Medicare Copays For New Alzheimer’s Drug Could Reach $11,500

WASHINGTON – According to a study paper released Wednesday, a new $56,000-per-year Alzheimer’s drug will hike Medicare rates across the board, and certain patients who are prescribed the prescription might have annual copayments of almost $11,500.

The medicine, named Aduhelm, was just recently authorised by the Food and Drug Administration. It’s the first Alzheimer’s drug in over two decades, yet it doesn’t treat a life-threatening neurological disorder. Although some specialists doubt that Aduhelm is of any help to patients, the FDA decided that it can reduce dangerous plaque clumps in the brain, perhaps delaying dementia.

The independent Kaiser Family Foundation’s report comes as congressional Democrats strive to reach an agreement on legislation that would allow Medicare to negotiate prescription medication pricing.

Senator Ron Wyden of Oregon, the head of the Senate Finance Committee, called the Alzheimer’s drug’s list price “unconscionable.” Despite President Joe Biden’s advocacy for giving Medicare bargaining rights, the bill’s prospects are bleak.

According to the Kaiser analysis, prescribing Aduhelm to only 500,000 Medicare patients would cost the government roughly $29 billion per year, significantly more than any other prescription.

“If this treatment is extensively utilised, the cost of this one medicine alone might exceed all others covered by Medicare,” said Tricia Neuman, a writer of the paper.

Medicare has not made a formal decision on whether or not to cover Aduhelm, although the cost is often not a factor in such decisions. Biogen claims to have priced Aduhelm properly.

Alzheimer’s disease affects around 6 million Americans, the great majority of whom are Medicare-eligible. The Kaiser report concluded, “The approval of Aduhelm presents the latest high-profile illustration of the possible financial ramifications of Medicare’s position as a price-taker in the pharmaceutical industry.”

The cascading consequences would include increased “Part B” rates for Medicare’s outpatient coverage and rises in monthly rates for millions with supplemental “Medigap” policies, in addition to greater public spending. Aduhelm is covered by Medicare’s outpatient care coverage as an infusion medication delivered in a doctor’s office. The regular Part B premium, which most participants pay, is present $148.50 per month.

There would be an influence on out-of-pocket payments in addition to monthly premiums. Thousands of dollars in copayments might be imposed on many individuals using the medicine, including those enrolled in Medicare Advantage plans from private insurers. According to analysts, the maximum might be over $11,500.

The expense of removing the upper-bound expense from patients’ budgets would amount to approximately 40% of the expected median income for Medicare participants of $29,650.

Patients may face these yearly out-of-pocket expenditures across numerous years because Aduhelm is not a cure for Alzheimer’s disease, according to the paper.

Biogen, which co-developed Alzheimer’s medicine with Eisai Co. of Japan, predicted a steady uptake rather than a sudden “hockey-stick” surge earlier this week.

According to Chirfi Guindo, Biogen’s head of worldwide product, the medicine was priced following extensive study. For the next four years, Biogen has promised no price rises.

The business looked at pricing for sophisticated pharmaceuticals to treat cancer and other complicated ailments, according to Guindo. During a teleconference this week, he added, “We have priced Aduhelm at around a third the level of cancer immunotherapies.” “So, we think this is a pretty reasonable price, and we think this is a price that the system can sustain.”

A National Coverage Determination is a Medicare assessment procedure that evaluates innovative medicines that potentially have far-reaching ramifications for the programme. Officials have yet to say how Aduhelm’s participation in the programme will be handled. It’s likely that Medicare will impose limits on the drug’s coverage depending on its clinical efficacy.

More than 60 million individuals are covered by the programme, including those aged 65 and over, as well as those who are handicapped or have significant renal disease. Medicare’s annual budget is reaching $1 trillion.