The drug pricing middlemen driving up drug costs

Healthcare continues to be front and center in the national discourse, particularly in the midst of the pandemic. As Congress works on policy solutions to lower healthcare costs for consumers, we face an unfair disadvantage when it comes to what we’re paying at the pharmacy counter.

Vaccines to protect all

 

By Sally Greenberg, NCL Executive Director
With co-author Marla Dalton, Executive Director and CEO, National Foundation for Infectious Diseases

COVID-19 has had profound implications on individual health and well-being and the U.S. healthcare system at-large. During the pandemic, we have seen routine vaccination rates decline significantly across all populations, putting individuals at risk of contracting vaccine-preventable diseases. The pandemic has also brought significant public attention to vaccines and now, perhaps more than ever before, many see the value of life-saving vaccines as one of the most effective public health prevention tools available to keep us safe and help end the pandemic.

The National Foundation for Infectious Diseases (NFID) and the National Consumers League (NCL) are committed to educating people about how to live healthier, safer lives. NFID is focused on educating the public and healthcare professionals about the burden, causes, prevention, diagnosis, and treatment of infectious diseases across the lifespan, and the mission of NCL is to protect and promote social and economic justice for consumers and workers in the United States and abroad.

NFID's Marla receiving her vaccine

NFID’s Marla Dalton receiving her flu vaccine.

Both organizations recognize the tremendous benefits that vaccination provides for both individuals and entire communities. While fall and winter raise the need for annual vaccination against influenza (flu), and the current pandemic has led to the need for COVID-19 vaccines and boosters, we must not overlook the importance of routine vaccines that may have been missed during the pandemic. Vaccines are for people of all ages and there are specific vaccines recommended for children, adolescents, adults, and older adults 65+ to protect against serious and potentially deadly diseases.

NCL and nearly 150 other partner organizations are proud to participate in the NFID *Keep Up The Rates campaign, to share messages to encourage all individuals to receive recommended vaccines that may have been delayed during the pandemic. Since the campaign launched in 2020, Keep Up The Rates has engaged national experts and leading public health organizations to reach populations most at risk of delaying vaccinations or experiencing complications from vaccine-preventable diseases.

Sally Greenberg getting vaccinated.

Keep Up The Rates recently released resources to educate healthcare professionals and consumers about vaccine coadministration—receiving multiple vaccines at the same time. When you bring your car in for an oil change, a good mechanic takes care of other routine maintenance to make sure your car runs safely. Protecting your health is not much different, so when you receive a COVID-19 vaccine or a flu vaccine, we encourage you to make sure that you are protected against other serious but preventable diseases. A new *PSA and infographics are available to help share that messaging with all relevant audiences.

The COVID-19 pandemic has demonstrated that protecting public health is more important than ever. Just as we must always protect the rights of consumers and workers, we must also encourage measures that promote better health and a safe environment for all.

*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings.

NCL applauds approval of the pediatric COVID-19 vaccine

November 2, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org or (412) 945-3242

Washington, DC—The National Consumers League (NCL) applauds the coordinated efforts of the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to approve the Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11. Consumers should be reassured that an unbiased advisory committee composed of medical and scientific experts have reviewed the data and have held public meetings to provide Americans with a transparent approval process.

“NCL is committed to educating consumers about vaccine safety and efficacy in order to increase vaccine confidence. Every day, parents make tough decisions to keep their children safe. We want parents to feel informed and empowered in their decision to vaccinate their children. As a parent of two boys ages 8 and 10, I’m looking forward to being able to protect my children from COVID-19 and put this pandemic behind us,” said NCL Director of Health Policy Jeanette Contreras.

Parents and guardians are encouraged to use the CDC’s V-Safe mobile app to tell the CDC about any side effects experienced after getting vaccinated. Parents will be able to add dependents to their account and get reminders if you need an additional dose. Register here: https://vsafe.cdc.gov/

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About the National Consumers League

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.

Jeanette Contreras portrait

¿Buscando cobertura médica? Healthcare.gov open enrollment begins November 1

By NCL Director of Health Policy Jeanette Contreras with contributions by NCL Intern Grace Mills

The 2022 open enrollment period for the Health Insurance Marketplace is about to begin! Consumers can enroll in a health plan on Healthcare.gov beginning November 1.

