The Virtues Of Predictability: US Medicare’s Review Of Aduhelm Coverage
Medicare’s decision to initiate a formal review of coverage for the newly approved Alzheimer’s agent is a highly unsettling development in many respects. It is also probably the best possible news for Biogen and Eisai at this point.
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Medicare Payment Advisory Commission also considering reviving least costly alternative policy in some way, but remains relatively hesitant about changes to ASP+6%.
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.
The US FDA revised labeling to clarify the target population, which could be helpful in reimbursement discussions for the Alzheimer's therapy.