Medicare Part B covers doctor visits, and other outpatient services, such as lab tests and diagnostic screenings. So, you are probably wondering how Part B is involved with a drug increase, and why not Part D (Prescription Drug Coverage)?
The Centers for Medicare and Medicaid Services (CMS) provided the following reasons for the historically high premium increase:
Rising prices to deliver health care to Medicare enrollees and the increased use of the health care system.
Added expenses of COVID-19 care.
Congress had previously taken action in 2021 to lower the expected Part B premium increase during the pandemic. However, CMS was directed to pay back that reduced premium over time and that payback is beginning now!
CMS is setting aside money in its reserves in the event it decides that Medicare will cover, Aduhelm, a new Alzheimer’s drug that was approved by the U.S. Food and Drug Administration (FDA) earlier this year. CMS officials stated the fact that they are setting aside money to cover the use of that drug "in no way implies what the coverage determination will be" but that they have to plan for the possibility that Medicare will cover this high-cost drug, whose price has been estimated at $56,000 a year.
Again, you ask…..why is Part B covering a prescription drug not Part D?
While Medicare Part D provides prescription drug coverage, some medicines are administered in a doctor’s office — as with Aduhelm, which is delivered intravenously — and therefore covered under Part B. And by law, CMS is required to set each year’s Part B premium at 25% of the estimated costs that will be incurred by that part of the program. Therefore, in its calculation for 2022, CMS had to account for the possibility of covering Aduhelm.
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