WASHINGTON (AP) – A new $ 56,000-a-year Alzheimer’s drug that leads to one of the largest increases in Medicare premiums on record highlights the limits of President Joe Biden’s strategy to reduce prescription drug costs.
The drug known as Aduhelm would be shielded from Medicare price negotiations for more than a decade under the Democratic Drug Price Compromise before Congress, which is part of the Social Agenda legislation. Biden. This is because the bill does not allow Medicare to negotiate on newly launched drugs, providing a window for drug makers to recoup investment in research and development. Organic products such as Aduhelm enjoy 13 years of protection.
Seniors will soon be paying higher premiums so Medicare can set aside a contingency fund to cover Aduhelm, which is created by pharmaceutical company Biogen. It is the first drug against Alzheimer’s disease for almost 20 years. But its benefits have been widely questioned.
Leading Democrats say their party cannot afford such a lens when it comes to saving money on prescription drugs. The Democrats’ Social Agenda bill would cap the cost of insulin at $ 35 per month, limit annual drug price increases, and protect Medicare beneficiaries from high out-of-pocket expenses.
If the legislation is passed, these changes would take several years to be fully implemented. The increase in health insurance premiums, however, is coming soon – at the start of an election year.
Medicare’s Part B premium for outpatient care will increase by $ 21.60 per month in 2022, to $ 170.10, the largest dollar increase on record, but not in percentage terms. About $ 11 of this amount is believed to be owed to Aduhelm.
“Seniors shouldn’t have to pay extra on their premiums every time a pharmaceutical company decides to set an astronomical price for their products.” Senator Ron Wyden, D-Ore., Said in a statement to The Associated Press. “I am ready to act to protect the wallets of the elderly and encourage Medicare to explore all available options to correct the course. “ Wyden heads the Senate Finance Committee, which oversees Medicare, and is a key player in drug pricing legislation.
Senator Bernie Sanders, an independent from Vermont, summed it up succinctly: “With the Democrats controlling the White House, the House and the Senate, we cannot let this happen” he wrote to Biden last week, urging the president to stop the part of the increase in health insurance premiums attributable to Aduhelm.
White House officials say they are well aware of the concerns and are dealing directly with Sanders. But Biden made no mention this week of Aduhelm when he promoted the drug pricing provisions in his $ 2 trillion legislation.
Usually, the financial impact of expensive drugs is passed on most directly to patients with serious illnesses such as cancer, rheumatoid arthritis or multiple sclerosis. But with Aduhelm, the financial pain is spreading among Medicare beneficiaries in general, not just Alzheimer’s patients who need the drug.
“It is the flagship drug to show how a drug can have a big impact on the premiums and costs incurred by people on Medicare, not just those taking this drug” said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, a non-partisan organization. “This is not a hypothetical question: ‘Do drug prices have an impact on premiums? This is a closed case.
Biogen says it has priced Aduhelm fairly after factoring in payments for other innovative drugs for hard-to-treat diseases. Alzheimer’s disease is a degenerative neurological disease with no known cure. It affects some 6 million Americans, most of them Medicare-eligible seniors.
By endorsing Aduhelm, the Food and Drug Administration determined that the drug’s ability to reduce plaque buildup in the brain may slow dementia. But experts, including the FDA’s own external advisers, objected, saying the benefits had not been clearly demonstrated. A nonprofit drug pricing think tank estimated Adulhelm’s value to be between $ 3,000 and $ 8,400 per year, not $ 56,000, based on its unproven benefits.
Medicare reviews payment claims for Aduhelm on a case-by-case basis, pending a determination of broader coverage that isn’t expected for months. The reason Aduhelm would increase the cost of Medicare Part B outpatient coverage is because it is administered intravenously in a doctor’s office.
Sanders is asking Medicare to delay approval of coverage until there is scientific consensus that the drug is safe and effective. He also urges Biden, through executive action, to restore government policy that drugmakers charge “reasonable prices” for treatments that receive federal funding.
Two House committees are investigating FDA approval of Aduhelm. The Inspector General of Health and Social Services conducts his own examination.
Supporters of Democratic drug pricing legislation are mostly silent on the controversy. But some say they would have preferred an earlier version of the legislation that also applied Medicare negotiations to new drugs. Echoing the arguments of the pharmaceutical industry, a few Democratic lawmakers feared this was going too far. Their opposition nearly killed the Democrats’ drug pricing plan and ultimately led to a compromise limiting medicare negotiations.
“It’s a long fight and you have to take a long view, especially when trying to defeat one of the most powerful lobbies in the world” said David Mitchell, founder of the patient advocacy group Patients for Affordable Drugs. “I think the issue of introductory prices will be imposed on us in the years to come because we do not have unlimited resources.”