KHN’s ‘What the Health?’: Dealing With Drug Prices

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Medicare officials have preliminarily decided to restrict reimbursement for Aduhelm, the controversial Alzheimer’s drug, to only patients participating in approved clinical trials. The FDA approved the drug in 2021 over objections of the agency’s outside advisers, who complained the evidence of Aduhelm’s efficacy is thin. But the prospect of wide use of the drug — originally priced at $56,000 a year — helped prompt the largest-ever increase in Medicare Part B premiums. Now the Department of Health and Human Services is looking at whether it can reduce that increase before 2023.

Meanwhile, covid confusion continues, as the Biden administration belatedly seeks to expand testing and the availability of higher-quality masks, and the Supreme Court delays an emergency decision on the administration’s rules on vaccine requirements for workers.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

• The wait for a Supreme Court decision on whether President Joe Biden’s plan to mandate vaccinations of all health care workers and require vaccines or testing of those employed by most big businesses is adding more confusion to the chaos surrounding the pandemic right now. Already there are complaints that advice on testing is not clear, that federal officials are split in their recommendations on quarantines, and that statistics on the number of cases and hospitalizations are inaccurate.
• Biden has announced that private insurance companies will reimburse patients for up to eight at-home tests a month for individuals who want them. But one big group left out of that directive are Medicare beneficiaries. Despite the obvious need for tests in this vulnerable population, that omission may be because of strict federal laws on what can be provided to beneficiaries.
• Advocacy groups and public health experts are pressuring the federal government to provide better guidance to the public about what are the best masks to use. Many people have switched from the cloth masks used early in the pandemic to N95 or KN95 masks, which provide better protection but are often harder to wear. Still, federal officials insist that the best mask is the one a person will wear properly and for the required period. If a person is more likely to use a cloth mask regularly and doesn’t like to keep a better-quality mask on, she is better off using the cloth mask, they point out.
• Dr. Rochelle Walensky, head of the Centers for Disease Control and Prevention, is among the officials taking heat for not effectively communicating with the public. Officials clearly have made missteps, but the change in covid variants surging through the country has also called for changes in messaging, which has confused many people.
• Medicare’s announcement this week proposing to restrict coverage of Aduhelm, the controversial new drug to treat Alzheimer’s disease, suggests officials overseeing the health care program were not in sync with the FDA, which gave the drug limited approval late last year. Medicare will pay for the drug only for beneficiaries enrolled in clinical studies that Medicare approves. That will help test the effectiveness and safety of the drug.
• The decision on Aduhelm, however, could lead to inequity problems since those managing clinical trials often have difficulty recruiting a diverse clientele.
• The limits on coverage also could prompt Medicare to move more quickly on the call by Health and Human Services Secretary Xavier Becerra to revise premiums for this year. Medicare announced in the fall that premiums would rise by nearly 15% because of concerns about the annual cost of Aduhelm, which at the time was priced at $56,000. The drugmaker slashed the price in half later.

Plus, for “extra credit,” the panelists recommend their favorite health policy stories of the week that they think you should read, too:

Julie Rovner: The AP’s “Flush With COVID-19 Aid, Schools Steer Funding to Sports,” by Collin Binkley and Ryan J. Foley

Joanne Kenen: The New York Times’ “Covid Test Misinformation Spikes Along With Spread of Omicron,” by Davey Alba

Rachel Cohrs: KHN and Fortune’s “App Attempts to Break Barriers to Bankruptcy for Those in Medical Debt,” by Blake Farmer

Sarah Karlin-Smith: Stat’s “‘I’m Going to Prove You Wrong’: How a D.C. Power Couple Used an ALS Diagnosis to Create a Political Juggernaut,” by Lev Facher

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This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.