Potential 2022 Medicare Part B increases tied to uncertainty regarding Aduhelm coverage
Click Here to Manage Email Alerts
Additional contingency reserves related to uncertainty surrounding the potential use of Aduhelm by individuals with Medicare contributed to projected increases in the 2022 Medicare Part B premium and deductible, according to CMS.
CMS initiated a National Coverage Determination analysis process in July to examine if and how Medicare will cover Aduhelm (aducanumab, Biogen/Eisai) and similar Alzheimer’s disease drugs; however, as the process continues, CMS remains unsure regarding Medicare beneficiaries’ coverage and use of these drugs next year.
For 2022, CMS said in a fact sheet on its website that the standard monthly premium for Medicare Part B enrollees will be $170.10, up $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries will be $233, up $30 from the annual deductible of $203 in 2021.
“CMS is committed to ensuring high quality care and affordable coverage for those who rely on Medicare today, while protecting Medicare’s sustainability for future generations," CMS administrator Chiquita Brooks-LaSure, said in a CMS press release. “The increase in the Part B premium for 2022 is continued evidence that rising drug costs threaten the affordability and sustainability of the Medicare program. The Biden-Harris administration is working to make drug prices more affordable and equitable for all Americans and to advance drug pricing reform through competition, innovation and transparency.”
In a fact sheet, CMS noted that although the outcome of the coverage determination is unknown, the projection does not signal what the coverage determination will be.
“ ... We must plan for the possibility of coverage for this high-cost Alzheimer’s drug, which could, if covered, result in significantly higher expenditures for the Medicare program,” CMS officials wrote.
Other reasons for the increase include rising prices and utilization across the health care system that raise premiums year-over-over coupled with expected increases in the intensity of provided care. Further, Congressional action to combat the increase in the 2021 Medicare Part B premium led to a $3 per beneficiary monthly increase in the Medicare Part B premium continuing through 2025.
References:
2022 Medicare parts A & B premiums and deductibles/2022 Medicare Part D income-related monthly adjustment amounts. https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment. Published Nov. 12, 2021. Accessed Nov. 15, 2021.
CMS announces 2022 Medicare Part B premiums. https://www.cms.gov/newsroom/press-releases/cms-announces-2022-medicare-part-b-premiums. Published Nov. 12, 2021. Accessed Nov. 15, 2021.