placed on a registry, should at least be aware that their name is there. And I think, you know, everyone should agree with that. It's not stating that they can remove their name.
It's not stating that you're going to have to ask them for anything, but at least allow them to be aware. You know, as you know, in digging deep into this issue, it has come to my attention that there is a requirement out there that requires cancer reporting facilities and physicians to employ a mechanism to ensure that their patients are informed that cancer has been designated as a reportable disease and that the facility will report each patient with cancer to CDPH as required by law. That is a requirement that's already on the books for facilities and physicians. I thought we can just give them the pamphlet at the oncology department. And then I realized that within the cancer reporting regulations, it's not just cancer, it's also cancer in situ, which I had no idea, as a gynecologist, that anyone that I had diagnosed with CIN three, which is cancer in situ, we don't consider that to be cancer, we don't send them to an oncologist, that it was my responsibility to inform them that they were now being their names, their information was being sent to this California Cancer Reporting Regulation.
And so, trying to figure out how can we get this information out there, because now what you're talking about based on this regulation is that every single physician would have to be educated, and every single physician would have to
Speaker 1
accountable. Whether you are an oncologist, or you're a dermatologist that does skin biopsies, or you are a GI doctor that does biopsies of the colon for a colonoscopy, or you're a gynecologist, like every single provider, whether you are managing true cancer patients or just patients that might have insight to, which we don't consider to really be cancer, would be responsible for this. And so the only way I could think that we could do that is with this signage. And so I really appreciate you working with us, working with me. I know I was coming back, you know, every day with a different idea.
But it is an important issue for people to know that their information is now registry. It's already law that they're supposed to know. It's interesting now that I've discovered which patients qualify for this registry. But I really want to thank you for continuing to work on this issue, to continue to educate us, even myself, about this issue. And I will continue to work with you to make sure that we get it right, and along with any concerns that opposition And may if you would allow me to, I would love to be a co author on this bill Yeah.
As
Speaker 9
I think that would be very appropriate to have you on. As you may know or may not know, some of the advocates and some of the stakeholders know that this was, born out of a constituent in my district several years ago that came to me very upset that she had been contacted by the cancer registry. She did not know that there was a cancer registry. And for whatever her personal reasons were for keeping her cancer diagnosis private, she kept it private. She didn't even tell her own family that she had cancer.
And then she was obviously surviving and recovering, and then when she gets a phone call out of the blue from a third party stranger, asking her very specifically, had her cell phone number and asking very specific detailed questions about her cancer diagnosis and treatment, she was very shaken and taken aback by that. When she brought that to me, I was like, this cannot be right. There's no way this is right. So I started digging into it. And as a cancer survivor myself, in 1999, discovered, yes, I'm on this cancer registry as well without knowing it.
And so now it became a little bit personal. But it's obviously across the population of California. I was getting a little choked up because I'm thankful that USC Keck is here. Because they literally saved my mother in law's life. But she's a cancer survivor too, and doesn't know that she's in the cancer registry.
Speaker 5
I mean, she knows now, but I want to thank you as chair for taking this serious. We've, you know, this is, don't know, fifth, sixth, eighteenth time, I don't know how many times we've tried this. And each step of the way has been positive and moved the ball forward because it obviously started originally with a lot of misunderstandings on both sides of the I don't even think there's two sides of the issue. There's multiple sides of the issue. But it started with a lot of misunderstandings that each time we've we've tried to, you know, get through those misunderstandings of the privacy issues, the the the purpose and the of the cancer registry and the good work that they're doing.
Speaker 9
And I'll I'll I've said it from the beginning. I'll restate it today. This is not about the cancer registry. I support the cancer registry. They do good work.
The people that are part of those cancer registries that are qualified to have access to this information are good people that are doing good work. But people just need to know. And so, you being involved in this, being the chair of this committee now, I obviously, again, back to taking it serious, digging deep into it, and discovering more things than than I even knew issues about it. I'm really excited about working with you on this and getting it getting something well done this year on it to fix the problem. So with that, I will ask for your aye vote.
Thank you.
Speaker 11
Well, first of all, this was news and surprise to me as well. And one, I'd love to be added as a co author. Two, I've told this story many times in different committee hearings and on the floor about my mother's own diagnosis with pancreatic cancer and her passing of that as well. I had no idea that she is on some list until this bill. Is there any way of notifying the next of kin as well?
I mean, maybe that's a longer conversation. There's more work to be done on this. But I do believe that this is a very sensitive topic. I think most people who have had cancer, have known someone to have cancer, whether they are a survivor or past, are supportive of the research and the data. I mean, I think we all say those, you know, four letter words about cancer all the time.
But understanding what's happening with your information is very basic from my perspective. So would love to dig more into this issue with you and love to be a coauthor.
Speaker 1
Not seeing anyone else. Know, Senator Valladares, one of the benefits to the amendment is that everyone is now aware. So when you go into your hospital, when you go into your clinic, they see that sign, then they will know that, Hey, if you happen to have a cancer diagnosis with the way we, you know, are designating that, as of right now, your name will be in that registry. So you will know that if your loved one got a cancer diagnosis and they choose to disclose that to you, then you will be aware of the fact that their name or their information has been sent to that registry.
Speaker 11
So, if you would mind. So, would that Would that mean that the signage is placed in in what type of is it oncology office? Where is the sign?
Speaker 1
So, we had kind of gone over this earlier. The way that we have it in our regulations, it's not just cancer, it's cancer in situ as well. And so because of that, people who are diagnosed with cancer in situ, you know, if it's cervical cancer, you've got CIN3 or, you know, BIN3. These are gynecologic things. The same thing happens in any specialty.
We don't say that you have cancer because it's not technically cancer. But by our cancer reporting regulations, even they are reported. And therefore, we can't just focus on oncologists, because those patients don't go and see oncologists. So this would be in hospitals and clinic settings, whether it's primary care, gynecology, pediatric. Anyone who sees a patient, has the potential to diagnose someone with cancer in situ.
And therefore, everyone should be aware that if you have that diagnosis of cancer or cancer in situ, the way things are being read right now, that they would be reported to our cancer registry. Thank you. So, Senator Jones, I know you had done a close,
Speaker 1
Thank you. And once we get a quorum once we have a quorum, we will take the motion that senator Valladares is done and take it up
Speaker 1
Alright. I see senator Arguin is here. So we will move to file item five, s b 1,400. Senator Arguin, you can begin whenever you are ready.
Speaker 14
Well, thank you very much, Madam Chair and members of the committee, for the opportunity to present SB 1,400. First, I will be accepting the committee amendments, which clarify that Alameda Health System can maintain the private nature of health facilities that it affiliates with, rather than the facilities it assumes ownership of. SB 1,400 will modernize the governance structure of the Alameda Health System, providing Alameda County with enhanced flexibility to improve oversight, operational efficiency, and the fiscal sustainability of local public hospitals. And this follows a multi session, multi year review process, stakeholder review process, not just the county officials, but also labor, which created an ad hoc committee on governance to identify gaps in the current governing structure and the delegation of operational responsibilities for AHS. The proposed statutory amendments reflect the ad hoc committee's determination that added flexibility will provide the Board with a more direct role in key and targeted issues that impact AHS, including labor relations and personnel.
SB 1,400 allows the Board of Supervisors greater flexibility to ensure that supervisors or county staff can sit on the board of the Alameda Health System, given the significant impacts of changes in our health care system and how those impact the quality of care, it's important to ensure that those that we are elected to represent are more directly engaged in these discussions. Current statutory authority limits governance flexibility by requiring the governing board that is appointed by, but legally distinct by, the Alameda County Board of Supervisors. Since that structure was established, the health care policy environment, as we know, has become significantly more complex. With the passage of H. One, along with other federal and state policy changes affecting coverage, reimbursement, and delivery system requirements, there is a need for timely coordination between county leadership and our public hospital system.
Speaker 20
In this evolving environment, the Alameda County Board of Supervisors has expressed a desire for greater flexibility to be more directly involved in strategic oversight and system level decision making, particularly as we're navigating the new fiscal and operational challenges affecting our safety net providers. At a time when our public health system is under pressure, we need transparency, accountability, and leadership that protects patients as well as our workers. And this bill is about making sure that Alameda County's public hospital system can continue to serve the most vulnerable residents in our county. I'm carrying this. This is a district bill.
Speaker 14
Our, trauma center and primary acute care hospitals in the city of Oakland, which I live in, Highland Hospital named after former Supervisor Chan. But there are hospitals throughout Alameda County, from Oakland all the way down to Center Wahhab's district, and this is a very important issue to make sure we can maintain this essential health care coverage at a time when it's needed most. With me to testify in support are Amy Costa, on behalf of Alameda County, and to Wanda Gilbert, the Chief Shop Steward for SEIU ten twenty one with the Alameda Health System.
Speaker 1
Thank you. You all will have a combined five minutes for your presentation. Great.
Speaker 11
Thank you. Good afternoon, Madam Chair and members. I'm Amy Costa, Full Moon Strategies. I'm here on behalf of the County of Alameda. Unfortunately, the Board has a budget workgroup meeting today, so a member of the Board cannot be with you personally.
Speaker 17
The bill before you, as the Senator explained, is the result of a very deliberative local process. Over the course of a year, the Board of Supervisors convened an ad hoc committee on the Alameda Health System governance model. Through six separate sessions, county leadership, health system experts, and community stakeholders were brought together to take an honest look at what is working within the system and what is not. We reviewed multiple governance models as part of the process, including whether the Board of Supervisors should take a more direct role or continue delegating their authority to an independent board. After those discussions and by consensus of those who participated in the process, we moved forward with a model that gives flexibility to step in where needed while still preserving operational expertise and independence where it matters most.
Speaker 11
What we learned through the process is that our current structure, while well intentioned at the time, is not nimble enough for today's health care realities. As we look at the stark realities of HR1, we want to be nimble coordination, particularly around labor, personnel, and system wide decision making. SB 1,400 allows the County Board of Supervisors to serve as the governing body or appoint others and explicitly allows the Board to delegate day to day operations while maintaining their accountability. This, at its core, is about making sure our public hospital system can continue to serve the most vulnerable residents in our county and our community. The county studied the issue, built consensus, and put forward a thoughtful solution.
SB 1,400 simply gives us the tools to implement what our community has already determined is needed. With that, I respectfully ask for your aye vote. Thank you. Thank you.
