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Health Advisory Council Newsletter | Winter 2022

NCL Health Policy at Work

Consumers for Safe CBD

During the 2021 holiday season, the Consumers for Safe CBD campaign released a PSA reminding consumers to be wary about the unknowns and risks associated with retail CBD products they may give or receive as gifts or encounter at gatherings.

On January 20, The Journal of Studies on Alcohol and Drugs published new research commissioned by the Consumers for Safe CBD campaign. The findings reveal the various tactics cannabidiol (CBD) companies use to thwart the Food and Drug Administration (FDA) review process and assert that their therapeutical claims are backed by science. The study, The Use of Academic Research in Medical-Cannabis Marketing: A Qualitative and Quantitative Review, exposes nearly 1,000 health claims touting CBD’s ability to mitigate symptoms or treat mental health, autism, pain, sexual health, AIDS, cancer, COVID-19, and more. This information provides just a snapshot of the current, unregulated marketing tactics being used to mislead the public.

Pharmacy Benefit Managers (PBM)

In our ongoing efforts to raise awareness of the role that Pharmacy Benefit Managers (PBMs) have in driving up prescription drug prices, NCL Executive Director Sally Greenberg spoke with policy expert, Antonio Ciaccia, President of 3Axis Advisors and Chief Executive Officer of 46brooklyn Research, on a recent We Can Do This! podcast to talk about how PBMs impact what consumers pay out-of-pocket for their medicines.

NCL also recently joined the PBM Accountability Project, which brings together leaders and stakeholders across healthcare, labor, business, pharmacy, and consumer patient advocacy to help ensure that patients or our private and public sector health plans aren’t overpaying for the prescription medicines we need. We’d like to highlight a new report Understanding the Evolving Business Models and Revenue of Pharmacy Benefit Managers.

NCL has been working to bring awareness to the need for PBMs to count all copayments made by or on behalf of an enrollee toward the enrollee’s annual deductible and out-of-pocket limit. NCL recently submitted comments on the Notice of Benefit and Payment Parameters (NBPP) 2023 Proposed Rule expressing our concern that the proposed rule does not include reference to copay accumulator adjustment policies. As a new member of the All Copays Count Coalition, NCL also signed onto the Coalition’s comment letter, which further discusses the negative implications that these additional costs have on consumers.

Access to safe drugs and devices

NCL submitted comments to the FDA on a proposed rule to establish a new category of over-the-counter (OTC) hearing aids. NCL stresses the need for safe and effective OTC hearing aids based on the consensus recommendations from leading hearing care professional associations. NCL is calling for increased sound level safety measures to be included for these devices. In an op-ed published in Inside Sources, NCL’s Director of Health Policy Jeanette Contreras, shared her own story of her experiences with her father’s hearing loss and use of hearing aids. She also recorded a PSA about this issue, which reached more than 850,000 impressions, garnering 100,000+ completed views, and roughly 600 clicks to our website. In addition, Jeanette also wrote a blog on the OTC Hearing Aids issue.

The Domain Reform for Unlawful Drug Sellers (DRUGS) Act is an important bill that NCL has been supporting, in efforts to address the sale of illegal and illegitimate drugs online. NCL’s Health Policy Associate, Milena Berhane, wrote a piece at our blog on the importance of holding internet registries accountable for monitoring what is being sold on their domains. The NCL Health Team also shared this legislation with Hill staff, as part of the Council for Affordable Health Coverage (CAHC).

In its advocacy to increase access to FDA-approved medicines and treatments, NCL is supporting a handful of bills aimed at increasing consumer access to biosimilars. NCL is lending its support to The Increasing Access to Biosimilars Act (S. 1427), which would increase Medicare payments for providers who use biosimilars. More specifically, it would create a pilot program by the Centers for Medicaid and Medicare Innovation (CMMI) that would encourage physicians to prescribe less expensive biosimilars for their patients. This legislation is important in addressing the high costs of drugs for patients.

