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Senate leaders introduce Tobacco 21 bill

Both McConnell and Kaine represent tobacco-producing states

On May 20, Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Tim Kaine (D-Va.) introduced legislation that would raise the federal age of sale for tobacco products from 18 to 21. The bipartisan Tobacco-Free Youth Act comes amid a public health crisis that has resulted in a 78% spike in youth use of e-cigarettes in recent years.

Raising the age of sale for tobacco products from 18 to 21 is one of several important public policy changes Congress is considering in response to this crisis that the American Cancer Society Cancer Action Network (ACS CAN) supports. In recent months several lawmakers have brought forward similar bipartisan proposals that would also raise the federal age of sale of tobacco products to 21, as well as prohibit most flavored tobacco products, restrict advertising of tobacco products like e-cigarettes, and grant the U.S. Food and Drug Administration (FDA) the authority to collect user fees from all tobacco product manufacturers, including e-cigarette manufacturers.

The following is a statement from Lisa Lacasse, president of ACS CAN:

"Today's bipartisan action by Senate Majority Leader Mitch McConnell and Sen. Tim Kaine is another welcome indication that Congress is taking the alarming crisis of increased youth tobacco use seriously and is committed to taking action. Raising the federal age of sale for tobacco products from 18 to 21 is one of several important federal policy changes necessary to ensure a new generation of Americans do not become addicted to the deadly products sold by the tobacco industry and face increased risk for tobacco-related cancers.

"As this bill advances through the legislative process, it will be crucial that Leader McConnell and Sen. Kaine keep it free of provisions or carveouts that would benefit the tobacco industry. Any federal legislation that advances cannot preempt state or local governments from enacting and enforcing their own strong tobacco control laws, must cover all tobacco products currently on the market or that may be introduced to the market, and must not exempt anyone under the age of 21 from compliance.

"We look forward to working with Majority Leader McConnell, Sen. Kaine and other lawmakers to pass strong tobacco control policies, including Tobacco 21 legislation. If passed, ACS CAN will work with states to make sure legislation raising the age of sale moves forward across the country without any additional policy changes that might negatively impact youth use. Together we can reverse this devastating youth tobacco use trend, protect our children from the dangers of tobacco and a lifelong nicotine addiction, and improve our nation's health."

The American Cancer Society Cancer Action Network (ACS CAN) is making cancer a top priority for public officials and candidates at the federal, state and local levels. ACS CAN empowers advocates across the country to make their voices heard and influence evidence-based public policy change as well as legislative and regulatory solutions that will reduce the cancer burden. As the American Cancer Society's nonprofit, nonpartisan advocacy affiliate, ACS CAN is critical to the fight for a world without cancer. For more information, visit

  • HHS hears cancer patients' concerns about timely access to drug therapies in Medicare Part D

    Final rule lessens potential impact

    On May 16, the Department of Health and Human Services (HHS) issued its final rule for Medicare Part D which does not include the full range of proposed changes to drugs in the ‘six protected classes’ of cancer, epilepsy, HIV/AIDS, mental illness, and organ transplants. HHS had proposed allowing plans to use additional utilization management, like prior authorization and step therapy, for all drugs in these classes, however the final rule would not interfere with already established medication regiments for cancer patients.

    In addition, the proposal that would have allowed insurers to exclude new therapies that exceeded a specific price was also omitted.

    A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network follows:

    “Current cancer patients will be relieved to hear their access to innovative new drug therapies will not be in question under this finalized rule. Cancer care often requires specialized treatment targeted at a patient’s specific tumor and these treatments are rarely interchangeable.

    “Additionally, coverage of new drugs will not be excluded based on a pre-determined price alone. Concern remains, however, over how this may affect patients starting new therapies.

    “Cancer care is a race against time. We are glad HHS and Secretary Azar listened to the countless patients who voiced their serious concern over the proposed rule. We will closely monitor implementation of this rule working to make sure all cancer patients have timely access to the therapies best suited to treat their disease.”

    Read ACS CAN's advocacy efforts around this issue.

  • Federal judge rules FDA acted illegally in delaying required review of e-cigarettes, cigars

    Judge says FDA’s delay has played a role in the skyrocketing youth use of e-cigarettes

    Below is the statement of Campaign for Tobacco-Free Kids, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, and Truth Initiative:

    In a major victory for America’s kids and public health, a federal judge ruled May 15 that, in August 2017, the U.S. Food and Drug Administration (FDA) acted illegally by allowing e-cigarettes to remain on the market until 2022 before applying for FDA authorization and by permitting products to remain on the market indefinitely during review.

