Researchers: Ancillary Services Likely To Add 20% to Medicare Spending on Aduhelm

In a research letter published in JAMA Health Forum, researchers say most of the cost figures for Aduhelm have left out the additional MRI scans and other services that will be required because the drug is associated with the development of amyloid-related imaging abnormalities (ARIAs).

The policy that CMS proposed this week to restrict Medicare coverage of Aduhelm (aducanumab) to people enrolled in approved clinical trials would likely lead to fewer Alzheimer’s patients taking the drug and reduced Medicare expenditures.

Even so, estimates of the cost burden of Aduhelm have focused almost exclusively on the annual price of the drug itself, which Biogen slashed in half late last year, from $56,000 to $28,200, in a bid to make the drug more palatable to payers. In November 2021, before Biogen announced a price cut, CMS announced a 14.5% increase in 2022 Medicare Part B premiums that was attributed, in part, to the added cost of covering Aduhelm.

But a research team led by John Mafi, M.D., M.P.H., of UCLA argue in a research published in JAMA Health Forum yesterday that Aduhelm will result in spending on PET and MRI scans and other “ancillary” services beyond the cost of the drug itself. In their calculations, the cost of those ancillary services will increase Medicare Part B spending on Aduhelm by additional 20%.

Prior to the CMS proposal that might restrict coverage to those enrolled in sanctioned clinical trials, Mafi and his colleagues calculated that 1.1 million people might be eligible for Part B coverage of Aduhelm in a “lower bound” estimate that assumes prescribers would stick to the criteria used in clinical trial. Their“upper bound” estimate of eligibility is 5.7 million factors would be eligible in an “upper bound estimate.

Based on those estimates and a projections that 25% of those eligible would receive Aduhelm, the researchers estimated that Medicare spending could range from $7 billion per year, of which $1.4 billion would be for ancillary services, up to $37.4 billion, of which $7.5 billion would be for ancillary services.

Some of the ancillary services included in these calculations are PET scans ($2,300 per year per patient on average, counting patient coinsurance), routine MRIs ($555), APO E serum testing ($100 per patient), and hospitalization for adverse events ($294).

One of the important predicates for these calculations is that a large percentage (41% of those on the highest dose) of the patients in the pivotal clinical trials of Aduhelm developed amyloid-related imaging abnormalities (ARIA) that are characterized by fluid retention and microhemorrhages in the brain. They weren’t necessarily serious or symptomatic, but ARIAs are would likely to mean additional MRI scans and visits with neurologists.