As with all health care costs, Medicare out-of-pocket costs are rising rapidly. In 2022, Medicare Part B premiums, which everyone with Medicare must pay–except for people with Medicaid–will be 14.5 percent higher. The reason in large part is Aduhelm, the new Alzheimer’s drug, which Medicare is likely to begin covering under Part B and which costs a hefty $56,000 a year.
About half of the Medicare Part B increase–$15 a month or $180 a year–can be attributed to an expected Centers for Medicare and Medicaid Services’ final determination that Medicare should cover 80 percent of the cost of Aduhelm. It is unacceptably tragic that Medicare would cover this extraordinarily costly drug, which has yet to show any benefits in clinical trials, yet does not cover long-term nursing home care and home care, or vision, hearing and dental care, which we know would benefit everyone.
Part B premiums for almost everyone with Medicare will be $170.10 a month in 2022, up $21.60 from this year. For people with annual incomes over $91,000, these premiums will be even larger. While Social Security benefits are increasing an average of $90 a month, this Medicare Part B premium increase will eat into more than 20 percent of that benefit increase.
Right now, few insurers are willing to pay for Aduhelm. And, for good reason. There is no evidence that it slows the progression of dementia and provides benefits worth anything close to its $56,000 a year price tag. But, it has been approved by the Food and Drug Administration. And, the Centers for Medicare and Medicaid Services historically has covered all drugs that are FDA approved, though it is not obligated to do so.
The non-profit Institute for Clinical and Economic Review has ascribed a value of around $5,000 a year to Aduhelm, based on the little known about its benefits. That’s about ten percent of what Biogen, its manufacturer, is charging for it.
Nothing in the Build Back Better legislation currently being finalized in Congress would bring down the price of Aduhelm. At best, the bill would bring down the cost of 60 drugs that Medicare covers, beginning with the 10 that are the most expensive for the program, so long as they have been on the market for nine years or more and 12 years or more for biologics.
If approved, Aduhelm will be covered under Medicare Part B, because it must be administered by a physician and cannot be bought at the pharmacy. In addition to bearing the expense of higher Part B premiums, people in traditional Medicare will likely see significantly higher premiums for supplemental insurance. And, people in Medicare Advantage plans will likely see far higher out-of-pocket costs.
Here’s more from Just Care:
- New Alzheimer’s drug has questionable benefits and costs a small fortune
- What are Medicare premium and other costs in 2022?
- Social Security benefits will increase nearly 6 percent in 2022
- Beginning January 2022, HHS bans surprise bills from out-of-network providers
- Medicare Open Enrollment: Don’t trust insurance agents
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