Speaker 13
Hello. Okay. Good afternoon, madam chair and committee members. My name is Towanda Gilbert. I am the chief shop steward of John George campus that's located within the Alameda County structure.
Speaker 16
I've worked for Alameda Health Systems for the last past fifteen years, and currently at the John George Psychiatric Hospital, I serve as a mental health specialist. AHS is the critical safety net for our community, and it employs 3,800 union workers who are committed to patient care, and that has never changed. Today I'll be speaking about why we need assistance to continue to evolve AHS to meet the most for the moment and need. I'm sorry, I'm a little nervous. In 2023, an ad hoc committee identifying gaps in the current structure and called for more direct involvement, especially on labor and system wide decisions.
SB 14 will modernize AHS governance and give Alameda County Board of Supervisors the oversight needed to ensure accountability, stability, and better decision making. This past winter, we saw that mattered when AHS moved to make deep cuts to staffing that would have reduced services and harmed patient care. These layoffs are on hold, but the decision making remains a concern. At a time where our public health system is under pressure, we need transparency, accountability, and leadership that protects both the patients and the workers. I respectfully ask for your I vote on SB 14.
Speaker 1
Thank you. If there's anyone else that would like to register their support for SB 1,400, this is your time to come to the microphone. State your name, your organization, and your position only. Thank you.
Speaker 2
Hi. My name is Maria Betancourt. I'm a specialist clerk working at John George Psychiatric Facility, part of Alameda Health Systems. And I support SB 1,400 and urge your I vote. Thank you.
Speaker 1
Thank you. Seeing no one else, if there's anyone that would like to speak as a lead witness in opposition to SB 1,400, please come forward now. Not seeing anyone, if anyone would like to register their opposition, this is your time to come to the microphone, state your name, your organization, and your position. Not seeing any. We'll bring it back to committee if there's any questions or comments.
No? All right. Well, Senator, thank you so much for bringing this bill forward. If you'd like to close, you may.
Speaker 1
close. At the appropriate time, we will take a motion to take that bill up. Thank you. I would also, offer any authors who have any bills to come down to Health Committee now, if you'd like to present.
Speaker 11
Yes. 10. Got it. We're now gonna move to file item number 10, s b ten ninety four by senator Weber Pearson, who is recognized when she is ready.
Speaker 1
Alright. Well, good afternoon. I am here to present SB ten ninety four. Half of all Californians report that their health care costs are rising faster than their paychecks. For too many Californians, that means delaying care or going without it altogether.
One underlying driver of rising health care costs are the cost of prescription drugs, which has increased by 72% since 2017. Biological products are particularly expensive. Despite comprising only 5% of all prescriptions, biologics account for over half of all drug spending. These are critical treatments, but their high price tags are putting a real strain on patients and our health care system in general. Fortunately, we have the opportunity to lower costs without compromising care.
Lower cost alternatives like generics and biosimilars offer the same safety and efficacy as their brand name counterparts at a significantly reduced price. In some cases, such as with the biologic HUMIRA, switching to a biosimilar can reduce costs by as much as 85%. And when biosimilars enter the market, they introduce competition that helps bring prices down across the board. Yet, despite these clear benefits, biosimilar uptake remains relatively low. This bill takes a practical approach to promoting biosimilar use.
It allows health plans to require patients to try a generic or biosimilar when it is available at the same or lower cost, unless a prescriber indicates otherwise by adding a do not substitute to the prescription. It also allows pharmacists to substitute a biosimilar for a biologic when appropriate, unless the prescriber indicates otherwise substitute to the prescription. The TRUBERB analysis estimates savings as follows: 3,740,000 in cost share savings for those patients who switch to a biosimilar around $90,000,000 in savings in the form of reduced premiums. With me today to explain how this bill will make health care more affordable while maintaining high quality care is Nick Luizo from the California Association of Health Plans and Susan Shea from Sharp Health Care.
Speaker 21
Great. Thank you, chair and members. Nick Luizo's here on behalf of the California Association of Health Plans. We're proud to be the sponsor of SB ten ninety four, and we thank Doctor. Weber Pearson for her leadership on this critical affordability measure.
We know that health care affordability is top of mind for policymakers and for their constituents. This is why our association is actively working to promote policies like SB ten ninety four to drive down spending while expanding access to FDA approved drugs that are safe and effective. Consider the data. Between 2017 and 2024, drug spending in California rose by a staggering 72%, and we cannot sustain that trajectory without bold policy shifts. As the author stated, the independent analysis is clear.
There are both premium and out of pocket savings for consumers resulting from this measure. And I'll just say, you know, in my nearly twenty years with the California Association of Health Plans, I've reviewed countless reports from SHBRP, and I can't remember a SHBERP analysis showing a decrease in premium growth until this bill. So this is momentous in that regard. So SB ten ninety four, as the author already explained, achieves these results by simply updating outdated statutes to reflect modern science, FDA clinical evolution, and follows Medicare policy where they've allowed for the automatic substitution of safe, effective, and lower cost biosimilars. This is a common sense update, crafted with extensive consumer protections, transparency, notification rules, and reporting requirements.
I mean, this is why you see a broad coalition of support, which includes labor, the business community, and consumer groups, including our association. So we need more solutions like this to lower costs in health care, and we urge your support for this bill.
Speaker 29
Good afternoon. My name is Suzanne Shea. I'm a licensed pharmacist with more than forty years of experience and currently serve as the Vice President of System Pharmacy and Clinical Nutrition at Sharp HealthCare in San Diego. I oversee medication use, compliance and affordability, including our Sharp Drug Formulary Committee. Sharp HealthCare is deeply committed to delivering high quality, affordable care to our patients.
Speaker 22
As part of that commitment, Sharp Pharmacy team uses a cost based approach to review all medications for safety, effectiveness, and then cost. This approach has generated significant savings for our health system and for our patients, as these lower cost alternatives that include both generics and biosimilars have reduced our acquisition costs and lowered our out of pocket expenses for patients. So, to give you an example, Yucintec is an FDA approved biosimilar for Stelera, a brand name biologic product for the treatment of psoriasis. As a biosimilar, Yucintec has been found to be as clinically effective as Stelera by the FDA, and the price for Yucintec is 97% lower than Stelera. Under current California law, pharmacists are authorized to substitute generic versions of prescribed medications unless the prescriber explicitly prohibits the substitution.
But the same state authority does not currently include substituting biosimilars for prescribed, reference biologics, even when the biosimilar is an FDA approved and clinically equivalent, just like my example for Stelera and Yocintech. This means the Sharp Pharmacy team must undertake additional time consuming steps, including multiple calls, oftentimes to individual prescribing physicians, to clarify treatment plans and switch these medications. These administrative hurdles take physicians away from their patients and can delay patient care. SB ten ninety four removes those barriers by providing pharmacists with the authority needed to make these prescription changes to biosimilars, the same way we'd have for generics, and help protect our limited health care dollars for everyone. Thank you.
Thank you. We'll now move
Speaker 11
to anyone else in the room that would like to express their support. Please state your name, the organization, and your position only.
Speaker 22
Good afternoon. Tim Taylor with the National Federation of Independent Business in support.
Speaker 26
Stephanie Watkins on behalf of the Association of California Life and Health Insurance Company is also in support.
Speaker 11
Aliyah Griffin with the American Federation of State County Municipal Employees in support. Megan Murray on behalf of the California Society of Health System Pharmacists in a supportive amended position, and we thank the author very much for the ongoing discussions.
Speaker 7
Anthony Butler Torres on behalf of the California Hispanic Chambers of Commerce in support. Thank you.
Speaker 27
Thank you, members. David Gonzalez on behalf of America's Physician Groups in support. Thank you.
Speaker 6
Good afternoon. E. J. Egwyle on behalf of the California Academy of Family Physicians in support.
Speaker 11
Thank you. We'll now move to any key witnesses in opposition of the bill. Please come forward. You're each recognized for a total of five minutes.
Speaker 29
You, Madam Chair and members. Brian Warren with the Biotechnology Innovation Organization. We have an oppose unless amended position. Our concerns are limited to the pharmacy substitution provisions, and we first of all thank the author and her staff for their receptiveness to hearing our concerns. Our position is based on the different licensing standards in federal statute for the distinct categories of biosimilar and interchangeable biologic.
To be approved as a biosimilar, a product must have no clinically meaningful differences in terms of safety, purity, and potency, but they are not tested for therapeutic equivalents. Comparing this to generic drugs, only therapeutic equivalent products may be substituted by pharmacists. Many prescribers and pharmacists are familiar with the FDA Orange Book, which lists products with therapeutic equivalence evaluations. This bill would treat all biosimilars as if they were therapeutically equivalent, even though that is not the case and has not been proven through their licensing standards. FDA has already taken steps to increase the substitution of biosimilars, and they've done this through the process that is outlined in federal statute, which is by streamlining the process to obtain the interchangeability designation.
So those are the products that have shown that patients can switch from one product to another without any clinically meaningful differences in their treatment outcomes. Allowing pharmacy level substitution of products that have not demonstrated they have meet the standard of interchangeability eliminates the ability of the FDA to say which products can be substituted safely, as well as which products cannot be substituted safely. I'd also like to point out that pharmacy substitution already occurs under existing law. Interchangeable biologics can be substituted without any intervention by the prescriber, and noninterchangeable biosimilars can be substituted with a phone call from the pharmacy to the doctor's office, as well as in integrated care settings, it can be done in a more streamlined way. It's important, however, those safety standards that exist under existing substitution are not recognized in the process outlined by this bill, which is why we have our concerns.
Thank you.
Speaker 27
Madam Chair and members, Tim Madden representing the California Rheumatology Alliance in opposition to SB ten ninety four. First of I'd like to thank the author and the author's staff. I think we've spent north of two hours talking through our concerns on the bill and are very appreciative of the time in listening to our perspectives. Our concerns are centered around the impact SB ten ninety four will have on rheumatology patients and rheumatologists' ability to provide what they believe is the best care for their patients. The conditions patients have when seeing a rheumatologist are quite unique in that there are no cures.
The most common condition rheumatology patients have is arthritis. Patients with these conditions experience chronic aching, throbbing, sharp or burning sensations. For some patients, the pain renders them unable to get out of bed, go to work, or have any type of functioning life. Treatments center around trying to find the best medication that will help the patient. This is not always straightforward and can often take months, even years, of trying different medications to find the one that works best for the patient.
