The Drug That Could Break American Health Care

www.theatlantic.com
7 min read
standard
Aduhelm, the first new Alzheimer's drug in 18 years, may not work. But states and Medicare might pay billions of dollars for it anyway.
Earlier this week, the Food and Drug Administration overruled—to much criticism—its own scientific advisory committee and approved the Alzheimer's treatment Aduhelm. The agency made this decision despite thin evidence of the drug's clinical efficacy and despite its serious side effects, including brain swelling and bleeding. As a result, a serious risk now exists that millions of people will be prescribed a drug that does more harm than good.

Less appreciated is how the drug's approval could trigger hundreds of billions of dollars of new government spending, all without a vote in Congress or indeed any public debate over the drug's value. Aduhelm's manufacturer, Biogen, announced on Monday that it would price the drug at an average of $56,000 a year per patient, a figure that doesn't include the additional imaging and scans needed to diagnose patients or to monitor them for serious side effects.

The federal government will bear the brunt of the new spending. The overwhelming majority of people with Alzheimer's disease are eligible for Medicare, the federally run insurance program for elderly and disabled Americans. If even one-third of the estimated 6 million people with Alzheimer's in the United States receives the new treatment, health-care spending could swell by $112 billion annually.

To put that figure in perspective, in 2020, Medicare spent about $90 billion on prescription drugs for 46 million Americans through the Part D program, which covers prescription medication that you pick up at your local pharmacy. We could wind up spending more than that for Aduhelm alone.

Most of the costs will be borne by taxpayers. But Medicare beneficiaries will take an additional hit. Because Aduhelm is an infusion drug that will be administered in doctors' offices and clinics, not taken at home, it will be covered by Medicare Part B—not Part D. Under Part B, beneficiaries pay 20 percent of the costs of their care, which, for a single year of Aduhelm treatment, will be at…
Nicholas Bagley, Rachel Sachs
Read full article