Nancy Glick

A New CMS Rule Could Be a Gamechanger for Adults with Obesity

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

If the story of combatting the nation’s obesity epidemic were a movie, it would be Groundhog Day.

Year in and year out, for over a decade, advocates and obesity specialists worked to get changes in federal policy. They pressed to get bills passed in Congress, drafted white papers, published research findings in medical journals, held roundtables and briefings, and sent letters and emails to policymakers over and over. But, using the Groundhog Day metaphor, the same day would start again.

Until now. Just as the protagonist in Groundhog Day changed his way of thinking and got the girl, the Centers for Medicare & Medicaid Services (CMS) changed its thinking to recognize obesity as a distinct and serious chronic disease requiring treatment. Based on this reinterpretation, CMS published a potentially game-changing proposed rule to establish the treatment of obesity as a medically necessary service under Medicare and Medicaid and allow Part D coverage of FDA-approved anti-obesity medications (AOMs), including new injectable drugs called GLP-1s (glucagon-like peptide-1 receptor agonists), as a result.

However, better obesity care is not a movie, and the proposed rule, while a major development, is not a final action. Before Medicare and Medicaid beneficiaries can get treated with new anti-obesity medicines, the agency must go through a formal rulemaking process to finalize the proposed rule, including receiving and analyzing comments from individuals and organizations concerned about obesity. This process is now underway, and the obesity community is coming out in force to urge CMS to update its Medicare and Medicaid coverage policy for AOMs based on medical evidence that obesity medications treat the disease of obesity and are not merely agents for “weight loss.”

As the organization that partnered with the National Council on Aging (NCOA) and leading obesity specialists across the country to develop and issue the first Obesity Bill of Rights for the nation, NCL submitted comments as the voice of the nation’s consumers and urged CMS to finalize the proposed rules for these reasons:

There Is a Widespread Scientific Consensus That Obesity Is a Distinct Chronic Disease – CMS’s reinterpretation of Medicare Part D policy is grounded in extensive medical evidence that obesity is not a cosmetic condition but a distinct and serious chronic disease requiring treatment. Reinforcing this recognition of obesity as a distinct disease state, major medical organizations now consider obesity a chronic disease due to its complex biological mechanisms and potential for significant health complications. This includes the American Medical Association, American Association of Clinical Endocrinologists, American College of Endocrinology, and all the leading obesity and nutrition organizations.

Obesity Is the Nation’s Most Prevalent Chronic Disease and Is Directly Linked to Numerous Chronic Diseases –Today, obesity affects 41.9 percent of US adults – more than 100 million people – which makes obesity the most prevalent chronic disease affecting Americans, significantly eclipsing the other most prevalent chronic diseases: heart disease, diabetes, chronic kidney disease, cancer, chronic lung disease, Alzheimer’s Disease, and stroke. Even more significantly, more than 230 medical conditions are directly linked to overweight and obesity, meaning these diseases worsen as the degree of obesity increases. Thus, obesity today is responsible for an estimated 400,000 deaths a year.

The Cost of Obesity Is Too High and Everyone Is Paying the Price – Obesity, due to its role in causing or worsening chronic disease, accounted for 47.1 percent of the total direct and indirect costs of treating chronic conditions in 2016. Accordingly, some estimates put the national cost of obesity at $1.7 trillion a year –more than what Social Security paid in retirement benefits in 2022.

Compared to Other Serious Chronic Diseases, Obesity Goes Largely Undiagnosed and Untreated – The Obesity Bill of Rights was issued to transform obesity care in the US at a time when obesity remains largely undertreated with costly repercussions in high rates of obesity-related diseases and preventable deaths. Reflecting this reality, only 30 million of the more than 100 million Americans living with obesity in 2022 received a diagnosis of obesity, and only around 2 percent of those eligible for anti-obesity medications were prescribed these drugs. Although multiple factors are responsible for this pervasive gap in obesity care, the most pernicious are access barriers that keep people with obesity from getting the care they need, whether through the exclusion of obesity treatments in many insurance plans, restrictive insurance practices that delay or deny treatment, or out-of-date government policies.

New Anti-obesity Medications Are Safe and Effective and Result in Savings From Improved Health Outcomes – As noted in the CMS proposed rule, there have been major advances in understanding and treatment of the disease of obesity since the Medicare Part D program went into effect in 2006, resulting in new therapeutic agents, such as GLP-1 drugs that can help people lose up to 20 percent of their weight in 26 months. Calculating the potential savings resulting from better health outcomes when obesity is treated, studies are beginning to project the potential savings to the economy from covering obesity medications. One recent study published December 5, 2024, in JAMA Network Open estimated that a 10 percent weight loss resulting from obesity treatment saved $2,430 in reduced medical expenditures, and for a 25 percent weight loss, the reduction in health expenditures is $5,444 per person.