As we commemorate Hispanic Heritage Month, the National Consumers League (NCL) wants Latino consumers to better understand their health coverage options through the Health Insurance Marketplace. Latinos make up approximately 18 percent of the U.S. population and represent the largest minority population (62.1 million). However, it is concerning that 22 percent of non-elderly Latinos are uninsured – the highest uninsured rate of any racial group in the United States.

Under the *American Rescue Plan, more consumers are now eligible for increased tax credits that further reduce the cost of monthly premiums. An estimated 69 percent of uninsured Latino adults can access a zero-premium plan and 80 percent can access a plan that costs less than $50 a month. Additionally, consumers can use the Healthcare.gov platform to find out if they or their dependents can qualify for Medicaid or the Children’s Health Insurance Program. Here is what you need to know to make sure that you and your loved ones are insured during 2022.

  • The open enrollment period starts on November 1, 2021, and runs through January 15, 2022. In order for your coverage to start on January 1, you must enroll by December 15, 2021.
  • Your income will determine what you will pay for your health coverage plan.
  • Applications will be accepted online, by calling 1-800-318-2596, or through a certified enrollment partner. Learn more about the different ways to apply.

This year, the Centers for Medicare and Medicaid Services (CMS) has issued $80 million in grants to fund Health Care Navigators across the country that are trained and certified to assist consumers with enrolling in a health plan. While agents and brokers are also available, Navigator Grantees are often a trusted source of information in their communities and can offer culturally competent enrollment assistance. Consumers can find local in-person assistance or an agent/broker in their area by clicking here.

¿Buscando cobertura médica? La inscripción abierta de Cuidadodesalud.gov empieza el 1 de noviembre

¡La inscripción abierta para el Mercado de Seguros Médicos por el año 2022 empezará muy pronto! Los consumidores pueden inscribirse en un plan de salud por medio de CuidadoDeSalud.gov empezando el 1 de noviembre.

Para conmemorar el Mes de la Herencia Hispana, la Liga Nacional de Consumidores (“NCL” por sus siglas en inglés) desea que los consumidores latinos conozcan sus opciones de cobertura de salud a través de los Mercados de Seguros Médicos. Los latinos constituyen el 18% de la población de los Estados Unidos y representan la población de minorías más grande (de 62.1 millones). Sin embargo, nos preocupa que solamente el 22% de los Latinos adultos (que no son mayores) no tienen cobertura de salud y representan la tasa más alta sin seguro médico de todos los grupos raciales en EE. UU.

Bajo el Plan de Rescate Americano (conocido como “American Rescue Plan” en inglés), más consumidores están elegibles por los créditos fiscales que reducen el costo de sus pagos mensuales. Aproximadamente, el 69% de los Latinos (no asegurados} pueden acceder a un plan sin costo alguno y el 80% pueden acceder a un plan que cueste menos de $50 por mes. Además, los consumidores pueden usar la plataforma CuidadoDeSalud.gov para ver si ellos o sus dependientes califican para Medicaid o el Programa de Seguro de Salud Para Niños (conocido como “CHIP” por sus siglas en ingles). Aquí está lo que necesitan saber para que usted y sus seres queridos tengan cobertura médica durante el 2022.

  1. El período de inscripción empieza el 1 de noviembre del 2021 hasta el 15 de enero del 2022. Para tener cobertura empezando el 1 de enero del 2022, necesitas inscribirte para el 15 de diciembre del 2021.
  2. Lo que tú pagarías por un plan de cobertura médica dependerá de tu ingreso anual.
  3. Se aceptarán solicitudes: En-línea, llamando al 1-800-318-2596, o cualquier sitio web de inscripción, que esté certificado. Para obtener más información sobre las diferentes formas de como inscribirse use este enlace: https://www.cuidadodesalud.gov/es/apply-and-enroll/how-to-apply/

Este año, Los Centros de Servicios de Medicare y Medicaid ha dado un subsidio de $80 millones para financiar los navegadores de salud a través del país que están calificados y certificados para ayudar con la inscripción en un plan de salud. Mientras que los agentes y corredores también están disponibles, los navegadores son una fuente de información en las comunidades latinas y ofrecen a sus comunidades asistencia confiada sobre la inscripción. Los consumidores pueden encontrar asistencia en persona o con un agente/corredor en donde viven, usando el enlace: https://ayudalocal.cuidadodesalud.gov/es/#/

*Links are no longer active as the original sources have removed the content, sometimes due to federal website changes or restructurings.

