There is a battle that’s been brewing over Medicare covering the cost of the controversial new Alzheimer’s medication Aduhelm. To boil this down, the FDA approved the treatment last year, providing a glimmer of hope for families and patients suffering from this soul-stealing disease. It had been over 18 years since the FDA last approved a drug for Alheimer’s.
Following the approval, the Centers for Medicare (CMS), which oversees Medicare, felt the pressure to offer coverage of the drug. Sounds good – let’s stamp out Alzheimer’s, ease the suffering, and bring back dignity to all inflicted. But wait, if we’ve learned anything from the last 2 years, it’s that nothing is that simple. Remember, we're talking about drug companies, lobbyists and government agencies.
Let’s look at Biogen’s price tag for Aduhelm. The annual drug cost alone comes to $28,000, not including the cost of all the necessary MRI’s and infusions that go along with the treatment. With a staggering 6.2 million people suffering from Alzheimer’s (and growing!), the costs would be astronomical to the Medicare model. Yet it would seem inhuman to deny a useful treatment to all suffering people because of a price tag, so CMS considered ways to fund the increased expense. Their solution? Increase the monthly premium of Part B to $170.10 (an increase of $21.60 from $148.50 in 2021).
I’ll do the rough math here. There are roughly 64 million people enrolled in Medicare. Multiply that by the annual premium increase, and Medicare now collects an additional $16.6 Trillion from its beneficiaries.
Now the plot thickens. Significant research and trial studies found that high doses of the drug slightly slowed progress of the disease in patients with early-stage Alzheimer’s, yet another study showed no benefit and was terminated before completion. As a result, large medical centers including Cleveland Clinic, UCLA and John Hopkins are no longer prescribing the drug, citing “a lack of clinical evidence the drug actually helps treat Alzheimer’s disease.”
Which brings us to CMS’s decision on Thursday to only provide payment for the drug for patients enrolled in clinical studies. If I, or a family member were suffering from Alzheimer’s, I’d find a clinical study stat!
Hey CMS, shouldn’t you consider rebating Medicare beneficiaries on the additional funds you are collecting? That’s probably for another day. Meanwhile, the battle rages on with pressure coming from drug companies, patients’ groups, Congress and academics to provide faster access to new drugs, but often at an unknown cost of proven effectiveness, hopes of recovery and our pocketbooks. Stay tuned!
If you have any questions about Medicare, would like a free plan review, or have a comment about this blog, drop me a line at Stew@MedicareAgentStew.com
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