Approval of the California Cancer Care Equity Act (SB 987) will provide Medi-Cal beneficiaries with greater access to National Cancer Institute (NCI)-designated Comprehensive Cancer Centers (CCCs) that can better serve each patient through access to unique clinical trials and care services, said Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical advisor for AccessHope in Duarte, Calif.
What were the differences in cancer outcomes that City of Hope and other institutions found that prompted your coalition to call for legislation for the Cancer Care Equity Act?
There are a few factors to this. And I’ll start with the challenge that many community physicians have described to us, which is that as a patient progresses through their care, whether it’s acute leukemia or lymphoma, myeloma or an advanced solid tumor, there are times when a transfer to an academic center or to a clinician at an NCI-designated CCC can help better serve that patient through access to unique clinical trials , thanks to care technologies, such as CAR [chimeric antigen receptor] T cells, even toward access to studies that look at cancers differently through genomic testing that might not be available in the community.
Under the existing Medi-Cal model, the way the state chose to control health care costs was to place 90% of Medi-Cal recipients in managed care. Many of these medical group-level managed care networks do not include an NCI-designated CCC, which means that functionally, oncologists’ hands have been tied not to make this reference due to the artificiality of these payment barriers.
And SB 987 allows this oncologist to do what is right for their patient as they see fit, including escalating their care to an alternate site of care based on real data and opportunities available through clinical trials. .
Shortly after signing the Cancer Care Equity Act, Governor Newsom rejected the parity legislation in genomic testing coverage. How will this affect equity in care?
So you asked a phenomenal question. As the days approached the final deadline for the Governor’s signing of the law, which is September 30 of this year, I was a bit disheartened to see that some bills were making the subject of a veto. One of them was a bill related to HPV [human papillomavirus] vaccination as a covered benefit. Another such bill was the Biomarkers Bill, which our coalition and City of Hope specifically supported.
I am disappointed that the bill has not been proclaimed. In the governor’s veto, he noted that the bill was too broad and that the bill was going through the legislative process, he did not feel the bill had been amended in a way that the would have liked to see. To me that means this road is not closed forever. I think there is an opportunity to rehire the governor and next year to seek parity in biomarker testing.
That said, under the terms of SB 987, the California Cancer Care Equity Act, whatever care that person needs, they will get. So if someone is eligible for access to care in an NCI[-designated] CCC, if genomics is part of the care portfolio, it will be done. If a CAR T cell is part of this care portfolio, the patient will have access to it. If a high-impact therapeutic interventional trial is the right thing to do, that will be part of the coverage. If supportive medicine and realigning goals of care is the right thing to do, then we can support that.
The beauty of SB 987 is that while it can apply to a somewhat restricted population, which it does, it goes beyond this idea of a second opinion and allows this patient to benefit from continuity of care for as long as he needs care in this setting. I see this as a huge step forward.