The comment period for the CMS proposed rule closes soon, and then it will be up to the new Trump Administration to finalize this important rulemaking. It is our hope that the new team at CMS will make this a priority. Simply put, this important change in CMS policy will make a significant difference in the lives of millions of Americans.

New NCL analysis of medical debt policies highlights need for reform

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By Sam Sears, Health Policy Associate, National Consumers League

The National Consumers League (NCL) recently published a new issue brief focused on hospital’s medical debt practices. With over 100 million Americans grappling with medical debt, and 1 in 7 of them reporting to KFF Health News that they’ve been denied care, it is prudent to evaluate these anti-consumer hospital policies.

The analysis, which was completed by Magnolia Market Access, found that 340B hospitals are significantly more aggressive with their medical debt policies – 340B hospitals are twice as likely to deny or defer chare and also significantly more likely to take legal action against a patient. Additionally, our analysis found that for-profit hospitals are significantly less aggressive in their practices against patients with medical debt than nonprofit or government hospitals, and that screening for financial assistance does not resolve medical debt issues.

Medical debt is unpredictable and can have long lasting consequences. Nearly 50% of Americans struggling with medical debt have it reported to their credit report, and over 40 million people owe nearly $88 billion that has been sent to collections. The Biden Administration has taken action to combat and address medical debt, which you can read more about here on our blog. However, there are additional actions that policymakers may take.

NCL has, and continues to fight to protect consumers from excessive troubles due to medical debt, including working with policymakers to combat anti-consumer debt collection policies hospitals continue to practice. The findings from the analysis conducted in this issue brief further highlight the need for 340B Drug Pricing Program reform, to ensure the savings that hospitals receive are reinvested in ways that continue to benefit consumers and patients.

Hospital Medical Debt

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

Nancy Glick

Science Should Drive Obesity Care

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Today, over 100 million Americans, or 40.3 percent of adults, are living with obesity. This makes obesity the nation’s most widespread chronic condition, impacting many more people than diabetes, heart disease, stroke, certain cancers, chronic lung disease, and chronic kidney disease.

Yet, the sad fact is obesity still gets short shrift from health professionals and policymakers, even though it worsens the outcomes of more than 230 chronic diseases, is responsible for an estimated 400,000 premature deaths annually, and costs society an estimated $1.72 trillion a year.  As a consequence, only 10 percent of people with obesity get help from medical professionals, meaning the disease remains largely undiagnosed and undertreated.  This is occurring even though leading medical societies, including the American Medical Association (AMA), agree that obesity is a serious disease requiring comprehensive care.

It doesn’t have to be this way, which is why the National Consumers League worked with the National Council on Aging and leading obesity experts to issue the first Obesity Bill of Rights for the nation, which establishes eight essential rights so people with obesity will be screened, diagnosed, counseled, and treated according to medical guidelines. The goal is to put an end to the prejudice, incorrect beliefs about obesity, misinformation about treatment options, and outdated government policies that keep Americans from getting the same standard of care as those with other chronic diseases.

It will take time for the Obesity Bill of Rights to be incorporated into clinical practice, but specific rights already have significance. This is the case with new “blockbuster” injectable medicines called GLP-1 (glucagon-like peptide-1 receptor) agonists that work by mimicking a hormone produced in the small intestine to reduce appetite and slow digestion. Considered a game-changer in chronic obesity treatment, GLP-1s can help people lose up to 20 percent of their weight in 26 months. Thus, The Right to Coverage for Treatment reinforces calls from obesity specialists and medical societies for an end to exclusionary coverage policies by insurers and government agencies, so GLP-1 medications are a treatment option for adults at higher risk for living with weight-related diseases.

The major challenge has been the Medicare program, which excludes coverage for weight loss drugs due to past safety concerns that no longer exist today. But this could change. On November 26, 2024 the Centers for Medicare and Medicaid Services (CMS) published a proposed rule to allow seniors on Medicare and adults with Medicaid to have coverage for GLP-1s, thereby removing one of the biggest obstacles impeding access to quality obesity care in the country. If CMS’s proposal is finalized, the right to coverage for obesity treatment will become a reality for 7.4 million Americans – a good start in ensuring that people with obesity receive individualized quality care.

