The government may reduce the increase in Medicare Part B premiums

The government may reduce the increase in Medicare Part B premiums

It’s possible that your Medicare Part B premiums will be decreased in 2022.

Secretary of Health and Human Services Xavier Becerra announced on Monday that the Centers for Medicare & Medicaid Services will reevaluate this year’s basic premium, which increased to $170.10 from $148.50 in 2021.

Despite not knowing to what extent the program will cover Aduhelm — a medicine that fights Alzheimer’s disease — around half of the higher-than-expected rise was due to the prospective expense of covering it. In any case, the manufacturer has since dropped the anticipated per-patient cost in half, from $56,000 to $28,000 per year, indicating that Medicare’s cost estimate was based on outdated data.

“There is a compelling foundation for CMS to revisit the previous proposal,” Becerra said, citing Aduhelm’s 50% price cut on Jan. 1.

CMS is “reviewing the secretary’s statement to determine next steps,” according to a spokeswoman.

In June, the Food and Drug Administration gave its approval to Aduhelm. Despite considerable reservations in the scientific community regarding the drug’s effectiveness and side effects, which include brain swelling and bleeding, the FDA approved it.

Officials from Medicare are scheduled to make a preliminary judgment on coverage this week, i.e., whether Aduhelm will be covered at all or will be limited to specific patients under particular conditions. In the spring, a final decision should be made.

Alzheimer’s disease, a degenerative neurological disease that steadily impairs memory and thinking skills and has no known cure, affects around 6 million Americans. It can also damage the life of the disease’s victims’ families and friends.

The majority of these patients are above the age of 65 and are covered by Medicare, which covers over 63 million people. According to the Kaiser Family Foundation, about 2 million beneficiaries utilized one or more of the then-available Alzheimer’s medications covered under Part D in 2017.

While Medicare Part D covers prescription drugs, some medicines are given in a doctor’s office — such as Aduhelm, which is given intravenously — and thus fall under Part B.

CMS is obligated by law to set the Section B premium at 25% of the expected expenditures for that part of the program each year. As a result, the agency had to factor in the potential of covering Aduhelm in its 2022 forecast.

Experts agree that making a retroactive change to Part B premiums is a good idea.

“It would be unprecedented, but it may not be unreasonable in this situation,” Juliette Cubanski, deputy director of the Kaiser Family Foundation’s Medicare policy program, said.

“It would be appropriate to make an adjustment to the Part B premium if it turns out that spending on this prescription is going to be much less than what Medicare’s actuaries projected,” Cubanski said.

CMS is obligated by law to set the Section B premium at 25% of the expected expenditures for that part of the program each year. As a result, the agency had to factor in the potential of covering Aduhelm in its 2022 forecast.

Experts agree that making a retroactive change to Part B premiums is a good idea.

“It would be unprecedented, but it may not be unreasonable in this situation,” Juliette Cubanski, deputy director of the Kaiser Family Foundation’s Medicare policy program, said.

“It would be appropriate to make an adjustment to the Part B premium if it turns out that spending on this prescription is going to be much less than what Medicare’s actuaries projected,” Cubanski said.