    In March 2018, our public health and medical organizations, and several individual pediatricians, filed suit in federal court challenging this FDA decision. Our lawsuit argued the FDA’s decision was unlawful, put kids at risk and harmed public health. The FDA’s delay allowed e-cigarettes – including candy, fruit, mint and menthol-flavored products that clearly appeal to kids – to stay on the market for years without a review of their public health impact. The FDA also delayed the deadline for cigar manufacturers to file such applications until 2021.

    On Wednesday, U.S. District Judge Paul W. Grimm of the U.S. District Court for the District of Maryland ruled in our favor, finding that the FDA had exceeded its legal authority and the FDA’s delay had played a role in the skyrocketing youth use of e-cigarettes. Judge Grimm ruled that the FDA’s delay gave “manufacturers responsible for the public harm a holiday from meeting the obligations of the law.”

    “Instead of addressing public health concerns associated with tobacco use by minors and others, the August 2017 Guidance [which delayed the product review requirement] exacerbates the situation by stating, in essence, that manufacturers can continue to advertise and sell products that are addictive and that target a youth market … at a time when minors’ use of tobacco products like e-cigarettes is at an epidemic level and rising,” Judge Grimm wrote.

    “Arguably, the five-year compliance safe-harbor has allowed the manufacturers enough time to attract new, young users and get them addicted to nicotine before any of their products, labels, or flavors are pulled from the market, at which time the youth are likely to switch to one of the other thousands of tobacco products that are approved – results entirely contrary to the express purpose of the Tobacco Control Act,” Judge Grimm continued.

    Judge Grimm has rightly recognized that the FDA’s years-long delay in reviewing e-cigarettes and cigars is causing great harm to kids and public health and cannot be allowed to stand. Judge Grimm gave the plaintiffs 14 days to tell him what remedial action they want him to order and the FDA 14 days to respond. It is now the FDA’s responsibility to take immediate action to protect our kids and require manufacturers to apply to the FDA if they want to keep their products on the market, including products like Juul that have fueled the youth e-cigarette epidemic.

    Judge Grimm noted that manufacturers have had plenty of time to meet this requirement, writing that “manufacturers long have been on notice that they will have to file premarket approval applications, substantial equivalence reports, and exemption requests, and if they have chosen to delay their preparations to do so, then any hardship occasioned by their now having to comply is of their own making.”

    The lawsuit was filed on March 27, 2018, by the American Academy of Pediatrics and its Maryland chapter, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, Truth Initiative and five individual pediatricians.

    The health groups are being represented by the legal staff of the Campaign for Tobacco-Free Kids, lawyers at Democracy Forward Foundation and the law firm of Brown, Goldstein & Levy.

  • ACS CAN ads call on HHS secretary to stop proposed changes to Medicare Part D

    Cancer survivors express concern at dangerous consequences of proposed changes to Medicare Part D drug benefit

    The American Cancer Society Cancer Action Network (ACS CAN) launched an ad campaign this week highlighting cancer patients and survivors’ deep concerns over the dangerous impact that proposed changes to Medicare Part D’s six protected classes could have on their access to critical drug therapies. 

    The ads will run on television and social media and feature actual cancer survivors and Medicare beneficiaries urging the Department of Health and Human Services (HHS) Secretary Alex Azar to protect cancer patients’ lives by halting the proposed changes. The campaign will air during programs including “Meet the Press,” “Fox & Friends,” “CNN Newsroom,” and “State of the Union,” in addition to running on Twitter.  

    The ads feature childhood cancer survivor Mariah Forster Olson of La Crosse, WI, and breast and thyroid cancer survivor Jennifer Wall of Buckland, MA, both of whom rely on medications included in Medicare Part D’s six protected classes. Forster Olson and Wall share their concerns about the impact of these proposed changes on their ability to access and afford their prescriptions. Both Forster Olson and Wall received breakthrough therapies during their initial cancer treatments and fear that these proposed changes to the six protected classes, if finalized by the Administration, could significantly delay access to the types of innovative treatments that saved their lives. 

    “Protecting access to lifesaving treatments is paramount to ensure both current and future cancer patients and survivors receive the most effective and medically appropriate therapies,” said Lisa Lacasse, president of ACS CAN. “If finalized, these proposed changes could undermine health provider recommendations and create significant and potentially life-threatening delays in access to cutting-edge therapies that play a crucial role in cancer care.”