However, there is a lot of misinformation about GLP-1 medications, so The Right to Accurate, Clear, Trusted, and Accessible Information is also important, especially because disinformation is raising concerns among health professionals and the public. To date, the Food and Drug Administration (FDA) has approved four GLP-1 drugs based on evidence from large-scale clinical trials that these medicines are safe and achieve substantial weight loss. Yet, critics of these drugs assert these compounds cause severe side effects in all users, claim GLP-1 medications cause depression and suicidal thoughts, and allege the European Union (EU) is investigating this matter.

Responding to these allegations, experts in obesity treatment have assembled the facts from scientific journal articles and government reports. In furtherance of the right of the public to have this information, here is a summary of these findings:

  • Regarding the potential side effects of GLP-1s, several studies dispute the assertion that GLP-1 drugs cause severe adverse effects in all people. The consensus is that because these drugs slow stomach emptying, they can cause gastrointestinal problems that are usually mild to moderate and often go away within one to two months.
  • As to GLP-1s causing suicidal ideation, a recent commentary in JAMA Open Network concludes that large-scale studies do not show any increased risk of suicidal ideation while a 2024 study by researchers at Case Western Reserve University School of Medicine found that people taking a GLP-1 drug had a lower risk of suicidal thoughts compared to those taking a non-GLP-1 compound.  Similarly, the FDA published a detailed report in January 2024 also finding no association. FDA reached this conclusion after analyzing information on adverse events from the FDA Adverse Event Reporting System (FAERS), reviewing a meta-analysis of GLP-1 clinical trials data, and analyzing post-marketing data in the FDA’s Sentinel System.
  • Concerning the investigation by the EU’s European Medicines Agency, EMA’s Pharmacovigilance Risk Assessment Committee conducted a review of health records and issued a finding that no causal association exists between GLP-1s and suicidal thoughts or self-injurious actions.

The Rand Corporation coined the term “truth decay” to call attention to the blurring of the line between opinion and fact. It is important that “truth decay” not become a new obstacle to Americans receiving quality obesity care.

Medical debt, a growing crisis for Americans, and the Biden Administration’s bold moves to tackle it

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By Sam Sears, Health Policy Associate, National Consumers League

Consumers, unfortunately, accrue debt quite often throughout their lives – be it a mortgage, a car loan, credit cards, or even student loans. However, there is one type of debt that consumers have no way of knowing when it will be incurred – medical debt.

At the National Consumers League (NCL), we have been fighting to protect consumers from the unfair burdens of medical debt, both as it relates to access to care and exposing the inadequacy of the 340B Drug Pricing program. However, medical debt as a whole has a moment in the spotlight this October as the Biden Administration tackles the issue.

As I’m sure consumers have noticed, the cost of everything has gone up– groceries, rent, and even healthcare. Many families are forced to make tough decisions between putting food on the table or paying their medical bills. For some, it means putting off medical care to avoid the cost of the visit.

Medical debt now plagues more than 100 million Americans across the nation. As KFF Health News found, 1 in 7 people with debt shared that they’ve been denied access to a hospital, doctor, or other healthcare provider, and two-thirds have put off care they or a family member needs because of the cost. Shockingly, nearly 50% of those Americans have medical debt reported on their credit report, and over 40 million people owe around $88 billion, which has been sent to collections. This makes medical debt the single largest source of debt in collections, outpacing auto loans and credit cards.

The harsh reality is medical debt doesn’t just linger on a credit report; it devastates lives and can have lasting consequences. NCL has previously covered how medical debt collection practices can leave consumers in a “never-ending spiral of debt.” Hospitals across the nation are suing patients over their medical debt, and patients may not know that they must go to court or have the resources to hire a lawyer to protect themselves. As a result, creditors may seek default judgements in which a court authorizes them to garnish a patient’s wages as part of a payment plan, or place a lien on their home, cars, or other property.

Over the past few weeks, the issue of medical debt has been highlighted in the national conversation. A new proposed rule from the Department of Defense would introduce a sliding-scale discount program for civilians who receive care at a military medical treatment facility (MFT). Health and Human Services Secretary Xavier Becerra also announced that the Center for Medicare and Medicaid Services (CMS) will be adding questions about medical debt to the Medicare Current Beneficiary Survey (MCBS), an annual survey of Medicaid beneficiaries used to understand their health needs. These new questions will allow CMS to further understand the impact of medical debt on the day-to-day lives of seniors and people with disabilities.

