Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:03/25/2009
ATTENDANCE
Time:10:28 AM to 12:38 PM
Carroll M.
X
Lundberg
*
Place:SCR 356
Mitchell
E
Morse
X
This Meeting was called to order by
Newell
X
Senator Boyd
Schultheis
*
Tochtrop
X
This Report was prepared by
Boyd
X
Elizabeth Burger
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
SB09-251
HB09-1237
SB09-250
Referred to the Committee of the Whole
Referred to Appropriations
Amended, Referred to Appropriations


10:28 AM -- Senate Bill 09-251

Senator Romer introduced Senate Bill 09-251. A handout concerning the bill was distributed to the committee (Attachment A). The bill permits optometrists and physicians to prescribe and sell drug dispensing contact lenses. He explained that new technology has allowed allergy drugs to be imbedded in contact lenses. Currently, Colorado law prohibits optometrists from legally selling drugs, and the bill will permit optometrists to prescribe and sell the new lenses.

3.25SENHHS.A.pdf

10:31 AM --
Dr. Donna Ellinger, representing Colorado Optometric Association, testified in support of the bill. She explained that contact lenses are fit and prescribed by an optometrist or an ophthalmologist, and they may be dispensed for a fee. Contact lenses are currently classified as a "device" by the federal Food and Drug Administration. The new lenses with embedded drugs are expected to be classified as a "drug." Optometrists and ophthalmologists will fit the new lenses, but under current Colorado law, cannot dispense the new lenses for a fee. She explained that the lenses would likely be only available from a pharmacy if the bill is not passed, which would inconvenience customers. She stated that it isn't clear that pharmacies are interested in stocking contact lenses. She responded to questions from Senator Carroll regarding the terminology "dispense for a fee."

10:37 AM --
Dick Brown, representing the Colorado Society of Eye Surgeons and Physicians, testified in support of the bill. He responded to questions from Senator Carroll regarding the bill's language expressly permitting an optometrist to charge a fee for dispensing the lenses. Senator Romer commented on the bill's provisions and the use and dispensing of contact lenses.

BILL:SB09-251
TIME: 10:46:45 AM
MOVED:Tochtrop
MOTION:Refer Senate Bill 09-251 to the Committee of the Whole with a recommendation that it be placed on the consent calendar. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
Yes
Mitchell
Excused
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 7 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS




10:50 AM -- House Bill 09-1237

Senator Shaffer introduced House Bill 09-1237 and two handouts concerning the bill were distributed to the committee (Attachments B and C). The bill makes changes to statutory provisions implemented by Senate Bill 07-004, which established methods of payment for early intervention services by private health plans.

3.25SENHHS.B.pdf 3.25SENHHS.C.pdf

10:51 AM --
John Miles, representing the Department of Human of Services, referenced attachment C, which is a comparison chart of the changes made by the bill. He explained that Senate Bill 07-004 was an attempt to streamline the payment for and implementation of early intervention services.

10:53 AM

Senator Shaffer responded to questions from Senator Schultheis regarding requirements related to private health insurance company financial contributions to the cost of the services. Mr. Miles returned to the table to respond to questions from Senator Schultheis. Mr. Miles responded to questions from Senator Lundberg regarding whether or not participation by insurance companies in the early intervention services system was mandatory. Mr. Miles responded to additional questions from Senator Lundberg regarding support of the insurance industry for the bill.
BILL:HB09-1237
TIME: 11:01:21 AM
MOVED:Tochtrop
MOTION:Refer House Bill 09-1237 to the Committee on Appropriations. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
Yes
Mitchell
Excused
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 7 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS




11:03 AM -- Senate Bill 09-250

Senator Tochtrop introduced Senate Bill 09-250. The bill requires a health benefit plan that covers cancer chemotherapy treatment to provide coverage for prescribed, orally administered anticancer medication. Senator Tochtrop described the benefits of oral anticancer medication. Senator Tochtrop responded to questions from Senator Carroll regarding oral anticancer medication and noted that Medicaid does not current restrict the prescription of oncology drugs. She responded to additional questions from Senator Morse regarding coverage of oral anticancer drugs in Medicaid, and from Senator Lundberg regarding insurance premium increases that could result from the bill.

11:16 AM --
Susan Cox, representing Kaiser Permanente, distributed three handouts (Attachments D, E, and F) and discussed the costs of oral chemotherapy medication. She noted that Kaiser Permanente does include oral chemotherapy drugs on its drug formulary and does cover oral chemotherapy for certain types of cancer with appropriate cost sharing. She discussed an article outlining common misconceptions about oral chemotherapy. She stated that the bill will effectively increase costs for all enrollees in Kaiser Permanente.

