A new $56,000 per year Alzheimer’s drug resulted in one of the largest increases in health insurance premiums in history, highlighting the limitations of President Joe Biden’s strategy to control the cost of prescription drugs.
According to the Democratic Party’s drug pricing compromise before Congress, as part of Biden’s social agenda legislation, the drug called Aduhelm will not be affected by medical insurance price negotiations for more than a decade. That’s because the bill does not allow medical insurance to negotiate on newly launched drugs and provides a window for drugmakers to recover their R&D investment. Biological products such as Aduhelm can be protected for 13 years.
Older people will soon pay higher premiums, so Medicare can set aside an emergency fund to pay for Aduhelm, which is made by the pharmaceutical company Biogen. This is the first Alzheimer’s drug in nearly 20 years. But its benefits have been widely questioned.
Leading Democrats say their party cannot afford such optics when they scramble to save prescription drugs. The Democratic Party’s Social Agenda Act will limit the cost of insulin to $35 per month, limit annual drug price increases, and protect health insurance recipients from high out-of-pocket costs.
If the legislation is passed, these changes will take several years to be fully implemented. However, the increase in health insurance premiums will come soon-at the beginning of the election year.
By 2022, Medicare’s outpatient care Part B premiums will rise by $21.60 per month to $170.10, which is the largest dollar increase in history, although not calculated as a percentage. Approximately $11 of this will be attributed to Aduhelm.
“Whenever a pharmaceutical company decides to set astronomical numbers for its products, senior citizens should not pay extra premiums,” Oregon Senator Ron Wyden said in a statement to the Associated Press. “I am ready to take action to protect the wallets of the elderly, and I encourage health insurance to explore all available options to correct the route.” Wyden is in charge of the Senate Finance Committee overseeing health insurance, and he is a key participant in drug pricing legislation.
Independent Senator Bernie Sanders of Vermont summed it up succinctly: “We can’t let this happen with the Democrats in control of the White House, House of Representatives, and Senate,” he wrote last week. To Biden, urge the president to stop this. The increase in medical insurance premiums attributed to Aduhelm.
White House officials said they are well aware of these concerns and are dealing directly with Sanders. But Biden did not mention Aduhelm when he promoted drug pricing provisions in his $2 trillion legislation this week.
Often, the financial impact of high-cost drugs falls most directly on patients with serious diseases such as cancer, rheumatoid arthritis, or multiple sclerosis. But for Aduhelm, financial pain is spreading among health insurance recipients in general, not just Alzheimer’s patients who need the drug.
Tricia Neuman, a medical insurance expert at the Non-Party Caesars Family Foundation, said: “This is a typical children’s drug, showing how a drug can have a significant impact on the premiums and costs of people in medical insurance. , Not just those who take the drug.”. “This is not a hypothetical question:’Does the price of the drug affect the premium?’ This is a case closed.”
Biogen said that after taking into account the payment of other innovative drugs for refractory diseases, it has set a fair price for Aduhelm. Alzheimer’s disease is a degenerative neurological disease, and there is currently no cure. It affects approximately 6 million Americans, most of whom are senior citizens who are eligible for health insurance.
When Aduhelm was approved, the U.S. Food and Drug Administration determined that the drug’s ability to reduce plaque in the brain might slow dementia. But experts, including the FDA’s own external consultants, objected, saying that its benefits have not been clearly proven. A non-profit think tank focused on drug pricing estimates that Adulhelm is worth between US$3,000 and US$8,400 per year instead of US$56,000, based on its unproven benefits.
Medicare is considering paying Aduhelm’s request on a case-by-case basis, waiting for a wider coverage decision that will not appear in a few months. The reason why Aduhelm will increase Medicare Part B outpatient insurance costs is that it is administered intravenously in the doctor’s office.
Sanders asked Medicare to postpone approval of coverage until a scientific consensus was reached on the safety and effectiveness of the drug. He also urged Biden to restore government policy through administrative action, that is, drugmakers charge “reasonable prices” for federally funded treatments.
Two House committees are investigating the FDA’s approval of Aduhelm. The HHS Inspector General is conducting his own review.
Supporters of the Democratic Party’s drug pricing legislation have mostly remained silent on the dispute. But some people say they prefer the earlier version of the legislation to apply medical insurance negotiations to new drugs. Echoing the arguments of the pharmaceutical industry, some Democratic lawmakers worry that this will go too far. Their opposition almost killed the Democratic Party’s drug pricing plan and eventually led to a compromise that restricted the negotiation of health insurance.
“This is a long-term struggle, and you have to look long-term, especially when you are trying to defeat one of the most powerful lobby groups in the world,” said David Mitchell, founder of the advocacy group “Affordable Drug Patients”. “I believe that the launch price issue will be imposed on us in the next few years because we do not have unlimited resources.”