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CMS released the Most Favored Nation Model pricing that replaces the current reimbursement for 50 drugs with a significantly lower reimbursement on every single drug. 

This new reimbursement is now at a level that is most likely less than the actual cost of the drugs.

Below you will find the information from CMS

MFN Pricing Released

The MFN Model Drug HCPCS Codes List and MFN Model Drug Pricing File will be updated on a quarterly basis.

• January 2021 MFN Model Drug HCPCS Codes List (XLS)
• January 2021 MFN Model Drug Pricing File (XLS)
• MFN Model: Billing Information Slides (PDF)

For more information:  https://innovation.cms.gov/innovation-models/most-favored-nation-model

For questions regarding the MFN Model, please email: MFN@cms.hhs.gov.

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For your convenience, MSHO has created a spreadsheet comparing the MFN reimbursement to the ASP +6% reimbursement CLICK HERE.  Keep in mind, for most of the codes, the negative number reflects the HCPCS unit, not the entire dose the patient will receive, so the actual impact is MUCH worse.

MSHO has submitted comments to CMS opposing the interim rule and encourages you to do the same! ACT NOW

ACCC, COA, and others have filed lawsuits to stop this for occurring but at this moment, this new pricing model is to begin on January 1, 2021.   

ASH joined dozens of other patient and provider organizations in a letter to Congressional leaders to oppose the Most Favored Nation Model. The letter, led by the Part B Access for Seniors and Physicians (ASP), highlights the potential harm this model could cause for Medicare beneficiaries. ASH is sending an additional letter to the Centers for Medicare and Medicaid Services (CMS) ahead of January 1 to express the Society’s extreme concern on the impact this model could have on Medicare beneficiary access to drugs and the potential impact on community hematology/oncology practices, which may not be able to withstand the financial impact. 

ASCO took steps to stop Most Favored Nation Model in Amicus Curiae Brief and submits comments to CMS. The analysis reflected in the amicus brief shows dire consequences for people with cancer under the MFN Model. CMS projects that the model will cause 19% of beneficiaries to lose access to its 50 targeted drugs, 38 of which are used in cancer treatment