Patient advocates and Democratic lawmakers want Medicare to lower its Part B premiums for 2022 after Biogen said Monday that it will cut the price of its controversial Alzheimer's drug Aduhelm in half.
The Centers for Medicare and Medicaid Services hasn't changed premiums after the fact before as far as Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation, knows. But that doesn't mean they can't do it, she said.
"It would be an unprecedented move, but I don't think it would be an unwarranted move, given that a big part of the reason why the increase for 2022 is as large as it is is because of the price of this drug," she said.
Biogen is reducing the price of its therapy, which is meant to slow the progress of Alzheimer's disease, from $56,000 per patient per year to $28,200 after finding that providers weren't offering patients the drug at the rate the company had wanted, CEO Michel Vounatsos said in a news release. Only about 100 patients were taking Aduhelm as of September, according to STAT.
The Food and Drug Administration approved Aduhelm in June, despite questionable evidence that the drug is effective at treating Alzheimer's. CMS is scheduled to make an initial proposal on whether Medicare should cover Aduhelm by Jan. 12.
CMS last month announced a 15% increase in beneficiaries' Medicare Part B premiums for 2022, citing Aduhelm's potential cost to the program as a reason for the increase. At its original price, experts predicted Aduhelm would cost Medicare $29 billion annually.
Beneficiary advocates are already calling on CMS to deflate the premiums.
"If they didn't reverse that… then I would be pretty unhappy as a Medicare beneficiary," said George Vradenburg, chair and co-founder of UsAgainstAlzheimers, who supports CMS covering the treatment.
Lawmakers including Sen. Bernie Sanders (I-Vt.) and Sen. Ron Wyden (D-Ore.), who leads the powerful Senate Finance Committee, have asked the Health and Human Services Department to limit premium increases related to Aduhelm.
"With this price decrease for Aduhelm, there is even less justification for the planned increase in Medicare Part B premiums. The wheels of government must turn quickly when it comes to protecting seniors," Wyden said in a statement Monday.
Cubanski said CMS is unlikely to change the premiums before January, if they do at all, since their actions could also depend on whether Medicare ultimately decides to cover Aduhelm.
That said, coverage determinations are based on clinical results, not price. The price drop won't have much of an effect on whether Medicare decides to cover Aduhelm, said Richard Frank, director of the USC-Brookings Schaeffer Initiative for Health Policy and former HHS assistant secretary of planning and evaluation. But this announcement brings attention to the fact that Biogen might be moderating their claims about Aduhelm, he said.
"My feeling is that it's still a questionably effective drug with kind of some bad—some really bad—side effects associated with an extraordinarily high price, given what it's doing," Frank said.
The price drop is good news for Medicare spending if the program does cover the drug, Cubanski said, while Wyden pointed out in his statement that Medicare finances would still take a hit if CMS decides to cover the drug. Whether the cut will encourage more providers to prescribe Aduhelm is an open question, Cubanski said.
Several health systems and private payers, as well as the Department of Veterans Affairs, have already decided against prescribing or covering the drug.
"I don't think the price matters when it comes to a doctor's judgment about whether this drug is good for their patients," Cubanski said.