State

Senator Scott Wiener (D-San Francisco) announced Senate Bill 1021, which will keep out-of-pocket drug costs low for consumers by preserving and strengthening existing drug pricing protections. SB 1021 does this by permanently extending drug co-pay limits and prescription drug pricing standards put in place in 2015 under a bill (AB 339) authored by Assemblymember Rich Gordon, which are currently set to expire at the end of 2019. SB 1021 also strengthens these protections, including by ensuring these pricing protections apply to HIV prevention drugs.

SB 1021 is sponsored by Health Access and co-authored by Senator Toni Atkins (D-San Diego.)  It is supported by public health advocacy organizations, including the San Francisco AIDS Foundation, APLA Health, and the California LGBT Health and Human Services Network.

Prior to the imposition of these protections under AB 339, consumers often were paying $6,000 in one month alone for badly needed medication. SB 1021 permanently extends the drug co-pay limits of $250 for a 30-day supply. The bill also makes permanent drug pricing standards that keep insurance companies from routinely placing specialty drugs on their highest pricing tiers.

SB 1021 also ensures that the provisions of the bill cover drugs such as PrEP that prevent the transmission of HIV/AIDS, not just those that treat it. PrEP (pre-exposure prophylaxis), if taken consistently, reduces the risk of HIV transmission by nearly 100%. In 2014, Senator Wiener, then a member of the San Francisco Board of Supervisors, became the first elected official to announce he was on PrEP, in hopes of spreading awareness and reducing stigma regarding PrEP.

“People living with serious health conditions should be able to focus on staying healthy and taking care of themselves, not living in fear that their life-saving medications are going to bankrupt them,” said Senator Scott Wiener. “In addition, maintaining access to prevention drugs like PrEP that can effectively eliminate the risk of transmission HIV is absolutely crucial to keeping people healthy. Nobody wants people living with multiple sclerosis or HIV or cancer to be forced to choose between paying for life-saving medication or putting food on the table. We need quality, affordable healthcare in California, and SB 1021 will help control the costs of expensive prescription drugs for consumers. ”

“California consumers need to be protected from extreme prescription drug co-payments, and other barriers that get in the way of patients getting the medications they need,” said Anthony Wright, Executive Director of Health Access. “Making sure California’s caps on co-pays continue will prevent patients that need high-cost medications, whether if they have MS or HEP-C, from facing a financial shock at the beginning of the year, or having to skip taking a needed pill.”

Before AB 339 went into effect, California residents with serious and chronic conditions like cancer, HIV/AIDS, multiple sclerosis, and lupus were particularly vulnerable to higher out of pocket costs for their medication. Specialty prescription drugs were often placed on the highest tier in the drug pricing formulary, which put them out of reach for many patients.

SB 1021 also adds several provisions not included in AB 339.  In addition to ensuring AB 339 pricing protections apply to HIV prevention medication, SB 1021 also codifies an existing Department of Managed Health Care regulation that prevents the cost of a drug copay from exceeding the retail price.  Finally, SB 1021 limits the number of tiers in health plans’ formularies to four, consistent with Covered California and Medicare formulary standards.

“San Francisco AIDS Foundation supports Senator Wiener’s bill to ensure that consumers, including people living with and at risk for HIV, continue to be protected against rising copays that otherwise could put medically-necessary drugs out of reach,” said Joe Hollendoner, San Francisco AIDS Foundation CEO. “Before AB 339 was enacted, health plans could put HIV and hepatitis C drugs on the specialty tier and require consumers to pay as much as 20-30% of the cost of the drug every month. Senator Wiener’s bill, which makes the protections under AB 339 permanent, is a practical and critical step forward to support the health and wellness of all Californians.”

“APLA Health strongly supports Senator Wiener’s bill to extend limits on drug copays and require plans to cover the most effective medications for HIV treatment and prevention,” said Craig E. Thompson, CEO of APLA Health. “As insurers increasingly shift the cost of expensive medications to consumers, this kind of legislation is absolutely critical to ensuring that Californians with chronic illnesses, including those living with HIV, can maintain access to the life-saving drugs they need to live healthy and productive lives.”

“The California LGBT Health and Human Services Network is happy to support SB 1021 by Senator Wiener,” said Amanda Wallner, Director of the California LGBT Health and Human Services Network. “This bill is an important piece of the puzzle in ensuring that LGBTQ Californians can afford to access necessary medications and in reducing health disparities throughout our communities. LGBTQ Californians are more likely than the general public to live in poverty and to report lacking the money needed to pay for health care. This is especially true for transgender people, LGBTQ people of color, women, immigrants, and LGBTQ people in rural areas. SB 2021 extends protections that have made health care more affordable for our communities and anyone in California who has struggled with the high cost of prescription drugs.”

