Amish J. Dave: Don’t let foreign price controls cut off lifesaving treatments for Washington patients

As a rheumatologist practicing in Seattle and Bainbridge Island, I’ve seen firsthand how far my field has come in treating serious joint, muscle, and immune system conditions. Just a few decades ago, patients with conditions like lupus, rheumatoid arthritis, and vasculitis had limited medications available and virtually all patients saw disease progression. Today, thanks to remarkable advances in treatment options, most of my patients can live full, productive lives.

That’s why I’m deeply concerned about proposals in Washington, D.C., to impose “most favored nation” price controls on U.S. prescription drugs. These proposals would tie U.S. prices to the lowest rates paid by foreign governments despite fundamental differences between their healthcare systems and ours. While I fully support efforts to improve affordability, MFN risks taking us backward by limiting patient access to essential rheumatologic medications.

To start, MFN could disrupt how complex therapies are delivered, particularly those treatments that must be administered in a clinical setting by a healthcare provider. Many of the medications I prescribe are infused or injected by a member of my team and require close monitoring. Safe delivery depends on highly trained staff, proper equipment and strict handling protocols.

Today, Medicare reimburses physician-administered treatments based on a market-driven formula: the average sales price plus a small percentage to help cover costs related to storage, preparation, administration, and patient care. Many commercial insurers use similar benchmarks when setting their own payment rates.

But, under an MFN policy, Medicare would pay doctors a fixed percentage based on the lowest prices paid in other countries. This would bring the base reimbursement for many medicines far below what it costs to administer them. For community clinics across Washington state, it could quickly become impossible to keep these therapies available in-office. That would have immediate and serious consequences for patients who depend on them.

Some patients could be pushed into more expensive hospital settings, ironically increasing costs for public programs like Medicare and Medicaid. Others might face treatment delays or choose to go without care altogether if treatment centers are too far and feel out of reach. In fact, when the Centers for Medicare & Medicaid Services proposed a prior version of the MFN Model in 2020, it warned that the policy itself could lead to “access to care impacts,” including patients “receiving an alternative therapy that may have lower efficacy or greater risks” or even “postponing or forgoing treatment.”

MFN is not just an abstract policy discussion. Actually implementing these proposals could determine whether my patients can continue to receive the care they need in the settings they trust. Many have tried multiple treatments before finding one that works. Others are counting on the next therapy in development. I worry that MFN could jeopardize these patients’ health.

Sen. Patty Murray has long been a champion for Washington patients. I urge her to continue her leadership and convince the administration to abandon MFN. Doing so would protect both the access to treatment we have today and the physicians who work tirelessly to provide for patients across our state.

Because no matter how promising a medication or therapy may be, it does no good if patients cannot access it.

Amish J. Dave, MD, MPH, is a rheumatologist based in Seattle and Bainbridge Island and a board member of the Coalition of State Rheumatology Organizations.