The U.S. House of Representatives is likely to pass legislation today that would increase access to health coverage for millions of Americans, including cancer patients and survivors, as part of its pandemic relief package.
Proposed Medicare Rule Likely to Limit Cancer Patients’ Access to Necessary Prescription Drugs
Over Half of Drugs Included in Most Favored Nation Rule Are Oncology Drugs
Washington, D.C.—Cancer patients would likely be among those most affected by a proposed rule tying certain Medicare Part B drug reimbursement rates to that of foreign countries.
According to comments filed by the American Cancer Society Cancer Action Network (ACS CAN), 35 of the 50 drugs listed under the interim final “Most Favored Nation” (MFN) rule are used for treating cancer. While the rule’s intent is to save Medicare money, savings may in part come from scores of cancer patients unable to access necessary treatments.
The letter explains, “If providers cannot favorably negotiate with manufacturers on the MFN Model drugs, and do not want to risk financial liability, they may decline to administer those particular drugs and cancer patients would no longer have access to these particular treatments.”
The Department of Health and Human Services’ own analysis finds 19% of the program’s savings under the rule would come from seniors being unable to access certain prescribed drugs; an especially fraught problem for cancer patients who often need specific drugs to treat their particular form of the disease and whom often have numerous other health conditions that complicate their care. These changes might also force patients to seek different providers, necessitating more travel and delayed care, which could harm patient health outcomes.
Additionally, the rule may prompt drug makers to increase prices on non-Part B drugs resulting in cost shifting rather than cost savings.
For these reasons ACS CAN urges the Biden administration to rescind the interim final rule.