Creating Hope Act 2010 Bill Would Extend Priority Review Voucher System To Rare Pediatric Diseases

** By Chris Hempel

Great news for the pediatric rare disease community came out late last week — rare disease advocates please get this out on your blogs!

Senators Sam Brownback (R-KS), Sherrod Brown (D-OH), and Al Franken (D-MN) are supporting the bipartisan bill S. 3697, the “Creating Hope Act of 2010.” Nancy Goodman, Executive Director of Kids v Cancer, is the person leading the charge on S. 3697 and a priority review voucher system for pediatric rare diseases.

In 2009, Nancy lost her son Jacob to a rare pediatric cancer called medulloblastoma. She is an inspiration to all in the rare disease community!

The Creating Hope Act of 2010 builds upon the Food and Drug Administration Amendments Act of 2007, often called the “treat and trade” program, which established a priority review voucher program for drugs or biologics targeting neglected tropical diseases. At the time this bill was passed, rare childhood diseases were excluded.

he Creating Hope Act of 2010 will encourage the creation of new drugs for underserved children like Addi and Cassi who suffer from serious and life threatening medical conditions by providing a priority review voucher (PRV) as an incentive to pharmaceutical companies who develop drugs for rare pediatric diseases like Niemann Pick Type C.

This is exactly the type of novel incentive system I have been asking for that could fast track cyclodextrin research. For example, with a PRV system in place, I could get a company like Johnson and Johnson to actually take on Niemann Pick Type C disease research and help me make a cyclodextrin drug for Niemann Pick Type C kids.  In turn, Johnson and Johnson could receive a priority review voucher that gives them priority FDA review of another application that would otherwise be reviewed under FDA’s standard review clock.

This priority review voucher could be used for a blockbuster drug that a company would want want to bring to market and receiving priority review could mean millions of dollars to a Pharma or biotech company.  This is why they would be willing to invest in Niemann Pick Type C research and cyclodextrin and help our small community bring a potentially life saving compound to market for kids like Addi and Cassi.

Since I already have an orphan drug application filed and approved with the FDA, having a priority review voucher system in place potentially makes Niemann Pick Type C an attract investment risk by Pharmas or BioTechs.

Priority reviews vouchers for pediatric rare diseases are a  win-win for everyone!  We need to rally the rare disease community to fight for the passing of S. 3697, Creating Hope Act 2010 bill.

Below are some key provisions of the S. 3697, Creating Hope Act 2010 bill:

• Extension to pediatric rare diseases: This legislation includes rare pediatric disease within the scope of the program. This category encompasses any disease that is “rare” within the meaning of the Orphan Drug Act (affects less than 200,000 people, or the cost of development would exceed revenue) is recognized in the medical community as affecting a pediatric population and is a new drug that has not received FDA approval for an adult indication
• Closing a loophole: This legislation would prevent companies from receiving a voucher for tropical disease products that they already market in other countries. This change will ensure that the program rewards only innovative treatments
• Unlimited transferability of vouchers: A voucher may now be transferred unlimited times provided that the transferee, in each instance of transfer, notifies the FDA of the change in ownership. This change enables drug companies to maximize the value of the voucher in the marketplace
• Optional upfront priority review designation process: Under the current law, sponsors do not know whether their new drug application will qualify for a voucher until the time of FDA approval. The proposed legislation permits sponsors of both tropical disease drugs and rare pediatric disease drugs to seek a designation that the new drug would qualify for a voucher, should it be approved, even before they submit their new drug application.
• Adds Chagas disease to the list of neglected tropical diseases: Chagas disease is responsible for more deaths in Central and South America than every other parasite-borne disease, including malaria. Yet, despite its profound impact, research and development of new treatments is severely underfunded. The addition of Chagas to the list of eligible diseases fulfills the intent of the original authors.
• Reporting and marketing requirements: The Creating Hope Act requires that the sponsor submit a statement of good faith intent to market the eligible drug, as well as a report describing the demand and distribution of the ultimate product.

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Take Action for Me: Please send this letter to your reps!

Remember back in January when I wrote THIS LETTER in support of the Ryan Dant bill?  Well, the HR number has changed, but the importance of this bill has not.

Please, please, please just take a moment to send this letter off either via snail mail or email to your local congress and senators.  It is so very important!!  http://www.gaucherdisease.org/senator_congressman_cosponsor_letter.doc

Read more about the bill here:  http://www.gaucherdisease.org/legislation_ryan_dant.php

Dear Gaucher Community:

I would like to make you aware of a piece of legislation that not only affects the Gaucher population, but individuals with other rare diseases.

On April 9, 2008, Congressman Kenny Marchant (R-TX), introduced H.R. 5748, the Ryan Dant Healthcare Opportunity Act of 2008. This Bill is named for a constituent, Ryan Dant, who is in Congressman Marchant’s district and suffers from an extremely rare congenital disease. Ryan’s prescription drug costs are close to $500,000.00 annually. Ryan will soon exhaust the lifetime maximum of his private healthcare insurance. When this happens, he will have no choice but to enroll in the Medicaid program for the duration of his life, so that his lifesaving medication will be covered. This will greatly limit his earning capacity.