Script Your Future

This year marks the 11th year for NCL’s Script Your Future Team Challenge. This year’s program launched on January 17, 2022, and students of pharmacy will have until March 28 to conduct their patient outreach and counseling activities. The Team Challenge incorporates the topics of medication adherence, vaccine confidence, and safe drug disposal. There are 24 schools of pharmacy enrolled in this year’s challenge, and we have sent them materials including posters, stickers, and medication adherence cards to help them with their outreach activities. The teams will submit evaluation reports, and are competing to win awards in various categories: the national award, rookie award, health disparities award, media outreach award, creative interprofessional team event award, and the technology innovation award. Award winners will be announced in early June.

Women’s and maternal health 

NCL kicked off the year with a January 2022 meeting of the Preterm Birth Prevention Alliance. The Alliance is focusing on raising awareness of preterm birth’s disproportionate impact on women of color as further urgency for representative research and Real-World Evidence on treatment efficacy across populations. NCL created infographics (see image at right) for provider and patient perspectives taken from recent surveys among women and women’s health, obstetric and neonatal nurses.

With the looming possibility of Roe v. Wade being overturned and the restrictive abortion laws that have been enacted in Texas and Mississippi, NCL’s Executive Director, Sally Greenberg, sat down with Karen Mulhauser – to discuss her personal story, and experience as the first Executive Director of NARAL and the upcoming elections – for the most recent episode of NCL’s We Can Do This! podcast. On this same topic, NCL health policy intern Grace Mills wrote a blog highlighting the current legal issues surrounding

women’s reproductive freedom.

Vaccine safety and confidence 

NCL has continued its work to increase vaccine safety and confidence. By being a part of Johnson & Johnson’s The Costs of Waiting Campaign headed by tv and movie star Kerri Washington, NCL has been able to share vaccine-related resources that aim to educate consumers on the importance of being vaccinated for COVID-19. On February 4, 2022, NCL Health Policy Associate Milena Berhane testified live before the CDC’s Advisory Committee on Immunization Practices (ACIP) on the recent approval of the Moderna COVID-19 vaccine for adults 18 years of age and older.

Adult immunization is an important consumer issue, especially during the COVID-19 pandemic. NCL has been working to increase awareness on the need for adult vaccine uptake. On January 12, NCL submitted comments to ACIP regarding the need for expanding access to influenza, hepatitis, and pneumococcal vaccines for adults.

In addition, NCL published an open letter to Spotify calling for the removal of Joe Rogan’s anti-vaccine podcast content. NCL firmly believes Rogan’s anti-vax statements cause significant harm to consumers, fueling misinformation about vaccines.

Health Advisory Council Newsletter | Winter 2022

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Member Spotlight: MANA

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    The work of the National Consumers League is making a difference in people’s lives across the country. Meet some of the consumers touched by our programs.

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    Paige, 55, a Nashville wife and mother of two, answered an employment ad for secret shoppers. Before sending payment to the scammers, she reached out to NCL.

    Read about NCL’s impact

  • Building a stronger generation

    A grease fire flared up in Decklan’s kitchen. As his family scrambled and panicked, fearing that the whole house might erupt in flames, Decklan remained calm. He hurried over to the pantry, grabbed some baking soda, and dumped it on the fire quickly extinguishing the blaze.

    Read about NCL’s impact

  • Script Your Future saved my life

    Cincinnati resident Charles, 45, lost his computer business — and health insurance— during a time of economic downturn. A diabetic, Charles was now unable to afford his medication. He stopped taking it which made him seriously ill and put his life at risk.

    Read about NCL’s impact

  • For a safer workplace

    Jeremy is a fast-food worker who has been employed at a number of Chipotle restaurants in New York City. When he was just 20 years old, he took part in an NCL research project that revealed that management practices within the fast food chain were putting workers—and food safety for customers—at risk.

