A new report says a $56,000 Alzheimer’s drug approved this week will massively raise Medicare premiums
WASHINGTON — A new $56,000-a-year Alzheimer’s drug would massively raise Medicare premiums, and some patients who have been prescribed the drug could end up paying nearly $11,500 annually, according to a research report published Wednesday. is.
The drug, named Aduhelm, was approved by the Food and Drug Administration this week. It is the first drug for Alzheimer’s in nearly 20 years, although it does not cure the life-threatening neurological condition. Some experts question whether EduHelm offers any benefit to patients, but the FDA determined that it can reduce harmful clumps of plaque in the brain, potentially slowing dementia.
Wednesday’s analysis by the nonpartisan Kaiser Family Foundation comes as Congressional Democrats seek to build consensus around legislation that would empower Medicare to negotiate drug prices.
The Kaiser Report estimates that if only 500,000 Medicare recipients were prescribed EduHelm, the program would cost about $29 billion a year, far more than any other drug.
“At this price, this one drug alone could be above all other drugs covered by Medicare, if it is widely used,” said report co-author Tricia Newman.
Medicare has not made a formal determination on what Eduhelme will cover, but traditionally cost does not enter into such considerations. Drugmaker Biogen has said it has priced Eduhelme responsibly.
Alzheimer’s affects about 6 million Americans, old enough to qualify for Medicare. The Kaiser analysis concluded, “The approval of EduHelm provides the latest high-profile example of the potential budgetary consequences of Medicare’s role as a value-gainer in the drug market.”
In addition to higher taxpayer costs, domino effects will include higher “Part B” premiums for Medicare’s outpatient coverage and an increase in monthly premiums for millions of people with supplemental “Medigap” plans. As an infusion drug that will be administered in a doctor’s office, EduHelm is covered by Medicare’s outpatient care benefits. The Part B standard premium, paid by most enrollees, is currently $148.50 per month.
Apart from the monthly premium, out-of-pocket expenses will also be impacted. Many patients taking medication, including those who sign up for Medicare Advantage plans from private insurance companies, can face thousands of dollars in co-pays. Researchers estimate that the maximum could reach $11,500.
The upper-bound cost out of patients’ budgets would be about 40% of the estimated median income of $29,650 for Medicare beneficiaries.
“Since EduHelm is not a cure for Alzheimer’s disease, patients may face these annual out-of-pocket costs over several years,” the report said.
Biogen, which developed the Alzheimer’s drug with Japan’s Isai company, said earlier this week that it expects a gradual spike and not a sharp “hockey-stick” spike.
Biogen’s head of global product, Chirfi Guindo, said Biogen had determined the price of the drug after careful research. Biogen has made a commitment not to increase prices for four years.
Gindo said the company looked at the prices of advanced drugs to treat cancer and other complex conditions. “We’ve priced EduHelm at about a third of the price of cancer immunotherapies,” he said during a teleconference this week. “So, we see it as a truly responsible value and we consider it a price that is sustainable for the system.”
Medicare has a review process known as a national coverage determination to evaluate new treatments that could have far-reaching implications for the program. Officials have yet to say how the program with Eduhelm will proceed. It is possible that Medicare may set conditions for covering the drug based on clinical effectiveness.
The program covers more than 60 million people, including people 65 and older, as well as people who are disabled or have severe kidney disease. Medicare spending is approaching $1 trillion annually.