    The six protected classes policy was established more than a decade ago to ensure Medicare beneficiaries were able to have access to innovative therapies. Medicare Part D plan sponsors are currently required to cover virtually all drug therapies in the designated six protected classes. In November 2018, HHS released a proposal to alter rules around Medicare Part D’s six protected classes and allow plan sponsors to use utilization management tools, including step therapy and prior authorization, to limit access to protected class drug therapies. ACS CAN recently released a nationwide survey of cancer patients, caregivers and doctors that details the negative effects insurance utilization management policies in private insurance have had on patient care.

    “Imposing utilization management tools on Medicare Part D beneficiaries could delay a patient’s access to the most clinically appropriate drug therapies, potentially interrupting their recommended course of treatment and ability to manage their disease,” Lisa said. “In the face of a new diagnosis or medical setback, cancer patients don’t have any time to waste. We strongly urge Secretary Azar to protect cancer patients’ lives and stop the proposed changes to Medicare Part D’s six protected classes.” 

    ACS CAN led nearly 60 patient and provider organizations in a print and digital ad campaign earlier this year to demonstrate the widespread opposition to policy changes that pose significant potential risk to patients with serious medical conditions, including cancer.

    The new ad campaign is available here.

  • House votes to stop tax subsidies for inadequate health plans

    ​ACS CAN urges Senate to quickly do the same

    On May 9, the U.S. House of Representatives passed a bill that would halt Department of Health and Human Services and Department of the Treasury guidance enabling individuals to use federal tax subsidies to purchase health insurance that does not meet coverage standards under the Affordable Care Act (ACA).

    A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN) follows:

    “Limiting the appeal of inadequate health plans is critical to maintaining protections for people with serious health conditions like cancer. These non-compliant plans are exempt from having to cover people’s pre-existing conditions, do not have to cover essential health benefits like prescription drugs, and can set arbitrary limits on what little coverage they do provide.

    “Allowing taxpayer subsidies to be used for these health plans feeds the misconception that they provide meaningful coverage, when in reality it could result in many more Americans being underinsured and facing potential financial devastation should they get sick. Proliferation of these plans will also lead to a split health insurance market, pricing those who want and need access to comprehensive coverage out of the market by making that coverage more and more expensive.

    “On behalf of the more than 1.7 million Americans who will be diagnosed with cancer this year and the more than 15 million American cancer survivors who need access to meaningful health coverage, we commend the House for passing this bill and urge the Senate to quickly to do the same.”

  • ACS CAN and other health groups urge FDA to investigate Juul for making unauthorized smoking cessation claims

    Six leading public health and medical organizations yesterday called on the U.S. Food and Drug Administration (FDA) to investigate and take enforcement action against Juul for making unauthorized claims that the company’s e-cigarettes help users stop smoking.

    In a letter to the FDA, the health groups assert that Juul’s current marketing campaign, which includes newspaper, television and radio ads, and website testimonials, makes unauthorized and unproven smoking cessation claims by urging smokers to “make the switch” from cigarettes to Juul. One highlighted newspaper ad repeats the phrase “Quit. Start Smoking Again” 30 times and concludes with the word Switch and then the statement, “The average smokers tries to quit 30 times. Make the switch.”

    “The ad clearly communicates the message that by switching to Juul, the smoker can achieve what he/she has previously been unable to achieve: quitting smoking. It is, unmistakably, a smoking cessation claim for Juul,” the health groups’ letter states.

    View examples of Juul marketing involving smoking cessation claims.

    The letter was sent by the Campaign for Tobacco-Free Kids, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, and Truth Initiative.

    Federal law prohibits a manufacturer from making a therapeutic claim unless the manufacturer applies to the FDA and demonstrates the product is safe and effective. This is a longstanding law that has effectively protected the public from fraudulent claims. A 2010 federal court ruling and a 2017 FDA rule established that this requirement applies to tobacco products marketed with therapeutic claims, including cessation claims. Like all other consumers, smokers deserve to know what products have been shown to be safe and effective at helping them quit. If Juul, or any other manufacturer, wants to make a therapeutic claim, they must follow the law. 

    “Juul, a product that FDA has found to be largely responsible for the current epidemic of youth usage of highly addictive e-cigarettes, is being advertised and marketed on a massive scale as a smoking cessation product, without the required review and approval by FDA,” the letter states. “Juul’s campaign not only creates consumer confusion among smokers; it also may cause non-smokers, particularly youth who already regard Juul as highly appealing, to mistakenly believe the product is FDA-approved as ‘safe,’ thus leading to greater initiation and continuation of its use.

    “We urge FDA to launch a full-scale investigation of all aspects of Juul’s advertising and marketing to determine the scope of its statutory violations and to take strong enforcement action to sanction the company and bring these violations to an end.”