Recently, the White House held a pivotal event hosted by the Consumer Financial Protection Bureau (CFPB), where individuals directly impacted by medical debt shared their heartbreaking stories. In tandem, the White House released a fact sheet unveiling the Administration’s new actions to address and reduce medical debt for consumers. Following these actions, the CFPB has taken several steps to protect consumers experiencing medical debt.

In his remarks, CFPB Director Rohit Chopra stated that the agency “has been laser-focused on dealing with the growing burdens of medical debt.” NCL commends CFPB and Director Chopra for their ongoing efforts to address the impact of medical debt on patients. Back in June, CFPB issued a proposed rule that would ban unpaid medical bills from being included on credit reports, and prevent the repossession of medical devices. The public comment period for this proposed rule closed on August 12. During the White House event, Director Chopra stated that CFPB is “working to finalize our credit reporting rule now.” But, with nearly 75,000 comments, NCL anticipates that it may take the agency some time to issue a final rule.

Given the complexities of medical bills, the CFPB has also been urging and requiring transparency from hospitals and debt collectors. New guidance was issued to crack down on deceptive medical billing practices, including the illegal collection of medical bills that are false, inflated, or not actually owed. CFPB has received several complaints from patients and consumers over medical debt collections, particularly for bills that the patient does not owe, were already paid by the consumer, insurance, or a government program (such as Medicare or Medicaid), or for debts that are covered by insurance, hospital assistance programs or other programs. More than ever, hospitals and healthcare providers are subcontracting medical billing and collection activities to third parties, who have legal obligations under the Fair Debt Collection Practices Act. CFPB has issued guidance to further clarify these legal obligations as they relate to medical debt and collection practices.

And let’s not forget the shameful practices of some nonprofit hospitals. As tax-exempt institutions, nonprofit hospitals are legally required to provide financial assistance to offset healthcare costs for low-income patients and consumers —yet many fall woefully short. In early October, CFPB published a comprehensive blog post drawing attention to billing and debt issues arising from nonprofit hospitals, many of which provide inadequate financial assistance. Often referred to as ‘charity care,’ federal regulations do not provide further guidance on the eligibility of patients or spending standards for hospitals. Thus, financial assistance policies are left to the hospitals themselves. While some states have intervened in an increasingly bipartisan manner, there are still too few regulations governing what financial assistance should look like or how it should be administered. NCL supports and recognizes the critical role hospitals, particularly nonprofit hospitals, play in their communities. However, the lack of transparency, as well as the predatory practices of some, need to change. NCL applauds CFPB for the spotlight they’ve put on these practices as a driver in the medical debt crisis.

CFPB has also taken steps to remove all medical collections under $500. This last step went into effect on April 11, 2023, and with this change, it’s estimated that roughly half of those with medical debt on their reports will have it removed from their credit history. If you find a medical collection under $500, a paid medical collection, a collection less than a year old, or errors on your report, you can dispute that information with the credit reporting company.  One of the first steps you can take is to check your credit reports for any outstanding medical bills.

NCL stands in strong support of the efforts of the CFPB and the Biden Administration as they work to safeguard consumers and bring transparency to the healthcare and credit reporting systems. NCL shares CFPB’s concerns regarding how consumers accrue these inaccurate, undue bills in the first place. The Biden-Harris Administration continues to prioritize consumers’ access to healthcare and a commitment to protecting vulnerable populations from the unfair consequences that arise from an illness or medical emergency. NCL applauds Director Chopra, the Biden-Harris Administration, and federal agencies for their leadership in addressing the burden of medical debt.

We look forward to the CFPB’s final ruling on medical debt and credit reporting, which could be a game-changer for millions of Americans.

To learn more about your rights, and actions you can take, if you have medical debt on your credit report or need to dispute a medical bill, visit CFPB.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

As election looms, regulators can act now to help consumers save at the pharmacy counter

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By Sally Greenberg, Chief Executive Officer, National Consumers League

Now that we are a mere 15 days away from the election, all attention is unsurprisingly laser-focused on the outcome of the general election. Surprisingly, however, both candidates have made it clear that one of the leading healthcare issues on the ballot is the future of the Affordable Care Act (ACA). Ten years after its enactment, the ACA has become intertwined with the very fabric of the healthcare landscape in the US and thus requires federal agencies to regularly revisit the statutes to ensure it is fulfilling its original intent.

Now that the current administration has released proposed rulemaking on core provisions of the ACA, it has become more important than ever to add statutes to address a loophole in the essential health benefits (EHB) provision of the ACA. There is no better time for three federal agencies – the Department of Treasury, Department of Labor, and Department of Health and Human Services – to change language in the ACA that is constantly exploited by profit-seeking insurers, producing severe access and affordability barriers for patients and undermining the original intent of the ACA.

