A new Biogen Alzheimer’s drug, which could cost $56,000-a-year, could require Medicare patients to pay copayments of about $11,500 annually, according to a new research report. The drug, Aduhelm, was approved by the Food and Drug Administration and quickly sparked controversy over its price-tag and questionable benefits. The new study by the Kaiser Family Foundation estimated that if just 500,000 Medicare recipients are prescribed Aduhelm, it would cost the program nearly $29 billion a year, far more than any other medication. Aduhelm is the first Alzheimer’s medication in nearly 20 years. It doesn’t cure the neurological condition, but the FDA determined that its ability to reduce clumps of plaque in the brain is likely to slow dementia. Many experts say that benefit has not been clearly shown.
The drug’s approval came as congressional Democrats are trying to build consensus around legislation that would empower Medicare to negotiate prescription drug prices.
Medicare has not made a formal determination on covering the Alzheimer’s drug, but cost traditionally does not enter into such considerations. Drugmaker Biogen has said it priced Aduhelm responsibly. Alzheimer’s affects about 6 million Americans, the vast majority old enough to qualify for Medicare.
Beyond monthly premiums, there would also be impacts on out-of-pocket costs. Many patients taking the medication, including those signed up in Medicare Advantage plans from private insurers, could face thousands of dollars in copayments,. The maximum could reach about $11,500, researchers estimated, well beyond the budget of a typical Medicare enrollee.
“Because Aduhelm is not a cure for Alzheimer’s disease, patients could incur these annual out-of-pocket costs over multiple years,” the report noted.
Biogen, which developed the Alzheimer’s drug with Japan’s Eisai Co., said earlier this week that it expects a gradual uptake and not a sharp “hockey-stick” spike.
The drug’s price was determined after careful research, said Chirfi Guindo, Biogen’s head of global product. The company has committed to no price increases for four years.
Guindo said that the company looked at prices for advanced medications to treat cancer and other complex conditions. “We have priced Aduhelm at roughly a third the level of the cancer immunotherapies,” he said during a teleconference this week. “So, we consider this to be a really responsible price and we consider this to be a price that is sustainable for the system.”
Medicare covers more than 60 million people, including those 65 and older, as well as people who are disabled or have serious kidney disease. Medicare spending is approaching $1 trillion a year.
JEFFREY NEWMAN REPRESENTS WHISTLEBLOWERS WORLDWIDE INCLUDING THOSE REPORTING MEDICARE FRAUD . HE IS REACHABLE AT 978-880-4758 AND AT JEFFYREY.NEWMAN1@GMAIL.COM