US Medicare Part B users, do you have concerns regarding an upcoming change to Medicare called "Most Favored Nation?"

[onajourney]

My oncologist sent out an email to patients recommending that we contact our US Senators and Representatives to OPPOSE this change. Are you hearing the same from your providers?

Press release from the US Oncology Network:

apnews.com/press-release/pr...

Federal Register :: Most Favored Nation:

federalregister.gov/documen...

Text from my oncology office:

MFN is bad for patients. If passed, this rule will likely cause severe disruptions in access to important medications. The Center for Medicare & Medicaid Services (CMS) admits outright that the policy will likely hurt patients, stating that, “beneficiaries may experience access to care impacts by…having to travel to seek care from an excluded provider, receiving an alternative therapy that may have lower efficacy or greater risks, or postponing or forgoing treatment.”

In addition, CMS also commented that in 2021 9 percent of Medicare beneficiaries are projected to forgo access to treatment because of the MFN rule. That number increases to 19 percent Medicare beneficiaries in 2023. Further, CMS predicts in 2023 19 percent of Medicare beneficiaries will no longer have access to life saving cancer treatment because of the MFN rule.

MFN is bad for healthcare providers. 36 of the 50covered drugs under MFN are used in oncology and hematology. While we understand and agree that action is needed to address the rising cost of prescription drugs, including cancer treatments, the MFN is a rushed policy that is likely to have significant unintended and disastrous consequences on America’s seniors.

The American Hospital Association stated, “It is alarming that the Administration has issued this operationally burdensome rule after over two years, in the middle of a pandemic with cases at record levels, and with less than six weeks’ notice before the model begins.”

[onajourney]

One more link: Centers for Medicare and Medicaid Services, innovation.cms.gov/media/do...

[Hidden]

Just great, first cancer then covid, now a good ole' fashion rear reaming. That's alright, they have been trying to kill me off for many years. To quote Ronald Reagan “The most terrifying words in the English language are: I'm from the government and I'm here to help.”

[onajourney]

I am trying.

[Hidden]

I’m happy that she’s recovered .

[cesces]

"Trump Administration’s announced “most favored nation” (MFN) payment model for Medicare Part B drugs. The mandatory seven-year MFN model, scheduled to take effect in just over a month, without any opportunity for meaningful public comment..."

Interesting, a superficially good policy, that is going to generate apparently unintended consequences, being implemented in an apparently incompetent autocratic manner, to a socialist program, being lamented by ant-socialist supporters of the autocrat.

In answer to your question xpo1, for once I am left befuddled and speachless.

No where do I see any informed comment on the rule and how exactly it works to generate these unintended consequences.

Personally I would like to see informed comment about the substance of the rule.

[kapakahi in reply to cesces]

I had to look it up too. Drug pricing in the US is a scandal with lethal consequences, though it works just fine for politicians' campaign (cough-cough) "donations."

Here's a start: nytimes.com/2020/11/20/upsh...

But it didn't really help me get a clear understanding of it, except that it would drastically reduce the astronomical prices hospitals can charge you for drugs while you're in their care. I see nothing wrong with that on the surface, but...unintended consequences.

Still, we have to start somewhere. If Congress had allowed Medicare to negotiate drug prices many years ago, we might not be in this situation, or if Congress had allowed importation of drugs from other countries with rational pricing, we might not be in this situation. Since a huge proportion of our meds are manufactured in other countries, you can't convince me that safety is the main concern here, no matter what Big Pharma says.

Socialism? Please. Social Security. Medicare. Medicaid. The VA. Public schools. Government-funded research (where a lot of our drugs started). Food stamps. Infrastructure. Subsidized Big Oil and Big Ag. Tax breaks and tax cuts for the rich. Taxpayer-funded sports stadiums. C'mon. We're a society. We have socialism.

[cesces in reply to kapakahi]

Agreed kapakahi

With basically everything you said.

I keep remembering that misspelled hillbilly sign "keep your government hands off my social security" by a Trump voter. LOL

The gang that couldn't shoot straight. Skipping the comment period was stupid on top of stupid.

Well I guess we'll see what happens. I think the problem is they are applying the law to docs when the real source of the problem is the Pharmas.

It would be so simple to just remove the drug company exemption from price discrimination laws. It would be direct, effective and unlikely to generate surprise consequences.

It could create a few other problems, but they would be fixable.

Unfortunately an effective solution like that would require strong Dem control of congress. 51 percent control wouldn't be able to do it.

I guess we all will have to hope there is no attempt to block the results of the election with some martial law scam and the Biden Admin is able to sort out these unintended consequences.

