MFN Impact on Patients
The American Cancer Society’s Cancer Action Network is working in every state across the country. They worry, “the executive order involving Medicare drug coverage creates significant questions around drug accessibility, which could potentially make it much harder for cancer patients to get the drugs necessary to treat their disease.”
MFN Impact on Providers
The American College of Rheumatology (ACR) is dedicated to improving the care of patients with rheumatic diseases like arthritis that cause the immune system to attack joints, muscles, bones and organs. ACR has determined that, “the (MFN) rule threatens the financial solvency of many rheumatology practices… and jeopardizes the ability of rheumatologists to provide treatments to patients most in need. This will be detrimental to provider solvency and patient access to medications.”
POLICY IMPACT
Provider Impact
The Most Favored Nation (MFN) Model jeopardizes the ability of physicians to provide care to patients most in need. MFN ties the hands of healthcare providers. If they cannot obtain the most innovative, effective medications for their patients at or below the government-set price, providers must decide between incurring financial losses, selecting an alternative, less effective treatment, or turning patients away altogether. This new Medicare model for Part B drugs would place unmovable barriers between doctors and patients.
How does the MFN proposal impact providers?
1 Obstructing Physician Decision-Making. MFN puts intense pressure on physicians to prescribe treatments based on Medicare’s reimbursement rather than providers depending on their medical expertise to determine which therapy is most effective for a patient’s unique medical condition.
2 Restrict Breakthrough Therapies. MFN’s international referencing pricing threatens to reduce Medicare patient access to groundbreaking therapies to the alarmingly low levels found in other countries. These government price controls will significantly shrink investments in new research and development.
3 Increase Financial Risk. Under MFN, Medicare reimbursement rates may be lower than the cost of acquiring and administering many of the therapies used to treat some of the most complex chronic conditions. Providers face a choice between operating at a loss or forgoing treatment of Medicare patients altogether. Neither option is sustainable. Providers treating a large volume of Medicare patients may even be forced to close their doors entirely.
4 Increase Administrative Burden. Beginning January 2021, providers may be forced to manage multiple inventories of drugs, those for Medicare patients subject to MFN, and those patients who are not. Increasing operational and administrative burdens on providers already struggling to comply with COVID-19 protocols and existing regulatory burdens diverts resources from direct patient care.
5 Further Consolidation. The increased financial risk, administrative burden, and interference with the physician patient bond could result in clinic closures, depriving patients of care close to home and pushing them to a less convenient, more-costly setting of care.
Physicians do not set or control the price of a drug. But they do control the treatment plan. The course of treatment selected for a patient should be a decision that is made between the patient and their physician – not driven by a policy solely focused on cost control, rather than successful patient outcomes.
Treating complex chronic diseases shouldn’t be further complicated by an unproven Medicare payment experiment that places barriers between physicians and patients, disrupts access to personalized treatment and jeopardizes access to medical care close to home.