    Read about NCL’s impact

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PBPA Commends HHS Funding to Support Maternal and Infant Health

The Preterm Birth Prevention Alliance (PBPA), a coalition of maternal and women’s health advocates dedicated to improving preterm birth outcomes in the United States and addressing its disproportionate impact on women of color, applauds the U.S. Department of Health and Human Services (HHS) for awarding nearly $350 million to states across the country to improve support for safe pregnancies and healthy babies.

“For far too long, U.S. maternal health care has lagged behind that of other developed countries, particularly for women of color,” noted Sally Greenberg, Executive Director of the National Consumers League. “This additional funding will enable local health departments and nonprofits to better address the health care needs of the most vulnerable mothers and their babies.”

The funding, awarded by HHS’ Health Resources and Services Administration (HRSA), will support home visiting services, increase access to doulas, address infant mortality and maternal illness, and improve data reporting on maternal mortality.

“Maternal health care in the U.S. has consistently failed women of color,” Greenberg continued.  “We applaud HHS for this additional funding that will help to improve the maternal health for all mothers and babies, especially women of color and those most at-risk.”

The funding announcement follows the release of a report by the U.S. Commission on Civil Rights which found that Native American women are more than two times more likely to die from pregnancy-related complications than white women in the U.S. This disparity was further exacerbated for Black women in the U.S., who are three to four times more likely to die from pregnancy-related complications than white women.

“In addition to expanding programs to support maternal health, we must increase representation from racially and ethnically diverse groups in research and clinical trials, particularly those studying treatment options to prevent maternal morbidity and mortality,” said Greenberg.  “The need for the additional HHS funding and the report from the Commission on Civil Rights clearly illustrate how critical representative research and real world evidence are to ensuring all mothers and their babies have the same opportunity for the best possible health outcomes.”

Diverse research for a diverse America: The value of equitable, real-world research

August 12, 2021/in Blog, Health, Prevention Blog Post

By Sally Greenberg, NCL Executive Director

While the COVID-19 pandemic has led to hardship for all Americans, it is clear that people of color have been disproportionately burdened. Across the health care continuum, addressing this disparity has become part of the broader conversation about the history of systemic racism and the underlying social determinants of health that negatively affect the mental, physical, and economic health of individuals and entire communities.

The pandemic has underscored persistent health disparities, and there is growing recognition that representation in research and clinical trials can have a profound impact on health outcomes. A lack of representation from racially and ethnically diverse groups in research and clinical trials have typically led to gaps in data, missing the opportunity to assess the full impact of various treatments and drugs across a range of populations. The collection and use of real-world research and data to inform the potential use, risks, and benefits of medical products and treatments can ultimately lead to better health outcomes, particularly for those who have been underrepresented in the past.

Existing efforts to improve inclusion

Efforts to expand diversity and representation in medical research are underway in Congress. Policymakers are encouraging the incorporation of Real World Evidence (RWE) in drug development through the recent Cures 2.0 draft legislation released by Reps. Diana Degette (D-CO-1) and Fred Upton (D-MI-6). While the status quo limits us from effectively reaching underserved populations, the proposed legislation would allow studies that include RWE for some drugs after they have been approved. At the heart of this issue is a growing appreciation that the same therapy can affect different populations in different ways, which is why Cures 2.0 supports collecting data that more accurately reflects the unique experiences and needs of patients across diverse populations.

Recognizing the potential for RWE in maternal health

The lack of representative research in the field of maternal health is undeniable, and its implications are staggering. The dismal state of maternal care in the United States reflects how our health care system has failed women of color, including by not adequately studying treatment options to prevent maternal morbidity and mortality. The need for RWE is clear when you consider the persistent disparities in health outcomes that plague minority communities.

Preterm birth and its disproportionate impact on women of color is a stark illustration of the need to make progress on representative research in maternal health. Preterm birth is the second-largest contributor to infant death in America today. Despite the tremendous physical, emotional, and financial toll that preterm birth continues to take on our country — disproportionately so on women and families of color — not enough therapeutic tools currently exist to prevent it.

