On September 14, 2016, the Rare Disease Congressional Caucus gathered a contingent of thought-leaders in the rare disease space to discuss Strengthening Medical Innovation in America for Rare Disease Patients.
With debate around the costs of prescription drugs swirling, a new report was issued from IMS Health detailing future spending on orphan drugs. The authors found that despite growth in the number of available treatments, overall oprhan drug spending will continue to be sustainable in the future. Below is the article abstract, click here to read the full article.
The Orphan Drug Act of 1983 established incentives for the development of drugs that treat rare, or orphan, diseases. We used the IMS Health MIDAS database of audited biopharmaceutical sales to measure US annual spending on orphan drugs in the period 2007–13, and we estimated spending on the drugs for the period 2014–18. We identified 356 brand-name orphan drugs that were approved by the Food and Drug Administration in the period 1983–2013. While we included orphan drugs with both orphan and other indications, we adjusted spending to include only spending for orphan indications. In 2014 dollars, expenditures on orphan drugs totaled $15 billion in 2007 and $30 billion in 2013—representing 4.8 percent and 8.9 percent of total pharmaceutical expenditures, respectively. Our future trend analysis for the period 2014–18 suggests a slowing in the growth of orphan drug expenditures. The overall impact of orphan drugs on payers’ drug budgets is relatively small, and spending on orphan drugs as a percentage of total pharmaceutical expenditures has remained fairly stable. Concerns that growth in orphan drug expenditures may lead to unsustainable drug expenditures do not appear to be justified.
TheMighty published an editorial by Sharon Rose on the need for the rare disease community to advocate in support of the 21st Century Cures Act:
Rare disease has changed my life in many ways, but the most unexpected recent change has been my interest in laws and political issues regarding health care and treatment options. You see, I am a right brainer. I enjoy and flourish in the arts. I’ve never jumped for joy while taking a math or science class. I can recall looking up medical terminology after diagnoses and subsequent MRI or test reports years ago, and how strange it was for me to learn about medicine. I was in a new arena and out of my comfort zone.
However, I realized that in order to advocate for my care, it was a necessary step, and I was finding it interesting! I was being forced to expand in ways I had never imagined. Being creative had always been my focus whether in study, or for fun. But more recently, as a patient and advocate, I’ve experienced another surprising shift in interests. Why, you ask? Because for the past 6+ years, I’ve been relentlessly and urgently seeking treatments as a patient for Klippel-Feil syndrome, cervical dystonia, Ehlers-Danlos syndrome, and vasculitis – all rare diseases. Time and time again, I have found little understanding or relief. I’ve traveled to five states seeking care. Yes, there are a few great doctors out there. Great doctors who have limited time, limited accurate information, and limited treatment and medication options to offer me as a patient dealing with such an odd laundry list of rare conditions.
To read more from this article, click here.
What do the opioid legislation, the Zika legislation and Cures/Innovations bills have in common, other than that they are “hot button” issues? In each case, Congress has done its best to seriously consider healthcare problems facing our nation and managed to find compromises in order to reach consensus. Also — significantly — the three pieces of legislation are stalled by funding issues.
Some Members of Congress (mostly Democrats) think that action on these three topics is so pressing that the legislation should contain enough mandatory funding so that they can be implemented as soon as possible. Other Members of Congress (mostly Republicans) agree on the importance of the three issues, but feel strongly that funding should be left to the appropriations committees. For the moment, the three bills are deadlocked, but it is money, not substance, that is holding them back.
One or more of the three bills may move next week or in September or (possibly) during a lame duck session. But then again, there is no guarantee that they aren’t deadlocked for the year because of the funding issues.
Meantime, the appropriations process seems to be facing a similar fate. There is some compromise and consensus baked into the current set of bills, but also lots of “poison pill” amendments and games-playing. Analysts are still predicting either a continuing resolution or an omnibus bill.
Heading into a presidential election and a difficult transition (regardless of who wins), it is already clear that the most important issue next year, as this year, will be money to fund programs. Under the existing budget agreements, there is not enough domestic discretionary spending to meet high priority needs, no less to handle emergency situations (like Zika and opioids). Under the circumstances, it is hard to say where the money will come from to pay for the new administration’s initiatives. The primacy of funding concerns will occur regardless of which party controls the House and the Senate.
None of this is good news for FDA or any of the public health service agencies. As the foremost advocate for FDA funding, the Alliance will continue to tell Congress about the broad mission and ever-increasing responsibilities on FDA. It will take all of us to make a dent against so much downward funding pressure.
