Dubious $56,000 Alzheimer’s drug spurs largest Medicare price hike ever

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Seniors across the US will see a huge increase in their health care premiums next year, thanks to Biogen’s Alzheimer’s drug, EduHelm, which costs $56,000 a year and is not clearly proven effective in treating Alzheimer’s. it happens.

Centers for Medicare and Medicaid Services (CMS) announced Friday The standard monthly premium for Medicare Part B will increase from $148.50 in 2021 to $170.10 in 2022, an increase of $21.60, or about 14.5 percent. This is the largest increase ever in dollar terms and the largest percentage increase in recent years.

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CMS officials said on Friday that Eduhelm was responsible for nearly half the increase in Part B premiums, According to the Associated Press, Although CMS is still determining how it will cover Eduhelm under Part B, the agency said it is likely to pay all necessary “additional contingency reserves” for Eduhelm.

“We must plan for the potential for coverage for this high-cost Alzheimer’s drug, which may be covered, resulting in significantly higher expenses for the Medicare program,” CMS said,

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In general, Medicare Part B Cover Medically necessary services, including doctors’ services and tests, such as laboratory tests, cancer screenings, diabetes screenings and supplies. This includes outpatient care, home health services, durable medical equipment—such as walkers—and some preventive services—such as flu shots—among other medical services.

Biogen did not immediately respond to a comment request from Ars.

Controversy

In November 2020, a committee of independent advisors to the Food and Drug Administration voted almost unanimously against FDA approval for Aduhelm. The data did not indicate that the drug was effective, the committee concluded. Ten of the 11 committee members voted against the approval while one voted “inconclusive”.

But in June of this year, the FDA anyway drug approved, Outside experts quickly called the approval “outrageous,” and three experts on the FDA’s advisory committee resigned in protest. A watchdog organization called for the removal of FDA officials involved in the decision, and an investigative media report suggested a highly fickle relationship between Biogen and the FDA review staff. About a month after approval, the FDA’s acting commissioner limited the use of the drug and requested the inspector general’s office to investigate the agency’s decision.

Meanwhile, Biogen had set the list price at $56,000 a year. Media analyzes suggested that at that price, the drug could cost Medicare up to $334.5 billion per year, roughly half the Defense Department’s budget. A cost-effectiveness analysis by the nonprofit Institute for Clinical and Economic Reviews pegged a fair price for EduHelm at between $3,000 and $8,400 per year.

money problems

Medicare premium hikes for 2022 are likely to spark further frustration over Eduhelm and restart debate about Medicare price negotiations. In a statement Friday, Representative Frank Palone Jr. (DNJ) said:

“Today’s announcement from CMS reaffirms the need for Congress to finally give Medicare the ability to negotiate lower prescription drug costs… but also increases their health care premium. Doctor’s visits and outpatient care…. We cannot wait any longer to provide real relief to seniors.”

For now, a 2022 cost of living adjustment to senior citizens’ Social Security benefits will easily offset Medicare Part B premium increases. It is still unclear how many seniors will take the drug. Amidst all the controversy surrounding Aduhelm’s effectiveness, serious side effects, and pricing, many high-profile medical providers, such as the Cleveland Clinic and large health insurance providers, have said they will not administer or cover the drug.

Aduhelm’s uptick has been slow. State News reported that just over 100 patients Received the drug within the first few months of availability. About 5.8 million Medicare-eligible adults have Alzheimer’s disease, and in 2017, nearly 2 million Medicare beneficiaries accessed Alzheimer’s treatment covered by Medicare. But, last month, Biogen reported that EduHelm brought in just $300,000 in revenue between July and September, well below expectations. The New York Times reported that Wall Street analysts had predicted that Eduhelm bring in at least $12 million in the third quarter.

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