In a brand new Coverage Watch, KFF specialists clarify why Medicare’s preliminary determination to cowl a brand new Alzheimer’s drug just for a restricted group of beneficiaries is more likely to intensify strain on officers to rethink the rise within the Medicare Half B premium for 2022.
Earlier this week, CMS issued a preliminary Nationwide Protection Dedication that might restrict protection of the brand new drug, Aduhelm, to beneficiaries with delicate cognitive impairment who take part in accepted scientific trials – a call that’s anticipated to end in a comparatively small variety of Medicare beneficiaries receiving Aduhelm over the following a number of years.
Medicare officers cited the excessive worth of the drug as a key purpose for a 14.5 % improve within the Half B premium, from $148.50 in 2021 to $170.10 in 2022. However that was earlier than Biogen, the drug’s producer, introduced a 50 % discount within the drug’s worth on the finish of 2021, and earlier than the proposed protection determination was made. Collectively, these components counsel that Medicare Half B spending on this drug just isn’t anticipated to be as massive as beforehand forecast.
Medicare beneficiaries who use Aduhelm, nonetheless, will nonetheless face hundreds of {dollars} in coinsurance prices if they don’t have supplemental protection to assist defray the price.
The Coverage Watch and different analyses associated to Aduhelm and Medicare spending can be found at kff.org.