Increasing State Health Agency Capacity to Improve 17P Utilization

December 28, 2015|10:44 a.m.| Claire Rudolph

In 2014, nearly one in 10 infants were born before 37 weeks gestation, or preterm. A major public health issue in the United States, preterm birth is the leading cause of long-term neurological disabilities in children, and the most common cause of neonatal death is preterm birth.

Unfortunately, the United States ranks poorly on preterm birth compared to other countries, and the March of Dimes gave the United States a “C” on the 2015 Premature Birth Report Card. Within the United States there is wide variation in preterm birth rates. While the causes of preterm birth are not always known, women who have already experienced a preterm birth are more likely to have another compared to women who have not. Other risk factors for preterm birth include low or high maternal age, black race, high blood pressure during pregnancy, late prenatal care, stress, and tobacco and alcohol use. Women who have experienced a preterm birth are eligible for a progesterone medication called 17-alpha hydroxyprogesterone caproate, or 17P.

17P has been shown to prevent the recurrence of preterm birth by 33 percent. 17P is available via an FDA-approved injection known as Makena, and a non-FDA approved injection at specialty compounding pharmacies that customize the drug to meet specific needs of individual patients. Despite the drug’s effectiveness, only a fraction of the approximately 133,000 women who are eligible for 17P annually receive treatment. In order to identify why so many eligible women are not receiving 17P treatment and to learn what states are doing to address it, ASTHO conducted a thorough literature review and in-depth interviews with six states that are employing innovative techniques to increase access to 17P. ASTHO’s interviews made it clear that state and territorial health departments are uniquely positioned to assume a leadership role in promoting access to, and use of, 17P.

ASTHO interviewed six states including Iowa, Louisiana, North Carolina, Ohio, South Carolina, and Texas. These states are partnering with various stakeholders to increase access to 17P by improving identification of 17P-eligible women, collaborating with Medicaid agencies, enhancing the 17P ordering and administration process, increasing provider and patient education about the importance of 17P in preventing preterm birth, and improving state 17P reimbursement policies. Among the many innovative activities taking place in these states, Texas has been a pioneer in allowing data sharing between the department of state health services and Medicaid. This data sharing has allowed for improved identification of 17P-eligible women. Louisiana created the first of-its-kind progesterone pay-for-performance measure for Medicaid managed care plans that could cost up to $250,000 if they do not meet their progesterone-specific goal. The South Carolina Birth Outcomes Initiative developed the Universal 17P Authorization Form, which allows physicians to order either Makena or compounded 17P using the same form. The form is used for all managed care plans in the state, and clearly indicates that the decision to prescribe either Makena or compounded 17P is in the hands of the physician.

While each state has made great strides in increasing access to 17P, too many eligible women still do not receive this lifesaving treatment. It is crucial that state and territorial health agencies continue to explore issues related to program changes, using data to drive action, policies and partners, and remain engaged in the important work of improving access to 17P to prevent preterm births.

The results of the state interviews are captured in ASTHO's issue brief “Increasing State Health Agency Capacity to Improve 17P Utilization.”

Claire Rudolph

Claire Rudolph, MPH, MCHES, is the senior analyst for maternal and child health at ASTHO. In this position, she manages ASTHO’s support of the Infant Mortality CoIIN initiative. Claire most recently worked at the National Institute for Health Care Management (NIHCM) Foundation where she led NIHCM’s efforts to improve the maternal and child health programs and policies of Blue Cross Blue Shield health plans.