Note: This week’s Analysis and Commentary was written by Steven Grossman, the deputy executive director of the Alliance for a Stronger FDA.
On April 6th, the Senate Health, Education, Labor and Pensions (HELP) Committee held the last of three markups to discuss biomedical innovation legislation. The legislation considered and approved in those mark-ups will be conferenced with the 21st Century Cures Act which passed the House of Representatives with broad bipartisan support last summer. In addition to approving the five bills under consideration, members of the Committee offered several amendments of particular interest to the rare disease community. Read more
WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI), Ranking Member Frank Pallone, Jr. (D-NJ), and Rep. Diana DeGette (D-CO) issued the following statement following a meeting at the White House with Vice President Joe Biden on H.R. 6, the 21st Century Cures Act. Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) also attended this afternoon’s meeting.
Upton, Pallone, and DeGette commented:
“Today’s meeting with Vice President Biden and Senate leaders was positive and productive. The #Path2Cures connects both the White House and U.S. Capitol, and we welcome the vice president’s enthusiastic participation in this bipartisan effort. As many patients and their families are too painfully aware, there’s not much time. But the good news is, we are more than half way there as we’ve already done the legwork in the House and the Senate is making headway on its innovation package.
“We are seeing a tremendous opportunity for Cures, with our legislative efforts coupled with the ‘moon shot’ and the administration’s Precision Medicine Initiative, there is no question that 21st Century Cures is the right vehicle to get this done. We will all continue working together – House, Senate, and White House – until we are successful in delivering #CuresNow for patients across America.”
Thanks to their diligent work educating Members of Congress, rare disease advocates were successful in expanding the ranks of the Rare Disease Congressional Caucus. In March, nine legislators agreed to join the Rare Disease Congressional Caucus:
Senator James Risch (Idaho)
Senator David Vitter (Louisiana)
Representative Brad Ashford (NE-2)
Representative David Cicilline (RI-1)
Representative John Garamendi (CA-3)
Representative Joe Kennedy, III (MA-4)
Representative Donald Norcross (NJ-1)
Representative David Rouzer (NC-7)
Representative Juan Vargas (CA-51)
We applaud these legislators for taking leadership on the issues that are important to the rare disease community. You can find the complete Rare Disease Congressional Caucus membership at http://rareadvocates.org/rarecaucus/.
From The Hill:
The Senate Health Committee will be turning its attention to a medical innovation bill now that it has completed the overhaul of No Child Left Behind, Chairman Lamar Alexander (R-Tenn.) said.
“No. 1, what we want to turn our attention to next is what we call our innovation bill,” Alexander said on C-SPAN’s “Newsmakers.” The innovation bill is the Senate’s version of a measure that has already passed the House, called 21st Century Cures. The idea behind both bills is to speed up the Food and Drug Administration’s approval process for new drugs and boost funding for research at the National Institutes of Health (NIH).
The 21st Century Cures bill passed the House on a bipartisan vote in July, but since then the momentum has slowed.
Alexander had previously said that the committee would finish its work on the bill by the end of the year, but the panel has not released a bill, much less advanced it to the full Senate.
Still, Alexander noted the bipartisan support for the idea behind the measure and said the panel is moving forward.
One of the major points of contention has been deciding whether the funding increase for the NIH will be in the form of mandatory spending, meaning that it is guaranteed over a number of years and not subject to the annual appropriations process. Sen. Patty Murray (Wash.), the panel’s top Democrat, has made her support for the bill contingent on mandatory NIH funding.
Alexander reiterated on C-SPAN that he is willing to have mandatory funding but acknowledged that not all Republicans are. He also said he wants the NIH funds to be offset by cutting other mandatory spending, which could cause Democrats to balk.
“I’m willing to consider [mandatory funding] under some circumstances,” Alexander said, if it “replaces other mandatory funding.”
“Not all my Republican colleagues are, but I’m willing to do it,” he said. “And I’m willing to do it because this is such an exciting time in science. We’re coming up with so many things to help people, and we’ve got a person like Francis Collins, who’s a genius heading the National Institutes of Health, we ought to take advantage of that.
“It affects every American, so I’m willing to do something that I normally wouldn’t do, and that’s going to be one of the toughest parts of the innovation bill that we have to decide next year.”