The loophole goes something like this: Essential health benefits are a central pillar of the ACA and provide affordability protections to Americans by ensuring that everyone in the individual and small group health insurance markets has access to coverage that actually covers the services they need. These essential health benefits fall into ten categories, one of which is prescription drugs.

If a patient pays out-of-pocket for their prescription (an essential health benefit), that dollar amount counts towards their out-of-pocket maximum. Once they hit the out-of-pocket cost maximum set by the ACA, insurance kicks in and covers the remainder of their out-of-pocket costs. However, insurers and pharmacy benefit managers (PBMs) are designating some specialty prescriptions to be “non-essential” – regardless of whether a patient needs them to stay alive. Once labeled “non-essential,” the patient is no longer protected by the out-of-pocket maximum set by the ACA.

What does this look like in practice? A patient may spend money on lifesaving medications that don’t count toward their out-of-pocket maximum. All year, a patient could pay out-of-pocket for prescriptions but never reach their maximum and see their insurance kick in. This saves a few bucks for insurers and PBMs but imposes massive financial burdens for patients who would otherwise be protected under the ACA. The EHB loophole forces patients to pay more out-of-pocket, a situation that circumvents the original intent of the law — which, as a reminder, is to keep drug costs affordable for consumers.

How can we close this loophole? The Department of Treasury, Department of Labor, and Department of Health and Human Services could act now. The tri-agencies can integrate language to close the EHB loophole into the Notice of Benefit and Payment Parameters (NBPP) to clarify that any service covered by a health plan is defined as an EHB.

Both of the frontrunners of the 2024 presidential election have signaled their intent to find solutions that lower prescription drug costs for Americans. While the country braces for the ripple effects of a new administration regardless of the results, regulators should close the EHB loophole to protect consumer access to treatments in line with the original intent of the ACA – affordable and accessible care for patients.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

The Obesity Bill of Rights: Priorities for government action

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Americans need and now have an Obesity Bill of Rights for a reason: People with obesity do not receive the same concern, level of attention, and quality care as those with any other serious chronic disease.  

Put into real-life terms: Though the adult obesity rate now exceeds 42 percent – the highest level ever recorded – obesity is still viewed as a problem of lack of willpower; too many health professionals act in discriminatory ways based on people’s size; and those seeking obesity care often face exclusions in insurance plans, restrictive practices that delay or deny treatment, or are not factored into decisions regarding medicine use.   

The consequence is that only 10 percent of people with obesity get help from medical professionals and only 2 percent of those eligible for treatment with Food and Drug Administration (FDA)-approved anti-obesity medicines (AOMs) have been prescribed these drugs, meaning the disease remains undiagnosed and undertreated. Compounding the impact, untreated obesity worsens the outcomes of more than 230 other chronic diseases, which is why obesity is responsible for as many as 400,000 Americans dying from obesity annually and costs the nation $1.72 trillion a year  in direct and indirect health expenditures – more than what Social Security paid in retirement benefits in 2022. 

It does not have to be this way. 

And this is where the Obesity Bill of Rights enters the picture. Developed by the National Consumers League (NCL) and the National Council on Aging, in consultation with leading obesity specialists, the bill of rights establishes eight essential rights with the core requirements so adults will receive the same person-centered, quality care for obesity as those with other chronic conditions. As such, the bill of rights serves as a blueprint for necessary changes in medical practice and government policy, starting with actions that can happen now. 

One immediate action item is pressing Congress to pass the Treat and Reduce Obesity Act (TROA), an important legislation that will allow more seniors to be treated with FDA-approved anti-obesity medications under the Medicare program. This matter is a high priority because obesity rates have nearly doubled among older adults to include two in every five Americans ages 65 and older. 

Another priority is ensuring that health professionals have the prescribing information to effectively treat people with obesity when they are taking drugs for other conditions, such as depression, schizophrenia, infections, and cancer. The simple fact is that certain drugs work differently in people with obesity and the consequences can be underdosing, a delay in response time, or the drug remaining in the body too long, potentially causing side effects. For example, studies show the drug brexpiprazole (Rexulti®), which treats depression and schizophrenia, takes significantly longer to reach effective levels in people with obesity – and some patients never reach these levels. Fortunately, the same research provides an improved dosing regimen so all patients with obesity can achieve efficacy. 

