We have now reached the stage of politicizing health policy where even the dry, dusty people over at the Office of the Actuary are not off limits. As we mentioned a few weeks ago when the Part B premiums were announced, the Office of the Actuary did not estimate an impact of Aduhelm in its annual report, suggesting there is no actuarial basis for including the cost of the drug in the premium calculation.
That did not stop the communications office at CMS from blaming the price of Aduhelm in the press release that enumerated the drivers of the premium increase. Other causes - ones so believable you would think an actuary was involved - included higher cost of care and more intense utilization. All things you might expect for a population most at risk for serious disease or death from COVID.
Now, Secretary of HHS, Xavier Becerra has asked CMS to reconsider the premium increase in light of the National Coverage Decision that greatly limits the uses of Aduhelm to clinical trials environments. Since the cost of the drug was not included in the Actuary's work, how are they going to estimate a reduction of something that was not there? Or perhaps the premium wasn't established with the help of the Actuary? In that case, Congress might have some oversight questions.
While they are at it, and getting more and more fed up with NIH, it might be worth asking how we got so vested in one theory of treating Alzheimer's, to the exclusion of virtually all others, that a useless drug was approved by the FDA. Was, to paraphrase Janet Woodcock, putting the amyloid theory to rest only possible if Aduhelm was released into the wild?
Have a great day.
Emily Evans
Managing Director – Health Policy
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