NCL offers support for Star Rating for Biosimilars Act, H.R. 2855

October 13, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org or (724) 799-5392

Washington, DC—The National Consumers League (NCL) is pleased to support the Star Rating for Biosimilars Act, as introduced by Representatives Paul D. Tonko (D-NY) and Bob Gibbs (R-OH). NCL believes that implementing a rating system for biosimilars would incentivize insurers to provide lower cost drug alternatives and alleviate the financial burdens on patients.

The Centers for Medicare and Medicaid Services (CMS) currently has a star ratings system for insurance plans under Medicare Advantage and Part D. The quality measures capture items such as clinical quality, beneficiary satisfaction, patient outcomes, and regulatory compliance. This rating system helps the CMS evaluate which plans to keep and discontinue. To date, we do not have a comparable rating system where biosimilars are concerned. “Biosimilars are on average 30 percent cheaper than their biologic counterparts, yet many existing barriers in our current healthcare plans prevent patients from accessing these cost-saving medicines,” said NCL Director of Health Policy Jeanette Contreras.

The Star Ratings for Biosimilars Act would require the CMS to put in place a five-star performance rating system for biosimilar products under Medicare Advantage Plans. For each plan, the ratings will be based on quality measures meant to evaluate the level of access that each insurance plan provides to biosimilars, such as whether a biosimilar is on the formulary, and the percentage of enrollees prescribed a biosimilar when its biologic counterpart is available. Aside from Advantage Plans, the bill would also require the CMS to incorporate these measures into a similar rating system for plans under the Medicare Part D prescription drug benefit.

The NCL believes in transparency as a core function of informed decision-making. Knowing whether cost saving biosimilars would be available to enrollees under various Medicare (including the Medicare Advantage plans) and Part D plans would bring in more transparency to help consumers be more informed when selecting a plan. “Allowing consumers to see which plans are offering access to lower cost biosimilars would also incentivize Medicare plans to increase patient access to biosimilars,” said Contreras. We encourage Congress to pass the Star Rating for Biosimilars Act in order to broaden access to and encourage increased provision of cost-saving biosimilars.

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About the National Consumers League

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.

NCL supports the Helping Adults Protect Immunity (HAPI) Act

September 30, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242

Washington, DC—The National Consumers League (NCL) is pleased to support the Helping Adults Protect Immunity (HAPI) Act (HR 2170), introduced by Representative Darren Soto (D-FL) in the House and by Senator Sherrod Brown (D-OH) in the Senate. The bill would expand access to immunizations for adults by eliminating cost-sharing for vaccines recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP).

“Throughout its rich history, NCL has advocated for increased access to vaccines as life-saving medical interventions. The HAPI Act is common sense legislation that would help to eliminate out-of-pocket costs for all vaccines recommended by the ACIP,” said NCL Director of Health Policy Jeanette Contreras. This legislation would apply to crucial immunizations such as Shingles and tetanus, diphtheria, and pertussis vaccines, along with future vaccines.

NCL is grateful for the important role of the ACIP to make recommendations using evidence-based research methods, examining the harm-benefit ratio, and understanding the values of the affected populations. Currently, all ACIP and CDC recommended vaccines are covered with no out-of-pocket costs under private insurance, Medicare Part B, and ACA Medicaid Expansion. Unfortunately, traditional Medicaid beneficiaries must often pay varying out-of-pocket costs for recommended vaccines depending on the state.

More than 50,000 adults in the United States die annually from vaccine preventable deaths. The HAPI Act would help to lower that number significantly by providing more vaccine access to Medicaid beneficiaries, our most vulnerable low-income populations. “No one should be unable to obtain a vaccine due to cost barriers. We can ensure that all Americans are protected against preventable diseases regardless of their state of residence or their ability to pay,” said Contreras.

NCL urges Congress to pass the HAPI Act to ensure Medicaid beneficiaries across the country have  equitable access to recommended vaccines across lifespan.

About the National Consumers League

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.