    The health groups’ letter cites numerous examples of Juul marketing with cessation claims:In addition to the print ad cited above, other print ads feature testimonials from longtime smokers who switched to Juul, with the tagline “Make the switch.” “In each of these ads, switching to Juul is presented as equivalent to smoking cessation,” the letter states.Juul’s TV ads also feature testimonials from smokers about how they switched to Juul and stopped smoking cigarettes. In one ad, a man named Patrick states, “I gave the Juul a real chance and found out I liked it. Found out it really works. The switch was easy. It was a no-brainer really. But now that I look at people who smoke, I’m like, ‘Dude really? You’re still doing that? You know there’s an alternative to that right? You don’t have to do that.’”

    Juul’s website also features testimonials from users recommending the product as a means to stop smoking by replacing cigarettes with Juul. A woman named Laura states, “Just replace the cigarette with the Juul! It really helps to keep some physical habits the first week or two. Just focus on using the Juul instead of a cigarette.”CNBC recently reported that Juul had established a 17-person team to market its e-cigarettes to insurers and to companies that want to help their employees stop smoking. The leader of this Juul effort told CNBC that “Juul is planning to design a program to help smokers switch from combustible cigarettes to e-cigarettes.”

    The health groups assert that a disclaimer on Juul’s website, which states that “Juul is a switching product” and “not intended to be used as cessation products,” is insufficient to overcome the cessation claims in Juul’s ads. “Calling Juul a ‘switching product’ in a website disclaimer (a disclaimer that does not appear in Juul ads) does nothing to dispel the health-related message inherent in Juul’s repeated equation of ‘switching’ with quitting smoking,” the letter states.

  • ACS CAN supports legislation to raise the tobacco sales age to 21 nationwide

    Warns that Tobacco 21 legislation should be a complement to – and not a substitute for – other effective measures to reduce tobacco use

    Below is a statement released April 30 by ACS CAN, Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association, and the American Academy of Pediatrics:

    Our public health and medical organizations strongly support the Tobacco to 21 Act, legislation introduced in Congress today that prohibits the sale of tobacco products to anyone under the age of 21 nationwide. We applaud Sens. Brian Schatz (D-HI), Todd Young (R-IN), Dick Durbin (D-IL), and Mitt Romney (R-UT) and Reps. Diana DeGette (D-CO) and Chris Stewart (R-UT) for introducing this bipartisan legislation to help prevent young people from starting down a path that often leads to addiction, disease, and premature death.

    Raising the tobacco age of sale to 21 is an important component of a comprehensive strategy to reverse the youth e-cigarette epidemic and continue reducing tobacco use in the United States. We urge Congress to pass this strong legislation and to reject tobacco industry efforts to add special interest provisions that block other policies needed to protect kids and public health, such as prohibitions on flavored tobacco products. The industry has sought to include such provisions in state and federal Tobacco 21 legislation, as recently reported by The New York TimesPoliticoThe Hill, and other media.

    While an important step, Tobacco 21 legislation should be a complement to – and not a substitute for – other effective measures to reduce tobacco use. A prohibition on flavored tobacco products is especially critical to address the youth e-cigarette epidemic and stop tobacco companies from continuing to target kids. The evidence is clear that flavors play a key role in youth initiation and continued use of tobacco products.

    Background on Tobacco 21

    Increasing the age of sale for tobacco products to 21 will help reduce tobacco use among youth and young adults – age groups when nearly all tobacco use begins and that are heavily targeted by the tobacco industry. Ninety-five percent of adult smokers began smoking before they turned 21, and tobacco companies spend $9.4 billion a year – more than $1 million every hour – to market their deadly and addictive products, much of it aimed at young people. Increasing the tobacco age of sale to 21 will help counter the industry’s relentless efforts to target young people. It will also help keep tobacco out of high schools, where younger teens often obtain tobacco products from older students.

    A 2015 report by the National Academy of Medicine (previously called the Institute of Medicine) concluded that increasing the tobacco age of sale to 21 would, over time, significantly reduce the number of youth and young adults who start smoking, as well as smoking-caused deaths. To date, 12 states and more than 450 localities have enacted Tobacco 21 laws. Bills await governors’ signatures in Maryland and New York, and other states are moving similar bills.

    The need for bold action to further reduce tobacco use in the United States is clear. While we have made enormous progress, tobacco use remains the leading preventable cause of death in our country, killing more than 480,000 people each year and costing about $170 billion in health care expenses. In addition, e-cigarette use among high school students soared by 78 percent in 2018, to 20.8 percent of the student population.

