HealthcareCMS to adjust Medicare premiums in 2023 due to...

CMS to adjust Medicare premiums in 2023 due to lower Aduhelm costs

The Centers for Medicare and Medicaid Services will take lower-than-anticipated spending on the controversial Alzheimer’s disease medication Aduhelm into account when calculating Medicare Part B premiums for 2023, the agency announced Friday.

CMS concluded that passing on the savings to Medicare enrollees this year wasn’t operationally feasible. In addition, the agency concluded it doesn’t have the authority to refund premiums except in cases when beneficiaries pay more than they are billed.

Projections for how much Aduhelm, also known as aducanumab, would cost the government in 2022 were the primary reason for a 14.5% Medicare Part B premium hike that brought the monthly cost to $170.10 this year, CMS disclosed in November.

Circumstances have changed since then. CMS has limited Aduhelm coverage to beneficiaries enrolled in clinical trials. And Biogen, the drug’s manufacturer, halved the original $56,000 yearly price.

When Biogen lowered the medicine’s cost, patient advocates and Democratic lawmakers called on CMS to cut Part B premiums for 2022, and Health and Human Services Secretary Xavier Becerra directed the agency to investigate its options.

CMS concluded that delaying the adjustment until next year is the only practical method, the agency wrote in a notice. The agency expects Part B premiums to be lower in 2023 because Adulhelm spending won’t meet projections this year.

“CMS and HHS are committed to lowering healthcare costs—so we look forward to seeing this Medicare premium adjustment across the finish line to ensure seniors get their cost-savings in 2023,” Becerra said in a news release.

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