H.R. 5748 provides an alternative to individuals facing a similar situation, by allowing a Medicaid state option that would permit individuals to be released from the qualifying earnings restrictions. This legislation would apply only to individuals who pay more than $250,000.00 per year in prescription drug costs and have exhausted at least $1,000,000.00 in private insurance coverage.

As with any piece of legislation, it takes the efforts of thousands of individuals to bring it to fruition. The National Gaucher Foundation is committed to doing everything possible to see H.R. 5748 passed.

I am asking you to please join with me and Mark Dant, Ryan’s father, in mobilizing our forces. I have always been so proud of how the Gaucher community pulls together to not only help each other, but others in need as well. Inside, you will find sample letters and contact numbers for both your Legislators and members serving on the Health Sub-Committee. I urge you to please contact these individuals, as well as, distribute this information to anyone you know who could assist us. Time is of the essence! We need to move on this as quickly as possible!

Sincerely,

Rhonda P. Buyers
Ceo/Executive Director
National Gaucher Foundation

Thank you, Senator John Cornyn!

It has been EATING at me that we got declined for SSI because of our income (which is not that great for a family of five!).  So, you know me, I decided to take action!  It is just WRONG that people who need assistance don’t receive it, especially if they have been paying into the system for decades! 

I wrote a letter to Senators John Cornyn and Kay Bailey Hutchison, our Texas senators, about our situation last week.  I ended the letter asking for help with that issue as well as “In addition to requesting assistance from your office to obtain eligibility, I would like to work with your office to alter the eligibility requirements for individuals with severe chronic medical issues to obtain SSI benefits.“

I also wrote our local congressman, Kevin Brady.  Kevin Brady’s office sent me an “I’m sorry but that is the way it is” letter with a phone number to call the state senator to see if there are other assistance programs available.  Not quite what I was looking for. 

Today, less than a week later, I received a letter back from Senator Cornyn’s office:

“Thank you for your recent correspondence and for bringing this matter to my attention.  The decisions of the federal agencies have a direct impact on the lives of many Texans.  For that reason, I understand the iportance of this issue to you.  As your United States Senator, I am happy to offer my assistance.

However, the Privacy Act of 1974 requires me to have your written authorization before obtaining personal information from a federal agency on your behalf.  If you would like for me to proceed with a congressional inquiry, please complete, sign, and return the enclosed form to my office…It is a priviledge to represent you in the United States Senate.  I will await your response.”

How awesome is this!   I don’t know how a “congressional inquiry” proceeds and what exactly it means, but it has to mean something!

Letter to the Congressman…

This letter is going to be presented to a congressman working on the bill I mentioned last night, HR 5748.   I hope I made it powerful enough to catch his attention!

Dear Congressman,

One of my cherished roles in being a mother is to guide my three children on the path to following their dreams and to pursue the career of their choice.   For my two oldest children, I can encourage them to reach for the stars and dream big.  For my youngest daughter, I have to tell her that she cannot dream.

My youngest daughter, Hannah, is six months old.  She was born with an enlarged spleen, enlarged liver, and extremely low platelets.   She has suffered through numerous procedures (IVIg transfusions, platelet transfusions, skeletal surveys, skin biopsies, etc.) and probably has had more blood draws than most adults.  Finally, after five months of searching for a diagnosis, we now have one.  Gaucher’s Disease, type 1 or type 3.

Hannah has one of the most severe forms of Gaucher’s disease, as her body produces absolutely no enzyme to help break down the fat in her body, so it gets stored in her spleen, liver, and possibly her brain (type 3).  It is incredibly rare for a newborn to display this disease, so we feel we are travelling a road that very, very few have travelled before us.

For the physical aspects of this disease, she will be starting Cerezyme treatments via IV infusion every two weeks for the rest of her life.   Picture if you will, an infant baby girl having to be painfully pricked with an IV and attached to a machine for 3 to 4 hours every two weeks in order to save her life.  How does a mother explain this to a baby, a toddler, or even a young girl?

Cerezyme is one of the most expensive drugs on the market today.  As an adult, the cost of her treatment will average about $250,000 to $300,000 a year by today’s standards.  Even as an infant, the Cerezyme alone will cost over $30,000, and this doesn’t include other related medical bills such as doctor visits, use of the infusion center for the treatments, possible upcoming surgeries, etc.

Because of the numerous doctor appointments, weekly therapy sessions, and Cerezyme treatments every month, I am unable to return to work.  We are now living off our small personal savings along with my husband’s income from his job to raise our three children in addition to dealing with our mounting medical debt.

We applied for Supplemental Security Income to give us a little assistance.  We were immediately turned down once I shared what our current income was.  Just like that, our chance for any help was dashed.  What was even more shocking is that our income is not that great compared to most families of five.  My husband and I have both been regularly employed for over 20 years, never needing government assistance.  We have been “paying into the system” for years, and now when we need help from the system we have been funding for over two decades, the door gets slammed in our face.

Our family has gone from living a comfortable two-income middle-class lifestyle with a small savings to now being faced with possible future bankruptcy because of the cost of medical treatments and procedures for our daughter. 