Biosimilars can be an effective choice, but every patient is going to react differently to a biosimilar. And the experience of rheumatologists is that there are some patients who have negative reactions when switched. A larger concern is around multiple switching that occurs between biosimilars and the lack of notification by the pharmacist to route you to the physician when a switch is made. One example I was told was a patient being switched from one biosimilar to another three times over a four month period. The physician did not become aware of the multiple switches until the patient came into the office after four months and was complaining of a rash.
Speaker 25
The rheumatologist was left with trying to figure out which biosimilar caused the reaction, and then what to prescribe to get the patient back on track. Removing the physician from the decision making process for the care is particularly frustrating. Lastly, an additional challenge with the pharmacist switching medications is the lack of knowledge and access the pharmacist has to a particular patient's medical history. A rheumatologist was sharing a situation when a patient was switched to a biosimilar they had already tried, while with a different health plan, that did not work. Since the pharmacist did not know this and was not in contact with the rheumatologist, the patient ended up going on to the biosimilar with the same ineffective outcome.
Speaker 27
Rheumatologists are not opposed to patients being on biosimilars. Our concerns are how the bill is further removing the physician from being able to provide what they believe is the best care for these patients. Thank you.
Speaker 11
Great timing. Thank you. We'll now move to anyone else in the committee room that would like to express their opposition. Please state your name, your organization, and your position.
Speaker 20
Afternoon. Gilbert Lara here with BioComm, with an oppose unless amended position. Looking forward to working with the author's office. Thank you.
Speaker 17
Senator Dudaso. Updated information. Opposition says or well, actually, what I have in front of me, the notes are that the plan must give a thirty day notice to the doctor, and then the doctor has the ability to disagree and then not not allow it to the change to move forward. Is is that I I just heard opposite of that, that the doctors are removed from the decision making.
Speaker 27
Thank you, Senator, for the question. So, the bill has two parts. There's one part that deals with the pharmacists making a switch, and then a second part that deals with the health plans making changes. So, you're correct that as it relates to the health plan, they would be required to give thirty days advance notice to the physician, which we think is a good thing and we're appreciative of that amendment that was taken. So, that kind of gets to our point.
It gives our folks an opportunity to say, okay, let's take a look at this and then we have an opportunity to work with the health plans if we think there's a different course that's effective. So it kind of brings us back into the loop as compared to the pharmacist side where that is not the case. The pharmacist can make that switch without giving any prior notification to the physician, which is where we've kind of centered our concerns is on that side versus what the thirty days notice part.
Speaker 1
So, from my understanding, and we can continue to have conversations, the provider would get a thirty day notice. And then once, if the pharmacist chose to, was able to make that switch, that the provider would then be notified within five days that that switch had been made. So, it's not that providers are not being notified of this. That's number one. And number two, providers, like with generics at this point, if I write a prescription, I want my patient to get the brand name and not the generic, I can always say, Do not substitute.
Check the box, Do not substitute. So if a provider did not want his or her patient on a biosimilar, they still have that option of saying no.
Speaker 17
I'm sorry. So if you could further explain why the difference between doing this with the pharmacists and not the health plan.
Speaker 1
The The difference The pharmacist is already in law. Right? That's already current statute. So if a pharmacist switched, they have to inform the provider within five days. That's already law.
We took an amendment to go a step further with this bill to have the insurance companies also inform the providers thirty days before.
Speaker 1
could have aligned with current law, which is only five days, but we gave them, for the insurance companies, thirty.
Speaker 11
So did you have any questions? Senator. Okay. So just to kind of clarify, to get to the bottom, from the patient perspective, when a patient goes to their doctor and they are prescribed, you know, whatever it is, and they go and the doctor's prescribed a certain prescription, there's no the doctor doesn't say whether or not they want to opt out of a biosimilar being used. So the patient then goes to fill that prescription at the pharmacist, and the pharmacist would tell the patient, Oh, you have a cheaper option, X, Y, Z.
Would you like to use this prescription or this biosimilar instead?
Speaker 1
So, it's similar to what happens now with generics. When you get a prescription from your provider, you would go to the pharmacist. You may end up with that specific name, or you may end up with a different medication. Depending
Speaker 1
they have in stock, depending on what your insurance, which brand your insurance covers. And at that time, the physician is also notified, Hey, I know you prescribed ABC. However, your patient was given CDF based on, you know, the fact that it's generic and this is
Speaker 11
what the plan covers? Yeah. So I'm not understanding from the opposition, because notification is happening. It's it's thirty days, but it is happening from both the pharmacists and from now the health plans. I'm not understanding how there is concern that this could impact, patients negatively in terms of their treatment, especially when it's my understanding that pharmacists have a pretty significant knowledge of what the side effects are of every prescription.
So, have a disconnect. It's important, your opposition, but I'm having a disconnect in understanding that.
Speaker 29
Thank you, Madam Chair, if I may. So, a couple of things. One is that the side effect profiles of biosimilars and their reference biologics should be the same. The concern is that patients sometimes have different treatment outcomes when they're on an established course of treatment of a biologic and switch to a biosimilar. The other thing is that the provisions that require a health plan to provide thirty days notice to a doctor are not limiting factors on what the pharmacist's authority would be given by this bill.
Speaker 23
It does not say that if the health plan refuses to provide notice to the doctor, or if a patient just walks in, that a pharmacist is not allowed to substitute a noninterchangeable biosimilar, as would be allowed under the bill. So, they are if you required the pharmacist to give thirty day prior notice to the doctor before switching, then that would be alignment, I think, with what the way some people are perceiving the health and safety code sections of the bill. But those would also need to be in the business and professions code.
Speaker 11
Okay. So if, one, I would like to establish a quorum so we don't lose anyone. So if we can do a real quick pause,
Speaker 31
Senators Weber Pearson? Aye. Weber Pearson here. Valadares? Here.
Valadares here. Cavallero? Here. Cavallero here. Darazzo?
Speaker 31
Dorazo here. Gonzales? Grove? Menjivar? Here.
Menjivar here. Padilla? Perez? Rubio? Present.
Rubio present. Smallwood Cuevas?
Speaker 11
Yay. We have a quorum. So, it seeming like the sponsors' health plans would like to weigh in and probably Doctor. Weber Yeah. Pearson as well.
Speaker 6
I mean, I think, you know, one of the things that we're hearing from the opposition is that they're trying to basically leave you with the impression that, you know, biosimilars that don't meet this, what we would call a pretty meaningless interchangeable designation. They want to cast, you know, some sort of doubt on them. And I'm just reading from the FDA fact sheet that all biosimilar products meet the U. S. Food and Drug Administration's rigorous standards for approval for the conditions of use described in product labeling.
Speaker 21
Patients and healthcare providers can be as confident in the safety and effectiveness of the biosimilar as they can be for the reference product. So, I mean and they include interchangeable or otherwise. So they are moving away from that, and I think, you know, what the opposition is trying to do is try to cast some doubt on their efficacy or safety, which is just not what the FDA is saying at all. In fact, they're decidedly moving away from all that. And so we have the right.
You know, you can go your own way. The BNP yeah, I said I would weave a song lyric into this. But What about? Cool. But, you know, this the pharmacy provisions of this bill were debated pretty thoroughly in BNP, and it passed 10 to zero.
You know, the committee analysis in that committee, you know, definitively stated that, you know, pharmacy level substitution is within the authority of the state and is governed by state law. So
Speaker 1
I appreciate, all of the conversations with the opposition, as was stated by the by the sponsors of this bill. I mean, it's I'm also looking at the FDA sheet that basically states that the reference project, which would be considered like the brand name, the biosimilar and the interchangeable, all meet FDA's rigorous approval standards. They're all safe options. They're all effective options for patients. And, you know, when we talk about potential side effects, you can have potential side effects to any medication.
And that does not prevent pharmacists from switching a patient from brand name to generic. And that's why, one, we do have that notification. But two, just like if I prescribed something for you, you got a generic, you had a rash from it or something, you would call me. I would immediately tell you to stop, write the new prescription, say do not substitute. It's the same way.
And so, you know, I think in this situation, as was stated, I don't remember seeing any kind of analysis that really talks about saving money. And we are really focused on ways in which we can lower the cost of health care. And at the core, that is exactly what this bill is about. It's about affordability. It's about access, which are really key components of adherence.
It's about making sure Californians can get care they need without having to choose between their health and financial stability. We have many safe, effective, lower cost alternatives to the staggeringly expensive biologics available today. But we're not using them to their full potential, and we are seeing the repercussions of that in our very high and continued rising health care costs. This bill offers several practical ways to encourage biosimilar use to bring down cost and inject more competition into the system that pharmaceutical manufacturers have controlled for a very long time. Four out of every ten Californians are struggling with medical debt.
Six out of ten Californians report skipping medical care due to cost. And seven out of 10 Californians are more worried about medical bills than the price of housing or utilities. We all know these numbers. We all see these statistics from the surveys that we've had. We need to get serious about addressing the rising cost of health care, and this is one piece of that puzzle.
And I respectfully ask for an I vote on SB ten ninety four. Thank you. Do I
Speaker 11
have a motion? Senator Caballero Moosevelt. Secretary, please call the roll.
Speaker 11
The motion is due, pass, and re refer to the committee on appropriations.
Speaker 31
Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares? Aye.
Valadares, aye. Caballero?
Speaker 31
Cavallero aye. D'Arrazzo aye. Gonzalez Grove. Menjivar aye. Menjivar aye.
Padilla Perez. Rubio. Smolut Cuevas. I. Oh.
No. Rubio.
Speaker 1
Thank you. We are now going to move back in the file to file item nine, s b thirteen fourteen by senator Menjivar. You may begin when you are ready.
Speaker 4
Thank you, madam chair. As a state, we are confronting a growing youth drug crisis from the surge in our youth, vaping among teens, the recent rise of nitrous oxide use commonly known as whippets. We are seeing emergency departments are seeing a surge of visits from individuals because of nitrous oxide or their misuse of nitrous oxide. There have been reports of middle and high school students seeing their peers carrying these canisters in their backpacks and even at times, inhaling this on school campuses. Repeated use of whipids can cause severe neurologic, cardiovascular, psychiatric effects, including hallucinations, delusions, organ damage, nerve damage, seizures, coma, and even death in some cases.
And it doesn't help that at the same time that we're seeing these several reports, the places that are selling these things are popping up near school sites. When kids are walking to school, what are they seeing constantly? Our smoke shops. Smoke shops. For some reason, these smoke shops have targeted their location to near sensitive areas.