Today, “17P,” the only FDA-approved treatment to help reduce the likelihood of spontaneous, recurrent preterm birth in the United States is at-risk of being withdrawn from the market in all its forms, including the branded product and five generic versions. Unfortunately there is conflicting evidence from two different clinical trials, one representative of a diverse U.S. population and another studied in a largely white population in Europe. It’s not a straightforward comparison. If 17P is withdrawn, the women most affected by preterm birth, predominantly women of color, would be left without an FDA-approved treatment option.

The FDA is considering the path forward, including additional data collection through leveraging RWE from past patient use. The success of the first (approval) trial for 17P in the impacted communities signals the importance of RWE. Continued access to 17P is, at its core, a matter of health equity. Black women must not yet again be left vulnerable to a system that historically has overlooked them.

PRETERM BIRTH PREVENTION ALLIANCE APPLAUDS FDA’S GRANTING OF HEARING FOR THE ONLY FDA-APPROVED THERAPIES TO REDUCE RECURRENT PRETERM BIRTH

WASHINGTON, DC, August 26, 2021 –

Preterm Birth Prevention Alliance a coalition of maternal and women’s health advocates dedicated to improving preterm birth outcomes in the United States and addressing its disproportionate impact on women of color, commends the U.S. Food and Drug Administration (FDA) for granting a public hearing to discuss 17P, the only FDA-approved class of branded and generic treatments to reduce preterm birth in indicated patients.

We appreciate the FDA’s willingness to hear directly from individuals facing prematurity and the providers who treat them about their experiences with 17P,” said National Consumer League’s Executive Director Sally Greenberg. “It is an important step towards better understanding variations in efficacy across diverse populations and ensuring all women have an equal chance at the best possible outcomes.”

Last week, the FDA agreed to grant Covis Pharma, the manufacturer of the branded 17P product Makena its request for a public hearing to discuss 17P. Hydroxyprogesterone caproate—or “17P”—has been approved since 2011 and is the only FDA-approved class of treatments to help prevent spontaneous, recurrent preterm birth in the United States. In 2020, the FDA proposed withdrawing 17P in all its forms, including the branded product and its five generic versions, based on conflicting efficacy data from two studies composed of vastly different populations, one predominantly inclusive of women in the U.S. most vulnerable to preterm birth and one not.

“Mothers and birthing people deserve access to the best possible treatments to prevent preterm birth. We cannot achieve birth equity if we study pregnant women as a monolith,” said Blythe Thomas, Initiative Director of 1,000 Days. “It is only by systematically researching the real-world, post-market impact of 17P on individuals from a variety of racial and ethnic backgrounds, while maintaining access for all affected, that we can reduce disparities in maternal and infant health.”

While the hearing date has not yet been set, the Alliance looks forward to sharing the perspectives of affected individuals and their physicians with the agency once the hearing is scheduled and will continue to advocate for at-risk moms and babies of all races and ethnicities.

###

ABOUT THE PRETERM BIRTH PREVENTION ALLIANCE

The Preterm Birth Prevention Alliance (PBPA) is a coalition of maternal and women’s health advocates who share a common concern about the state of preterm birth in the United States and the proposed market withdrawal of 17P, the only FDA-approved class of treatments to help prevent spontaneous, recurrent preterm birth. Formed in 2021 by the National Consumers League, the 15 partners in the PBPA seek to improve preterm birth outcomes in the United States by maintaining access to safe, FDA-approved treatment options and advocating for more diverse medical research that adequately represents the experiences of women and newborns of color. Women of color need a seat at the table. To learn more, visit www.pretermbirthalliance.org

LEADING PATIENT ADVOCATES LAUNCH PRETERM BIRTH PREVENTION ALLIANCE TO PROTECT CRITICAL ACCESS TO THE SOLE FDA-APPROVED CLASS OF THERAPIES TO REDUCE RECURRENT PRETERM BIRTH

WASHINGTON, DC, April 20, 2021 – Today, the National Consumers League (NCL), along with a coalition of patient advocacy organizations dedicated to advancing the health of mothers and infants, announced the launch of the >Preterm Birth Prevention Alliance.

