What Is MFN And How Will It Impact Medicare Coverage
The Centers for Medicare and Medicaid Services (CMS) announced a new Medicare Part B prescription drug payment model known as the Most Favored Nation (MFN) Model, effective January 1, 2021.
The new payment model has generated many questions among Medicare beneficiaries who are worried about its impact on their current benefits.
What is the Most Favored Nation (MFN)?
The new model will overhaul the Medicare pricing system. The measure will change the existing market-based approach to a Rule based approach implementing drug reimbursement amounts calculated from the lowest available in any one of 22 countries regardless of healthcare structure.
How Will MFN Impact You as a Medicare Beneficiary
The new MFN rule will likely restrict your access to care at your physician’s office. Under the new rule, your physician may not be able to acquire your drugs at a cost lower than the proposed drug reimbursement. As a result, there is a possibility you will be forced to seek an alternative site of care as directed by your physician.
Healthcare providers and patients are equally as concerned about possible delays in treatment, which may cause adverse outcomes, including disease flare-ups, loss of quality, and enjoyment of life, not to mention increased healthcare costs
Will MFN Affect Non-Medicare Patients?
Although the rule applies to Medicare Part B benefits, it will directly impact the families of Medicare patients who will have to find alternatives for their loved ones to receive their infusion treatments.
Additionally, if your physician is unable to financially sustain its office, non-Medicare patients will still lose their physician office as a site for their treatments.
Why Will MFN Restrict My Access to Care at My Doctor’s Office?
Under the new rule, your physician may not be able to acquire your drugs at a cost lower than the proposed drug reimbursement.
If the acquisition cost of your prescription drug is higher than the reimbursement offered by CMS, then your doctor will have to make one of two devastating choices:
- Stop providing these prescription drugs to Medicare beneficiaries. This scenario will leave patients in an extremely vulnerable position with severe negative health outcomes; or
- Operate their business in an unprofitable and unsustainable manner, which will ultimately result in their practice closing.
What Can I Do?
Your health matters! Your voice counts!
If you care about patient access or your choice to choose where to receive your treatments, you need to act now!
We encourage you to visit our advocacy page https://bit.ly/StopMFN to email your US Senator and Representative and ask them to Stop MFN. On our advocacy page, you can select between stopping MFN as a Medicare patient or as a Non-Medicare patient. Please also share this information with other Medicare patients who may be impacted.
Let’s work together to ensure all patients have access to quality, affordable, timely, and convenient medical treatments.