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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Proposed reimbursement decision to be released 1 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.
Some Democratic senators are not fans of FDA’s approval of Biogen/Eisai’s Aduhelm, and are even more critical of the price of the Alzheimer’s therapy. That is providing a new hook to urge action on creating a federal price ‘negotiation’ program – but not any more clarity on a viable path to enacting one.