Medicare’s Most Favored Nation Is My Least Favorite Notion!

With large price points and small margins, any fluctuation could cause severe financial ramifications—especially for small practices. Meanwhile, of course, patients’ access to treatments will be at risk.

Take Action
What is being done to stop the MFN? All three branches of government are starting to hear from stakeholders. Industry has engaged the judiciary by predictably filing lawsuits to stop the model from going into effect. They rightly claim the scope is too large for a pilot demonstration project (the CMS claims authority to implement the MFN as an experimental pilot project), because covering the entire country leaves no control group for comparison. They also allege the plan is an illegal regulation, because it skipped the usual process of publishing a draft for comment and went straight to an Interim Final Rule.³ In the decade I’ve been doing advocacy work, I hadn’t yet heard of an Interim Final Rule.

The ACR makes it easy to raise your voice to the executive branch. The ACR website has pre-written comment language in its Legislative Action Center. It only takes a few minutes to add in your own details and concerns and send an email to the CMS with a few clicks. Comments are due by Jan. 26, 2021.

A little advice about sending comments to the CMS: Be polite, describe the consequences of the regulation from patients’ perspectives (e.g., if practices go underwater, the patients they serve lose access), and please note that comments are published publicly. (Note: Your address and email will not be made public when you submit comments through the ACR website.)

Lastly, if neither the courts nor President Trump’s CMS stop this plan, we’ll need Congress to step in. Tell your representative and senator to block the MFN from going into effect by emailing them through the ACR’s Legislative Action Center or by publicly tagging on Twitter. Tell them your concerns about the rapid timeline for implementation, administrative burdens that take you and your team away from patients and pandemic preparation, and, most importantly, the harmful consequences of the MFN on their constituents, whom you serve.

Angus Worthing, MD, FACP, FACR, is a practicing rheumatologist with Arthritis & Rheumatism Associates PC, Washington, D.C., and a clinical assistant professor of medicine at Georgetown University.

References
1. Most favored nation (MFN) model. A rule by the Centers for Medicare & Medicaid Services. 42 CFR 513. Federal Register. 2020 Nov 27;85 FR 76180:76180–76259.
2. McCormick N, Wallace ZS, Sacks CA, et al. Decomposition analysis of spending and price trends for biologic antirheumatic drugs in Medicare and Medicaid. Arthritis Rheumatol. 2020 Feb;72(2):234–241.
3. Morse S. American Hospital Association and PhRMA question legality of Most Favored National Model. Healthcare Finance. 2020 Nov 23.