publication date: Dec. 4, 2020

Cancer groups say Trump administration’s drug pricing rule will likely harm patients 

By Paul Goldberg

On the way out, the Trump administration has finalized a rule that uses international reference prices to lower Medicare Part B prices.

The Most Favored Nation Rule, published Nov. 20, would place a large number of cancer drugs out of reach of Medicare patients, critics say.

“Medicare pays substantially more than other countries for many of the highest cost Medicare Part B drugs that beneficiaries receive in an outpatient setting for which Medicare Part B allows separate payment. In many instances, Medicare pays more than twice as much for certain drugs as other countries do,” the rule states.

“The MFN Model aims to take a global approach to calculating Medicare Part B drug payment amounts, by testing a new payment methodology that takes into account the discounts that other countries enjoy, and pays providers and suppliers with a fixed add-on amount that does not reward the use of higher-cost drugs.

“We expect that this model will reduce Medicare program expenditures while preserving or enhancing quality of care furnished to Medicare beneficiaries, and will lower beneficiary cost-sharing through lower drug payment amounts. The MFN Model will be tested in all states and U.S. territories by the CMS Innovation Center for seven performance years, from Jan. 1, 2021 to Dec. 30, 2027. “

Several cancer groups point out that countries that enjoy MFN status with the U.S. have very different drug development, approval, supply and pricing systems. As a result, Medicare patients in the U.S. may be denied access to drugs.

Pointing to a procedural problem, critics say that the … Continue reading Cancer groups say Trump administration’s drug pricing rule will likely harm patients

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