Medicare Part B Premiums May Increase Due To Expensive Alzheimer’s Drug

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We are all thrilled that a new drug has been approved by the Food & Drug Administration (FDA) to treat Alzheimer’s disease.  It has been over a decade since a new drug has been introduced to treat this horrible condition.   As regular readers of my blog know, both my father and my grandmother had Alzheimer’s disease when they passed away.  I asked Nana when she was 94 if she knew who I was and she looked at me for several minutes trying to come up with a name.  Finally, she said, “I don’t know who you are but I know that you love me.â€Â  On the bad news side of the equation of Leqembi is that it’s very expensive and could drive up Medicare Part B premiums by almost $10/month in 2024.   The drug will be the third most costly drug covered by Medicare Part B, according to the non-profit health researcher KFF.  Another estimate from a non-partisan seniors group The Senior Citizens League, estimates that the drug will add $5/month to the tab for everyone who has Medicare Part B.

There was a 15% increase in premiums in 2022 when another Alzheimer’s drug, Aduhelm, was approved by the FTC and hit the market.  The Senior Citizens League has projected a 3.0% cost of living, or COLA, in 2024, and a Part B premium increase of 8.7%.  Medicare is estimated to cost about $5K/year to Medicare recipients who take the new drug, with $26,500 the government paying the balance of the treatment, according to KFF.

Carmel, CA Medicare News : Pharmaceutical Companies Facing Financial Penalties

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The Centers for Medicare and Medicaid Services announced on Wednesday that 27 drugs had large price hikes like the rheumatoid-arthritis treatment Humira from AbbVie.  These drug companies will all face price-increase penalties from the government.  The money taken back will go into the hospital Medicare Trust Fund, which is facing a shortfall.

Biden Gives Proposes Additional Funding To Medicare

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President Joe Biden is about to release a budget proposal which would extend the solvency of a key Medicare trust fund by at least 25 years.  This would be funded by raising the Medicare tax on people earning more than $400K per year from 3.8% to 5.0%.  The tax would not only apply to earnings, it would be taxed on business income, self-employment income and investment income.  President Biden also said he would divert some taxes from the government’s general fund to a Medicare fund.  Reserves for Medicare’s hospital-insurance fund are only sufficient to fund it through 2028, at which point it would only cover 90% of hospital coverage.

Medicare To Cut Payments To Medicare Advantage Plans

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A battle is brewing between the Centers for Medicare and Medicaid and major insurance companies as Medicare Advantage plans could receive reduced payments next year.  Such a move could cut into profit margins unless insurers cut back on benefits to Medicare Advantage plan holders.  The proposal would change the way Medicare pays insurers.  A “risk adjustment†would give insurers more money for those who are sicker as they will generate higher expenses.  However, the new proposal would either eliminate or reduce payments for some conditions such as atherosclerosis (plaque build up) and a specific type of malnutrition.  The government says this will result in more money for insurance companies but Medicare Advantage plans think differently

Couple Jailed For Medicare Scam

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The owners and manager of a string of Houston health companies have been sent to prison for bilking Medicare out of millions of dollars in services.  They would bill Medicare for procedures done for people who were dead or in prison.  Felix Amos, a senior citizen himself at age 72, was given 30 years in prison.  His wife had already been sentenced to six years in prison while an office manager received a 12-year sentence.  The trio improperly billed Medicare for more than $21 million and spent it on things like a $3.5 million home and a small business for the office manager.

Trio Jailed For $21 Million Medicare Scam : Off To Prison They Go

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The owners and manager of a string of Houston health companies have been sent to prison for bilking Medicare out of millions of dollars in services.  They would bill Medicare for procedures done for people who were dead or in prison.  Felix Amos, a senior citizen himself at age 72, was given 30 years in prison.  His wife had already been sentenced to six years in prison while an office manager received a 12-year sentence.  The trio improperly billed Medicare for more than $21 million and spent it on things like a $3.5 million home and a small business for the office manager.

CVS Could Make $10 Billion Acquisition Of Senior Primary Care Clinics

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The giant drugstore chain CVS Health Corp. is nearing an agreement to acquire Oak Street Health Inc., which would rapidly expand the company’s footprint of primary-care doctors.  This deal would balloon  its network of medical facilities specializing in senior health.  The deal is massive at roughly $10.5 billion and could be announced as early as next week.  The transaction would follow CVS’s $8 billion agreement to acquire home-care provider Signify Health Inc.  Oak Street has 160 centers across 21 states, focused on the care of patients enrolled in Medicare.

Pressured By Medicare, Drug Companies Moderate Price Increases

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Drug companies raised list prices of 983 prescription drugs by an average of 5.6% in January, lower than inflation and lower than it has raised them in prior years.  A report put out by 46brooklyn Research, a nonprofit drug-price analytics group, said that Pfizer Inc., Novartis AG and Eli Lilly & Company are among the companies that took the price increases.  After several years of taking double digit prices on many drugs, the companies have moderated price increases, in part due to pressure from the government.  “The industry doesn’t want to stick its neck out and make itself a target of politicians, particularly given the lessened support in the Republican Party for the industry compared to 5 or 10 years ago,†David Risinger, an SVB Securities analyst, told the Wall Street Journal.

Medicare Savings On Drugs And Immunizations Will Kick In During 2023

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A number of changes have been made to Medicare which hopefully will save you money!  For instance, as of January 1, the Shingrix vaccine to prevent shingles is free for those with a Part D prescription drug plan, a significant relief since it cost almost $200 last year.  If you are diabetic, your copay for a 30-day supply of insulin for Part D enrollees is capped at $35.  During the pandemic, the cost for a month’s supply was hundreds of dollars.  Public awareness of many of these changes are low because they were passed as part of a massive legislation.  However, you will definitely notice it at your pharmacy’s cash register!

Amazon Launches $5/Month Prescription-Drug Plan

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Amazon.com Inc. is launching a new subscription service called RxPass on Tuesday.  It’s available only to Prime members and offers unlimited access to commonly prescribed generic medications, including high-blood pressure and anxiety drugs, for only $5/month.  John Love, the VP of Amazon Pharmacy, said the service will save the average Prime member around $100/year on prescription costs.  “We think even if we can just make things a little bit better for a whole lot of people, that’s going to have a resounding impact on health,†Love told The Wall Street Journal.  Amazon started selling prescription medicines in 2020, two years after its acquisition of online pharmacy PillPack Inc.