Speaker 27
In 2025 alone, 14.2% of tobacco retailers, includes smoke shops, liquor stores, gas stations, convenience stores, deli markets, and supermarkets, were caught selling to youth and and young adults. Why I say young adults is because it is illegal for anyone under the age of 21 to purchase this. And out of all of them, the tobacco smoke shops in particular had a higher rate of violations sitting at almost 30% of them being caught selling to young people and minors. These bad actors are taking advantage of the fact that we define them all as an umbrella, all the things that I mentioned. And so my bill is looking to do a couple of things, and one of them is to pull out the tobacco and smoke shop and have it be defined on its own so it's not coupled in with the deli markets, the supermarkets, and the gas station.
Speaker 4
And what would be good with the statewide definition of tobacco retailers is to be able to place additional regulations on their operations to safeguard our communities. Because right now, unfortunately, some of these shops are located, like I mentioned, to these youth sensitive locations. And according to the American Lung Association, the density of the tobacco tobacco retailers, particularly around, schools, has been associated with increased smoking rates, and one third of illegal tobacco sales take place within 1,000 feet of schools. So enter s b thirteen fourteen, the Youth Oversmoke Act, looking to address this crisis by doing the following. Like I mentioned, create a statewide level definition for smoke shops whose primary business is a self tobacco products that must adhere to the requirements in this bill.
And those requirements include imposing a default sensitive use buffer of 600 free feet away from a sensitive receptor like a score day care center beginning 07/01/2027. It will prohibit these same smoke shops from possessing or selling nitrous oxide or nitrous oxide paraphernalia. Because currently right now, it is you can purchase them, but the moment you step outside and you're caught within possession, a law enforcement can arrest you. There just there's a discrepancy in how we're treating this. It would now with the amendment, it no longer authorizes CDPH, but currently authorizes CDTFA to develop additional regulations for the operation of smoke shops because I am taking the committee amendments.
And it preserves, of close of course, the local control by allowing the local governments to develop even more stringent. They can go below 600, but they can increase that to up to a thousand or whatever they feel is best. It aligns the revenues out of the violation to go into a fund that currently exists right now, which is the Stop Tobacco Access to Kids Enforcement Act and their civil enforcement mechanisms. Lastly, I want to flag that there were continuing conversations from the previous committee. And I know that none of those are being absorbed here because it doesn't fall under the jurisdiction, but I'm still committed to taking those, amendments in the in appropriations, before it hits the the senate floor.
Madam Chairman, I'd like to now turn over to my witness, the council member.
Speaker 32
Thank you very much. Thank you, chair and, senators. Eric Guerra, council member for the city of Sacramento, here in strong support of SB thirteen fourteen, the Youth Oversmoke Act. Cities across California are increasingly struggling to manage the rapid proliferation of smoke shops. Sacramento is no different.
Many of them now selling whippets, and local enforcement capacity is limited. In Sacramento, a 500,000 plus city, roughly only five to 10 code officers are responsible for overseeing hundreds of smoke shops and ensuring compliance with both state and local ordinances on top of all of their responsibilities. This is why cities need the state's help now. SB thirteen fourteen is good land use policy and it ensures that commercial spaces have a higher and better use within our neighborhoods, particularly in front our schools. In my district, a smoke shop once proposed opening directly in front of Tahoe Elementary.
But through local policy, that space ultimately became a business, that provided businesses of greater value for the community. For some, a very popular brunch spot you may know, bacon and butter, and also an autism awareness center better than having a smoke shop right in front of our schools. SB thirteen fourteen strives to ensure commercial spaces near our schools are not consumed by smoke shops, and those spaces are available for a business of higher and better use. Some child care centers and some schools are near city and county borders, and this is why it's important this state law passed so we can have a statewide standard. Sacramento has a thousand foot restriction, more than the 600, but if it's right across the county line, then that restriction doesn't comply.
Speaker 4
A statewide standard like SB thirteen fourteen, like a buffer, operating hours, restrictions on nitrous oxide, these WIPETs, will help cities protect youth and support responsible retail practices and create consistency across California. This is why our cities this is why cities need your help now. And for this reason, I respectfully urge your support of SV thirteen fourteen.
Speaker 1
Thank you. If there's anyone else in the audience that would like to register your support, please come to the microphone, state your name, your organization, and your position.
Speaker 11
and members. Amy Jenkins here on behalf of the California Cannabis Operators Association, as well as the Orange County Board of Supervisors in strong support. Thank you. Thank you. Serena Scott, on behalf of
Speaker 34
Afternoon. Angela Blanchard, on behalf of the American Academy of Pediatrics, California Chapter, in strong support. Thank you. Thank you.
Speaker 27
Brendan McCarthy with Csecond support. Apologies for not getting our letter in time for the committee, but we are in support.
Speaker 27
Brian Sherman with the California Narcotic Officers Association in support. Thanks.
Speaker 20
Gilbert Lara here on behalf of the council member's district constituent
Speaker 1
Thank you. Seeing no one else who's coming forward, if there's anyone here who would like to speak and lead opposition on this bill, this is your time to come forward. Seeing no one, if anyone would like to register their opposition, it's your time to come forward. State your name, your organization, and your position. Seeing no one, I will now bring it back to the committee.
Senator Caballero.
Speaker 30
Senator Menjivar, thank you for, bringing this forward. This makes a lot of sense to me. I have a question, and I don't I'm we're in the wrong committee kind of to I'm, I believe that alcohol outlets have a restriction from these sensitive sites. And I'm just wondering if somebody could look up what the reason where my thought is going is if we line it up with the alcohol outlets, then we have a map that shows where the sensitive sites are, and the ABC does the enforcement on these, and it may be able to there's a synergy in using the same distance so that we're looking at the same things. Alcohol and tobacco have no business around day care centers and schools and other sensitive sites where children are likely to be located, between parks, that kind of thing.
Speaker 4
Yeah. I don't I don't know what all fall falls under that. Mine is just on schools and day day care centers. I I would have to check what extended list they are allowed to be away from.
Speaker 30
They use. Yeah. I I just think this is a really good bill, and and a big part of the of the challenge is that a lot of these the the reason that the alcohol distances were set up in the first place is they were popping up in over concentrated areas around poor neighborhoods. And so the restrictions have been adopted for a really long time. We may just want to look at that and see if we can do an overlay at some I'm other going to support you, Bill.
I think it's a really good idea. But it just seems to me that we're battling them kind of one thing at a time. And if we put them all together, we may it may make more logical sense.
Speaker 4
That's a great point. You know, we at least for the 600 buffer, Senator, we aligned it to the cannabis kind of buffer. So, we wanted to make it as standard as possible. But it's the first time someone's pointed that out to me, so we'll take it back.
Speaker 17
Just, I will be supporting as well. I I think it's correct. We we're dealing also with vaping, something that was deliberately targeting young people with the flavors and all of that. I'm curious. This isn't anything that's exclusive to children.
Right? I mean, adults. So do you have any information as to is it more of the kids, a higher percentage of kids? Is it more adults? I mean, something about the usage so that we can figure out prevent how do you prevent the kids?
How do you prevent the adults from using this?
Speaker 4
Yeah. So we've have reports on deaths. Even today, think LA Times had an opinion piece on this very, very topic. I think there's about four bills going through the legislature on this, so there's an interest on it. But we weren't able to desegregate the percentage of who were the deaths for the kids versus the adults.
So I had asked for that information, so we've been looking for it. It just we haven't found desegregated information. What we have seen is just a surge of youth yeah, utilizing vaping. And what law enforcement has seen also is a lot of DUIs, where people have been are passed out after utilizing nitrous oxide. So that could be young adults as well.
Speaker 17
I'll just mention my teenage granddaughter says it's common to go into the bathroom and
Speaker 4
Yes. They're seeing that constantly. So if we make nitrous oxide illegal to for them to sell, that could help deter it. Obviously, it's hard for us to say anything we do. We'll always stop whatever we're looking to fix, but at least it helps the situation.
Speaker 33
Thank you. I really appreciate this, though. Since I've been here in the legislature, I have numerous bills on just trying to tackle smoking in our youth. Know, as a teacher, I always share how, you know, our kids find creative ways of hiding what they smoke. And I just remember passing bills on vaping to tackling marketing strategies to engage our youth to these devices that are meant to conceal.
In fact, I tried an educational program to teach parents because we had pens, we had markers, staplers, things that are ordinary devices. And every time we tackle one issue, three more come up. And this one is an issue that my fellow teachers, will call and share. It's becoming a common occurrence just like, all the other things like vaping. So I'm really encouraged by this.
Speaker 19
And I do think it's critically important, especially because they're always seeking to, be in proximity of these schools or vulnerable areas where they find our youths that are not, accompanied by adults or they walk by. And so I I think it's important. And and I've also had many bills on the mechanisms on how to enforce the violations and have stricter penalties. But I'd love to be a coauthor and and just, you know, have a conversation with you to see how we can, you know, go a little further on it. I know this is not a place to amend, but, you know, just talk about ideas because it's an important issue, and it's not going away.
Speaker 33
It just keeps getting worse. So I appreciate you bringing it up. Thanks, senator. Thank you.
Speaker 11
can appreciate what the author is is trying to accomplish here as a mom of of a daughter who I hope, you know, never is attracted to smoking or vaping, any of it. I just have concerns that we've we've done so many things to try and reduce the usage, and it's not happening. And I'm not gonna get in into all of that right now because I'm trying to understand the reasoning or the thought process behind this aspect of the bill which would permit a smoke shop only to engage in the retail sale of tobacco products directly to the public between the hours of 6AM and 10PM, which seemed like those are kid hours. Right? Like so I'm not understanding, you know, where this concept from the bill came from, if you could explain.
Speaker 4
We we matched it to the operating hours that are imposed right now on cannabis shops. Those are the same exact hours. That's where it came from.
Speaker 4
But, senator, if it was up to me, I would rework it to say you cannot be open during when kids are walking to school or walking out. But that'd be too much of a Swiss cheese kind of situation.