What makes matters worse is that Hannah is never going to get the chance to make a decent income as an adult.  Since most insurance companies would probably not insure her because of the cost of her treatments, she is going to have to rely on Medicaid to cover her treatments.  In order to qualify for Medicaid, she has to settle with only being able to work a low paying job.

How do I tell my daughter that her brother and sister can strive for any job in the world, but you have to resign yourself to the fact that you can’t have a “dream job” and instead will have to take a low-paying job for the rest of your life just to save your life?

Because of her Gaucher’s Disease, she has already been given monumental life obstacles to deal with over her lifetime.   But this disease does not take away her ability to dream.  You have the opportunity to give my daughter the chance to dream and to be anything she wants to achieve by supporting bill HR5748. 

Thank you,

 

HR5748 – First step towards change!

I got a phone call from someone representing the Ryan Dant bill, HR-5748.  She is heading to Washington this week to meet with a congressman about getting this bill moved forward.  ”H.R. 5748 would amend title XIX of the Social Security Act to permit States to exclude earned income in determining eligibility for medical assistance for individuals with extremely high prescription drug costs.” 

This bill will directly affect Hannah in so many respects.  With the laws the way they are now, if Hannah is able to get insurance coverage when she is an adult and she hits the maximum cap, then she would have to apply for medicaid for her life-saving bi-weekly treatments.  In order to qualify for medicaid, her income has to be below a certain level.  This means that Hannah would not have the opportunity to strive for the job of her dreams; instead, she would have to resign herself to a low-paying job in order just to have her medical treatments.  How do I tell my daughter that her brother and sister can strive for any job in the world, but you have to resign yourself to the fact that you can’t have a “dream job” and instead will have to take a low-paying job for the rest of your life just to save your life?

H.R. 5748 provides an alternative to individuals facing a similar situation, by allowing a Medicaid state option that would permit individuals to be released from the qualifying earnings restrictions. This legislation would apply only to individuals who pay more than $250,000.00 per year in prescription drug costs and have exhausted at least $1,000,000.00 in private insurance coverage. (NGF)

I was asked to write a 3 to 4 paragraph letter to the congressman this evening sharing our story to be presented at this meeting.  I was also asked that if requested, would I consider testifying in congress about our personal situation with Hannah.  Absolutely, unequivocally, without a hesitate, hell yes I would!!  I will admit, there is the selfish part of me that would be so proud to be able to truly be able to fight first hand for Hannah to have a better future.

I’m going to work on that now, and I will post it in the morning to share.

This bill would give Hannah the chance to dream to become anything she wants to be.  How can I not do everything and anything I can to give her that opportunity?

Seriously Utah Representative Dougall???

As most of you know, Hannah’s upcoming medical treatments for life scare the heck out of me financially. 

Not only do we have the stress of having the most severe form of Gaucher’s disease, regardless of type, but we also have the fear of type 3, one which will add neurologic problems and shorten Hannah’s life expectancy dramatically.   Because presentation of GD is so rare in newborns, we are in somewhat unchartered territory, and because it is such an extremely rare disease, there isn’t a lot of information out there to compare against.

Putting all that aside, Hannah’s Cerezyme treatment is going to help us try and keep away the physical symptoms of GD…bone crises and bone death, growth retardation, severe pain, compression of the lungs, and more.   But Cerezyme is considered one of the most expensive drugs in the world.   Hannah will need this drug, as well as other therapies, procedures, and surgeries for the rest of her life.  I’m not going to rant about this again.  You all know how I feel.

Tammy, Parker’s Mom, is dealing with similar financial issues and hoping that insurance and medicaid will help provide those life-requiring treatments for her beautiful boy.  

But her representative, Utah’s John Douglass, has championed legislation that disabled the Disabled Tax exemption.  Mr. Douglass — what the hell are you thinking?!?  Tammy mentions his “lack of compassion.”  She is being too kind.  The words I feel are much stronger, and they would probably require an R-rating, possibly an X-rating.  

Take a moment to read Tracy’s letter.  This is just beyond horrible… We need to fight ignorant people, especially politicians who are SUPPOSED to look out for the future of our children.

Orphan Drug Act of the 1980′s

From the US Food and Drug Administration:

The original definition of “rare disease or condition” in the Orphan Drug Act was amended in October 1984 by P.L. 98-551 to add a numeric prevalence threshold to the definition:

“…the term rare disease or condition means any disease or condition which (a) affects less than 200,000 persons in the U.S. or (b) affects more than 200,000 persons in the U.S. but for which there is no reasonable expectation that the cost of developing and making available in the U.S. a drug for such disease or condition will be recovered from sales in the U.S. of such drug.”

The Orphan Drug Act (P.L. 97-414, as amended) includes various incentives that have stimulated a considerable amount of interest in the development of orphan drug and biological products. These incentives include tax credits for clinical research undertaken by a sponsor to generate required data for marketing approval, and seven years of marketing exclusivity for a designated drug or biological product approved by the FDA.

The FDA, through OOPD, funds the development of orphan products through its grants program for clinical studies.