On Sept. 13, the Trump administration signed the “Most Favored Nation” (MFN) executive order, aimed at reducing drug prices in the U.S.
Unfortunately, these actions will instead adversely affect the care and treatment of Medicare patients with immunologic diseases like cancer, rheumatoid arthritis and Crohn’s who require expert medical care.
The MFN will put an unaccountable bureaucracy in the middle of doctor-patient decision-making. This would interrupt available treatment pathways for some of our most vulnerable populations and imperil the financial stability of the clinics that serve them. I reject the premise that importing restrictions on access will help patients achieve the same outcomes at a lower cost.
Chronic diseases are challenging for patients and providers. A diagnosis of rheumatoid arthritis can alter a patient’s life significantly by causing joint pain, stiffness, injury and disability. Medicare patients with complex illnesses must often try multiple prescription drugs before finding the appropriate treatment. These patients need immediate access to the right medication at the right time.
A 2018 Avalere study took a deeper look at the impacts an international price index like MFN would have on Medicare patients and providers, and the results are disheartening. Less than 1% of Medicare patients would experience lower out-of-pocket costs should an IPI be implemented. Conversely, specialty providers would experience reduced Medicare reimbursement by 6 to 14% for delivering the same services as before.
Lowering reimbursement will make it exceedingly difficult for patients and rheumatologists to care for their patients or obtain and administer needed therapies. The consequences of this proposal would threaten existing Medicare beneficiaries’ access to quality of care and leave patients without treatment options while pushing others to more expensive hospitals.
With many providers already grappling with reduced capacity due to COVID-19, an additional cut in revenue could put many clinics and infusions centers out of business and leave patients with nowhere to go except a regional hospital. For Americans living in rural parts of the country, that could mean hours of additional driving to get needed arthritis or cancer infusions.
For serious answers to these challenging questions, the administration need only look at how providers are already innovating on the front lines. The fix, in large part, is transforming care delivery to a value based care (VBC) model, which incentivizes physicians to prioritize their time and attention to their sickest patients in order to improve outcomes.
Currently, our health care system incentivizes volume; more patients yields more reimbursement. A VBC model would instead reward providers who provide the highest-quality care by linking reimbursement to health care outcomes. Making this transition would require whole systems cost transparency, so we can understand where cost is embedded in the care delivery process, and double down on investments that are improving quality of care.
At Arthritis Northwest, we announced a new VBC contract designed to provide cost transparency to physicians and remove strict step therapy barriers for patients. By focusing on outcomes, the new agreement will lower costs and support higher-quality care. By supporting health care decision-making and integrating evidence-based decision support tools, physicians can provide comprehensive, consistent care to their patients. When VBC models contain these key design elements, such as transparent formularies, clinical pathways, care coordination and outcome metrics, they lead to greater provider enthusiasm and lasting success.
As federal policymakers consider how best to lower out-of-pocket cost liability for vulnerable patient populations, they should rethink short-sighted proposals like the MFN model. The cost-savings touted in press events would only reduce the government’s financial responsibility to Medicare by foisting extra costs onto patients and providers. Reforms should instead protect the sanctity of the doctor-patient decision-making process and focus on qualitative outcomes that drive cost down for all participants in the system.
Karen Ferguson is the Practice Administrator at Arthritis Northwest, and co-founder/CEO of Discus Analytics, Inc., a health care company specializing in the capture, analysis and application of actionable clinical data.