Most Favored Nation Model is Misguided & Will Decrease Access to Cancer Care

Statement By Monica M. Bertagnolli, MD, FACS, FASCO Board Chair of the Association for Clinical Oncology (ASCO)
November 24, 2020

“The Association for Clinical Oncology (ASCO) opposes the Most Favored Nation (MFN) Model for Medicare Part B drug reimbursement, which outlines a structured, nationwide, mandatory demonstration that will be phased in over four years, with full implementation for the final three years of the seven-year model. This plan effectively overrides a statutory provision under the guise of a demonstration project by imposing a new reimbursement model on cancer care absent any evidence that it can lower costs without negative consequences for Medicare beneficiaries.

“Starting January 1, 2021, the model will cut reimbursement for a number of cancer drug treatments, which will limit access to care for Medicare beneficiaries. Amid the ongoing stress and uncertainty of the COVID-19 pandemic, implementing such a model will further strain providers’ ability to provide high-quality cancer care to their patients.

“In fact, the MFN interim final rule acknowledges that ‘… a portion of the savings is attributable to beneficiaries not accessing their drugs through the Medicare benefit, along with the associated lost utilization.’ Patients with cancer require timely access to potentially lifesaving treatment, and limited and specific treatment options are often indicated. That the rule plans for and achieves part of its savings by limiting or restricting access to care for nearly one in five patients is unconscionable and unacceptable.

“ASCO has engaged in good faith with the Administration on the shared goal of controlling the rising cost of drugs. However, ASCO has consistently opposed the imposition of any mandatory demonstration projects on oncology practices, particularly those that carry significant risk of harm to patients with cancer.

“ASCO urges the Centers for Medicare & Medicaid Services to withdraw the MFN model. The Association will continue to work with the Administration to adopt policies that address the high cost of care and improve Medicare beneficiary access to cancer care during the COVID-19 pandemic and beyond.”