  • ACS CAN launches new education campaign: Medicaid Covers US

    ​The goal  is to help people better understand what Medicaid means to individuals and their communities

    This week the American Cancer Society and the American Cancer Society Cancer Action Network (ACS CAN) launched a new public education campaign, Medicaid Covers US, to advance our mission-critical work in the area of access to health coverage for individuals and families with low incomes.

    The campaign is a deliberate, robust, and strategic project that aims to bring together decision makers, community members, and the public in a dialogue about the critical services Medicaid provides. The campaign focuses on six target states: Alabama, Georgia, Kansas, North Carolina, Virginia, and Louisiana. Since September of 2018, ACS CAN staff have been traveling throughout these states gathering stories from patients and health care providers about what Medicaid has meant to them and/or what it could mean for them if more people had access to it.

    The education goal of the campaign is to help people better understand what Medicaid means to individuals and their communities. As a health insurance program from low-income children and adults, seniors, and people with disabilities, Medicaid helps millions of Americans manage their care – including an estimated 2.3 million Americans with a history of cancer. 

    Having health insurance through Medicaid not only helps people when they are sick, but it helps people stay healthy, so they can go to work, care for their families, and pay their bills. It helps communities thrive by keeping hospital doors open to provide lifesaving care, securing more jobs, and keeping the workforce strong. It supports schools and students by helping kids get screening services and manage health issues like asthma or vision problems to help them better participate and succeed in school.

    The campaign kicked off on Tuesday in Overland Park, Kansas, with the premiere of a short documentary, Critical Condition: Health in the Heartland. The film features Kansas community members discussing their own experiences as they strive to take care of themselves and their families in the face of serious diagnoses and without health insurance. It also features health care providers who speak to the struggle of helping patients and keeping facilities open when so many in their communities are uninsured. Following the screening, a panel featuring some of the individuals in the film, health care professionals, and ACS CAN leadership discussed the film and other stories featured in the campaign.

    The new Medicaid Covers US website highlights stories from patients with serious diseases who’ve received lifesaving care through Medicaid, and from providers who rely on the program to be able to reach as many residents in their communities as they can, and to support their hospitals and clinics. Also available on the website are ACS CAN-commissioned research on public support for Medicaid and other fact sheets and resources.

    If you have questions about Medicaid Covers US, please contact Citseko Staples, ACS CAN director, State & Local Campaigns.

  • New legislation aims to reverse youth tobacco epidemic

    Bill would raise tobacco purchase age to 21, prohibit most flavored tobacco products, and restrict e-cigarette advertising

    Congressman Frank Pallone (D-N.J.), chairman of the House Committee on Energy and Commerce, introduced legislation on Tuesday that aims to address the skyrocketing rates of youth use of tobacco products, a trend that has been largely driven by the popularity of flavored e-cigarettes. 

    Reversing the Youth Tobacco Epidemic Act of 2019 would raise the minimum age for purchasing tobacco products to 21 years, prohibit flavoring of almost all tobacco products, restrict advertising of newly deemed tobacco products like e-cigarettes and grant the U.S. Food and Drug Administration (FDA) the authority to collect user fees from all tobacco product manufacturers. Additionally, the bill would compel the FDA to finalize and enact a rule requiring graphic warning labels be placed on tobacco products, a proven deterrent to tobacco initiation and continued use. 

    Introduction of the legislation comes at a time of unprecedented youth use of tobacco products. According to the 2018 National Youth Tobacco Survey, the number of youths using tobacco products rose by 1.3 million children, from 3.6 million in 2017 to 4.9 million in 2018. The alarming spike in youth tobacco product use drove former FDA Commissioner Scott Gottlieb and the U.S. Surgeon General to label the problem as an epidemic.

    The following is a statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN): 

    "The Reversing the Youth Tobacco Epidemic Act of 2019 contains provisions that would put critical safeguards in place to keep tobacco products out of the hands of our children. The bill would also include necessary and appropriate scrutiny of the advertising and marketing practices of the profit-driven tobacco industry and its allies. Chairman Pallone is a steadfast champion of public policy solutions that aim to improve the public health of our nation and we applaud him for bringing forward legislation that would better protect our kids from the dangers of tobacco use. 

    "In the last year, rates of e-cigarette use among youth have increased by more than 78%. The time for action is now and ACS CAN will advocate for timely consideration and passage of Chairman Pallone's bill in both chambers of Congress. ACS CAN will also continue to urge the FDA to use its full regulatory authority over all tobacco products and conduct premarket review of e-cigarettes and cigars. 

    "The public health risks associated with allowing the current status quo of youth use of tobacco products to continue are simply unacceptable and will become a major burden on the health of our nation for years to come if left unaddressed."  

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