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COA Viewpoint

Preliminary Comment Letter on Most Favored Nation Experiment and Impact on Older Adults With Cancer

Authored by

Nicolas Ferreyros, director of communications, Community Oncology Alliance


J Clin Pathways. 2020;6(10):24.

COAWarning of the dangerous impact it will have on seniors with cancer, the Community Oncology Alliance (COA) Board of Directors has submitted a preliminary comment letter to the Centers for Medicare & Medicaid Services (CMS) requesting the immediate withdrawal of the Most Favored Nation (MFN) Model interim final rule.

In the letter to CMS Administrator Seema Verma, COA notes that the lives of seniors battling cancer and other very serious diseases are at stake in less than 30 days unless the MFN experiment is withdrawn. By CMS’ own estimates, 9% of Medicare seniors will forgo treatment next year due to the MFN experiment. In 3 years, CMS estimates that a staggering 19%—nearly one in five seniors—will not be treated.

COA’s comment letter also notes that the MFN experiment is a violation of the Administrative Procedure Act by skipping the required notice and comment rulemaking process, and also unconstitutionally exceeds CMS’ authority by effectively end-running Congress in amending Medicare Part B statute as set forth in the Medicare Modernization Act.

“I’ve been in Washington a long time and have never witnessed a brazen and misguided political stunt like this,” said Ted Okon, executive director of COA. “This is literally an experiment on seniors that creates a significant deficit in care where none exists now. And, as community oncology practices face almost insurmountable obstacles in keeping their doors open to treat cancer patients during a COVID-19 resurgence, CMS hits practices broadside. This literally endangers the lives of seniors with cancer.”

Community oncology providers agree that the increasing cost of drugs is a problem that needs to be solved. However, the solutions lie in the 35 oncology payment reform models community oncology practices are participating in across the country and other solutions that COA is developing for Medicare, employers, and private insurers.

The government should focus on stripping away unnecessary regulations so that drug competition is fostered in value-based arrangements, including the availability and use of lower-cost alternatives, like biosimilars. Very importantly, we need to reform the 340B Drug Pricing program so that drug discounts go directly to patients in need, not to the more expensive, large hospitals and health systems.

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