“Most Favored Nation” Doesn’t Favor Patients

January 19, 2021

By Angus Worthing, MD

A new federal experiment could force tens of thousands of patients off of their medication in 2021.

I’m referring to a model called Most Favored Nation. It is an effort to curb government spending for Medicare Part B drugs, which are infused or injected in a doctor’s office or outpatient setting. To cut expenses, the U.S. would align its Medicare reimbursement rates with the lower prices that selected other countries pay for medications. The approach would apply to 50 of the costliest Part B prescription drugs.

Most Favored Nation is anticipated to save the federal government $87 billion in the coming years. The cost to patients, however, could be greater.

When reduced reimbursement rates make it financially impossible to continue providing a given medication, offices will stop stocking it. Patients, in turn, could experience a loss of access to their medication or be forced to switch to something new. Both situations can lead to uncontrolled disease progression and side effects. For example, the patients I treat who have arthritis may experience painful flares. Some patients will probably seek urgent care. If symptoms spiral out of control, they could require immunosuppressive steroids to treat the flare or even be hospitalized.

As COVID-19 continues to surge across the country, there has probably never been a worse time to enact a change that could result in more patients being immunosuppressed or hospitalized. Beyond the additional strain this would put on the health care system, Medicare wouldn’t even save money if patients were hospitalized. The cost would simply shift from a “Part B” drug expense to a “Part A” hospital inpatient expense. 

This model could also harm patients well beyond those who take the 50 directly affected medications. The loss of income on those drugs could jeopardize the solvency of medical practices and infusion clinics – places that also serve patients with multiple sclerosis, Crohn’s disease, cancer and many other conditions. As these offices close, especially in rural areas, patients with all manner of health challenges may face undue hardship and lack of access to specialists or treatment.

Doctors have been sounding the alarm about how the Most Favored Nation model will impact access to medications since it was first proposed. Fortunately, lawsuits have forced the federal government to postpone implementation until the public comment period ends on January 26. 

Providers and patients may be spared from this policy in the near term, but mustn’t get complacent as this and other policies are debated. I strongly urge patients and family members of those who receive a provider-administered medication to raise their voice by emailing their members of Congress and submitting public comments. Tell policymakers to seek a different way to curb Medicare expenses without harming so many patients and health care practices. 

Angus Worthing, MD, is a practicing rheumatologist in Washington, D.C. and a member of the American College of Rheumatology, a member organization of the Biologics Prescribers Collaborative. 

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