NCL stands behind CDC COVID-19 booster recommendations

September 29, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242

Washington, DC—The National Consumers League (NCL) applauds the coordinated efforts of the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to approve the Emergency Use Authorization (EUA) of the Pfizer-BioNTech COVID-19 vaccine booster. As the Delta variant continues to cause more breakthrough cases among vaccinated individuals, it is clear that we need to ensure the protection of our most vulnerable populations.

On September 24, CDC Director Rochelle Walensky went beyond the recommendations of the Advisory Committee on Immunization Practice (ACIP) and made the call to recommend the single-dose booster to frontline workers in addition to those groups recommended by ACIP. Walensky’s recommendations are in line with those of the FDA’s Vaccines and Related Biologic Products Advisory Committee (VRBPAC), which voted to approve the EUA of the booster shot for individuals older than 65 years of age, individuals at high risk for severe disease, and those with institutional or occupational exposure to COVID-19.

“NCL has long advocated for increased access to the vaccine for frontline, essential workers and equitable distribution of the vaccine to populations hardest hit by the pandemic,” said Jeanette Contreras, NCL Director of Health Policy. “The single-dose booster shot is a necessary measure to ensure the safety of those most at risk, and to further mitigate the spread of the COVID-19 virus.” The essential workers who received their Pfizer-BioNTech vaccines early in the pandemic are next in line for the booster shot, recommended at least six months after completion of the primary two-dose series.

“Consumers who were vaccinated with the Moderna or Janssen COVID-19 vaccine are on the edge of their seats,” said Contreras. “In some cases, consumers may want to get a Pfizer-BioNTech booster shot even if they’ve had one of the other vaccines. We want consumers to know that there is still not enough data for the FDA to approve mixing the vaccines.” The Administration has signaled that while recommendations for ‘mixing and matching’ vaccines will come later in October, they are working closely with Moderna and Johnson & Johnson to get their booster shots approved in the coming days.

Consumers who completed the primary series of the Pfizer-BioNTech COVID-19 vaccine, branded as Comirnaty, now have ready access to the booster shot. Consumers must demonstrate they had their second dose of the vaccine at least 6 months ago and attest to being in the approved high-risk population groups. NCL stands behind the recommendations of the CDC and will continue to ensure that consumers have access to life-saving vaccines.

About the National Consumers League

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.

National Consumers League applauds decision to ban vaccine misinformation from YouTube

September 29, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242

Washington, DC—The National Consumers League (NCL), America’s pioneering consumer and worker advocacy organization, today applauded YouTube and its parent company Alphabet for their decision to ban anti-vaccine misinformation from the platform. NCL has been a leading voice in promoting vaccine confidence and pushing online platforms to do more to counter misinformation and disinformation about COVID-19 and vaccines, which has contributed to far too many preventable deaths.

The accounts being removed are known anti-vaccine organizations. Robert F. Kennedy’s Children’s Health Defense Fund, one of the most high-profile anti-vaccine organizations in America, was responsible for more than half of the paid advertisements on Facebook in years past. Joseph Mercola, founder of Mercola.com Health Resources, authored an article falsely stating that COVID-19 vaccines released via emergency authorization may cause massive side effects. Tenpenny Integrative Medical Center, spearheaded by physician, Sherri Tenpenny, promotes alternative health in lieu of vaccines and authored the book, “Say No to Vaccines: A Resource Guide for All Ages.”

The following statement is attributable to NCL Director of Health Policy: Jeanette Contreras:

“Vaccine hesitancy driven by rampant misinformation online is costing lives every day and prolonging a pandemic that has devastated consumers financially as well as physically. YouTube’s decision to ban anti-vaccine misinformation, while overdue, is nonetheless an important step forward in the fight against the COVID-19 pandemic.”

About the National Consumers League

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.

NCL lends support to Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act, H.R. 2815

September 24, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242

Washington, DC—The National Consumers League (NCL) is pleased to support the Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act (H.R. 2815), introduced by Representatives Adam Kizinger (R-IL) and Kurt Schrader (D-OR). NCL believes that expanding the use of biosimilars is a safe and effective option for making prescription drugs more affordable for all.

