CMS May Review Medicare Premium in Light of Aduhelm Price Drop

Aduhelm, Biogen's approved drug for early Alzheimer's disease, is seen at Butler Hospital, one of the clinical research sites in Providence, R.I., on June 16, 2021. Jessica Rinaldi/Pool via Reuters

President Joe Biden’s administration is considering a reassessment of Medicare Part B premiums after the drugmaker behind a new Alzheimer’s drug cut its price.

The administration announced in November 2021 that the monthly premium would rise by nearly $22 and attributed the rise in part to the potential use of Aduhelm, an Alzheimer’s drug from Biogen Inc.

The uncertainty surrounding the drug triggered a need to increase contingency reserves, officials said.

The following month, Biogen announced it was slashing the price of Aduhelm to $28,200.

Biogen CEO Michel Vounatsos said in a statement at the time that company executives hoped the price drop would help the Centers for Medicare and Medicaid Services (CMS) decide to cover Aduhelm.

On Jan. 10, Health Secretary Xavier Becerra instructed CMS “to reassess the recommendation for the 2022 Medicare Part B premium, given the dramatic price change of the Alzheimer’s drug.”

With the price decrease, “there is a compelling basis for CMS to reexamine the previous recommendation.”

A CMS spokesperson confirmed to The Epoch Times in an email that the agency has received Becerra’s instruction.

“CMS is reviewing the Secretary’s statement to determine next steps.”

The agency declined to say how long the review would take and whether people could expect lower Medicare premiums in light of the Aduhelm price drop.

The Food and Drug Administration approved Aduhelm over the summer. Regulators said the treatment was the first of its kind because it targeted “the fundamental pathophysiology” of Alzheimer’s, a disease that causes memory loss and eventually affects people’s ability to carry out daily tasks.

Still, the high cost and lack of certainty that the drug will benefit patients led to several resignations from the administration’s drug advisory panel and calls for a probe into the approval.

Shortly after the approval, CMS launched an analysis to determine whether and how Medicare would cover Aduhelm and similar drugs used to treat Alzheimer’s.

The agency has met with a number of organizations, including Biogen, the Alzheimer’s Association, and the BlueCross BlueShield Association during the process, and solicited public comments regarding the effort.

A decision is expected on Jan. 12.

The American Academy of Neurology, whose experts consulted with the government, said in late 2021 that because Medicare Part B pays only 80 percent of the cost of most covered drugs, even if CMS decides to cover the drug, any beneficiaries who get it would pay thousands of dollars of out-of-pocket costs.

The organization described the drug as having “substantial risks” and lacking “proven clinical benefit.”

European regulators said recently that they opposed clearing Aduhelm, dealing a blow to Biogen, which asked regulators to reexamine the decision in light of data suggesting the drug is effective and safe.