Speaker 1
Seeing no further comments, senator, really want to thank you for bringing this bill forward. You know, it seems like we're always having to figure out new ways to protect our children as these people in these various industries find new, creative ways to target our children, they know that if they get them when they're young, they can get them addicted and have a customer for life. And so, I really appreciate you bringing this forward, and the sponsors for bringing this forward, and educating all of us on this issue that we may or may not have been aware of ourselves. And so, would also love to be a co author
Speaker 4
Thank you so much. You're right. We keep having to come back. It's because they're finding new ways. And I think we're going to have to continue to come back and do new regulations after new regulations because one day, they're gonna be selling bananas that you can just inhale, then that's gonna get you high.
I just they're finding new ways to get our kids. And senator Caballero, they are in black and brown communities. My district is saturated with these. I don't have parks, but I have smoke shops in my district. And if that's what a kid is consistently being exposed to, it's eventually, it it it will become like a self fulfilling prophecy of, like, if you say that happened to them and you put it in front of them, it's gonna happen.
So, we will continue to bring back legislation that will be creative as well and meet the moment to continue to protect our kids. And this is just one step in the right direction with that respectfully asking for an eye vote.
Speaker 1
Wonderful. Thank you. I will entertain a motion. Move by senator Rubio. The motion is due pass as amended and re referred to the committee on appropriations.
Assistant, please call the roll.
Speaker 31
Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares? Caballero?
Aye. Caballero, aye. D'Arzo? Aye. Drazo aye.
Gonzales Grove? Aye. Benjovar aye. Padilla? Perez?
Rubio? Aye. Rubio aye. Smallwood Cuevas? Aye.
Smallwood Cuevas aye.
Speaker 1
Six zero on call. That bill is six zero, and we will place it on call. We will now move back on file to file number eight, s b 13 o nine by senator Rubio. You may begin when you are ready.
Speaker 33
Thank you, Madam Chair and members of the committee. I want to note I'm accepting the committee amendments noted in the analysis. Want to thank you for the opportunity to present SP thirteen oh nine, the stop lung cancer early act, which will save lives by eliminating out of pocket expenses for medically appropriate lung cancer screenings. This bill makes it a a really critical change, which I believe will save lives. It will remove financial barriers preventing patients from accessing life saving follow-up care.
A lot of the times, we know that access is key. And studies show that people don't get preventative care because of cost barriers. And so preventative care is the best way, again, to stop unhealthy progressive ailments. And in this case, it's lung cancer. We also see the success through the lives saved already when we tackle decreasing the cost of screening for breast cancer, cervical cancer, and colorectal cancer.
So we want to do the same thing for lung cancer. Lung cancer is California's deadliest cancer, killing over ten thousand Californians a year. However, our screening rates are critically low, under ten percent to be exact, whereas other cancers are above seventy percent, and that's due to access. So the costs are the main reason why people avoid getting those necessary screening. So these barriers also disproportionately impact our vulnerable communities.
We know that veterans are having a hard time getting follow-up screenings, as well as disproportionately it impacts people of color. So we want to make sure that we do what we can to encourage that follow-up care. So also, I wanted to note some information. Less than a quarter of lung cancer cases are diagnosed at stage one when survival rate is the highest. Also, around half are diagnosed at stage four, and that's when the rate of success is the lowest.
So by removing the barriers, we increase early detection, we improve survival rates, and reduce term health care costs associated with late stage cancer treatments. So this bill, SB thirteen oh nine, is very targeted. It's evidence based, and it only updates an existing policy that we currently have, one that aligns lung cancer screening with other already other covers covered already and that we've done in the past. And with me today to speak on this very important bill is Laura Rose, oncology nurse practitioner at Providence St. John's Health Center.
We also have Chris Draft, former NFL linebacker and lung cancer advocate after the loss of his wife. So, if I may, sure, I'll turn it over to my guest.
Speaker 1
Thank you. You will have a combined total of five minutes for your presentation.
Speaker 28
Good afternoon, Madam Chair and committee members. My name is Laura Larose, and as the senator said, I'm an oncology nurse practitioner. I have over sixteen years of experience caring for cancer patients. I'm also a volunteer with the American Cancer Society Cancer Action Network. I'm here in strong support of Senate Bill thirteen oh nine.
In my practice, I care for patients from diagnosis through treatment, up until end of life care. One of the most concerning patterns that I see is delayed diagnosis of lung cancer. This isn't always just because screening isn't happening, but because patients can't afford the follow-up after an abnormal result. While screening may be covered, patients often face out of pocket costs for essential next steps like diagnostic imaging, biopsies, and specialist visits. From a clinical perspective, these are not optional.
They are medically necessary to confirm or rule out cancer. Lung cancer is an aggressive disease where timing matters. Delays in follow-up can mean the difference between early stage treatable cancers and advanced disease with far fewer options and significantly worse outcomes. I also see the burden fall disproportionately on patients already facing barriers to care. Cost sharing creates a real obstacle, especially for lower income patients, leading many to delay or forego care altogether.
SB thirteen oh nine closes this gap. It ensures that when we screen for lung cancer, patients can actually complete the process of care. As a clinician, ordering the right test only matters if my patients can access it. This bill helps turn clinical recommendations into real care. I urge you to support on SV1309.
Thank you.
Speaker 35
Thank you. Good afternoon, Chair whoever Pearson members. Sorry on that. My my name is Chris Draft, and I'm here to speak on s b 13 o nine. I am a former NFL player, but not just an NFL player.
I played for the forty niners and for the rams, and I grew up in Anaheim, California. Thank you. And graduated from Stanford University, so I am extremely biased with California. But, you know, more importantly, I'm here as a husband who lost his wife Keisha to lung cancer. She was diagnosed at 37 years old, no history of smoking, and passed a year later.
Stage four lung cancer, 37 years old, a year later, passed away. And I carry that memory to everything that I do. But I also have another connection. That other connection is to my my uncle. My uncle Eugene Polk, army vet, that as soon as he went to the army was introduced to smoking.
Speaker 10
And that became a part of his lifestyle where he was diagnosed with lung cancer and ended up passing in 2002. And so he's somebody that could benefit from lung cancer screening. And so many people ask me, they say, would lung cancer screening benefit your wife? And so unfortunately, she was diagnosed late stage. And it wouldn't have, based on the criteria, but it would save so many lives, my uncle being one of those, and so many other veterans, and so many other people that we know have been taken advantage of by the tobacco industry.
Speaker 35
You know, what we've learned through my experience through working with families across the country is early detection. It works. We know it. Alright? We see it in breast cancer.
We see it in colon cancer. It's a game changer. We find it early. It not only changes the cost, but it changes the lives of the people. It changes that they don't have to go to a cancer center very often or they have to go only for a little bit, but their quality of life is transformative.
So right now, than twenty percent or in California less than ten percent of eligible for lung cancer screening actually get screened. And even when people do take that step, cost can become a barrier to follow-up. Yeah. We know that. It's it's unfortunate because, again, if we can find it early, it can be transformative.
I've seen people do everything right, get screened, but then face unexpected out of of pocket costs for follow-up tests. And at that moment, some delay care or walk away entirely. Too often, we don't talk about that. We don't you know, we talk about how important it is to get diagnosed early, but we don't talk about the barriers that make it where somebody might just give up and not do it. Cancer is absolutely serious, but there are the financial toxicity is serious too.
So that's where we lose the opportunity to catch cancer really. So SB 13 o nine helps close the gap by ensuring that individuals who qualify for screening can also access to medically necessary follow-up care without cost barriers. This is about making sure early detection actually works and giving families a real chance at better outcomes and more time together. So on behalf of families like mine, I respectfully ask for your I vote for SB13O9. Thank you.
Speaker 1
Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone, state your name, your organization, and your position only. Thank you. Jennifer Snyder on behalf of City of Hope and the California Life Sciences in support. Thank you.
Speaker 1
support. Thank you. McKay Carney, on behalf of Cedars Sinai, in support. Thank you. Jennifer
Speaker 34
Tannehill with Erin Reed and Associates, on behalf of the California Society for Respiratory Care, representing respiratory therapists throughout the state, in support.
Speaker 6
E. J. Eguaya on behalf of the California Academy of Family Physicians, in support. Thank you.
Speaker 11
Megan Murray, on behalf of Breathe Southern California, in strong support. Thank you.
Speaker 1
Good afternoon. I'm Marie Kennedy, volunteer advocate with the American Cancer Society Cancer Action Network, and very much in support. Thank you. Thank you.
Speaker 25
Chair Gonzalez, on behalf of my clients, the Association of Northern California Oncologists and the Medical Oncology Association of Southern California, apologies for no letter. We are in support. My Board just has to formally adopt it next week. The letter will be forthcoming. Thank you.
Speaker 14
Kenneth Wilkerson, on behalf of the American Cancer Society Cancer Action Network, proud cosponsors in support.
Speaker 34
Keisa Bruce with the American Lung Association, proud cosponsor, in support.
Speaker 1
Thank you. Seeing no further individuals that would like to come forward to register their support, if there is anyone that would like to speak and lead opposition, this is your time to come forward to the table. Are you lead opposition? Okay. You can have a seat.
Speaker 36
Our remarks, Olga Shallow, on behalf of the California Association of Health Lands, in regretful opposition to SB thirteen oh nine. We share the author's commitment to early detection and timely follow-up care for lung cancer. And importantly, preventative screening is already covered without cost sharing, ensuring early ensuring access to early detection. Where we struggle with SB thirteen oh nine is not the goal, but the elimination of cost sharing for follow-up care. Costs don't disappear.
They get shifted to premiums and are paid by everyone families, small businesses and public purchasers. Also, wanted to know that your Burb estimates this would increase premiums by over $27,000,000 annually at a time when health care affordability is already one of the biggest pressures Californians face. So we want to work with the author and the committee on solutions to help patients most without increasing premiums for everyone. And for this reason, we oppose the bill. Thank you.
Speaker 1
Thank you. If you could come and sit at the table in case anyone has any questions for you.
Speaker 23
Good afternoon, Chair and Members. Matt Aiken, behalf of the Association of California Life and Health Insurance Companies, also respectfully in opposition to the bill, and would just like to align my comments with my colleague at CAP. Thank you.
Speaker 1
To in opposition, if you can come to the microphone, state your name, your organization, and your position. No others, we'll bring it back to the committee. Senator Caballero.
Speaker 30
Thank you very much, Madam Chair. If I could ask of the opposition, that $27,000,000 annually equates to what amount per ratepayer, for lack of a better
Speaker 36
Yeah. I believe that was noted in that analysis, an additional $0.06 to $0.31 per member per month.
