COA Continues Effort to Stop Most Favored Nation Model

The Community Oncology Alliance (COA) filed a motion for preliminary injunction and restraining order in an effort to prevent CMS from implementing the Trump administration’s Most Favored Nation (MFN) Model for drug pricing.¹ The proposed model would align drug prices for the top 50 Medicare Part B drugs in the United States with lowest available in economically similar countries.

The MFN interim final rule has been widely criticized by COA and other advocates for oncology practices, who agree that the rule meant to lower drug prices has the potential to cause irreparable harm to community oncologists and, in turn, cause Medicare patients to lose access to care. It would drastically reduce physician reimbursement for the 50 drugs it targets, 38 of which are used by oncologists to treat cancer and blood disorders.

“Here you have community oncology practices that are literally struggling every day to keep their facilities and their staff COVID-19 free, especially in the middle of what is a third wave—and an unchecked third wave—in this pandemic, to get a rule put on them that in a little over a month, will radically reduce the reimbursement for these drugs,” Okon told The American Journal of Managed Care® in an interview when the rule was first announced. “It’s going to put more pressure on these practices and it’s going to end up that some of these drugs are reimbursed at less than cost.”

COA’s request includes declarations from community oncology practices detailing the anticipated ramifications should the rule become operative. Oncologists would suffer business-threatening losses by either accepting below-cost reimbursement or having to transition seniors, a significant volume of their practices, to other providers such as hospitals.

“At its core, the MFN Interim Final Rule is a dangerous and unlawful gamble with the lives of some of America’s sickest and oldest cancer patients who require chemotherapy, immunotherapies, and other potentially life-saving drugs,” the COA memorandum reads.² “…Unless this unlawful program is stopped, community oncology practices will close and cancer patients will suffer and, in some cases, die.”

References

1. COA Files for Preliminary Injunction and Restraining Order to Stop Most Favored Nation (MFN) Implementation. News release. Community Oncology Alliance; December 21, 2020. Accessed December 21, 2020. https://communityoncology.org/coa-files-for-preliminary-injunction-and-restraining-order-to-stop-most-favored-nation-mfn-implementation/

2. Community Oncology Alliance v. U.S. Department of Health and Human Services, Alex M. Azar II, Centers for Medicare and Medicaid Services, and Seema Verma, Civil Action No. 20-3604.