In the United States, seniors and people with disabilities enjoy broad coverage of physician-administered medicines under Medicare Part B because the program relies on market competition to balance access, innovation and cost control. But the same cannot be said for patients in other countries. In fact, a new analysis from Avalere underscores the dangers of the Most Favored Nation (MFN) rule and other foreign reference pricing proposals.
The analysis compared coverage of breast cancer medicines under Medicare Part B with coverage of these medicines under England’s National Health Service (NHS), including the Cancer Drugs Fund (CDF), which is guided by National Institute for Health and Care Excellence (NICE) recommendations. Avalere found that more than half (56%) of Medicare beneficiaries who received physician-administered medicines for breast cancer in 2017 and 2018 would not have had access to the medicines their physicians determined was best for them if NICE decisions were used to determine Medicare Part B coverage.
Put another way, for more than 70,000 seniors and people with disabilities, NHS England would not have provided access to the treatment that their doctor prescribed.
Looking beyond just breast cancer medicines, another analysis found that only 62% of medicines available currently through Medicare Part B are available in the United Kingdom. And of those medicines that are available, there was an 11-month delay, on average, from the time these medicines first launched in the world and when they became available to patients in the United Kingdom.
The fact is that Medicare patients currently have far better access to medicines than patients in MFN reference countries like the United Kingdom.
Instead of recognizing this and looking for ways to make the program even better, the administration has chosen to implement sweeping changes in Medicare Part B, undoing a program that works well to ensure seniors and people with disabilities have affordable access to new medicines.
This is the wrong approach. The U.S. government shouldn’t gamble with seniors’ access to medicines through dangerous policies like the MFN rule.
Nicole Longo
Nicole Longo is Deputy Vice President of public affairs at PhRMA focusing on Medicare, 340B, importation and more. She previously worked for a D.C.-based public affairs firm where she assisted a wide range of clients with communications efforts on everything from trade policy to agriculture policy to health care policy. Outside the office, Nicole can be found trying new restaurants (usually Italian), taking an occasional barre class and cheering on the Cincinnati Bengals.
Nicole Longo
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New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England
Medicare
Part B
CMMI
International Reference Pricing
New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England
New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England