Speaker 30
Okay. And that includes everyone that's covered by insurance, the contract insurance? I believe that's the
Speaker 30
Thank you very much. I want to thank you for bringing this bill, and also thank you both for your testimony here. Quite frankly, I was shocked to find out that if you're diagnosed with lung disease, that the follow-up doesn't get covered, which I mean, I think there's expectations, from myself, the expectation that if something's going to be discovered, whatever needs to be done is going to be something that is going to be covered. And the amount just doesn't seem to be that cost prohibitive. I mean, this is part of the reason that we're moving slowly to single payer healthcare, because the bottom line is everything needs to get shared so that it's minute after a while if you're cutting out some of the middle people that are taking money but not rendering any services.
So, I know I'm on a soapbox. I wanted to just say that I think this is a really important bill, and the sooner we get things diagnosed, and the sooner we get people into treatment, the better off we're going to be. And I've seen that the incidence of lung cancer is surging among young people, and we've got to figure out why that's happening and how to prevent it, especially in a situation where there's the individual is not a smoker. So, for your loss, and thank you for being an advocate for resolution. Thank you,
Speaker 18
I also I hate to say this, repeat what Senator Caballero said. This is a really great, great bill, and thank you very much, senator, for bringing this forward. I also was ignorant of the fact that once you're diagnosed with an illness like that, that you wouldn't there wouldn't be follow-up. It just there's no doesn't make any sense. And not only the lives as your loss, the lives of people, but more importantly, all the suffering that takes place and all the stress, all the horrible things that somebody must go through when they so, anyway, I need to say, support it.
Speaker 17
I also, though, think we have to think about cost every time something like this comes up because it also falls on on the shoulders of working people. Working people, there are more and more poverty, working poor who just can't handle it. Spreading it could be 30¢ per person, but a lot of things get added on and added on and added on. So I hope there's a way of addressing this without just saying that's not our problem. You know, it is our collective problem as well, But I will be supporting it.
Thank you.
Speaker 11
Valladares. Thank you. I'm going to be supporting this bill, and I often share my mom's own diagnosis with pancreatic cancer. And, you know, she was diagnosed on accident in 2012, and she was in remission for nearly six years. She went for her follow-up year first every six months, then every year.
And come to find out that, especially with pancreatic cancer, there's just no there's no meaningful early detection, even when you know it exists and you're in remission. So I am curious to know I have two questions. One, when it comes to follow-up and screening for diagnostic services, what is covered? In my mom's case I know it's not lung cancer the only way they would have caught it again would have been if they were doing PET scans, and they weren't doing PET scans. They were doing, you know, blood work.
So is it pretty much any follow-up or diagnostic that the doctor would prescribe would be covered? To maybe the doctor.
Speaker 28
Nurse practitioner. Or sorry, nurse. So the follow-up tests might include PET scans, like you mentioned, follow-up CT scans, biopsies, things like that. So those would be the follow-up for an abnormal lung screening, but then the subsequent exams wouldn't be screening tests anymore. There would be a diagnostic workup, and that's where the cost sharing kicks in for patients.
Speaker 1
Okay. So I think the issue is not so much do health plans cover the follow-up, it's the cost sharing issue or the co pays. And so what this bill would do is it would eliminate the requirement for cost sharing because we know that for many people, that alone is prohibitive.
Speaker 11
Correct. And just some procedures are more expensive than others, so that was going to be part of the premise of my question, but that's okay. Is there any data that exists to show the cost of care for someone who is diagnosed after having been in remission, diagnosed early, you know, stage one or stage two, versus what's spent when caught, you know, stage four?
Speaker 33
Well, I have some numbers. I'm not sure if But this answers your basically, what patients have to pay after according to what I have here from the Scherber estimates, that a subset of patients will receive earlier stage diagnosis because they don't get care because of the bill and they avoid treatment. The approximate cost is $149,000 that they have to sometimes pay out of pocket. And so that just that alone discourages them from coming forward.
Speaker 11
And that's just the cost of diagnosis and some services. But I'm just looking at it from the perspective of if you can catch lung cancer or any cancer early, and just like anything, can intervene early, you're going to find a savings versus if you're caring for it at stage four when it's everything under the sun you
Speaker 11
don't know if the health plans have collected any data on what the cost of treating someone you diagnose early versus someone that's
Speaker 26
diagnosed later? Thank you, Senator. We don't have data. I don't have it on me at this point, but would be happy to see what we can find out from our individual members and report back to
Speaker 11
I mean, I think it's really important if we're looking at whether or not this is going to be I'm going to support the bill, but whether or not this is going to actually be more expensive or if we're going to save money or if it's a wash. So that's all. Thank you.
Speaker 7
clinician, when someone is diagnosed with early stage lung cancer, it is often treated with a single surgery or a course of radiation. Whereas if someone is diagnosed late stage, and we're making a lot of advancements in late stage lung cancer, but it is a lifelong treatment of very expensive medications, like tens of thousands of dollars a month for the rest of that person's lives. And the good news is people are living longer. But that's a huge cost burden to the health system. And so if I'm sure when they run the numbers, it's gonna add up, but a single surgery is probably more affordable than a decade of very expensive medication.
Speaker 1
Okay. Seeing no further comments or conversation, Senator, I want to thank you for bringing this bill forward. I wanna thank you for coming and testifying and sharing your your very personal story, being very vulnerable in public with all of us that are here and those who are watching. You know, my condolences to you and your family that I'm I'm so young. Like I said earlier, we attribute lung cancer a lot to tobacco, but there are other causes of lung cancer.
And those individuals are often much younger and just kind of out of the blue and completely unexpected. So, my condolences to you. You know, with this bill, we are focusing on follow-up for screening modalities. And we talk a lot about prevention, prevention, prevention, which I have said over and over and over again, that if we focus more on the preventative aspect for anything, then that will actually lower the cost of health care in the long run, because we will not have to pay for hospitalizations. We won't have to pay for surgeries.
We won't have to pay for very, very expensive medications. And for some reason, we have a difficult time focusing more on the preventative side and understanding that that will cost less in the end. But not only cost less to the health care system, but also quality of life for that particular individual. The ability for them to be able to contribute to their communities because they can continue to work. The impact that they'll have on their families is so significant, when we focus more on what we can do up front and not wait until someone has the actual condition, and we're now trying to treat that.
So, this is a great bill. I think it kind of goes in alignment with what we saw earlier with Senator Archuleta and talking about informing people about screening. So, if we're going to say, Hey, we need to screen more for lung cancer then if something is found on that screening test, then we shouldn't say, Okay, now you must pay something in order to go ahead and get the further diagnostic tests that you need to see if you truly have lung cancer or anything else. So thank you so much for bringing this bill forward. You may close.
Speaker 33
Thank you. And I want to just highlight thank you, Madam Chair, for what you just stated. I want to highlight that very important point, right? We are talking about pennies. It just, you know, it baffles me in terms of the costs at the tail end.
And we just heard the nurse practitioner talk about a lifetime of medication treatment, whatever that may mean for that family. But when you're in this business long enough, hear stories. I mean, I've heard it all from family members discovering that they need treatment, but their family's already financially stressed. So they don't even tell the family because now they're going to have to choose whether it's a college tuition or get care. And so people are not getting the care they need.
But another important point that I like to make as I like to educate our youth is, you know, I always ask about our youth. The other day in this committee, we had Alzheimer's. And I always ask, give me the diagnosis of the youngest individual, right? And I think it was 18. I was shocked because we always think of Alzheimer's, cancer, and all these issues as an older person's disease.
But when I heard 18 Alzheimer's, and that's the youngest diagnosed, something's happening clearly. So I do think that we're seeing a spike on younger people. I know a 25 year old young woman who died of breast cancer. And again, that's typical. But out of pocket costs cannot be the reason why they don't get care.
And I think that, you you just stated that we pay at the front end, but at the end we save money. Because not only are we saving the trauma to the family, we're saving cost to the health plans. And I think it just makes for a better society. With that, I respectfully ask for an eye vote. Thank you.
Speaker 1
Thank you. At this time, I will entertain a motion. So moved. Moved by, senator Valladares. The motion is due pass as amended and re refer to the committee on appropriations.
Assistant, please call the roll.
Speaker 31
Senators Weber Pearson. Aye. Weber Pearson, aye. Valadares? Aye.
Valadares, aye. Cavallero? Aye. Cavallero, aye. Darazo?
Aye. Darazo, aye. Gonzales? Aye. Gonzales, aye.
Grove? Aye. Menjivar? Padilla? Perez?
Rubio? Aye. Rubio, aye. Smallwood Cuevas? Aye.
Smallwood Cuevas, aye. Madam Churchill
Speaker 1
because I stopped to do mine, and then we'll do that because I need to call everybody back.
Speaker 11
Now moving to file item number 11, s B1199. Senator Weber Pearson, you are recognized when you're ready.
Speaker 1
Thank you. Good afternoon, madam vice chair and members of the committee. I am here to present SB eleven ninety nine, which would ban the use of copay accumulators in California, joining 20 other states in banning these. Will be accepting the committee amendments today. Copay accumulators are harmful practice increasingly used by health care insurers that can leave patients with significant out of pocket cost.
Co pay accumulators allow insurance and pharmacy benefit managers to pocket patient assistance intended to help those patients meet their shared cost, instead of counting those payments towards the enrollee's annual out of pocket limit. For individuals living with chronic or terminal illnesses, out of pocket costs can quickly add up when having to pay the plan's maximum out of year after year, making it difficult to afford essential medications and treatments. This is especially true for patients diagnosed with conditions that require medications to manage it. Over the past decade, insurers have increasingly shifted the cost share of specialty medications to patients by increasing deductibles and charging coinsurance for specialty medications, which allows California regulated plans to avoid California's $2.50 monthly copay cap for prescription drugs. As a result, many patients must rely on financial assistance from third parties to afford their vital medications, even though they do have health care coverage.
However, insurers are increasingly undermining this assistance by not counting the amount of money covered by manufacturer or charity co pay assistance programs towards the enrollee's annual deductible and out of pocket limit. Instead, the co pay assistance funds are accepted by the health plans, or PBMs, but not counted towards the patient's cost sharing obligation. Banning copay accumulators can also help avoid situations in which individuals may forgo necessary treatments due to cost concerns. By helping patients maintain adherence to their medications, this legislation can lead to better outcomes for patients and lower long term costs for our health care system by reducing costly ER room visits and hospitalizations. Additionally, these copay assistance programs help address health inequities by making necessary medications available to underinsured and under resourced patients who otherwise would have to choose between food and medicine.
