North Carolinians with autoimmune diseases face a new threat — this time from a federal drug pricing proposal.
President Trump recently gave major drugmakers until the end of September to comply with his proposed Most Favored Nation (MFN) policy, which would tie US medicine prices to the lowest rates set by governments in other wealthy countries.
On the surface, MFN may sound appealing — billed as a way to save money. In reality, it would slash reimbursements for essential medicines so severely that many community clinics and infusion centers could no longer afford to provide this essential care. Patients could be left waiting or traveling extensive distances for care, funneled into higher-cost hospital settings, or cut off from life-changing treatments entirely.
North Carolina’s congressional delegation should reject MFN outright and instead advocate for truly patient-centered reforms.
Patients with rheumatoid arthritis, psoriatic arthritis, lupus, multiple sclerosis and other autoimmune diseases rely on timely infusions and injections to control symptoms, protect their mobility, and maintain their quality of life. For many, these treatments are their only effective option — but effectiveness depends on precision. These infusions must be given on a strict schedule. Miss a dose, and symptoms flare. Delay treatment too long, and the damage can be lasting.
I help oversee one of many community-based infusion centers across North Carolina that provide these innovative therapies to patients battling complex autoimmune diseases. Our team delivers advanced IV therapies, helps patients navigate insurance approvals, and ensures medicines are stored, prepared, and administered safely. This system works, but it depends on sustainable reimbursement.
Infusion centers currently operate under what’s called a “buy-and-bill” model. We purchase medications up front, prepare and administer them, and get reimbursed later. Under Medicare Part B, that reimbursement is based on the average sales price of the drug plus a small add-on payment, currently 6%, to help cover costs like storage, specialized staff, equipment, and spoilage insurance.
MFN would upend a system that is already under immense pressure. Our operational costs have risen four-fold since the COVID-19 pandemic, making it increasingly difficult to sustain care with current reimbursement levels. By tying reimbursement to much lower prices paid in countries with government-run health systems, it would slash the base payment and the 6% add-on with it, worsening the financial squeeze on infusion providers. The result? Infusion centers may have to treat patients at a loss, stop offering certain medications, or shut their doors entirely.
When that happens, patients are pushed into hospital outpatient departments — an outcome that’s worse for everyone, given that hospitals often charge two times more for the same infusion. This is particularly challenging for rural patients, who may have to travel hours to the closest hospital to avoid missing a treatment.
The Centers for Medicare & Medicaid Services already noted that a similar MFN model would have reduced drug utilization by nearly 20%, as many beneficiaries would lose access to certain medicines. That loss of access would force patients to switch to less effective options, or delay or forgo treatments with proven success. And this won’t just affect Medicare patients: Commercial insurers often use ASP as a reference point when setting payment rates, impacting their beneficiaries as well.
In rheumatology, even short interruptions in care can erase years of progress and mean the difference between living independently and facing more permanent disability.
Our health care system is certainly in need of reform, but MFN gets it wrong. Rather than reducing waste or targeting the supply chain middlemen who drive up prices for patients, it harms the very sites of care that keep costs lower and access easier.
Community-based infusion centers, like the one I manage here in the Tar Heel State, are part of the solution. We deliver high-quality care close to home, we keep patients out of higher-cost hospital settings, and we help them stay on therapy, each of these things prevents expensive complications down the line.
North Carolina’s autoimmune patients deserve better than a false choice between affordability and access. US Sen. Ted Budd and our entire congressional delegation should stand up against the MFN model and instead push for solutions that reduce costs without putting life-changing treatments out of reach.