January 18, 2022 - In a new Policy Watch, KFF experts explain why Medicare’s preliminary decision to cover a new Alzheimer’s drug only for a limited group of beneficiaries is likely to intensify pressure on officials to reconsider the increase in the Medicare Part B premium for 2022.

Earlier last week, CMS issued a preliminary National Coverage Determination that would limit coverage of the new drug, Aduhelm, to beneficiaries with mild cognitive impairment who participate in approved clinical trials – a decision that is expected to result in a relatively small number of Medicare beneficiaries receiving Aduhelm over the next several years.

Medicare officials cited the high price of the drug as a key reason for a 14.5 percent increase in the Part B premium, from $148.50 in 2021 to $170.10 in 2022. But that was before Biogen, the drug’s manufacturer, announced a 50 percent reduction in the drug’s price at the end of 2021, and before the proposed coverage decision was made. Together, these factors suggest that Medicare Part B spending on this drug is not expected to be as large as previously forecast.

Medicare beneficiaries who use Aduhelm, however, will still face thousands of dollars in coinsurance costs if they do not have supplemental coverage to help defray the cost.

The Policy Watch and other analyses related to Aduhelm and Medicare spending are available at kff.org.
Source: Kaiser Family Foundation