On this episode of the podcast, Terry and Bob discuss President Trump’s “most favored nations” rule which ties federal reimbursements for Medicare Part B drugs to other developed nations’ prices. In other words, this rule is a de facto price control on Part B drugs, including cancer therapies. Terry and Bob explain how the order threatens the most vulnerable populations of patients who need Part B infusion drugs for their lives and livelihoods.
Terry interviews Dr. Julie Baak, practice manager at The Arthritis Center, near St. Louis, Missouri, who highlights what the rule means for doctors and patients. Julie explains how the government reimbursement rates for these drugs are roughly 30 percent lower than her acquisition costs. This scenario, she describes, is like a gas station purchasing gasoline at $3 a gallon, yet only allowed to sell it for $2. She’s had to send a letter to her patients saying she cannot stay profitable in such an environment.
Dr. Baak details how this rule will dramatically reduce access for America’s most vulnerable patients. Even CMS’s own estimates suggest that 10 percent of Part B patients will lose access to their medications in the first year of this rule’s implementation, and 20 percent will lose access by the second year. This rule will likely have unintended consequences of raising prescription drug costs because patients will migrate to the much more expensive Medicaid Part D, where drugs can be twice as expensive. Another unintended consequence is worse patient outcomes because medication compliance isn’t as strong in self-injectable Part D as in in-person infusion Part B.
Dr. Baak calls on patients and physicians to stand shoulder to shoulder against this grave economic and public health harm. She points to possible relief from the judiciary as a lifeline.
Patient correspondent Kate Pecora interviews Dennis, one of Dr. Baak’s patients, who explains what this rule means from a patient perspective. Dennis recounts his struggles with Achilles tendonitis, which severely reduced his quality of life for nearly four years to the point he couldn’t walk. After trying numerous medications, he finally found an infusion medication that worked through Medicare Part B. This rule threatens this medication — and his health and wellbeing.