3.25SENHHS.D.pdf 3.25SENHHS.E.pdf 3.25SENHHS.F.pdf

11:26 AM --
Jared Freml, representing Kaiser Permanente, testified that Kaiser Permanente has a process to review therapies and drugs for efficacy, and drugs that are shown to be effective are added to its formulary. He stated that many of the cancer drugs administered intravenously have been around for some time and have generic equivalents. The oral anticancer medications are newer, and therefore, generics are not available. He discussed the differences in side effects and toxicity of oral and intravenous cancer medications. He discussed advancements in the administration of chemotherapy intravenously. He responded to questions from Senator Carroll regarding whether the oral medications will be a replacement for all of the cancer treatment delivered intravenously. Ms. Cox responded to questions from Senator Carroll noting that the effect of the bill is to change the drugs from a "pharmacy" benefit to a "medical" benefit. Ms. Cox stated that the language of the bill will have the effect of driving up health insurance premiums.

11:48 AM --
Ben Price, Colorado Association of Health Plans, testified that the drugs are already covered by health plans. He stated that the bill opens the door to increased marketing by prescription drug companies.

11:52 AM --
Travis Berry, Colorado Competitive Council, testified in opposition to the bill. He stated that the bill is not a question of whether or not the benefit is covered, but how the copayments and cost sharing for the drugs are structured. He stated that the bill allows manufacturers to dictate that treatments with different costs be covered at the same level.





11:54 AM -- Dr. Mercedes Dombi, representing cancer patients, testified that it is easier for her to find care for patients without insurance coverage than those with coverage. She stated that some oral cancer drugs are becoming the first line of treatment for some forms of cancer, and that the bill is beneficial to patients. She responded to questions from Senator Morse regarding coverage of oral chemotherapy drugs in Medicaid. She further responded to questions from Senator Boyd regarding whether oral cancer drugs are subject to preauthorization in Medicaid. She responded to questions from Senator Lundberg regarding the differences in costs between the intravenous treatments and oral medications.

12:14 PM --
Dana Dzwonkowski, representing the American Cancer Society Cancer Action Network, testified that the bill was seeking to ensure that oral medications are treated as a medical benefit rather than a pharmacy benefit under health insurance plans. She discussed the travel time that some individuals in rural areas must undertake to seek intravenous chemotherapy. She encouraged the committee to support the bill.

12:17 PM --
Vicki Tosher, representing the Colorado Breast Cancer Coalition, testified in support of the bill, stating that the bill is really about how much patients will pay out of pocket for oral anticancer medication. She stated that the bill doesn't require physicians to prescribe oral chemotherapy, but allows its usage when appropriate. She discussed pharmaceutical manufacturers' drug discount programs.

12:23 PM --
Rosanna Reyes, representing the National Association of Hispanic Nurses and the Colorado Council of Black Nurses, testified regarding her experience caring for a patient with cancer.

12:24 PM --
Catherine Benavidez, representing the National Hispanic Nurses and the Colorado Council of Black Nurses, testified in support of the bill, stating that the decision about which medications are appropriate should be between the patient and the doctor.

12:26 PM

Senator Schultheis distributed amendment L.005 (Attachment G). The amendment specifies that Medicaid must include the same oral anticancer medication coverage as required by the bill. Senator Tochtrop gave concluding remarks regarding the bill. Senator Boyd distributed amendment L.001 (Attachment H). The amendment specifies that nothing in the bill prohibits the prescription of generic medications.

3.25SENHHS.G.pdf 3.25SENHHS.H.pdf
BILL:SB09-250
TIME: 12:28:06 PM
MOVED:Boyd
MOTION:Amend prepared amendment L.001 (Attachment H), line 2, after "for", insert "oral". The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Excused
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB09-250
TIME: 12:28:30 PM
MOVED:Boyd
MOTION:Adopt prepared amendment L.001 (Attachment H), as amended. The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Excused
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB09-250
TIME: 12:29:51 PM
MOVED:Schultheis
MOTION:Adopt prepared amendment L.005 (Attachment G). The motion passed on a 4-3 roll call vote, with one member excused.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Excused
Morse
Yes
Newell
No
Schultheis
Yes
Tochtrop
No
Boyd
Yes
Not Final YES: 4 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS
BILL:SB09-250
TIME: 12:35:52 PM
MOVED:Tochtrop
MOTION:Refer Senate Bill 09-250, as amended, to the Committee on Appropriations. The motion passed on a 6-1 roll call vote, with one member excused.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
No
Mitchell
Excused
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 6 NO: 1 EXC: 1 ABS: 0 FINAL ACTION: PASS



12:38 PM

The committee recessed.