Trump executive order threatens health care access during pandemic

On November 27th, the Trump Administration published its “Most Favored Nation” (MFN) executive order in the federal register, which begins a countdown to implementation on January 1st of 2021. MFN would tie reimbursement for Medicare Part B to a lowest denominator price assessment drawn from an index of other countries across the globe. This will spell disaster for patients like me who require specialty medication to manage complex medical conditions and the provider networks we rely on for care.


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I am diagnosed with one of the 105 world’s most severe forms of arthritis, of which only five have available treatment paths. My treatments, nearly 17 million US cancer patients’ treatments, and millions of others with auto-immune disorders like Crohn’s Disease and Multiple Sclerosis will have their medications restructured in a way that makes it harder, especially for those living in rural America, to keep the medication prescribed by their doctor and to find a clinical setting able to provide the therapies they need.

The Centers for Medicare and Medicaid Services (CMS) report that accompanies the publication of the MFN rule contains some shocking revelations.

Here is a direct quote: “beneficiaries may experience access to care impacts by having to find alternative care providers locally, having to travel to seek care from an excluded provider, or receiving an alternative therapy that may have lower efficacy or greater risks, or postponing or foregoing treatment.” There is only one medication currently on the market that effectively manages my psoriatic arthritis, and there is no cure for my disease. I’ll need to access my drug therapy for the rest of my life. There does not appear to be a plan for patients like myself who may lose access to their therapeutic options once MFN is implemented after the new year.

The justification for this dramatic action is couched in the language of lower drug costs, but a recent Avalere study found that fewer than 1% of older adults in Medicare Part B would see a reduction in out-of-pocket costs as a result of this kind of international price index model. CMS says there would be “savings” accrued by the government by implementing MFN, but those are: “attributable to beneficiaries not accessing their drugs through the Medicare benefit, along with the associated lost utilization”. So, Medicare saves money when fewer patients can access their medicines.

CMS also predicts a significant decline in payments towards clinicians that administer specialty treatments. neurologists will see an average reduction of 21%, medical oncologists will see an average reduction of 13%, and infectious disease physicians will see an average reduction of 10%. Taking resources away from infectious disease specialists in the middle of a pandemic seems like an especially bad policy prescription.

Heavy-handed regulatory intervention might limit how much the government pays for medicines, but the savings are at a long-term cost to American patients who will lose access to life saving therapies and the clinical providers that are already struggling to serve them in the midst of the COVID-19 response. The last thing we need when gaps in healthcare access are widening for every American is to punch holes in the existing clinical care network. I hope the President reverses course on this disastrous policy before patients start losing access to the therapies they need to secure their continued health and well-being.

Lisa Bayautet of Vancouver, WA has actively advocated for those chronically effected since 2014 when she was diagnosed with psoriatic arthritis. She currently serves on the Area Agency on Aging and Disabilities for SW Washington and the National Psoriasis Foundation’s Western Regional board.