A different challenge involves drugs like posaconazole (Noxafil®), an antifungal often prescribed by oncologists to prevent infections. Two separate clinical trials show that obesity significantly increases posaconazole’s “half-life” – a term reflecting the amount of time it takes to rid the drug from the body. Half-life is an issue with posaconazole because many oncology medications must be delayed until the drug is out of the body’s system. Thus, if the package insert does not flag this matter when patients have obesity, doctors prescribing posaconazole may not know about the increase in half-life and start using oncology medicines too soon.  

These problems are not rare, but drug labels to guide safe and effective prescribing are dismissing people with obesity. For this reason, the Obesity Bill of Rights includes language to make accurate prescribing a requirement for receiving person-centered obesity care. Moreover, because increasing research validates the consequences of “flying blind” when drugs behave differently in the bodies of people with obesity, the obesity community is raising alarm bells, supported by a position statement from the American College of Clinical Pharmacology (ACCP), which urges FDA to close gaps in the testing and approval process for new drugs intended for use by people with obesity.  

However, because more immediate action is needed, five leading obesity organizations – American Society for Metabolic and Bariatric Surgery, the Obesity Action Coalition, the Obesity Medicine Association, the STOP Obesity Alliance, and The Obesity Society – issued a joint statement calling on drug manufacturers to update their labeling immediately to provide correct usage instructions for people with obesity when there should be a difference in dosing.  

NCL stands with the obesity community in calling for this sensible action and urges FDA to be a catalyst in ensuring that health professionals have the prescribing information needed for their patients with obesity to take important therapeutics safely and achieve the maximum benefit. For more information, visit right2obesitycare.org.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

What we need now isn’t just abortion access; it’s time for a reproductive justice framework

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By Sam Sears, Health Policy Associate, National Consumers League

For two years now reproductive justice – as a term, a framework, and an ideal – has been thrust into the mainstream. While those who work in reproductive healthcare access and advocacy, particularly abortion access and rights, are familiar with the term, not many people knew about it before the Supreme Court of the United States handed down its decision in Dobbs v. Jackson Women’s Health Organization. Given the most recent rulings from the Court this past month, and what’s been happening in the states in the two years since Dobbs, reproductive justice is all that more important.

So, what is reproductive justice?

It’s actually a very simple concept and framework from which advocacy work stems. Coined by Black women in 1994 before the International Conference on Population and Development in Cairo, the term mashes together reproductive rights and social justice. These women recognized that the pro-choice movement at that time was not accomplishing enough for women of color. Expanding upon the human right to maintain personal bodily autonomy, reproductive justice is often defined as the right to have children, the right to not have children, and the right to parent the children in safe and sustainable communities and environments. Thus, reproductive justice not only includes access to reproductive healthcare, such as birth control and abortions, but it also encompasses economic factors, such as pay equity, childcare costs, and more.

Since the Dobbs decision, there has been an influx of state bans on abortion at various points of gestation and with ever-varying limitations. The most common in the mainstream knowledge base would be Idaho’s ban, one of the nation’s strictest which went into effect in August 2022 (not long after Dobbs). Idaho bans abortion at 6 weeks, with minimal exceptions for the life of the mother and in cases of reported rape or incest, making it one of the most restrictive bans in the country. However, there are 15 other states with some of the most restrictive abortion bans as well.

Anti-abortion conservatives have also begun attacking other aspects of reproduction, further bringing the need for reproductive justice to the forefront. In the last two years, there has been an increase in the dis- and misinformation being spread regarding birth control – calling them abortifacients.

Now, I want to be explicitly clear here. Birth control, be it intrauterine devices (IUDs), the standard pill, or a Plan B emergency contraceptive are NOT abortion-inducing drugs. Contraception prevents pregnancy; it does not end it. Because of this misinformation, attempts to secure the right to birth control or attempts to increase access are not passing within state legislatures. And in Idaho, state elected officials are seeing are being pushed to ban access to emergency contraception and IUDs.

Let’s not forget the chaos surrounding in-vitro fertilization (IVF) because of Alabama and this state’s Supreme Court. As a reminder, in February the Alabama State Supreme Court ruled that frozen embryos are recognized as children under state law. Now the big question is whether, because of this decision, IVF is banned within the state given that not all embryos are viable after being frozen and thawed for placement. So many of the state bans on abortion also include fetuses within the definition of personhood. The impact of the Alabama IVF decision is further-reaching than just the state, especially with the nation’s patchwork web of definitions of personhood because of these bans.