In the midst of a pandemic, consumers across the country are unable to receive necessary care for many reasons — the most prominent being high costs. Biologics are among the fastest-growing segments of the prescription product market, and costly to the patients who rely on them. What is unique about biologic treatments is that they are directly able to combat the underlying cause of a disease. NCL is committed to educating consumers about the value of biosimilars as alternatives to biologics.

Consumers are largely unaware that similar to generic prescription drugs, biosimilars are the generic equivalent to their biologic counterpart. As with generic prescription drugs, FDA-approved biosimilars have no clinically meaningful differences from their reference biologics. Biosimilars function in the same way as biologics and are subject to the same rigorous testing by the FDA to ensure their safety. The FDA has approved biosimilar medications to treat conditions such as cancer, diabetes, Crohn’s disease, colitis, rheumatoid arthritis, psoriasis, and more. Biosimilars can enter the market once the patent protections for brand-name biologics expire, and when multiple options exist on the market, competition drives prices down.

NCL believes that biosimilar treatment options are a great way to ensure that cost is not a factor that inhibits access to care. Currently, Medicare beneficiaries pay 20 percent coinsurance on Part B drugs, which includes both biologics and biosimilars. On average, biosimilars cut the price of biologics by about 30 percent, which provides beneficiaries with significantly lower prices than the biologic alternative. While biologics make up a small percentage of the total number of drugs on the market, and just 2 percent of prescriptions filled, they represent 40 percent of all drug spending.

Currently, Medicare reimburses participating physicians based on the average sales price (ASP) of a drug with an additional 6 percent of the reference price. However, because biosimilars are cheaper than biologics, physicians more often prescribe the higher-priced treatment. NCL supports increasing the reimbursement percentage for biosimilars as a way to incentivize physicians to prescribe biosimilars. The BIOSIM Act would maintain the 6 percent reimbursement for prescribing a biologic and increase the return for prescribing biosimilars to 8 percent for a five-year period.

The BIOSIM Act provides the needed incentives to boost utilization by providers to prescribe biosimilars and makes it cheaper for beneficiaries to receive the care they require. “If enacted, this policy would not only provide significant savings to consumers, it would also drive down Medicare spending overall,” said NCL Director of Health Policy Jeanette Contreras. “Congress should act on passing the BIOSIM Act in order to increase access to safe and effective biosimilars that provide consumers an affordable alternative to high-cost biologics.”

About the National Consumers League

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.

NCL applauds full approval of Pfizer-BioNTech vaccine

August 24, 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242

Washington, DC—The National Consumers League (NCL) applauds the Food and Drug Administration (FDA) for granting the Pfizer-BioNTech vaccine full licensure approval. The FDA’s gold standard approval is a testament to the remarkable safety and efficacy of the Pfizer-BioNTech vaccine. Though the vaccine will now be marketed under the name Comirnaty, it will remain free to U.S. residents.

Today’s announcement is a historic victory for science, and a signal that the Moderna vaccine will also receive full licensure approval in the coming weeks. NCL has long-advocated for access to vaccines as life-saving interventions. It is our hope that this news will instill more vaccine confidence in the nation and persuade the vaccine hesitant to get vaccinated.

While the vaccine has been approved for people 16 years of age and older, it remains available under Emergency Use Authorization for children ages 12 to 15. Parents of adolescents can share a collective sigh of relief as they send their kids to school this fall. Already, 45 percent of children ages 12-15 have had at least one dose of the vaccine, but only 32 percent are fully vaccinated. Full approval may help to ease concerns that hesitant parents have about the safety of the vaccine.

The approval of the vaccine will allow more employers to implement vaccine mandates in states where the state legislature has banned these measures. Advocating for workers as well as consumers, NCL supports vaccine mandates that provide paid sick leave, financial incentives, and exemptions for verifiable religious or medical reasons.

Over 200 million Americans have received at least one-dose of a COVID-19 vaccine, but we are far from reaching herd immunity.  Only 51.5 percent of the total population is fully vaccinated. The Delta variant now accounts for over 137,000 new cases on average each week and is spreading faster than earlier strains of COVID-19. The only way to end this pandemic and prevent the emergence of further variants is to increase vaccinations. NCL remains committed to increasing vaccine confidence and uptake. We are hopeful today marks a turning point in our fight to end this pandemic.

About the National Consumers League

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.