It is imperative that we take action to ensure that all patients have access to the care they need without facing financial obstacles. To date, 20 states, both red and blue, have banned their use, and California should be added to the Thank you, and I respectfully ask for an aye vote. With me today in support is Miguel Pasidas, representing the sponsor, the Department of Insurance, and Jerica Code? Jerica. Jerica, I'm sorry.
Volunteer and patient advocate with the Arthritis Foundation. Thank you.
Speaker 38
Good afternoon, Vice Chair and Committee members. My name is Miguel Bastidas, Chief Deputy Legislative Director for the California Department of Insurance, here under the leadership of Assurance Commissioner Ricardo Lara. As a proud sponsor of SB eleven ninety nine, Commissioner Lara would like to thank the chair, Senator Weber Pearson, for her leadership in authoring this critical patient protection and affordability measure. SB eleven ninety nine simply fixes an accounting issue. If cost sharing is paid by a consumer or on their behalf by anyone to obtain their medications, it should count towards their maximum out of pocket limit, also known as MOOP.
Existing federal law requires all cost sharing to count towards the MOOP. This includes payments made by a consumer but also payments made on their behalf. In California, existing law bans manufacturer assistance on cost sharing for prescription drugs except in specific circumstances. SB eleven ninety nine does not change the underlying policy of the state or federal government regarding the use of coupons. Instead, SB eleven ninety nine would homogenize existing federal requirements related to accounting cost sharing with California's existing public policy related to manufacturer coupons.
Speaker 12
By merging current state and federal requirements, SB eleven ninety nine encourages carriers and PBMs, or pharmacy benefit managers, to put lower cost generics on their formularies, which in turn helps steer patients away from higher cost brand name drugs and discourages their overuse. At the same time, SB eleven ninety nine ensures that patients are able to have their cost sharing count towards their MOOP when legal in California. Patients shouldn't have to rely upon coupons to afford life saving or maintaining prescriptions, but when they are paying for insurance, they should be able to rely upon the full protection of their insurance policy when cost sharing has been paid by the patient or anyone else. At least 26 other states, as well as D. C.
Speaker 38
And Puerto Rico, have enacted laws codifying or exceeding federal requirements. As one of the regulators of the private health insurance market in California, it is critical that the department has the tools to enforce both state and federal law. SB eleven ninety nine simply codifies what is already good federal law. On behalf of insurance commissioner Ricardo Lara, I respectfully ask for your vote. And with me today also is assistant chief counsel for the department and the health equity and access office answer any technical questions.
Thank you.
Speaker 15
Good afternoon. Good afternoon, Vice Chair and members of the committee. My name is Jerica Code, and I'm a longtime patient advocate with the Arthritis Foundation. My involvement with the foundation began nearly twenty years ago when my daughter, Macy, was diagnosed with juvenile arthritis. When I thought of arthritis, I thought of an older person with swollen fingers and slowed movement.
But in October 2008, my daughter was diagnosed at just 18 old. I come today to ask for support of SB eleven ninety nine. This bill would end the use of copay accumulators. This patient focused bill aims to ensure that all payments made by or on behalf of the patient are applied towards deductibles and out of pocket maximums. I first learned about accumulators a few years ago when I called the specialty pharmacy to refill Macy's biologic medication.
This should have been a simple, routine phone call that took about five minutes. However, it lasted about forty minutes and resulted in weeks of other calls and follow-up. What should have happened is that the copay of nearly $1,600 should have been covered by our copay assistance card, leaving me with just a $5 cost. In that call, I learned that the funds from the card had been exhausted. After many calls with our health plan, specialty pharmacy, drug manufacturer, our doctor's office, I learned that all year, the funds from the copay card had not been applied to our out of pocket maximums.
Typically, she would have met this amount in the spring and then would be covered at 100% for the rest of the year. I was now faced with the problem of coming up with $1,600 for the copay to avoid a delay in treatment. I felt overwhelmed figuring out such a big financial decision. There was a lack of transparency from the insurance provider for me to understand what caused the change. Ultimately, we sacrificed to cover this expense while I continued to fight for coverage.
Speaker 28
In addition to the obvious financial costs, there are many invisible costs that have had a profound effect on my family when it comes to her treatment. Monthly appointments at a specialist three hours away, weekly physical therapy, monthly infusions, trips to the pharmacy, hours spent on the phone with insurance. Not to mention the time spent just comforting her when she was in pain. This all led me to leaving a successful career that I loved, which meant loss of income and loss of contributing to retirement for fifteen years. My husband often feels tied to his job because we need insurance that has her drugs on their formulary.
Speaker 15
Plus, the social and emotional impacts, disease progression, and the list goes on. These biologic drugs are life changing. But due to issues with co pays, they can be cost prohibitive for many patients. For Macy, without these medications, she lived in constant pain, struggled to make it through the school day, and often felt sidelined from her own life. She's also a patient advocate and shares her own story of invisible costs.
She tells a story about how much she loved school, particularly science. In third grade, she was so excited because her class was going to use microscopes for the first time. But the pain in her legs was too much and she went home early before she had the chance. That same little third grader is now finishing her first year of college, and she still loves science. In fact, she's a double major in biology and public health with dreams of going to medical school.
She's also a Division I college athlete and a patient advocate. And all of this is possible because of timely and affordable access to treatment. SB eleven ninety nine would directly support patients like Macy by removing the barrier of copay accumulators. I urge you
Speaker 11
to vote for patients by voting yes on SB eleven ninety nine. Thank you. We'll now move to anyone else in the room that would like to express your support. Please state your name, your organization, and your position only.
Speaker 27
Tim Madden, representing the California Chapter of the American College of Emergency Physicians, the California Chapter of the American College of Cardiology, and the California Rheumatology Alliance, all in support.
Speaker 6
E. J. Aguayo, on behalf of the California Academy of Family Physicians, in support. Thank you.
Speaker 15
behalf of the Bleeding Disorders Council of California and the California Rare Disease Access Coalition, in strong support.
Speaker 25
Ms. C. Johnson, on behalf of the Cystic Fibrosis Foundation, in support.
Speaker 5
Doctor. Ryan Spencer, on behalf of the California Podiatric Medical Association, and the Crohn's and Colitis Foundation, in support.
Speaker 10
Kathy Mossberg on behalf of the San Francisco AIDS Foundation, in support.
Speaker 18
Good afternoon. Linda Way with Western Center on Law and Poverty, in support.
Speaker 13
Michelle Johnston with the National Multiple Sclerosis Society, in support. Thank you.
Speaker 11
Thank you. We'll now move to any key witnesses here in opposition. Thank you. And you're both recognized for a combined five minutes.
Speaker 26
Madam Chair and members, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance, regrettably here in opposition to SB eleven ninety nine. I'd like to thank the Chair for her thoughtful engagement on this issue, as well as her staff and sponsors. We had a sincerely productive conversation last week, we appreciate all the time that they spent with us as we worked through what can otherwise be a really complicated issue. While we share the goal of making prescription drugs more affordable, we have serious concerns about codifying the existing federal rule related to copay accumulators into statute. Would require health plans and insurers to count manufacturer copay coupons and other third party payments towards a member's deductible and annual out of pocket max.
Speaker 9
Currently, pharmaceutical companies often offer coupons to privately insured patients in order to provide discounts on brand name drugs, even when lower cost generic alternatives are available. While these coupons are often lower or eliminate the patient's co pays, in the short term and then long term, they could lead to uncertainty about a patient's out of pocket cost for month to month, since pharmaceutical companies can change their coupon programs and patient eligibility roles for those programs at any time. We further are concerned that these coupons enable drug manufacturers to maintain high list prices and drive up costs for all patients through higher insurance premiums. Drug companies often keep these drug prices high by setting their own list prices and then offering copay coupons in order to help some patients afford those high prices. Companies also use drug coupons to increase drug sales for a particular brand name drug and to steer patients away from lower cost generics.
Speaker 26
The goal here is to establish brand name loyalty over lower cost options. To that end, our position is underscored by a recent bipartisan effort on the federal level to ask the Governmental Accountability Office to assess whether manufacturer copay coupons steer patients toward higher cross brand name drugs. This oversight is intended to clarify how coupon programs affect utilization and total spending over time. Having said that, we would caution the legislature at this time from codifying the standard, as it appears this issue will likely be included on the spring calendar to be reviewed. At this time, given the potential cost and broader implications of this policy, we think it warrants the legislature slowing down the process in order to give us time to evaluate the impact of policy on access and affordability.
For those reasons we are opposed to the bill, We understand and appreciate if it moves forward today. We'd like to continue our engagement on the issue. Thank you.
Speaker 24
Madam Chair, members, Sean Winger here on behalf of America's Health Insurance Plans. We're the National Trade Association for Health Plans. In the interest of time, I'd just align my comments with ACLIC and certainly agree that this is really fluid at the national level and believe that this bill is a little bit premature related to that. But should the bill move forward, you know, we have been active in other states, and we've continued advocate for particular amendments to this type of legislation. One would be requiring manufacturers to provide financial assistance to the patients for the entire plan year and notifying the patient of their terms and conditions in advance.
Speaker 8
We would also advocate for requiring manufacturers to annually report on the amount that they spend on financial assistance and also require manufacturers to inform health plans when they are providing a coupon or other type of financial assistance to an enrollee of that plan. A lot of times, we're left out of the loop. It's directly between the patient and the pharmacy and the drug company. And so, we feel like more transparency there would be warranted and look forward to further discussions on all of that.
Speaker 11
Thank you. We'll now move to the committee room. Is there anyone else here that would like to express their opposition? Please come forward, state your name, organization, position. Seeing none, we'll move to the committee.
Senator Caballero.
Speaker 30
I appreciate what you're trying to do. I was impressed with the list in terms of things that need to be considered. I've never seen these coupons before, but one popped up recently that I was made aware of. And you can't tell if it's a scam or who's offering it and how much it's gonna be. You have to click through the the pages.
And in the end, I recommended that the person that received it just erase it because I couldn't tell if it was a scam. And so I think the documentation and everything that was said. So my question is, are you willing to continue working? And I'm sure you will. And I'll support it today to keep it moving, because I think you're going in the right direction, except for that I think these issues have to be addressed as well.
