Scrapping Most Favored Nation Model
The Centers for Medicare and Medicaid Services recently announced that it plans to formally rescind the Medicare Most Favored (MFN) Nation Model. Since MFN was initially floated back in 2018 (referred to back then as International Pricing Index model), Patients and Providers United (P+P) has steadfastly spoken out on the detrimental and disruptive impact of this policy on patients, providers and caregivers. MFN is so flawed that its implementation was challenged in court and it has yet to go into full effect.
The MFN Model would base Medicare payment for therapies administered by physicians and infusion clinics to treat complex and chronic diseases like cancer, rheumatoid arthritis, macular degeneration, and other autoimmune diseases on the price of these drugs and biologics in 22 foreign countries. Medicare would be prohibited from paying more than the MFN calculated rate, even if physicians are unable to acquire drugs for that price. This could result in providers incurring destabilizing financial losses and being forced to choose less effective alternative therapies for patients.
Tying Medicare drug reimbursement for therapies used to treat serious chronic conditions to that of prices paid in select foreign countries limits the medical decision-making of physicians and makes it harder for Medicare patients to get the drugs they need when they need them to treat their disease. For these reasons, P+P staunchly opposes MFN and supports the action taken by CMS to rescind it.
As the debate on drug pricing rages on and policy solutions are offered, P+P will continue to amplify calls to keep patients and providers – not government middlemen focused primarily on cost control – at the center of medical decision making. Meaningful drug pricing policies must address out-of-pocket copays and cost sharing that disproportionately burdens patients with serious chronic conditions, like cancer. It must also preserve maximum flexibility for providers to tailor individual treatment plans for patients. Patients win when they can access the medication, procedures and care recommended by their physician; care is compromised when middlemen that lack clinical expertise are at the center of medical decision making.