Dr Joseph Alvarnas: Cancer Care Equity Act Meets the Needs of Patients With Advanced Disease

The approval of the California Cancer Care Equity Act (SB 987) will provide Medi-Cal beneficiaries with improved 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 adviser of AccessHope in Duarte, California.

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What were the differences in cancer outcomes that City of Hope and other institutions were seeing that caused your coalition to seek legislation for the Cancer Care Equity Act?

There are a couple factors into this. And I'll start with the challenge that many community physicians have described to us, which is as a patient has evolved in their care, whether it's someone with 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, through care technologies, like CAR [chimeric antigen receptor] T cells, even toward access to studies that are looking at cancers differently through genomic testing that might not be available in the community.

Under the existing Medi-Cal model, the way that the state has chosen to control health care costs has been by putting 90% of Medi-Cal beneficiaries into managed care. Many of those managed care networks at a medical group level do not include an NCI-designated CCC, which means that functionally the oncologists’ hands have been tied from making that referral due to the artificiality of these payment-related barriers.

And SB 987 allows that oncologist to do the right thing for their patient as they see fit, including escalating their care to another site of care based upon real data and opportunities available through clinical trials.

Not long after the Cancer Care Equity Act was signed, Governor Newsom rejected legislation on parity in coverage for genomic testing. How will this affect equity in care?

So, you've asked a phenomenal question. As the days were getting closer to the final deadline date for the governor signing legislation, that was September 30 of this year, I was a bit discouraged in seeing that some bills were getting vetoed. One of those was a bill related to HPV [human papillomavirus] vaccination as a covered benefit. Another one of those bills was the biomarker bill, which our coalition and City of Hope had specifically supported.

I'm disappointed that the bill did not get signed into law. In the governor's veto, he noted that the bill was overly broad and as the bill went through the legislative process, he didn't feel that the bill had been amended in ways in which the state would have liked to have seen. To me this means that that road isn't closed forever. I think that there's an opportunity to re-engage the governor and next year to seek biomarker testing parity.

That said, under the terms of SB 987—that's the California Cancer Care Equity Act—whatever care that person needs, they will get. So, if someone qualifies for access to care at an NCI[-designated] CCC, if genomics is part of the care portfolio, it will be done. If a CAR T cell is part of that portfolio of care, 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 care medicine and realignment in the goals of care is the right thing to do, then we can support that.

The beauty of SB 987 is that while it may apply to a somewhat restricted population, what it does, it goes beyond this idea of a second opinion and allows that patient to enjoy continuity of care for as long as they need care within that setting. I see that as a huge advance.