Speaker 1
Yeah. No, thank you for that. And absolutely, they have been meeting with staff, but this is actually my first time hearing some of those recommendations, and I actually think they're valid. So I would definitely continue.
Speaker 30
That sounds great. Thank you so much for that. I appreciate your I appreciate all the testimony.
Speaker 11
Senator Gonzalez. I, too. I thank you very much also for bringing this forward. I had a question on the brand name issue that had been brought up versus perhaps a lower cost drug. Can you just specify like how this would be perhaps could be reconciled in the future or how you're thinking about that?
Because overall, the affordability issue with drug costs is, of course, important to all
Speaker 1
And I will let the Department of Insurance tackle that question, but affordability is key.
Speaker 3
Currently, state law actually forbids insure I mean, drug manufacturers from offering coupons if there's a generic therapeutic equivalent that's on the formulary on a lower cost sharing tier. So, this bill, if those three things are met, then the coupon they couldn't use a coupon for that drug. Does that answer your question?
Speaker 11
Yes. Thank you very much. I appreciate it. Seeing no other questions, Senator, I just want to clarify that you are accepting the committee's amendments.
Speaker 1
I would like to thank the committee and staff for all of the work that they've done on this bill. I know, you know, this has been a conversation that we have had for many years about copay accumulators. And so definitely look forward to continuing to work with the opposition and taking some of their recommendations into account and ensuring that we have that transparency that is desperately needed. And with that, respectfully ask for an I vote.
Speaker 11
Members, I'll be entertaining a motion. So moved. Smallwood Cuevas motions. The motion is do pass when we refer to the committee on appropriations. Do pass as amended, and we refer to the committee on appropriations.
Secretary, please call
Speaker 31
the roll. Senators Weber Pearson? Aye. Weber Pearson, aye. Valadez?
Not voting. Caballero?
Speaker 11
That's five zero, and that bill is still on the call. I will move the consent file when appropriate, Madam Chair.
Speaker 1
Thank you. The consent file has been moved by Vice Chair. Assistant, please call the roll on the consent calendar.
Speaker 1
The bills on the consent calendar are file item one, s b nine twelve by senator Cervantes with amends and file item four, s b twelve seventy one, Senator
Speaker 31
Reyes. Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares?
Aye. Valadares, aye. Caballero? Aye. Caballero, aye.
D'Arrazzo? Gonzalez? Aye. Gonzalez, aye. Grove?
Benjevar? Padilla. Perez. Rubio. I.
Smolikovas. Smolikovas I.
Speaker 1
Six zero. We will place that on call. At this time, I'm gonna ask any member of the health committee to please come to the committee room. We have finished hearing all of our bills and are now taking role. We will now move to file item two, SB eleven twelve.
Can I get a motion? Love. SB eleven twenty four. Moved by Senator Gonzalez. The motion is due passed as amended and re referred to the committee on appropriations.
Assistant, please
Speaker 31
call the roll. Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares?
Aye. Caballero? Aye. Caballero, aye. D'Arrazzo?
Aye. Gonzales, aye. Grove? Menjivar? Padilla?
Perez, Rubio? I. Rubio, I. Smallwood Cuevas? I.
Smallwood Cuevas, I.
Speaker 1
That bill has five to zero. We'll place that on call. We'll now move to file item number three, SB eleven fifty. That has been moved by Senator Valladares. The motion is due pass as amended.
Assistant, please call the roll. Senators Weber Pearson? Aye. Weber Pearson, aye.
Speaker 31
Valadares? Aye. Valadares, aye. Caballero? Aye.
Caballero, aye. D'Arrazzo? Gonzalez? Gonzalez, aye. Grove?
Menjivar? Padilla, Perez, Rubio? Aye. Rubio I. Smolod Cuevas?
Aye. Smolod Cuevas I.
Speaker 1
60. We'll place that on call. We will now move to file item number five, s B1400 by senator Aragain. Can I get a motion?
Speaker 1
Moved by senator Caballero. The motion is due pass as amended. Assistant, please call the roll. Senators Weber Pearson.
Speaker 31
Aye. Weber Pearson, aye. Valadares? Aye. Valadares, aye.
Caballero? Aye. Caballero, aye. Dorado? Gonzalez?
Aye. Gonzalez, aye. Grove? Mengevar? Padilla?
Perez, Rubio? Aye. Rubio I. Smolod Cuevas? Aye.
Smolod Cuevas I. Six zero on call.
Speaker 1
That bill has six zero. We'll place that on call. We will now move to file item number eight, s b 13 o nine by senator Rubio. Please call the absent members, senators, Grove, Menjivar, Padilla, Perez. Excuse me.
Senator Padilla, would you like to vote on
Speaker 1
That is eight zero. We will place that on call. We'll now move to file item nine. Please call the absent members.
Speaker 1
Padilla I seven zero. That bill is seven zero. We'll place that back on call. We will now move to file item number 10. Please call the absent members.
Senators Gonzales.
Speaker 31
Aye. Gonzales, aye. Grove, Padilla? Aye. Padilla, aye.
Perez? Small would quibus.
Speaker 1
That bill has, it's eight zero. We'll place that on call. We'll now move to file item 11. Please call the absent members. File item 11 s b eleven ninety nine.
Please call the absent members. Senators Valadez, Dorazo, Grove, Menjivar, Padilla, Padilla I, Perez. So 60 on call. 60 on call.
Speaker 1
I am requesting that all members of the health committee come down because we have concluded hearing our bill presentation, and we are now voting. I will go back to the consent calendar. Please call the absent members. Senators D'Arrazo, Grove, Menjivar, Padilla,
Speaker 1
File item number two, s b 1124. Please call the absent members. Senators Valadez, Dorazo, Grove, Menjivar, Padilla Aye. Padilla aye. Perez.
Aye. Perez aye. 70. That's 0. We'll place that back on call.
We'll move to file item three, SB eleven fifty. Please call the absent members. Senators D'Arrazo, Grove, Menjivar, Padilla, Padilla, I, Perez, I. Perez, I. Eight zero
Speaker 1
80. We'll place that back on call. We'll now go to file item five. SB 1,400, please call the absent members. Senators D'Arrazo, Grove, Menjivar, Padilla, Padilla I, Perez I.
Perez I. Eight zero on call. That's 80. We'll place that on call. We'll go to file item eight.
Yeah. We need Perez. Senators s b 13 o nine. Please call the absent members. Senators Grove, Menjivar, Perez.
Speaker 1
90 on. 90 will place that on call. We'll move to file item 9SB1314. Please call the absent members, senators Valadez, Gonzales, Grove, Perez.
Speaker 1
We will now move to file item 10. I'm sorry. That is 80. 80. We'll place that on call.
We will now move to file item 10, s b ten ninety four. Please call the absent members. Senators Grove Perez. I.
Speaker 1
on 90. We'll place that on call. We'll go to file item 11, s b eleven ninety nine. Please call the absent members. Senators Valadez, Dorazo, Grove, Menjivar, Perez.
Perez I. 70. The 70, we'll place that on call. We will now move back to the consent calendar. Please call the absent members.
Senators Dorazzo, Grove, Menjivar, Perez. I.
Speaker 1
D'Arzo well, go go back. D'Arzo I. 90 on call. That's 90. We'll place that on call For the consent calendar, we will now move to file item two s b eleven twenty four.
Please call the absent members.
Speaker 1
That is 80. We'll place that back on call. We'll go to file item three s b eleven fifty. Please call the absent members. Senators D'Arzo?
Aye.
Speaker 1
on call. 90. Place that on call. We will now go to file item five, s b 1,400. Please call the absent members.
Senators D'Arzo? Aye.
Speaker 1
90, we'll place that on call. She's recorded on a We're on file item eight, s b 13 She's already She's already
Speaker 1
We will go to file item 11, s b eleven ninety nine. Please call the roll. Senators Valadez, Darazo?
Speaker 1
Requesting any members of health committee that have not voted to come down now, we have concluded our bill presentation and are awaiting the final members to vote. Senate Committee on Health will take a brief recess. Senate Committee on Health will resume in two seconds. All right. We will start with the Did she consent?
No. Not yet. Consent calendar. Please call the absent members. Senators Grove.
Menjivar.
Speaker 1
Menjivar. Aye. Ten zero. Ten zero. We'll place that on call.
File item two, s B1124. Please call the absent members. Senators Valadez, Grove, Menjivar. Aye. Menjivar, aye.
90 on call. File item three, s b Nine zero on call. 90 on call. File item 3SB1150. Please call the absent members.
Senators Grove. Mendrevar. Aye. Menjivar. Aye.
100. We'll place that on call. File item 5SB1400. Please call the absent members. Senators Grove.
Menjivar. Aye. Menjivar. Aye. 100.
We'll place that on call. We'll go to file item 8SB13O9. Please call the absent members. Senators Grove. Menjivar.
I. Menjivar. I. It's 100. We'll place that on call.
File item 11, s b 1199. Please call the absent members. Senators Valadez, Grove, Mendrevar I. Mendrevar I. Nine zero on call.
Speaker 14
90 on call. The senate on health will wait for until 4PM to conclude. Absent members. Senators Grove? For I-nine 12?
Speaker 1
Grove I. Eleven zero. Eleven zero. That bill is out. File item number two, SB eleven twenty four.
Please call the absent members. Senators Valadez? Grove.
Speaker 1
Nine zero. That bill is out. File item number three, SB1150. Please call the absent members. Did he take the amendments?
He did take the amendments. Everybody did. K. Go ahead. Sorry.
Senators Grove? Aye. Grove, aye. Eleven zero out. Eleven zero.
That bill is out. File item number 5 s B1400. Please call the absent members. Senators Grove? Aye.
Grove, aye. It's eleven zero. Eleven zero. That bill is out. Go to file item eight s b 13 o nine.
Please call the absent members. Senator Grove? Not voting. Ten zero out. Ten zero, that bill is out.
File item nine s b thirteen fourteen, please call the absent members. Senators Valadez, Gonzales, Grove. Not voting. So that is eight zero out. Eight zero.
That bill is out. File item 10, s b ten ninety four. Please call the absent members. Senators Grove. Aye.
Grove, aye. Smolut Cuevas? 100. 100. That bill is out.
File item 11, s b 1199. Please call the absent members. Senators Valadez? Grove? Not
Speaker 1
Nine zero, that bill is out. Thank you, madam chair. You're welcome. Senate committee on health is concluded.
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