[Gearhead]

Based on about a 20-minute search and read of MFN facts and pro and con arguments, my conclusions are: This is a complicated issue. Lots of understandable biases in the healthcare community. Should I view this as a Medicare-insured patient with prostate cancer or as a citizen concerned about the fiscal health of my country?

[cesces in reply to Gearhead]

"Should I view this as a Medicare-insured patient with prostate cancer or as a citizen concerned about the fiscal health of my country?"

Explain please.

[Gearhead in reply to cesces]

You know, I kind of regret that sentence. That's because I think that posts that might trigger a political discussion have no place here on HU. We are bonded brothers, but as soon as we start sharing opinions regarding hot button issues, we will become estranged brothers.That sentence simply implied that I don't yet have a strong pro or con position on MFN. On the one hand, Medicare costs must be prudently managed (search "Medicare solvency"), and MFN will almost certainly but slightly reduce costs. On the other hand, as explained in the original post, MFN may motivate some providers to reconfigure their business in a way that compromises the quality or convenience of services provided to patients.

[cesces in reply to Gearhead]

Yes. It's complicated.

Sooner or later someone will explain it with some clarity here.

It's not so obvious to me what the unintended consequences are.

But I am guessing those lupron shots are affected. If they are we will soon hear what the effects, if any, are.

I don't see why it should be necessary that reducing Pharma margins need to involve anything but benefit to both patient and taxpayer.

But no doubt there are ways to do it that can harm both.

[onajourney in reply to Gearhead]

" I think that posts that might trigger a political discussion have no place here on HU."

I apologize for posting a political question here. When I received the letter from my oncologist it was my first knowledge of the impending changes. I figured this forum might shed some light on the situation, especially how it might affect our treatments, our access, etc.

I also recognize this question is primarily interesting only to forum members using US Medicare or Medicaid.

I am not interested in triggering a political discussion. My only interest is in gaining information from those who might understand this change better than I.

[Gearhead in reply to onajourney]

No apology necessary. My comment definitely wasn't aimed at your original post, which I regarded as appropriate and informative.

[jimreilly]

I sort of understand it but don't quite understand how it would work. Certainly the drug companies are not to be trusted to have our best interests at heart (remember the scheme to keep Viagra prices high, just to give an example than many of us know about?). I do know my Express Scripts drug prices have risen this year for reasons which Express Scripts has bailed to make clear to me. Someone is making a lot of money. But if the new regulations are indeed not well thought out, I'm pretty wary. To accomplish what is intended would require a thoughtfulness and competence not always recently in evidence.

[Gearhead]

A slightly relevant factoid: The "Amount Charged" for my most recent denosumab (i.e., Eligard, previously Lupron) injection = $46,663. The "Medicare Approved Amount" = $2,434. Medicare actually paid $1,947 and my supplement insurance paid $487.

My understanding is that the $46,663 comes from my provider's so-called Chargemaster. There may be a good reason for this, but I've never understood the utility of the absurdly high numbers in hospital's and other health care provider's Chargemasters.

[Gearhead]

Every 3 months also. Does your eob show the Medicare Approved Amount?

[j-o-h-n]

confusion.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 5:47 PM EST

[j-o-h-n]

middle name is actually : middle name....

Really don't want to be Alex right now...........

Day job: I work the grave yard shift in the city morgue...........(stiff work ya know)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 5:59 PM EST

[j-o-h-n]

me <=====onateeterboard

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 6:11 PM EST

[j-o-h-n]

Ya Right..... Rosetta and Monte are stoned........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 6:13 PM EST

[j-o-h-n]

Just our customers!!!....... Some of the guys would dance with the customers....but close partner dancing only.....No dipping.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 10:29 PM EST

[j-o-h-n]

Next serious one..... we'll invite you to the wedding..... (I'm usually best man)...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 10:38 PM EST

[j-o-h-n]

You supposed right...... The Coroner19...... Lockdown quarantine (a/k/a forever and ever).....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 10:51 PM EST

[Gearhead]

California

[Hidden]

👍

[jackcop]

I'm on Medicare and this is the first I've heard of this. After further researching, why not let Medicare negotiate with pharmaceutical companies and countries for the best price for drugs. Our leaders of the USA gov't feel beholden to the pharmaceutical lobbyists. Also, this law seems to be a reaction of big pharmaceutical companies to their outlandish drug prices.

"The American Hospital Association stated, 'It is alarming that the Administration has issued this operationally burdensome rule after over two years, in the middle of a pandemic with cases at record levels, and with less than six weeks’ notice before the model begins.' ” If this statement is true, (the 2 years and the six weeks' notice) I have lost my faith in my leaders.