In November, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Part B standard monthly premium would jump by 15% ($21.60) in 2022, from $148.50 to $170.10. As expected, the potential costs associated with covering the controversial new Alzheimer’s drug Aduhelm—for which a Medicare coverage decision is expected this spring—factored in significantly, accounting for nearly half ($11.00) of the total premium increase.
Notably, CMS’s cost calculation was based on Aduhelm’s initial annual list price of $56,000. In December, citing slow uptake and the desire to “facilitate patient access,” the drug’s manufacturer lowered its yearly cost to $28,000.
In response, on Monday HHS Secretary Becerra instructed CMS to “reassess the recommendation for the 2022 Medicare Part B premium.” He noted, “the 50% price drop of Aduhelm on January 1” was a compelling reason to do so.
The following day, CMS issued its draft Aduhelm coverage decision, recommending that Medicare only cover it for people who are enrolled in qualifying clinical trials. A final decision is expected by April 11. If finalized as written, fewer people with Medicare may be eligible for Aduhelm than originally thought. CMS may be able to consider this as part of any Part B premium “reassessment” it undertakes.
We support revising the 2022 Part B premium based on the price reduction or coverage decision. But doing so would not solve the underlying problem of high and rising drug prices. Without more systemic reforms, future drugs could have similar impacts on Medicare costs and affordability. Accordingly, we urge policymakers to pursue meaningful solutions, including those in the latest version of the budget reconciliation bill that would allow Medicare to negotiate drug prices, limit annual price hikes and out-of-pocket costs, and realign financial incentives. We also strongly support making Medicare’s low-income assistance programs—the Medicare Savings Programs (MSPs) and the Part D Low-Income Subsidy (LIS)—more available and accessible. Together, these reforms would allow Medicare to best fulfill its promise of affordable coverage and care.
Sign up to receive Medicare news, policy developments, and other useful updates from the Medicare Rights.