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November 30, 2020

DHPA Opposes Most Favored Nation Rule Announced by CMS

Misguided policy will dramatically restrict access to infusion medications and force patients into more expensive care setting

Washington, DC – The Digestive Health Physicians Association® (DHPA®) opposes the Most Favored Nation (MFN) rule recently announced by the Centers for Medicare & Medicaid Services (CMS). The MFN Rule could dramatically restrict patient access to infusion medications administered in physician offices, especially for patients with Crohn’s disease and ulcerative colitis, which are both major categories of inflammatory bowel disease (IBD).

Under the MFN model, reimbursements will be determined by the lowest price that drug manufacturers receive in any one of 22 different countries. The MFN rule also changes the current payment model for life-saving medications by providing a flat administration fee for each dose, which CMS projects will result in a 20 percent cut to gastroenterologists.

“Hundreds of thousands of patients are treated in DHPA member practices with medications that would be subject to this complicated scenario that bases reimbursements on what it costs to acquire the drugs in another country,” said Dr. James Weber, DHPA president and board chair. “We are greatly troubled about what this will mean for our patients. In its own rule, CMS projects that 19 percent of Part B drug utilization will be eliminated by 2023 because patients will no longer be able to access the drugs subject to this international pricing scheme.”

In addition to patient access concerns, DHPA is concerned that the MFN rule could threaten the viability of medical practices, especially smaller practices and those in rural or underserved areas. If private practices can no longer afford to administer these drugs, this policy is likely to force patients to seek care in the more expensive hospital setting where Medicare and patients pay dramatically more for drug administration. Such a result runs counter to policymakers’ desire to keep care out of the more expensive outpatient hospital setting.

“The effects of this rule could be seriously detrimental to our healthcare system, especially during the COVID-19 pandemic,” said Dr. Glenn Littenberg, DHPA chair of health policy. “Not only will the MFN rule increase overall costs to Medicare by forcing our patients into higher-cost settings, but hospitals are the last places we should be sending our patients with chronic conditions until the pandemic is under control.”

Dr. Weber stated that DHPA looks forward to working with policymakers on policies that lower costs without compromising the quality of patient care, but voiced concern that CMS has bypassed the normal regulation notice-and-comment rulemaking process. A nationwide demonstration project is set to go into effect on January 1, 2021, which is 20 days before the rule’s required comment period closes.

“This is far too serious an issue—with vast health policy and patient care implications—for CMS to have fast-tracked this rule without obtaining input from providers and patients,” said Dr. Weber.

Filed Under: Newsroom, Press Releases, Protecting Patient Access to Integrated GI Care in the Independent Setting

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