Federal lawmakers have begun trying to clarify and codify access to birth control and IVF. Earlier in June, Senate Democrats hoped to bring a floor vote forward to establish the right to IVF as a method of conceiving. However, the bill, which was authored by Sen. Tammy Duckworth (D-IL), who conceived her children with the help of IVF, was blocked by the GOP because of claims of religious freedom and states’ rights concerns. Senate Democrats have also seen the Right to Contraception Act be blocked by the GOP around the same time. Missouri Sen. Hawley states that his concerns regarding the Right to Contraception Act are regarding state laws and how the bill could lead to mifepristone, one of two medications used in the abortion pill, being available in states regardless of their laws.

Last month there were two small wins within the reproductive justice space. SCOTUS had two cases before it that were related to abortion – Alliance for Hippocratic Medicine v FDA and Idaho v. United States. For the first case, the suit took aim at the Food and Drug Administration (FDA) challenging the agency’s approval of mifepristone, arguing that the FDA did not adequately consider the evidence back in 2000. SCOTUS unanimously ruled that the Alliance for Hippocratic Medicine and the other plaintiffs in the case did not have the standing to challenge the FDA. SCOTUS ruled to dismiss Idaho v. United States thus leaving in place the order that blocks Idaho from enforcing its current abortion ban, described above. In this case, the Department of Justice (DOJ) filed against Idaho, arguing that the state’s abortion ban violates the Emergency Medical Treatment and Labor Act (EMTALA).

Overall, the anti-abortion groups are expanding their work well beyond simply abortion. Thirty years ago, the Women of African Descent for Reproductive Justice recognized that the then-pro-choice movement was not enough; it left women of color and other disenfranchised women behind and out of the conversation. These women expanded their work to also include childbirth and child-rearing. With the current attacks against contraception, as well as the uncertainty and expected attacks against IVF, the pro-choice movement must expand as well. It is time for the nation to begin working toward reproductive justice.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization.  Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad.  For more information, visit nclnet.org.

The Pain Project: Pain management doesn’t just mean opioids*

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By Sam Sears, Health Policy Associate, National Consumers League

Earlier this year, the National Consumers League (NCL) produced, as part of its health series, an episode of the “We Can Do This!” podcast focused on alternatives to opioids for pain control. In this podcast, listeners were able to hear directly from those with lived experience with opioid use disorder, both personally and as the loved one of someone with the disorder. You can listen to the podcast here. Each of the speakers on this episode was brought together, through the creation and launch of “The Painful Truth” campaign.

The campaign features a three-minute film, which features real individuals looking for pain control, discussing their options and the complications that can come with opioids. Matt Robinson, who is featured in the film and one of the speakers on our podcast, discusses his experience with opioid use disorder, and shares with NCL that his first experience with opioids for pain control was when he was 12; the result of a sports injury. Former Congresswoman Mary Bono discusses the founding of Mothers Against Prescription Drug Abuse, and her experience with a loved one who experienced opioid use disorder. Our final guest, Charlene Ng, Vice President of US Medical Affairs at Bayer, shares how recently her teenage son was offered a prescription for opioids for pain management after wisdom teeth removal.

I think it’s really important to highlight how in two of the stories the speakers shared on this episode how they or their loved one were first offered a prescription for opioids as young adults and as teens. We know we’re in a mental health, and, specifically a substance use disorder, crisis within the States, and while the overall national dispensing rate for opioids has declined between 2019 and 2022, our nation still consumes over four-fifths of the world’s opioids. Given that the US makes up less than 5% of the world’s population, that’s a truly staggering number.

Generally, we trust doctors. They’re highly educated, specialize in their field, and pledge an ethical code of conduct to ‘do no harm’. It’s understandable that when a doctor recommends something, especially a medication for pain management, there isn’t a whole lot of questioning or concern. However, opioids are not the only option for pain management that is out there and available for consumers – especially considering the significant side effects that come with such an addictive substance.

Not too long ago, in 2022, the CDC issued new and updated clinical guidelines for prescribing opioids for pain. There are 12 total recommendations for these guidelines, grouped into four categories, and I think the most important recommendations happen to be the first two related to determining whether or not to initiate opioids for pain. Regardless of the type of pain, be it chronic or acute, the CDC states that nonopioid options, both nonpharmacological and other medications that aren’t opioids, are preferred to opioid use for pain management. What really resonated with me in these is that nonopioid therapies can be as effective, if not more so, for common types of acute pain (which includes wisdom teeth removal and acute musculoskeletal injuries like common sports-related sprains and breaks). These therapies include non-pharmacological options such as heat therapy, massage, acupuncture, chiropractic care, and more, and pharmacological non-opioid options such as NSAIDs, acetaminophen, and more, depending on the cause of the pain.

