A hefty price cut and narrow coverage determinations for Biogen’s controversial Aduhelm have led Department of Health and Human Services Secretary Xavier Becerra to order a lower premium rate for the coming year. (Biogen)
Medicare Part B beneficiaries’ premiums will be lowered in 2023 to compensate for lower-than-expected spending on Biogen’s Alzheimer’s disease drug Aduhelm, Department of Health and Human Services (HHS) Secretary Xavier Becerra announced Friday afternoon.
The Centers for Medicare & Medicaid Services (CMS) had set the 2022 Medicare Part B premium in November at $170.10 per month. That rate was a 14.5% increase over the prior year’s $148.50 and was partially attributed to the potential costs of Aduhelm.
However, Biogen cut the price of Aduhelm from an average $56,000 per year to $28,200 in December, leading Becerra to instruct CMS to reassess the premiums in early January.
CMS’ review (PDF), delivered to the secretary last week, also took into account the narrow National Coverage Determination relevant to Aduhelm that was finalized in April.
“After receiving CMS’s report reevaluating the 2022 Medicare Part B premiums, we have determined that we can put cost-savings directly back into the pockets of people enrolled in Medicare in 2023,” Becerra said in the announcement. “We had hoped to achieve this sooner, but CMS explains that the options to accomplish this would not be feasible.”
Alongside determining that a midyear administrative premium redetermination would “not be operationally feasible” for the agency, CMS wrote in the report that it “does not have sufficient authority to send premium refunds directly to beneficiaries unless there is excess payment relative to the established premium.”
CMS wrote that premium recommendations for 2022 would have been $160.30 if “all of the possible effects of Aduhelm were completely eliminated” and all other assumptions remained the same.
However, using the same process but taking into account the price cut and National Coverage Determination would have yielded a 2022 premium recommendation of $160.40, CMS wrote.
“CMS and HHS are committed to lowering health care costs—so we look forward to seeing this Medicare premium adjustment across the finish line to ensure seniors get their cost-savings in 2023,” Becerra said.
Aduhelm’s approval in June 2021 was controversial within the healthcare industry, as many clinical experts expressed concern that data showing its efficacy were limited. Multiple providers and insurers vetoed the drug early on, while others like UnitedHealthcare waited for CMS’ finalized National Coverage Determination before officially adopting its own limited coverage policy.
Source: Fierce Healthcare