Today, San Francisco leaders joined together at a press conference to support a new bill authored by Senators Scott Wiener (D-San Francisco) and Henry Stern (D-Canoga Park) to expand and strengthen California conservatorship laws by giving counties broader reach and more flexibility to help those who cannot care for themselves and who are dying on our streets. SB 1045 is sponsored by San Francisco Mayor Mark Farrell, who is continuing the work Mayor Ed Lee started in bringing this issue forward.

Senator Wiener was joined at a press conference in support of the bill by Mayor Farrell, San Francisco Board of Supervisors President London Breed, Department of Public Health Director Barbara Garcia, and Community Housing Partnership Executive Director Gail Gilman, as well as supporters of the bill.  The press conference took place at the Richardson Apartments, a permanent supportive housing building for extremely low income, chronically homeless individuals.

Senate Bill 1045 allows local governments more flexibility in expanding the reach of the conservatorship system, modernizing its administration, and assisting individuals who suffer from chronic homelessness, accompanied by debilitating mental illness, severe drug addiction, repeated psychiatric commitments, or excessively frequent use of emergency medical services. SB 1045 is co-authored by Senators Ben Allen (D-Santa Monica) and Steven Bradford (D-Gardena.)

Senator Scott Wiener said: “In San Francisco, like in cities all across California, people are suffering and dying on our streets. Many of these people can no longer help themselves, and we need to get them off the streets, into housing, and into supportive services so they can get their lives back. But our counties need more ways to help these people, and that includes strengthening our conservatorship laws for the most extreme cases. Over the coming months, Senator Stern and I will work closely with counties, cities, advocates, and others to craft a bold and comprehensive bill that will save lives. Here in San Francisco our public health officials and community organizations have been working tirelessly, but they need more tools to help the people that are suffering on our streets. I’m greatly appreciative the work of my friend the late Mayor Ed Lee did laying the groundwork on this issue, and for the ongoing support of Mayor Farrell. This is an all-hands-on-deck situation, and that’s why I’m also supportive of efforts by Board President Breed to strengthen our existing laws and efforts. What’s happening on our streets is inhumane and we can no longer sit back and watch people die. We have to act.”

San Francisco Mayor Mark Farrell said: “San Francisco has an epidemic on our streets and we need to expand every opportunity to help those with behavioral challenges. When people cannot care for themselves, we have to step in and help. This can be a path toward to a new beginning for our at-risk communities.”

San Francisco Board of Supervisors President London Breed said: “As a progressive city, we must do more to care for those who cannot care for themselves. It’s not compassionate to let those who are grappling with severe mental health and substance abuse issues simply wither away on our streets. These necessary changes to state and local law are a critical step toward a more healthy and more human San Francisco.”

Barbara Garcia, Director San Francisco Department of Public Health said, “We are supportive of measures that will help provide our community members who have addiction disorders and who are homeless with more intensive treatment options. Treatment support and care is critically needed to reduce suffering and save lives.”

Gail Gilman, Executive Director of Community Housing Partnership said, The introduction of this bill allows a process to begin to have a serious discussion about how to care and provide support to individuals who sometime in the moment cannot make those decisions for themselves. We too often see in supported housing individuals who need a higher level of care and who in the midst of their addiction or mental health crisis are unable to make decisions for themselves and need an intervention. This legislation will create a framework for the community to come together and truly understand how to assist these individuals.”

SB 1045 has been introduced as intent language, so that Senators Wiener and Stern can work with local governments, service providers, and advocates over the coming months to determine how to ensure the conservatorships are structured to best help those most in need of shelter and recovery, should those counties elect to use it. No county will be required to use the new conservatorship.

The intent language of SB 1045 introduced can be found here.

The California conservatorship system is one of the most important safeguards for protecting individuals incapable of managing their own affairs. Currently two kinds of conservatorship are authorized in California: Lanterman-Petrie-Short (LPS) conservatorships are designated for individuals who are “gravely disabled” and thus unable to care for themselves, while probate conservatorships are designed for individuals unable to care for themselves due to physical health issues, cognitive impairment, or elder abuse.

California faces an unprecedented housing affordability crisis, accompanied by significant untreated mental illness and drug addiction. These conditions, coupled with the limitations of our state and local social services, have left some counties searching for more tools to provide help and support to those Californians in the most need. In San Francisco, many of the successful programs and services have still fallen short of providing meaningful rehabilitation to a small population of residents with severe mental illness and drug addiction who are deteriorating on the city’s streets. Los Angeles faces similar challenges. The Los Angeles County Board of Supervisors is currently evaluating the efficacy and reach of their conservatorship system pursuant to a motion coauthored by Supervisors Mark Ridley-Thomas and Kathryn Barger.

Many of these people routinely use social and emergency services and find themselves in law enforcement custody, effectively converting a health issue into a criminal issue. By allowing greater flexibility to conserve these extremely disabled individuals – who are unable to make decisions for themselves – we can keep people out of the criminal justice system and focus on their health and well-being.