WASHINGTON (AP) – A new $ 56,000-a-year Alzheimer’s drug could significantly increase Medicare premiums, with some patients on prescriptions being able to co-pay about $ 11,500 a year, according to a research report released Wednesday.
A drug called Aduhelm was approved by the Food and Drug Administration just this week. It is the first Alzheimer’s drug in nearly 20 years, although it does not cure a life-threatening neurological condition. Some experts question whether Aduhelm is beneficial for patients, but the FDA has determined that it may reduce harmful plaques in the brain by potentially slowing dementia.
Wednesday’s analysis by the non-partisan Kaiser Family Foundation comes as congressional Democrats seek to build a consensus on legislation that would allow Medicare to negotiate prescription drug prices.
Oregon Democrat Sen. Ron Widen, chairman of the Senate Finance Committee, said the price of the Alzheimer’s drug list was “unreasonable.” Although President Biden has called for Medicare to have negotiating powers, the prospects for the bill are unclear.
Kaiser’s report estimates that if only 500,000 Medicare recipients were assigned to Aduhelm, the program would cost $ 29 billion a year, far more than any other drug.
“At this price point, this drug alone can outperform all others covered by Medicare if it is widely used,” said report co-author Trisya Neumann.
Medicare has not made a formal decision to cover Aduhelm, but traditionally the costs are not taken into account. Drug producer Biogen said it was worth the price for Aduhelm responsibly.
Alzheimer’s affects about 6 million Americans, the vast majority of whom are old enough to qualify for Medicare. “Aduhelm’s endorsement is the most high-profile example of Medicare’s potential budgetary impact on the pharmaceutical market,” concludes Kaiser.
In addition to higher taxpayer costs, domino effects will include higher “Part B” premiums for Medicare outpatient coverage և increase in monthly fees by millions with additional Medigap plans. As an infusion to be administered in a physician’s office, Aduhelm is covered by Medicare outpatient care benefits. Part B The standard premium paid by the majority of those involved is currently $ 148.50 per month.
In addition to the monthly premiums, they will have an impact on out-of-pocket expenses. Many patients taking medications, including those enrolled in Medicare Advantage plans by private insurers, can face thousands of dollars in co-payments. The researchers estimated that the maximum could be as high as $ 11,500.
That out-of-pocket expenditure will translate into almost 40% of the median estimated median income of $ 29,650 beneficiaries.
“Because Aduhelm is not a cure for Alzheimer’s disease, patients can bear this annual out-of-pocket expense for several years,” the report said.
Biogen, which developed the Alzheimer’s drug in collaboration with Japan’s Eisai Co., said earlier this week that it expects gradual absorption rather than a sharp “hockey stick” spike.
Biogen set the price of the drug after careful study, says Chirfi Guindo, Biogen’s global product manager. Biogen has committed for four years without rising prices.
Gundo said the company was studying the price of advanced drugs to treat cancer and other complex conditions. “We have given Aduhelm a price of about one-third the level of cancer immunotherapy,” he told a teleconference this week. “So we think this is a really responsible price; we think it is a price that is stable for the system.”
Medicare has a review process known as the National Coverage Decision to evaluate new treatments that may have far-reaching implications for the program. Officials have not yet announced how the program will work with Aduhelm. Medicare may be able to set conditions for drug coverage based on clinical efficacy.
The program covers more than 60 million people, including 65-year-olds as well as people with disabilities or severe kidney disease. Medicare costs about $ 1 trillion a year.