Medicare Coverage Analysis Of Alzheimer’s Drugs Begins With Focus On Outcomes, Patient Eligibility
Proposed reimbursement decision to be released by 12 January 2022, with a final decision the following April. Biogen's Aduhelm expected to be covered in the interim. Medicare will not consider the cost of treatment in the analysis, but cost may have been a factor in initiating the process.
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Medicaid’s pharmacy director says the Biogen Alzheimer’s drug is ‘currently a covered outpatient drug.’ As the payer of last resort, Medicaid could find itself significantly impacted by a Medicare national coverage decision.
But results of the re-analysis of three HAE treatments aren’t necessarily expected to be typical for RWE-based updates undertaken in the future by the Institute for Clinical and Economic Review.
Some US Medicare Advantage plans are exploring alternatives to Medicare’s average sales price plus 6% payment formula for Biogen/Eisai's Aduhelm. Other MA plan sponsors urge the Medicare agency not to allow coverage for Aduhelm and similar drugs without an evidence development requirement.