WASHINGTON (AP) — Medicare said Thursday it is considering cutting premiums for enrollees, after officials stuck to an earlier decision to sharply limit an expensive new Alzheimer’s disease that is expected to drive up program costs Symptomatic drug coverage.
The agency “is considering this, and is still going through the process,” spokeswoman Beth Link said of the potential lower premiums as Medicare announces a final coverage decision for Aduhelm, the drug’s benefits has been widely questioned in the medical community.
Medicare will retain an earlier insurance limit imposed on the $28,000-a-year drug and only pay for Aduhelm when used in clinical trials approved by the U.S. Food and Drug Administration or the National Institutes of Health, officials said.
Aduhelm’s projected cost was the main driver of this year’s $22 increase in Medicare Part B premiums, raising it to $170.10 per month. More than 56 million Medicare recipients already pay higher prices for the plan’s outpatient insurance benefits.
Thursday’s decision illustrates the impact a single drug can have on the budgets of individuals and taxpayers. Legislation authorizing Medicare to negotiate prescription drug prices remains in the Senate as part of President Joe Biden’s stalled social and climate agenda.
Medicare decisions include an important caveat. If Aduhelm, or any other drug of its kind, were approved by the so-called “traditional” FDA, Medicare would provide patients with broader coverage, officials said.
Aduhelm received so-called “accelerated” approval last year due to its potential prospects. But manufacturer Biogen needs to conduct a follow-up study to definitively answer whether Aduhelm actually slowed Alzheimer’s progression. If the study is successful, the FDA will grant full approval.
This will also open up coverage for Medicare.
Aduhelm hits the market as the first new Alzheimer’s drug in nearly two decades. Originally priced at $56,000 a year, it is expected to quickly become a blockbuster drug, generating billions in revenue for Cambridge, Massachusetts-based Biogen.
But while the company slashed the price in half—$28,000 a year—the Aduhelm launch was disastrous.
Boycotts from politicians, doctors and insurers kept the company from just $3 million in sales from Aduhelm last year. Doctors have been hesitant to prescribe the drug, given weak evidence that it slows the progression of Alzheimer’s. Insurance companies have blocked or limited the drugs’ high price tags and uncertain benefits.
The CMS decision means that in order for Medicare to pay, patients taking Aduhelm’s drug must participate in a clinical trial evaluating the drug’s safety and effectiveness in slowing the progression of early dementia.
The restrictions remain despite the Alzheimer’s Association’s vigorous lobbying push to change Medicare’s stance, including contacts with members of Congress, online advertising and a social media campaign targeting the agency.
The association, the largest of its kind, has received donations from drugmakers including Biogen.
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