On January 26, 2021, Aimed Alliance submitted a comment to the Centers for Medicare & Medicaid Services (CMS) in response to the Most Favored Nation Model (Model) interim final rule. The Model is intended to cap reimbursement for 50 Medicare Part B drugs at the lowest price that drug manufacturers receive in other countries similar to the United States. The Model also changes payments made to health care practitioners who administer Part B drugs. Instead of receiving a percent of the drug price, they would receive a small flat fee. CMS is attempting to implement the Model on a nationwide and mandatory scope in violation of the Patient Protection and Affordable Care Act, and originally had planned to start the Model on January 1, 2021. Two district courts found that CMS had violated the Administrative Procedure Act by attempting to implement the rule without the opportunity for public comment.
Other concerns include that the Model likely exceeds CMS’s authority to conduct demonstration projects under the Patient Protection and Affordable Care Act, as it is implemented on a nationwide scope without conducting a smaller, test demonstration first. Additionally, the Model would force health care practitioners to choose not to provide the medication to their patients because reimbursement is so low that they would lose money. Instead, they would be forced to prescribe alternative therapies that may be less effective or pose greater risks to patients. As a result, patients may no longer be able to access medically necessary treatment. Read our comment here.