For many Americans, over the last decade, cutting-edge therapies and technology have changed the words “you have cancer” from a death sentence to a chronic disease, where quality of life and survival are preserved for many of our patients who in the past might not have been so lucky. Just this year alone there has been an extraordinary wave of more than a dozen new treatment options for patients that bring with them hope, comfort, longevity, the ability to continue contributing to society, and enhanced time with their loved ones. Why then does President Trump want to limit access to these lifesaving drugs with his misguided “Most Favored Nation” (MFN) model?
The stated purpose of the MFN model is to reduce the cost of drugs for the Medicare program. It will do this by benchmarking what the United States government pays for the top 50 Medicare Part B drugs to an average of what other developed countries pay. On the surface, this concept seems appealing, fair, and straightforward. But dig a little deeper into how the model will work – and even the government’s own analysis of its impact – and it quickly becomes apparent that this policy a very dangerous experiment that will hurt patients, actually raise costs, and devastate our nation’s cancer care system.
The MFN policy on drug pricing isn’t just about cancer care, but 38 of the 50 drugs covered by it are cancer therapies, and our patients will certainly be its victims. Under the proposal, many independent oncology clinics will be reimbursed far below their cost for providing standard and leading therapies, such as cutting-edge immunotherapy and targeted treatments that have had dramatic results in improving cancer survival for Americans. The goal, it seems, is to force drug companies to lower prices by denying sick cancer patients the drugs they need and that we know work.
The government’s own number crunchers agree that seniors will lose access to needed medicines. The Centers for Medicare and Medicaid Services’ (CMS) own actuaries estimate that in its first year, 9% of primary Medicare beneficiaries will “forgo” or not have access to selected therapies. By year three, that number multiplies to 19%. This means that by 2023, almost one-fifth of American seniors who are Medicare beneficiaries will likely not have access to the best cancer therapies available.
For those of us who have seen the unbelievable impact of modern cancer treatments, the end result of seniors losing access to these treatments is unambiguous: they will die earlier and face a lower quality of life. This coverage gap should be unconscionable in a nation that prides itself on taking care of its seniors. The MFN model hangs the nation’s most vulnerable cancer patients out to dry. Failure of our elected officials to recognize the consequence of this action and stop this absurd experiment will be disastrous.
It’s such a dangerous proposal for millions of Medicare beneficiaries that we and the other volunteer members of the Community Oncology Alliance (COA) board of directors sent a letter to the CMS Administrator Seema Verma last week requesting that the MFN experiment be terminated immediately. And, because time is of the essence in stopping this dangerous experiment before it is too late, today, COA has also filed an emergency suit against CMS to stop MFN immediately.
Oncologists agree that drug prices are out of control and welcome partnership with the government to find solutions. Indeed, many oncologists are enthusiastic participants in payment reform models, clinical trials, and experiments that seek create more efficient care. The key difference? The stated outcome of these models and experiments does not violate our Hippocratic oaths and will not leave our patients worse off. Any cancer care “experiments” that would diminish outcomes and access to lifesaving cancer care for one-fifth of American seniors is an unacceptable solution.
To add insult to injury, this poorly planned policy was dumped on practices with less than 40 days’ notice and in the middle of a global pandemic when we are focused entirely on staying safe and continuing to treat patients. The COVID-19 pandemic has already rendered cancer patients more vulnerable as it has caused delays and avoidance in diagnosis and therapy. Cancer screening is substantially down in 2020 due to the pandemic, and new cancer patient diagnoses are down 30%-70% from March-July 2020 among Medicare beneficiaries. The delays in screening and new patient intake are going to result in an explosion of more severe diagnoses in the near future and we need to be focused on preparing for the coming onslaught. Further obstacles and distractions only make matters worse.
Healthcare costs are a real problem. No reasonable physician, government official, or analyst disputes this statement. However, to solve the problem, we need well thought out policies based on evidence. The current evidence points to the MFN model as a misguided and dangerous experiment with very real consequences. We need to have robust partnerships to engage in sustainable solutions to continue to offer cutting edge treatments to the patients we serve and pave the way for a better future. If we do not act together to stop this policy now and focus on a meaningful collaborative path forward, patients will suffer, and some will die.
Debra Patt, MD, PhD, MBA, is a practicing medical oncologist and Executive Vice President, Policy and Strategic Initiatives, Texas Oncology in Austin, Texas. Lucio Gordan, MD, is President and Managing Physician, Florida Cancer Specialists in Gainesville, Florida. Both volunteer on the board of directors of the Community Oncology Alliance, a national non-profit dedicated to advocating for independent community oncology practices and the patients they serve.