In general, the most important thing for consumers to know is to talk to their doctor or health professional. Doctors work for and with us. Substance use disorder and addiction are a huge problem within the US currently, and it can be very scary to have to take a medication that can lead to that. But opioids aren’t our only option. If you are getting an opioid prescription, ask why, or ask about nonaddictive options! Make sure your health team talks to you about all the possible side effects and consequences that may develop, and if moving forward with an opioid is the right step for you.

If you or someone you know is struggling, options for treatment and help can be found on SAMHSA’s website.

*Medical Disclaimer: All information in this blog post is strictly for informational and educational purposes only.  Nothing in this post is a substitute for medical advice, diagnosis, or treatment.

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 About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Not so fast, PBMs: You aren’t fooling consumers

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By Robin Strongin, Senior Director of Health Policy

A recent op-ed, “It’s Time for Facts in the PBM Debate” by the president of one of the nation’s largest pharmacy benefit managers (PBMs), is at odds with the reality of what consumers are facing when we go to the pharmacy.

In his commentary, David Joyner paints a rosy picture of how the largest PBMs lower drug prices. Meanwhile, consumers across the country are being hit with higher out-of-pocket costs and a lack of understanding about what goes into the costs for their medicines. This opaque system results in consumers running into several issues trying to access more affordable drug options.

The PBMs aren’t fooling anyone.

In Joyner’s own company, a whistleblower brought suit over the PBM’s scheme to keep lower-cost generics off its formularies for Medicare beneficiaries, pushing seniors to more expensive drugs (for which the PBM had negotiated higher profits for itself). The whistleblower said she was told by company executives that the financial benefits of this manipulation outweighed the possibility of getting caught.

More recently, community pharmacies in Iowa filed a lawsuit against CVS Health and its Caremark PBM claiming that they violated antitrust laws and illegally collected fees from pharmacies filling Medicare prescriptions. We’ve seen this behavior often force trusted, and long-established local pharmacies out of business.

What’s most concerning is that such questionable PBM behavior can have tragic results beyond pharmacy closures. In Wisconsin earlier this year, a young man with severe asthma died after he was informed at the pharmacy that his inhaler was no longer covered by insurance and he couldn’t afford the hefty out-of-pocket cost.

We can’t let this happen to another person. Consumers deserve more transparency. They deserve accountability in this middlemen PBM system. Most of all, we all deserve better than to be inundated with large PBM falsehoods.

Even as these mega-PBMs assure us that they are patient advocates, they are fighting tooth and nail in Congress and state legislatures to block measures that would take the necessary steps to ensure that consumers – and not the PBMs themselves – actually benefit.

Those are the facts in the big PBM debate.

Nancy Glick

It’s time to care about obesity care

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

Every year, the calendar is full of national health observances – special months, weeks and days that raise awareness of serious diseases and health issues. While all are valuable to advance the health of the Americans, Obesity Care Week taking place March 4-8 is especially significant.

Why?  Because even though the adult obesity rate now exceeds 42 percent – the highest level ever recorded – obesity is still viewed as a problem of lack of willpower, too many health professionals act in discriminatory ways based on people’s size, and those seeking obesity care often face exclusions in insurance plans or restrictive practices that delay or deny treatment.

The consequence is that that only 10 percent of people with obesity get help from medical professionals, meaning the disease remains largely undiagnosed and undertreated.

It doesn’t have to be this way. There are a variety of safe and effective treatment options. And medical societies, including the American Medical Association (AMA), agree that obesity is a complex disease requiring ongoing quality care. The key is for society – including health professionals, insurers and policymakers – to care about obesity and agree that treatment matters. Here are the reasons why.

It is long past time for health professionals, employers, insurers, policymakers and the American public to care about obesity and work collectively to break down the barriers that prevent people from accessing proper care and treatment. This is the purpose of Obesity Care Week – to shine a light on a disease that no one has wanted to talk or think about and shift the way society views obesity and treats the disease.

Obesity Care Week is also an opportunity to call attention to the first Obesity Bill of Rights for the nation, developed by NCL and the National Council on Aging in consultation with leading obesity specialists and issued in January 2024. Starting with the recognition that obesity is a treatable disease, the Obesity Bill of Rights establishes eight essential rights so adults will receive the same level of attention and care as those with other chronic conditions and have access to all treatments deemed appropriate by their health providers. Now is the time to advance changes in federal, state, and employer policies that will ensure these rights are incorporated into medical practice.

More information about the Obesity Bill of Rights is available at: www.right2obesitycare.org.