Medicare Managers to Adjust 2023 Part B Premiums for Alzheimer's Drug

What You Need to Know

CMS decided Medicare would not cover Aduhelm, which is expensive and can have serious side effects, except for clinical trial participants.
Cutting 2022 Part B premiums now to reflect the change would be too difficult, officials say.
The current monthly Medicare Part B premium is $170.10.

Medicare program managers plan to build a cost reduction related to a new Alzheimer´s drug into the premiums for 2023 Medicare Part B coverage, rather than trying to provide a 2022 premium cut this year, officials announced Friday.

Medicare may not have the legal authority to send enrollees refunds, and doing so would be very difficult, officials warned.

Medicare Part B is a program that covers physician care and outpatient services for Medicare enrollees. The 2022 monthly premium for Part B coverage is $170.10, up from $148.50 in in 2021.

What It Means

Next year, Medicare Part B premiums could cost about $10 per month less than they would if officials had not tried to build the cost of the new Alzheimer´s drug, Aduhelm, into Part B premiums this year.

Aduhelm

Alzheimer´s disease is a neurological condition that now affects about 5.8 million U.S. residents ages 65 and older, and 250,000 people under 65.

Researchers have estimated that Medicare paid $155 billion for Alzheimer’s-related care in 2020, and that Medicaid, people with Alzheimer’s and other payers paid another $250 billion for care related to the condition.

Biogen developed Aduhelm in an effort to reduce the impact of Alzheimer’s, by clearing up a wax-like substance called amyloid that builds up in the brains of people with Alzheimer’s. The drug is one of the few drugs ever shown to do anything to slow the progression of the disease, and Biogen was planning to charge $56,000 per year for the drugs.

Originally, actuaries at the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare, expected Medicare to pay for Aduhelm for many Medicare enrollees in 2022.

But Aduhelm can cause serious side effects, and CMS ended up deciding to cover the drug only for Medicare enrollees involved in clinical trials. Biogen cut the annual cost to $28,200.