This one drug threatens to tank Medicare’s entire prescription drug model

When Biogen’s new Alzheimer’s drug, Aduhelm, was officially approved for use by the Food and Drug Administration (FDA) back in June, it was a decision that flouted overwhelming pushback from doctors in the field, dozens of whom argued that Biogen had failed to demonstrate whether the drug had any clinical value. Since then, only about a hundred Americans have been prescribed the medication – a vanishingly small amount for a disease that afflicts 5.8 million. But even as the scope of Aduhelm’s use remains limited, critics are now warning that its fiscal implications could spell disaster for American healthcare as we know it. 

Aduhelm alone, priced at a whopping $56,000 a year, has already contributed to an approximate $10 spike in monthly Medicare Part B premiums, according to a recent CNN report. Comprising about half of this year’s price increase, Aduhelm will bring the monthly cost of Medicare up from $148.50 to $170.10 – the biggest jump in dollar terms throughout the program’s entire history, according to NBC15. It should be noted that the $10 upcharge applies to all Medicare enrollees – that is, over 62 million Americans – most of whom will never directly benefit from Aduhelm. And for the drug’s actual recipients, the $10 add-on is just the tip of the iceberg. 

First, there are co-payments. Because Medicare recipients are typically required to cover 20% of Part B treatments as part of the program’s co-insurance policy, Aduhelm patients have to cough up an extra $11,600 out of pocket annually. An $11,600 copayment is already cost-prohibitive for the vast majority of Americans. But when it comes to Medicare enrollees – whose median income is roughly $30,000 a year – it’s easy to see how just a year’s worth of treatment is completely out of the question. 

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Then there’s the cost of routine screening. In order to monitor the risk of brain bleeding and swelling – side-effects which occurred in about 41% of clinical patients from 2019 and may have led to the recent death of a 75-year-old woman – Aduhelm patients will also have to cover 20% of the cost of PET or MRI scans. To put this into context, the average national price range for brain MRI scans is $1,600 to $8,400. PET scans can be as pricey as $10,700. And Medicare does not guarantee coverage for either, at times leaving patients to pay for them in full. 

Unsurprisingly, Aduhelm is expected to be a massive burden on the American healthcare system.

According to a conservative estimate by the Kaiser Family Foundation, if Medicare covered the drug for 1 million Americans, spending on Aduhelm would exceed $57 billion in a single year – $20 billion more than was spent on all Part B drugs in 2019 combined. 

Judging by the numbers alone, the U.S. healthcare system cannot afford to absorb Aduhelm, David Mitchell, founder of Patients For Affordable Drugs, told Salon. “It’s a back-breaking drug for Medicare and for Medicare beneficiaries,” Mitchell explained in an interview. “We’re going to have to confront the fact that we can’t…