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New Alzheimer’s Drug Could Increase Medicare Spending by $100 Billion


Scientists want more clinical proof of a new Alzheimer’s drug, Aduhlem. Home care providers expected to grow under Medicare Advantage plans. And when it comes to healthcare, where you live actually matters. Check out this month’s biggest Medicare news stories making headlines around the country!

Medicare Experts Concerned with Price Tag of New Alzheimer’s Drug Aduhlem

A new drug for Alzheimer’s disease has many patients, insurance companies, and health care experts worried about the hefty price. The FDA approved Aduhelm, the first new treatment for Alzheimer’s disease in nearly 20 years. Biotechnology company Biogen created the drug and is determined to treat the cause of Alzheimer’s disease, rather than just the symptoms.

Unfortunately, having FDA approval does not always guarantee coverage. Medicare Part B is expected to cover Aduhlem if doctors consider it “medically reasonable and necessary” for care. However, due to the extravagant price tag of $56,000 a year, and Medicare not being allowed to negotiate prices of drugs under Part B, we can expect some limitations on who’s considered eligible for coverage.  

Insurers may not cover it for patients with advanced Alzheimer’s disease because researchers say it’s not effective for these patients. Medicare experts have called on CMS to create a national standard for coverage of Aducanumab. More than six million Americans over the age of 65 have been diagnosed with Alzheimer’s. This holds a lot of weight on Medicare in regards to the success of the drug. 

Concerns Over New Alzheimer’s Drug Aduhlem Effectiveness

Leading up to its approval, researchers analyzed the drug’s effectiveness in three separate studies involving 3,42 patients. Aduhelm is the first drug to slow down the progression of this neurodegenerative disease. Many scientists want more clinical evidence to support the drug’s effectiveness.

Some scientists have spoken out saying the drug’s approval could set the research community back. The FDA approved the drug based on data from two trials, which some say could sway developers from focusing on patients’ cognitive benefits. 

The FDA will require Biogen to begin a new clinical trial. The trial will test Audhelm’s overall benefits and see if it can improve cognition. Aduhlem is given via intravenous infusion every month. The medication aims to get rid of toxic proteins that destroy the brain’s neurons and cause dementia. The Alzheimer’s Association reports that more than 6 million Americans, ages 65 or older, are living with Alzheimer’s. Almost two-thirds are women. 

Medicare-Medicaid Cheif Focuses on Insurance Expansion 

The federal agency’s newest Medicare-Medicaid Cheif, Chiquita Brooks-LaSure, says expanding insurance coverage and access are two of her top priorities. In a recent interview, Brooks-Lasure revealed she wants to make sure regulations and policies help improve health coverage.

She said working with Congress will be critical in expanding Medicare benefits and reviewing Medicare’s structure. She also plans on supporting efforts for expanding Medigap coverage

Right now, Democrats are considering lowering Medicare’s eligibility age and making other changes to the program.

Home Care Providers Expected to Grow with Medicare Advantage Enrollment

The number of people enrolled in Medicare Advantage is expected to grow expeditiously over the next several years. By 2023, nearly 40 million beneficiaries are projected to have an Advantage plan, according to the Congressional Budget Office. This means home care providers will have more employment opportunities

Medicare Advantage significantly increased by almost 2.1 million beneficiaries between 2019 and 2020, according to the Kaiser Family Foundation. Since 2018, Advantage plans have played a huge role in-home care after the Centers for Medicare & Medicaid Services expanded benefits. As of today, 42% of beneficiaries have Medicare Advantage plans.

Experts are concerned with the extensive amount of ads from Medicare Advantage carriers. While they have many pros, they also have many cons. Beneficiaries are being pressured by Medicare agents who receive a kickback from Advantage carriers to enroll in these fee-for-service plans. While Medicare Advantage plans are not bad, they are just not the right plan for everyone. It’s crucial that beneficiaries are fully educated on the differences between Medigap & Medicare Advantage plans before enrolling. 

Best & Worst States for Medicare Beneficiaries Quality of Care

A recent study shows Medicare beneficiaries living in certain states have a better quality of healthcare. An insurance technology company conducted the study using public data. Researchers analyzed each state, using 24 different categories including prescription drug costs, access to Medicare, life expectancy, and more. 

Researchers found that each state’s health care system played a significant role in access to care and life expectancy. Minnesota ranked number one thanks to its integrated health care system. However, Oklahoma came in last due to limited access to primary care, especially in rural areas.

Top 5 States for Medicare:

  1. Minnesota
  2. North Dakota
  3. Massachusetts   
  4. California
  5. Nebraska   

Worse States for Medicare:

  1. Louisiana
  2. Mississippi
  3. District of Columbia
  4. Georgia
  5. Oklahoma

The number of baby boomers could double in the next few decades. For perspective, this means 20% of the U.S. population will be baby boomers by 2050. Now that you know the quality of Medicare is different in each state, learn more about your state’s Medicare options, plans, and prices. 

CDC: Covid-19 Health Disparities, Care Costs Medicare $6.3 Billion

New data discovered health disparities amongst Medicare fee-for-service beneficiary spending for Covid-19 care in 2020. Researchers from the CDC studied administrative claims for patients between April 2020 through December 2020. Covid-19 related care provided to Medicare fee-for-service beneficiaries cost $6.3 billion.

Researchers discovered men and non-white patients had higher chances of having higher medical bills and being hospitalized. The study, published in the Annals of Internal Medicine also revealed:

  • 92.6% of the $6.3 billion dollars were for hospitalizations 
  • 57% of Medicare fee-for-service beneficiaries were female
  • Rural residents, non-white patients, and men had higher medical spending
  • People living in urban areas were least likely to be hospitalized by almost 3% due to lack of access to health care

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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