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.