New Alzheimer's Drug Approved by FDA, CMS

[somarco]

The last time Medicare thought they were going to cover an Alzheimer's drug, part B went up about 14%. Wonder if we can expect roughly the same increase? $187? Maybe not, but I could see a part B premium of $175.

Increased from $148.50 in 2021 to $170.10 in 2022, down to $164.90 for 2023


Aduhelm is not without its' issues. Sketchy approval process. Original price $56k soon dropped to $28k. Cleveland Clinic and VA declined to participate in trials due to side effects such as brain swelling and bleeds.




"With the 50 percent price drop of Aduhelm on January 1, there is a compelling basis for CMS to reexamine the previous recommendation," he said at the time.

HHS's decision comes after the Centers for Medicare and Medicaid Services (CMS) released a report that found the costs saved from lower than expected spending on Aduhelm could be passed to Medicare beneficiaries in 2023.

Last month, Medicare announced that it would be limiting coverage of Aduhelm to only include clinical trial patients. HHS did not mention this decision in its announcement, though it may have contributed to the lower than expected costs for Aduhelm, on top of Biogen lowering its price.

https://thehill.com/policy/healthca...-from-alzheimers-drug-to-be-lowered-next-year

 

[Newby]

If someone on an advantage plan takes that med, how are they being charged? 20% of the cost similar to if they just had A&B? Or is it different.

 

[straightnochaser]

If someone on an advantage plan takes that med, how are they being charged? 20% of the cost similar to if they just had A&B? Or is it different.

Part B Meds are 20% on MAPD

 

[StephanieCJ]

Brain swelling, brain bleeding, rectal bleeding...no thank you. I'll just take the memory loss.

 

[Chazm]

Increased from $148.50 in 2021 to $170.10 in 2022, down to $164.90 for 2023

I assumed everyone here knew the premiums, so I didn't post them. The fact still remains, They raised the Medicare premiums because they thought they would cover Aduhelm. After the premium increase, they decided they would not cover the medication and next year they lower the premiums.

what kind of percentage increase will we see now that they will cover this new Alzheimer drug?

 

[somarco]

I assumed everyone here knew the premiums, so I didn't post them. The fact still remains, They raised the Medicare premiums because they thought they would cover Aduhelm. After the premium increase, they decided they would not cover the medication and next year they lower the premiums.

what kind of percentage increase will we see now that they will cover this new Alzheimer drug?

The B premiums were posted as a refresher, mostly for me, and yes Congress SAID they were increasing premiums because of Aduhelm but several "experts" said that was more than needed . . . so they backed off the next year.

How much will B increase next year (if at all)? I have no idea but I do believe the premiums and deductibles are a political football to buy votes.

YMMV

 

[kgmom219]

Part B will get jacked up between $10-$15-its not an election year

Part D deductible is maxed at $545 for 2024. Donut Hole at $5K. Catastrophic at $8K.

Part of the IRA Part D provisions is that premiums can't rise more than 6% (I think. It may be 4%. Whatever. I'm on Catalina and don't care enough to look it up) annually. Premiums aren't going to be the issue.

The issue is going to be tighter networks and formularies. "Sure, we cover Eliquis as required. It's tier 5 on our $25 plan or tier 3 on our $75 plan"

This will also show greater discrepancy between drug costs on MAPD vs PDP.

And if you don't think PBMs send a report to MAPD carriers monthly on docs prescribing too many tier 3, 4 and 5, I've got a bridge to sell you.

 

[KandKsmommy]

The issue is going to be tighter networks and formularies. "Sure, we cover Eliquis as required. It's tier 5 on our $25 plan or tier 3 on our $75 plan"

So this may be helpful for your clients. I am way up here in Northern Maine so it's not uncommon for my clients to get their medications in Canada (they have a generic for Eliquis). As long as the persons Dr. can write scripts for Canada our local pharmacy will ship anywhere. Eliquis is around $98.39 (Canadian for a 3-month supply) and they charge $25 (Canadian) for Shipping. So for right around $100 every 3 months they can get their meds.

Pharmacy info:
Familiprix - Eric Lee
Phone: 506-992-3393
Fax: 506-992-2044
[EXTERNAL LINK] - Familiprix Pharmacy | ,Rue Principale