Members of the Alliance are joining forces in an effort to preserve patient access to the only Food & Drug Administration-approved class of treatments for pregnant women who have previously had an unexpected, or spontaneous, preterm birth. Together, Alliance members seek to ensure that the Food & Drug Administration (FDA) hears concerns from the full range of stakeholders about the potential risks and impact of withdrawal for at-risk pregnant women and their providers.

For the fifth year in a row, the U.S. preterm birth rate has increased (to 10.2 percent of births), and preterm birth and its complications were the second largest contributor to infant death across the country. Preterm birth also represents a significant racial health disparity, with Black women in America experiencing premature delivery at a rate 50 percent higher than other racial groups throughout the country.

However, in 2020, the FDA >proposed withdrawing hydroxyprogesterone caproate, commonly called “17P” or “17-OHPC”, the only FDA-approved class of branded and generic treatments to help prevent the risk of preterm birth in women with a history of spontaneous preterm birth. The FDA is currently determining whether to hold a hearing on the status of 17P, based on conflicting efficacy data from two studies composed of vastly different patient populations, one inclusive of women in the U.S. most vulnerable to preterm birth and one not.

“We’re fighting for a more inclusive healthcare system that gives everyone an equal chance to have the best outcomes possible,” said Sally Greenberg, executive director of the National Consumers League. “We don’t believe that removing 17P from the market without gaining a better understanding of who could benefit the most from its use is in the best interests of patients, nor their healthcare providers, particularly as there are no other approved treatment options available.”

To date, 14 organizations have joined NCL to advocate for the health interests of at-risk pregnant women and infants, including: 1,000 Days; 2020 Mom; American Association of Birth Centers; Black Mamas Matter Alliance; Black Women’s Health Imperative; Expecting Health; Healthy Mothers, Healthy Babies Montana; HealthyWomen; Miracle Babies; National Birth Equity Collaborative; National Black Midwives Alliance; National Partnership for Women & Families; Sidelines High-Risk National Support Network; and SisterReach.

“As a trained obstetrician and gynecologist, I know firsthand the impact of preterm birth on Black women and birthing people. I also know that racism – not race – is the driving factor leading the disproportionate impact of preterm birth on Black women and birthing people thereby exacerbating systemic inequities in maternal and infant health. To achieve birth equity, which is the assurance of the conditions of optimal births for all people with a willingness to address racial and social inequities in a sustained effort, we must work to protect and uphold a standard of care for spontaneous, recurrent preterm births and ensure it remains accessible and affordable for all who stand in need,” added Dr. Joia Crear Perry, founder and president of the National Birth Equity Collaborative.

The Preterm Birth Prevention Alliance is calling for the FDA to grant a public hearing to fully consider all of the data, additional research methods, and stakeholder perspectives before deciding whether to withdraw approval of this critical class of therapies. The health of America’s moms and babies warrants the utmost care and consideration.

###

ABOUT THE PRETERM BIRTH PREVENTION ALLIANCE

The Preterm Birth Prevention Alliance is a coalition of maternal and women’s health advocates who share a common concern about the state of preterm birth in the United States and the proposed market withdrawal of 17P, the only FDA-approved class of treatments to help prevent spontaneous, recurrent preterm birth. Formed in 2021 by the National Consumers League, we seek to improve preterm birth outcomes in the United States by maintaining access to safe, FDA-approved treatment options and advocating for more diverse medical research that adequately represents the experiences of women and newborns of color. Women of color need a seat at the table. To learn more, visit www.pretermbirthalliance.org.

Initial support for the Preterm Birth Prevention Alliance is provided by Covis Pharma.

MEDIA CONTACT:

Carol McKay, carolm@nclnet.org

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