12-16-15 – Washington, D.C. – In a show of bipartisan support for the rare disease community, members of the House and Senate have come together to form the first bicameral Rare Disease Congressional Caucus.
The Caucus will be critical in raising awareness of the challenges faced by rare disease patients and serve as a platform for giving those individuals a voice in both the House and Senate. In addition, the Caucus will convene briefings throughout the year to educate Congressional staff on topics of importance to the rare disease community.
The Caucus will be co-chaired by Representatives Lance (R-NJ) and Crowley (D-NY) and Senators Hatch (R-UT) and Klobuchar (D-MN).
“Throughout my time in the Senate, I have worked hard to help the 30 million Americans with rare diseases,” Sen. Hatch said. “While we have previously taken important steps, like passing the Orphan Drug Act, the fact that 95 percent of rare diseases currently have no treatment shows that much more needs to be done. Senator Klobuchar has been a terrific partner on legislation to get vital treatments to patients in need, and I am honored to join her as Senate Co-Chairs of the Rare Disease Congressional Caucus.”
“While there are about 7,000 known rare diseases, there are fewer than 500 drugs approved to treat any of those conditions,” Sen. Klobuchar said. “It is critical that we work together to increase the number of safe, effective, and affordable treatments that are available for people with rare diseases. I have long worked with Senator Hatch on this issue and I look forward to continuing this work as a Senate Co-Chair of the Rare Disease Congressional Caucus.”
The Rare Disease Congressional Caucus, originally formed in 2009 by Rep. Upton (R-MI), is currently comprised of 88 Members of the House and will be expanded to include the Senate.
“We are grateful to our House champions and to Senators Hatch and Klobuchar for stepping-up to lead this Caucus on behalf of the rare disease community. We are looking forward to raising awareness about the importance of public policy to spur the development of new therapies for rare disease patients,” said Julia Jenkins, Executive Director of the EveryLife Foundation for Rare Diseases.
Rare Disease Legislative Advocates (RDLA), a program of the EveryLife Foundation for Rare Diseases, will continue to coordinate regular Hill briefings and act as a legislative clearinghouse for the patient community, with the goal of mobilizing patients to be effective legislative advocates (www.rareadvocates.org).
More than 300 patient advocates and industry leaders as well as staff from Capitol Hill and federal agencies joined us last week for the fourth annual RareVoice Awards Gala at Arena Stage in Washington, DC.
Dr. Steve Groft received a Lifetime Achievement award for his dedication to stimulating research and advancing development of therapies during his tenure at the Food and Drug Administration (FDA) and National Institutes of Health (NIH), where he served as Director of the Office of Rare Disease Research from 1993 until his retirement in 2014.
The judges had difficulty selecting the winners among the passionate patient advocates making a difference in states across the country and on Capitol Hill. Patricia Weltin, President and Founder of the Rare Disease United Foundation, received an Abbey for patient advocacy at the state level. Lisa and Max Schill with RASopathies Network received an Abbey for patient advocacy at the federal level for their efforts in support of the 21st Century Cures Act. Ronald Bartek, President and Founder of the Friedreich’s Ataxia Research Alliance, received a Lifetime Achievement Award for his tireless advocacy before Congress as well as the FDA and Social Security Administration.
The Chairman and members of the House Energy and Commerce Committee were recognized for their leadership on the 21st Century Cures Act which has several provisions critical to the rare disease community, including incentives to spur development of new therapies. Representative Fred Upton (R-MI) received a Lifetime Achievement Award. Representative Gus Bilirakis (R-FL), G.K. Butterfield (D-NC) and Diana DeGette (D-CO) were honored with Congressional Leadership Awards. Saul Hernandez, Deputy Chief of Staff and Legislative Director for Representative G.K. Butterfield, and Clay Alspach, Chief Health Counsel of the Energy and Commerce Committee, received Abbeys for their work on behalf of the rare disease community.
Dr. Kakkis, President and Founder of the EveryLife Foundation for Rare Diseases, ended the awards ceremony with a call to action, urging everyone in attendance to contact their Senators to ask that the many provisions of the 21st Century Cures Act supported by the rare disease community be included in Innovation for Healthier Americans, the Senate companion bill.
Thank you to Shire, the Presidential Sponsor, and other sponsors including AbbVie, Alexion, Amgen, Amicus, Genzyme, Novartis, PhRMA, Raptor, and Vertex. Proceeds from the Gala fund Rare Disease Week on Capitol Hill, to be held February 29 through March 3 next year.