As a rheumatologist in St. Clair Shores, I treat patients with serious autoimmune diseases like rheumatoid arthritis, lupus, and psoriatic arthritis — conditions that, not long ago, often meant a lifetime of pain and progressive disability. But thanks to major therapeutic advances, many of my patients are now able to live active, fulfilling lives.
Unfortunately, that progress is now at risk.
Washington is again considering a “Most Favored Nation” (MFN) model — a scheme that would link U.S. medicine prices to the lowest price paid by other industrialized countries. On paper, it may sound like a good way to level the playing field. In reality, it threatens the ability of community-based physicians like me to continue offering essential medical treatments.
The federal government’s own analysis of a previous MFN proposal in 2020 projected that patients could lose access to their medications — not as a side effect, but as a built-in source of savings to the federal government. The Centers for Medicare & Medicaid Services (CMS) warned that care impacts could mean “having to travel to seek care from an excluded provider, receiving an alternative therapy that may have lower efficacy or greater risks, or postponing or forgoing treatment.”
In rheumatology, many of the most effective treatments are infusions or injections — complex medications that must be administered by trained healthcare providers in a clinical setting. These therapies aren’t interchangeable with over-the-counter drugs and, for many patients, they’re the only way to keep the disease stable and prevent long-term damage.
At my practice — and clinics across Michigan — we purchase these medicines upfront, administer them to our patients and are reimbursed by health insurance plans using a market-based formula. Through Medicare, the current reimbursement for physician-administered therapies includes the Average Sales Price (ASP) and a marginal add-on payment, minus government sequestration, to help cover overhead, including staff salaries, rent, and supply and intake costs. In the commercial market, insurers often take cues from the ASP rates when setting their own.
Margins are already tight for operating a safe infusion suite and managing complex patient care. But MFN would slash those ASP-derived payments further, pushing many practices to the brink.
The policy would tie reimbursement to the lowest prices set by government-run foreign health systems that bear little resemblance to our own. These systems rely on discriminatory cost-effectiveness thresholds and centralized price-setting agencies to ration care and control access to innovative therapies. Importing those pricing benchmarks would have severe consequences.
We know what happens when reimbursement is slashed. Providers take on unsustainable losses. Clinics are forced to cut services or close. Patients are pushed to hospitals, where care is harder to access and significantly more expensive. In fact, hospitals charge up to 200-300% more to administer a drug than independent physician practices.
The burden falls hardest on rural and lower-income patients, who already face long travel times and limited options. That’s especially concerning in Michigan, where more than 60% of our 83 counties are rural and there are over 250 designated “Health Professional Shortage Areas.”
Preserving and expanding access to local infusion sites is the best way to ensure timely care.
But MFN would make it even harder for providers like me to stay afloat under mounting financial pressure. One recent survey found that almost all practices that directly administer drugs to patients are already “underwater” on several medications, struggling with reimbursement far below acquisition cost.
MFN could accelerate clinic closures, retirements and the sale of independent physician practices — fueling further health system consolidation, driving up costs, narrowing patient choice and disrupting essential treatment for autoimmune diseases.
We all want to lower drug costs. But this policy isn’t the answer.
Sen. Gary Peters, D-Bloomfield Hills, has long led patient-centered healthcare reforms — a commitment that has made a real difference. I urge him to continue that leadership by asking the administration to reject the MFN model and instead pursue solutions that protect both affordability and access.
As someone on the front lines of patient care in the Wolverine State, I see how high the stakes are — and I know we can do better than a policy that puts essential treatments out of reach.
Amar Majjhoo, MD, is a rheumatologist based in St. Clair Shores and a board member of the Coalition of State Rheumatology Organizations.